JMIR Publications

ABSTRACT

Background:

Digital mental health is a rapidly growing field with an increasing evidence-base due to its potential scalability and potential impacts on access to mental healthcare. As well, in the context of under-funded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders (SSDs) compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown.

Objective:

To describe the available literature investigating the use of personal technologies (i.e., phone, computer, tablet, wearables) to deliver or support specialized care for schizophrenia examine opportunities and barriers to integrating this technology into care.

Methods:

Given the size of this review, we employed a blended approach from both scoping and systematic reviews. We searched three major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow PRISMA guidelines.

Results:

This search resulted in 999 studies, which, through review by at least two reviewers, included 92 publications. Included studies were published in a range of mainly developed countries from 2010-2023. Most examined multi-technology interventions (n=40) or smartphone applications (n=25), followed by SMS text messaging (n=16) and internet-based interventions (n=11). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (n=32), followed by randomized control trials (RCTs, n=20), secondary analyses (n=16), RCT protocols (n=16), development papers (n=5) and non-randomized/quasi-experimental trials (n=3). Most studies did not report on safety indices (60%) or privacy precautions (70%). Included studies tend to report consistent positive user feedback regarding the useability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Further, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes.

Conclusions:

Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and useability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. Authors highlight trends and common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined here. Clinical Trial: NA