Published online Nov 19, 2020. doi: 10.5498/wjp.v10.i11.272
Peer-review started: April 12, 2020
First decision: September 11, 2020
Revised: September 25, 2020
Accepted: October 12, 2020
Article in press: October 12, 2020
Published online: November 19, 2020
Processing time: 217 Days and 17.9 Hours
Recently, a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder (BD) have been published. However, their efficacy for BD remains unclear.
The present study aimed to assess randomized controlled trials and single-group trials of smartphone-based interventions and monitoring for reducing the symptoms of BD.
The main objective was to update and evaluate innovative treatment suggestions for BD.
We performed a systematic literature search on PubMed, Embase, Clinical trials, psycINFO, Web of Science, and Cochrane Library. Randomized clinical trials or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included. We synthesized data using a random-effects or a fixed-effects model by Review Manager version 5.3 to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD. The primary outcome measures were set for mania and depression symptoms. The subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.
We identified ten articles, including seven randomized clinical trials (985 participants) and three single-group trials (169 participants). Analysis of the between-group study showed that smartphone-based interventions had positive effects in reducing manic (g = -0.19, 95%CI: -0.33 to -0.04, P = 0.01) and depressive (g = -0.28, 95%CI: -0.55 to -0.01, P < 0.05) symptoms. In within-group analysis, smartphone-based interventions significantly reduced manic (g = 0.17, 95%CI: 0.04 to 0.30, P < 0.01) and depressive (g = 0.48, 95%CI: 0.18 to 0.78) symptoms compared to the baseline. Nevertheless, smartphone-based monitoring systems significantly reduced manic (g = 0.27, 95%CI: 0.02 to 0.51, P < 0.05) but not depressive symptoms. Subgroup analysis indicated that the interventions with psychoeducation were effective for depressive (g = -0.62, 95%CI: -0.81 to -0.43, P < 0.01) and manic (g = -0.24, 95%CI: -0.43 to -0.06, P = 0.01) symptoms compared to the controlled conditions, while the interventions without psychoeducation did not (P > 0.05). The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms (g = -0.47, 95%CI: -0.75 to -0.18, P = 0.01).
Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.
The current meta-analysis suggests that smartphone-based interventions provide evidence of any reduction in manic and depressive symptoms. Nevertheless, smartphone-based monitoring systems are only effective for participants with manic but not depressive symptoms. The findings have implied that these digital tools can be used as the clinically future treatments for symptoms of BD. However, future trials need to keep pace with the development of these apps and a better understanding of the numerous factors that influence outcomes of smartphone interventions for BD are also required.