Arnautovska Urska, Trott Mike, Vitangcol Kathryn Jemimah, Milton Alyssa, Brown Ellie, Warren Nicola, Leucht Stefan, Firth Joseph, Siskind Dan
Medical School, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia.
Schizophr Bull. 2024 Sep 27. doi: 10.1093/schbul/sbae143.
Digital health interventions (DHIs) may enable low cost, scalable improvements in the quality of care for adults with schizophrenia. Given the fast-growing number of studies using these tools, this review aimed to assess the efficacy and feasibility of randomized controlled trials (RCTs) of DHIs among people with schizophrenia, focusing on human support.
A systematic search of PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane databases was conducted in January 2024 to identify relevant RCTs. Random effects meta-analyses were undertaken to evaluate the effects on psychosis symptoms, cognition, and other health-related outcomes.
Twenty-six RCTs (n = 2481 participants) were included. Pooled recruitment and retention rates were 57.4% and 87.6%, respectively. DHIs showed no statistically significant effect sizes across all examined outcomes, including psychosis symptoms, depression, quality of life, global and social cognition, global and social functioning, and medication adherence. A third (34.6%) of DHIs were developed using co-design while the majority (70%) personalized the intervention to its users and 69.2% were deemed to be at high risk of bias. There were trends toward effects in favor of DHIs with human support for social cognition and quality of life.
DHIs are feasible for people with schizophrenia and potentially useful for improving health outcomes, particularly when including human support. More high-quality studies are required to examine the benefits of human support within DHIs. Future research should examine the feasibility of sustained adherence and benefits from digital interventions, possibly incorporating human interaction complemented with artificial intelligence, in real-world clinical settings.
数字健康干预措施（DHIs）可能有助于以低成本、可扩展的方式提高精神分裂症成年患者的护理质量。鉴于使用这些工具的研究数量迅速增加，本综述旨在评估精神分裂症患者中DHIs随机对照试验（RCTs）的疗效和可行性，重点关注人力支持。
2024年1月对PubMed、Embase、PsycINFO、CINAHL、Web of Science和Cochrane数据库进行了系统检索，以识别相关的RCTs。采用随机效应荟萃分析来评估对精神病症状、认知和其他健康相关结局的影响。
纳入了26项RCTs（n = 2481名参与者）。汇总的招募率和保留率分别为57.4%和87.6%。在所有检查的结局中，包括精神病症状、抑郁、生活质量、整体和社会认知、整体和社会功能以及药物依从性，DHIs均未显示出具有统计学意义的效应量。三分之一（34.6%）的DHIs是采用协同设计开发的，而大多数（70%）对干预措施进行了用户个性化定制，69.2%被认为存在高偏倚风险。对于社会认知和生活质量，有证据表明在人力支持下DHIs有积极作用的趋势。
DHIs对精神分裂症患者是可行的，并且可能有助于改善健康结局，特别是在包含人力支持的情况下。需要更多高质量的研究来检验DHIs中人力支持的益处。未来的研究应考察在现实临床环境中持续依从数字干预措施的可行性以及从中获得的益处，可能需要结合人工智能辅助的人际互动。
