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de Azevedo Cardoso T, Kochhar S, Torous J, Morton E. Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions. JMIR Ment Health 2024; 11:e58631. [PMID: 38557724 PMCID: PMC11019420 DOI: 10.2196/58631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/25/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Bipolar disorder (BD) impacts over 40 million people around the world, often manifesting in early adulthood and substantially impacting the quality of life and functioning of individuals. Although early interventions are associated with a better prognosis, the early detection of BD is challenging given the high degree of similarity with other psychiatric conditions, including major depressive disorder, which corroborates the high rates of misdiagnosis. Further, BD has a chronic, relapsing course, and the majority of patients will go on to experience mood relapses despite pharmacological treatment. Digital technologies present promising results to augment early detection of symptoms and enhance BD treatment. In this editorial, we will discuss current findings on the use of digital technologies in the field of BD, while debating the challenges associated with their implementation in clinical practice and the future directions.
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Affiliation(s)
- Taiane de Azevedo Cardoso
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
- JMIR Publications, Toronto, ON, Canada
| | | | - John Torous
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Emma Morton
- School of Psychological Sciences, Monash University, Clayton, Australia
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Horan WP, Sachs G, Velligan DI, Davis M, Keefe RS, Khin NA, Butlen-Ducuing F, Harvey PD. Current and Emerging Technologies to Address the Placebo Response Challenge in CNS Clinical Trials: Promise, Pitfalls, and Pathways Forward. INNOVATIONS IN CLINICAL NEUROSCIENCE 2024; 21:19-30. [PMID: 38495609 PMCID: PMC10941857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Excessive placebo response rates have long been a major challenge for central nervous system (CNS) drug discovery. As CNS trials progressively shift toward digitalization, decentralization, and novel remote assessment approaches, questions are emerging about whether innovative technologies can help mitigate the placebo response. This article begins with a conceptual framework for understanding placebo response. We then critically evaluate the potential of a range of innovative technologies and associated research designs that might help mitigate the placebo response and enhance detection of treatment signals. These include technologies developed to directly address placebo response; technology-based approaches focused on recruitment, retention, and data collection with potential relevance to placebo response; and novel remote digital phenotyping technologies. Finally, we describe key scientific and regulatory considerations when evaluating and selecting innovative strategies to mitigate placebo response. While a range of technological innovations shows potential for helping to address the placebo response in CNS trials, much work remains to carefully evaluate their risks and benefits.
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Affiliation(s)
- William P. Horan
- Dr. Horan is with Karuna Therapeutics in Boston, Massachusetts, and University of California in Los Angeles, California
| | - Gary Sachs
- Dr. Sachs is with Signant Health in Boston, Massachusetts, and Harvard Medical School in Boston, Massachusetts
| | - Dawn I. Velligan
- Dr. Velligan is with University of Texas Health Science Center at San Antonio in San Antonio, Texas
| | - Michael Davis
- Dr. Davis is with Usona Institute in Madison, Wisconsin
| | - Richard S.E. Keefe
- Dr. Keefe is with Duke University Medical Center in Durham, North Carolina
| | - Ni A. Khin
- Dr. Khin is with Neurocrine Biosciences, Inc. in San Diego, California
| | - Florence Butlen-Ducuing
- Dr. Butlen-Ducuing is with Office for Neurological and Psychiatric Disorders, European Medicines Agency in Amsterdam, The Netherlands
| | - Philip D. Harvey
- Dr. Harvey is with University of Miami Miller School of Medicine in Miami, Florida
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Kalman JL, Burkhardt G, Samochowiec J, Gebhard C, Dom G, John M, Kilic O, Kurimay T, Lien L, Schouler-Ocak M, Vidal DP, Wiser J, Gaebel W, Volpe U, Falkai P. Digitalising mental health care: Practical recommendations from the European Psychiatric Association. Eur Psychiatry 2023; 67:e4. [PMID: 38086744 PMCID: PMC10790232 DOI: 10.1192/j.eurpsy.2023.2466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 01/06/2024] Open
Abstract
The digitalisation of mental health care is expected to improve the accessibility and quality of specialised treatment services and introduce innovative methods to study, assess, and monitor mental health disorders. In this narrative review and practical recommendation of the European Psychiatric Association (EPA), we aim to help healthcare providers and policymakers to navigate this rapidly evolving field. We provide an overview of the current scientific and implementation status across two major domains of digitalisation: i) digital mental health interventions and ii) digital phenotyping, discuss the potential of each domain to improve the accessibility and outcomes of mental health services, and highlight current challenges faced by researchers, clinicians, and service users. Furthermore, we make several recommendations meant to foster the widespread adoption of evidence-based digital solutions for mental health care in the member states of the EPA. To realise the vision of a digitalised, patient-centred, and data-driven mental health ecosystem, a number of implementation challenges must be considered and addressed, spanning from human, technical, ethical-legal, and economic barriers. The list of priority areas and action points our expert panel has identified could serve as a playbook for this process.
