Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Nov 19, 2020; 10(11): 272-285
Published online Nov 19, 2020. doi: 10.5498/wjp.v10.i11.272
Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis
Jia-Yuan Liu, Kang-Kang Xu, Guang-Lin Zhu, Qi-Qi Zhang, Xiao-Ming Li
Jia-Yuan Liu, Xiao-Ming Li, Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
Jia-Yuan Liu, Department of Anesthesia, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
Kang-Kang Xu, Guang-Lin Zhu, Department of Clinical Medicine, Second Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
Qi-Qi Zhang, Department of Clinical Medicine, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
Author contributions: Li XM conceived and guided the study; Liu JY and Shao WJ carried out the literature searches; Liu JY and Xu KK extracted the data; Zhu GL and Li XM assessed the study quality; Liu JY, Xu KK, and Li XM performed the statistical analysis; Liu JY wrote the manuscript; Xu KK, Zhu GL, Shao WJ, and Zhang QQ revised the manuscript.
Supported by The Anhui Natural Science Foundation, No. 1808085MH291; The Project of Human Social Science of Anhui Province, No. SK2016A047; and Grants for Scientific Research of BSKY from Anhui Medical University, No. XJ201826.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Ming Li, PhD, Adjunct Professor, Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, No. 81 Meishan Road, Shushan District, Hefei 230032, Anhui Province, China. psyxiaoming@126.com
Received: April 12, 2020
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
Abstract
BACKGROUND

Recently, there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder (BD). However, their efficacy for BD remains unclear.

AIM

To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.

METHODS

A systematic literature search was performed on PubMed, Embase, Clinical trials, psycINFO, Web of Science, and Cochrane Library. Randomized clinical trials (RCTs) 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. Data were synthesized using a random-effects or a fixed-effects model 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. Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.

RESULTS

We identified ten articles, including seven RCTs (985 participants) and three single-group trials (169 participants). Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic [g = -0.19, 95% confidence interval (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 had positive effects on 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).

CONCLUSION

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.

Keywords: Smartphone, Bipolar disorder, Monitoring, Interventions, Meta-analysis, Systematic review

Core Tip: To date no study has used meta-analysis to pool the existing evidence to examine the efficacy of smartphone-based interventions and monitoring for bipolar disorder. This is the first systematic review and meta-analysis investigating the effects of interventions and monitoring delivered via smartphone on bipolar disorder.