JMIR Publications

ABSTRACT

Background:

Digital wearable devices, worn on or close to the body, have potential for passively detecting mental and physical health symptoms among people with Severe Mental Illness (SMI), however the roles of consumer grade devices are not well understood.

Objective:

To examine the utility of data from consumer grade, digital, wearable devices (including smartphones or wrist-worn devices) in remotely monitoring or predicting changes in mental and/or physical health among adults with schizophrenia or bipolar disorder. Studies were included that passively collected physiological data (including sleep duration, heart rate, sleep/wake patterns, and/or physical activity) for at least 3 days. Research-grade actigraphy methods and physically obstructive devices were excluded.

Methods:

Systematic review of the following databases: Cochrane Central Register of Controlled Trials; Technology Assessment; AMED (Allied and Complementary Medicine); APA PsycINFO; Embase; MEDLINE(R); and IEEE XPlore. Searches were completed in May 2024. Results were synthesised narratively due to study heterogeneity, divided into the following phenotypes: physical activity, sleep and circadian rhythm, and heart rate.

Results:

Overall, 23 studies were included reporting data from 12 distinct studies, mostly using smartphones and centred on relapse prevention. Only one study explicitly aimed to address physical health outcomes among people with SMI. In total, data were included from over 500 participants with SMI, predominantly from high income countries. Most commonly, papers presented physical activity data (N=18), followed by sleep and circadian rhythm data (N=14) and heart rate data (N=6). Eight papers reported using smartwatches to support data collection; the rest used only smartphones. There was some evidence that lower levels of activity, higher heart rates, and later and irregular sleep onset times were associated with psychiatric diagnoses and/or poorer symptoms. However, heterogeneity in devices, measures and statistical approaches complicated interpretation.

Conclusions:

Consumer grade wearables show capability of passively detecting digital markers indicative of psychiatric symptoms or mental health status among people with SMI, but few are currently utilising these to address physical health inequalities. The digital phenotyping field in psychiatry would benefit from moving towards agreed standards regarding data descriptions and outcome measures, and ensuring that valuable temporal data provided by wearables is fully exploited. Clinical Trial: PROSPERO CRD42022382267; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382267