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Affiliation(s)
- Janos L. Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Miriam John
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
| | - Ozge Kilic
- Department of Psychiatry, Bezmialem Vakıf University Faculty of Medicine, Istanbul, Turkey
| | - Tamas Kurimay
- North-Buda Saint John Central Hospital, Buda Family Centred Mental Health Centre, Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary
| | - Lars Lien
- National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Diego Palao Vidal
- Mental Health Service, Parc Taulí University Hospital, Unitat Mixta de Neurociència Traslacional I3PT-INc-UAB, Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jan Wiser
- CNWL NHS Foundation Trust, London, UK
| | - Wolfgang Gaebel
- WHO Collaborating Centre DEU-131, VR-Klinikum Düsseldorf, Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Munich, Germany
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Goulding EH, Dopke CA, Rossom R, Jonathan G, Mohr D, Kwasny MJ. Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:109-118. [PMID: 36542401 PMCID: PMC9857325 DOI: 10.1001/jamapsychiatry.2022.4304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022]
Abstract
Importance Bipolar disorder-specific psychotherapy combined with pharmacotherapy improves relapse risk, symptom burden, and quality of life, but psychotherapy is not easily accessible. Objective To determine if a smartphone-based self-management intervention (LiveWell) can assist individuals with bipolar disorder to maintain wellness. Design, Setting, and Participants An assessor-blind randomized clinical trial enrolled participants from March 20, 2017, to April 25, 2019, with 48-week follow-up ending on April 10, 2020. Participants were randomly assigned to usual care or usual care plus the smartphone intervention stratified by relapse risk based on initial clinical status (low risk: asymptomatic recovery; high risk: continued symptomatic, prodromal, recovering, symptomatic recovery). Participants with bipolar disorder I were recruited from clinics in the Chicago and Minneapolis-Saint Paul areas. Data were analyzed from June 19, 2020, to May 25, 2022. Interventions The smartphone-based self-management intervention consisted of an application (app), coach, and website. Over 16 weeks, participants had a coach visit followed by 6 phone calls, and they completed daily and weekly app check-ins. The app provided adaptive feedback and information for developing a personalized wellness plan, the coach provided support, and the website provided summary data and alerts. Main Outcomes and Measures The primary outcome was time to relapse. Secondary outcomes were percentage-time symptomatic, symptom severity, and quality of life. Results Of the 205 randomized participants (mean [SD] age, 42 [12] years; 125 female individuals [61%]; 5 Asian [2%], 21 Black [10%], 13 Hispanic or Latino [6%], 7 multiracial [3%], 170 White [83%], 2 unknown race [1%]), 81 (40%) were randomly assigned to usual care, and 124 (60%) were randomly assigned to usual care plus the smartphone intervention. This clinical trial did not detect a reduction in relapse risk for the smartphone intervention (hazard ratio [HR], 0.65; 95% CI, 0.39-1.09; log-rank P = .08). However, decreased relapse was observed for low-risk individuals (HR, 0.32; 95% CI, 0.12-0.88; log-rank P = .02) but not high-risk individuals (HR, 0.86; 95% CI, 0.47-1.57; log-rank P = .62). Reduced manic symptom severity was observed for low-risk individuals (mean [SE] difference, -1.4 [0.4]; P = .001) but not for high-risk individuals (mean [SE] difference, 0 [0.3]; P = .95). The smartphone-based self-management intervention decreased depressive symptom severity (mean [SE] difference, -0.80 [0.34]; P = .02) and improved relational quality of life (mean [SE] difference, 1.03 [0.45]; P = .02) but did not decrease percentage-time symptomatic (mean [SE] difference, -5.6 [4.3]; P = .20). Conclusions and Relevance This randomized clinical trial of a smartphone-based self-management intervention did not detect a significant improvement in the primary outcome of time to relapse. However, a significant decrease in relapse risk was observed for individuals in asymptomatic recovery. In addition, the intervention decreased depressive symptom severity and improved relational quality of life. These findings warrant further work to optimize the smartphone intervention and confirm that the intervention decreases relapse risk for individuals in asymptomatic recovery. Trial Registration ClinicalTrials.gov Identifier: NCT03088462.
