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:
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.
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
Research background

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.

Research motivation

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.

Research objectives

The main objective was to update and evaluate innovative treatment suggestions for BD.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.