JMIR Publications

ABSTRACT

Background:

Increasing screen time exposure from digital devices like smartphones has shown a variety of mixed associations with cognition, behavior, and well-being in adults and children but little is known about its associations with symptomatology in individuals with serious mental illness.

Objective:

To determine the range of associations between screen time and symptoms of individuals with mental illness, we utilized a method call specification curve analysis.

Methods:

In this observational study, we recruited smartphone-owning adults (≥ 18) with schizophrenia and healthy controls. We installed two research source smartphone apps, mindLAMP and Beiwe, to collect survey results, cognitive test results, and screen time metrics, over a period of three months. Surveys were scheduled for twice a week, but participants were instructed to take the surveys naturally as much or as little as they wanted. Screen time was collected continuously in the background. A total of 140 participants were recruited from the outpatient clinic population as well as through general public advertising. Age-matched, smartphone-owning healthy controls were also part of the recruitment pool. A specification curve analysis was a priori designed to explore the relationship between every combination of independent variable and dependent variable in order to demonstrate to what degree screen time relates to symptoms in individuals with serious mental illness.

Results:

88 participants (54 with schizophrenia and 34 healthy controls) completed both the initial visit and follow-up, completed at least one self-reported survey, and had a minimum passive data cutoff of 5 consecutive days. While we found an association between smartphone screen time metrics and cognition (adjusted R2 = 0.107, p = 0.0004), specification curve analysis revealed a wide range of heterogenous associations with screen time from very negative to very positive. The effects differed based on diagnostic group, age bracket, type of regression model used, and the specific independent and dependent variables selected for analysis.

Conclusions:

The associations between screen time and mental health in patients with schizophrenia are heterogenous when examined with methods that reduce analytical bias. The heterogeneity in associations suggests that complex and personalized potential effects that must be understood in a greater context of an individual. This analysis of longitudinally collected screen time data shows potential for future research that could benefit from high resolution metrics on smartphone use.