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Affiliation(s)
- Evan H. Goulding
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Cynthia A. Dopke
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | | | - Geneva Jonathan
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Mohr
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Mary J. Kwasny
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Anmella G, Faurholt‐Jepsen M, Hidalgo‐Mazzei D, Radua J, Passos IC, Kapczinski F, Minuzzi L, Alda M, Meier S, Hajek T, Ballester P, Birmaher B, Hafeman D, Goldstein T, Brietzke E, Duffy A, Haarman B, López‐Jaramillo C, Yatham LN, Lam RW, Isometsa E, Mansur R, McIntyre RS, Mwangi B, Vieta E, Kessing LV. Smartphone-based interventions in bipolar disorder: Systematic review and meta-analyses of efficacy. A position paper from the International Society for Bipolar Disorders (ISBD) Big Data Task Force. Bipolar Disord 2022; 24:580-614. [PMID: 35839276 PMCID: PMC9804696 DOI: 10.1111/bdi.13243] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The clinical effects of smartphone-based interventions for bipolar disorder (BD) have yet to be established. OBJECTIVES To examine the efficacy of smartphone-based interventions in BD and how the included studies reported user-engagement indicators. METHODS We conducted a systematic search on January 24, 2022, in PubMed, Scopus, Embase, APA PsycINFO, and Web of Science. We used random-effects meta-analysis to calculate the standardized difference (Hedges' g) in pre-post change scores between smartphone intervention and control conditions. The study was pre-registered with PROSPERO (CRD42021226668). RESULTS The literature search identified 6034 studies. Thirteen articles fulfilled the selection criteria. We included seven RCTs and performed meta-analyses comparing the pre-post change in depressive and (hypo)manic symptom severity, functioning, quality of life, and perceived stress between smartphone interventions and control conditions. There was significant heterogeneity among studies and no meta-analysis reached statistical significance. Results were also inconclusive regarding affective relapses and psychiatric readmissions. All studies reported positive user-engagement indicators. CONCLUSION We did not find evidence to support that smartphone interventions may reduce the severity of depressive or manic symptoms in BD. The high heterogeneity of studies supports the need for expert consensus to establish ideally how studies should be designed and the use of more sensitive outcomes, such as affective relapses and psychiatric hospitalizations, as well as the quantification of mood instability. The ISBD Big Data Task Force provides preliminary recommendations to reduce the heterogeneity and achieve more valid evidence in the field.
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Affiliation(s)
- Gerard Anmella
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Maria Faurholt‐Jepsen
- Copenhagen Affective Disorder research Center (CADIC)Psychiatric Center CopenhagenCopenhagenDenmark
| | - Diego Hidalgo‐Mazzei
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Joaquim Radua
- Imaging of Mood‐ and Anxiety‐Related Disorders (IMARD) groupIDIBAPS, CIBERSAMBarcelonaSpain,Early Psychosis: Interventions and Clinical‐detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Centre for Psychiatric Research and Education, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Ives C. Passos
- Laboratory of Molecular Psychiatry and Bipolar Disorder Program, Programa de Pós‐Graduação em Psiquiatria e Ciências do Comportamento, Centro de Pesquisa Experimental do Hospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Luciano Minuzzi
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Sandra Meier
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Pedro Ballester
- Neuroscience Graduate ProgramMcMaster UniversityHamiltonCanada
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Tina Goldstein
- Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Elisa Brietzke
- Department of PsychiatryQueen's UniversityKingstonONCanada
| | - Anne Duffy
- Department of PsychiatryQueen's UniversityKingstonONCanada
| | - Benno Haarman
- Department of PsychiatryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Carlos López‐Jaramillo
- Research Group in Psychiatry, Department of Psychiatry, Faculty of MedicineUniversity of AntioquiaMedellínColombia,Mood Disorders ProgramHospital Universitario San Vicente FundaciónMedellínColombia
| | - Lakshmi N. Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W. Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Erkki Isometsa
- Department of PsychiatryUniversity of Helsinki and Helsinki University Central HospitalHelsinkiFinland
| | - Rodrigo Mansur
- Mood Disorders Psychopharmacology Unit (MDPU)University Health Network, University of TorontoTorontoONCanada
| | | | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, UT Center of Excellence on Mood Disorders, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonTXUSA
| | - Eduard Vieta
- Digital Innovation Group, Bipolar and Depressive Disorders Unit, Institute of NeuroscienceHospital Clinic, University of Barcelona, IDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Center (CADIC)Psychiatric Center CopenhagenCopenhagenDenmark,Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
