Melbye Sigurd, Kessing Lars Vedel, Bardram Jakob Eyvind, Faurholt-Jepsen Maria
The Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Centre Copenhagen, Rigshospitalet, København Ø, Denmark.
Department of Applied Mathematics and Computer Science, The Technical University of Denmark, Lyngby, Denmark.
JMIR Ment Health. 2020 Oct 29;7(10):e17453. doi: 10.2196/17453.
Psychiatric disorders often have an onset at an early age, and early identification and intervention help improve prognosis. A fine-grained, unobtrusive, and effective way to monitor symptoms and level of function could help distinguish severe psychiatric health problems from normal behavior and potentially lead to a more efficient use of clinical resources in the current health care system. The use of smartphones to monitor and treat children, adolescents, and young adults with psychiatric disorders has been widely investigated. However, no systematic review concerning smartphone-based monitoring and treatment in this population has been published.
This systematic review aims at describing the following 4 features of the eligible studies: (1) monitoring features such as self-assessment and automatically generated data, (2) treatment delivered by the app, (3) adherence to self-monitoring, and (4) results of the individual studies.
We conducted a systematic literature search of the PubMed, Embase, and PsycInfo databases. We searched for studies that (1) included a smartphone app to collect self-monitoring data, a smartphone app to collect automatically generated smartphone-based data, or a smartphone-based system for treatment; (2) had participants who were diagnosed with psychiatric disorders or received treatment for a psychiatric disorder, which was verified by an external clinician; (3) had participants who were younger than 25 years; and (4) were published in a peer-reviewed journal. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias in each individual study was systematically assessed.
A total of 2546 unique studies were identified through literature search; 15 of these fulfilled the criteria for inclusion. These studies covered 8 different diagnostic groups: psychosis, eating disorders, depression, autism, self-harm, anxiety, substance abuse, and suicidal behavior. Smartphone-based self-monitoring was used in all but 1 study, and 11 of them reported on the participants' adherence to self-monitoring. Most studies were feasibility/pilot studies, and all studies on feasibility reported positive attitudes toward the use of smartphones for self-monitoring. In 2 studies, automatically generated data were collected. Three studies were randomized controlled trials investigating the effectiveness of smartphone-based monitoring and treatment, with 2 of these showing a positive treatment effect. In 2 randomized controlled trials, the researchers were blinded for randomization, but the participants were not blinded in any of the studies. All studies were determined to be at high risk of bias in several areas.
Smartphones hold great potential as a modern, widely available technology platform to help diagnose, monitor, and treat psychiatric disorders in children and adolescents. However, a higher level of homogeneity and rigor among studies regarding their methodology and reporting of adherence would facilitate future reviews and meta-analyses.
精神疾病往往在早年发病，早期识别和干预有助于改善预后。一种细粒度、不引人注意且有效的监测症状和功能水平的方法，有助于将严重的精神健康问题与正常行为区分开来，并有可能在当前医疗体系中更有效地利用临床资源。使用智能手机监测和治疗患有精神疾病的儿童、青少年及青年已得到广泛研究。然而，尚未发表关于这一人群基于智能手机的监测和治疗的系统评价。
本系统评价旨在描述符合条件的研究的以下4个特征：（1）监测特征，如自我评估和自动生成的数据；（2）应用程序提供的治疗；（3）自我监测的依从性；（4）各研究的结果。
我们对PubMed、Embase和PsycInfo数据库进行了系统的文献检索。我们检索的研究需满足以下条件：（1）包括用于收集自我监测数据的智能手机应用程序、用于收集基于智能手机自动生成的数据的智能手机应用程序或基于智能手机的治疗系统；（2）有经外部临床医生确诊患有精神疾病或接受过精神疾病治疗的参与者；（3）有年龄小于25岁的参与者；（4）发表在同行评审期刊上。本系统评价按照系统评价和Meta分析的首选报告项目指南进行报告。对每项研究的偏倚风险进行了系统评估。
通过文献检索共识别出2546项独特研究；其中15项符合纳入标准。这些研究涵盖8个不同的诊断组：精神病、饮食失调、抑郁症、自闭症、自我伤害、焦虑症、药物滥用和自杀行为。除1项研究外，其他研究均使用了基于智能手机的自我监测，其中11项报告了参与者自我监测的依从性。大多数研究为可行性/试点研究，所有关于可行性的研究均报告了对使用智能手机进行自我监测的积极态度。有2项研究收集了自动生成的数据。3项研究为随机对照试验，调查基于智能手机的监测和治疗的有效性，其中2项显示出积极的治疗效果。在2项随机对照试验中，研究人员对随机分组进行了盲法处理，但在任何研究中参与者均未设盲。所有研究在几个方面均被判定存在较高的偏倚风险。
智能手机作为一种现代、广泛可用的技术平台具有巨大潜力，可帮助诊断、监测和治疗儿童和青少年的精神疾病。然而，研究在方法学和依从性报告方面更高水平的同质性和严谨性将有助于未来的综述和Meta分析。
