JMIR Publications

ABSTRACT

Background:

Psychiatric disorders often have an onset during early age and early identification and intervention may improve prognosis. A fine-grained unobtrusive and effective way to monitor symptoms and functioning could help distinguish severe psychiatric health problems from normal behaviour and potentially lead to a more efficient use of clinical resources in today's health care system. An increasing number of studies have investigated the use of smartphones for monitoring and treatment in young people with psychiatric disorders. However, no systematic review concerning smartphone-based monitoring and treatment in this population has been published.

Objective:

This systematic review aimed to describe eligible studies according to (1) monitoring features as according to self-assessment and automatically generated data; (2) content of treatment delivered by the application; (3) adherence to self-monitoring; and (4) the results of the individual studies.

Methods:

We conducted a systematic literature search in PubMed, Embase and PsychINFO. We searched for studies (1) including a smartphone application for collection of self-monitoring data and/or automatically generated smartphone-based data and/or the study used a smartphone-based system for treatment; (2) with participants diagnosed with a psychiatric disorder according to DSM-IV or ICD-10 diagnostic criteria, and/or received treatment for the disorder; (3) where participants were 25 years old or younger; (4) published in a peer-reviewed journal. This systematic review was conducted in accordance with the PRISMA guidelines.

Results:

A total of 2064 unique articles were identified. Of these, 21 articles fulfilled the criteria for inclusion. The studies covered nine different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, suicidal behaviour, and one with a mixed clinical population. Smartphone-based self-monitoring was used in all studies but one, with 19 studies reporting on adherence to self-monitoring. Most studies were feasibility/ pilot studies, and all studies on feasibility reported positive attitudes towards the use of smartphones for self-monitoring. A total of four studies were randomized controlled trials investigating the effect of smartphone-based monitoring and treatment, with three of these showing a positive treatment effect. In two studies, automatically generated data was collected. Of these four RCTs only two conducted Intention-to-treat analysis, the remaining two did not describe how dropout were analyzed. Two studies described conducting the study in accordance with a predefined protocol, the remaining two did not mention following a protocol. In two of the studies researchers where blinded for the randomization, in none of them the participants were blinded.

Conclusions:

Smartphone-based monitoring, diagnosing, and treatment hold great potentials as a modern, widely available technology platform for child and adolescent psychiatric care. However, more homogeneity and rigour among studies regarding methodology and reporting of adherence would facilitate future reviews and meta-analyses. Clinical Trial: not applicable