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Eis S, Solà-Morales O, Duarte-Díaz A, Vidal-Alaball J, Perestelo-Pérez L, Robles N, Carrion C. Mobile Applications in Mood Disorders and Mental Health: Systematic Search in Apple App Store and Google Play Store and Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042186. [PMID: 35206373 PMCID: PMC8871536 DOI: 10.3390/ijerph19042186] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The main objective of this work was to explore and characterize the current landscape of mobile applications available to treat mood disorders such as depression, bipolar disorder, and dysthymia. METHODS We developed a tool that makes both the Apple App Store and the Google Play Store searchable using keywords and that facilitates the extraction of basic app information of the search results. All app results were filtered using various inclusion and exclusion criteria. We characterized all resultant applications according to their technical details. Furthermore, we searched for scientific publications on each app's website and PubMed, to understand whether any of the apps were supported by any type of scientific evidence on their acceptability, validation, use, effectiveness, etc. Results: Thirty apps were identified that fit the inclusion and exclusion criteria. The literature search yielded 27 publications related to the apps. However, these did not exclusively concern mood disorders. 6 were randomized studies and the rest included a protocol, pilot-, feasibility, case-, or qualitative studies, among others. The majority of studies were conducted on relatively small scales and 9 of the 27 studies did not explicitly study the effects of mobile application use on mental wellbeing. CONCLUSION While there exists a wealth of mobile applications aimed at the treatment of mental health disorders, including mood disorders, this study showed that only a handful of these are backed by robust scientific evidence. This result uncovers a need for further clinically oriented and systematic validation and testing of such apps.
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Affiliation(s)
- Sophie Eis
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
| | - Oriol Solà-Morales
- Fundació HiTT (Health Innovation Technology Transfer), 08015 Barcelona, Spain;
- Correspondence:
| | - Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), 38109 Tenerife, Spain;
| | - Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, 08272 Barcelona, Spain;
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVIC-UCC), 08500 Vic, Spain
| | | | - Noemí Robles
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
| | - Carme Carrion
- eHealth Lab Research Group, School of Health Sciences and eHealth Centre, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain; (N.R.); (C.C.)
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Hernández-Gómez A, Valdés-Florido MJ, Lahera G, Andrade-González N. Efficacy of Smartphone Apps in Patients With Depressive Disorders: A Systematic Review. Front Psychiatry 2022; 13:871966. [PMID: 36032248 PMCID: PMC9411805 DOI: 10.3389/fpsyt.2022.871966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital interventions have become an accessible format in clinical practice to provide better support for patients with mental disorders. However, the clinical efficacy in patients with depressive disorders is not well known. We aimed to determine the efficacy of smartphone applications (apps) in patients diagnosed with a depressive disorder. METHOD An electronic database search was performed of PubMed, PsycINFO, and Web of Science, to identify relevant articles up to June 12, 2021. Peer-reviewed articles were screened and selected based on predetermined inclusion and exclusion criteria. RESULTS Seven articles met the inclusion criteria and therefore were selected for the systematic review, which included a total of 651 patients. The results were heterogeneous, essentially due to the different methodologies used in the selected studies. CONCLUSIONS Digital smartphone-delivered interventions do not appear to reduce depressive symptomatology nor improve the quality of life in patients diagnosed with depressive disorders when compared to an active control group. Taking into account the inherent methodological difficulties and the variability among such studies, it is apparent that further research-with more methodologically refined clinical trials, including larger sample sizes-is needed.
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Affiliation(s)
- Alba Hernández-Gómez
- Department of Personality, Assessment and Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - María José Valdés-Florido
- Psychiatry Service, University Hospital of Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Guillermo Lahera
- Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain.,IRyCIS, CIBERSAM, Madrid, Spain.,Príncipe de Asturias University Hospital, Alcalá de Henares, Spain
| | - Nelson Andrade-González
- Psychiatry and Mental Health Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain.,Faculty of Medicine, Alfonso X el Sabio University, Villanueva de la Cañada, Madrid, Spain
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Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, Carvalho AF, Keshavan M, Linardon J, Firth J. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 2021; 20:318-335. [PMID: 34505369 PMCID: PMC8429349 DOI: 10.1002/wps.20883] [Citation(s) in RCA: 239] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.
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Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Pauline Whelan
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jake Linardon
- Deakin University, Centre for Social and Early Emotional Development and School of Psychology, Burwood, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
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9
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Fellendorf FT, Hamm C, Platzer M, Lenger M, Dalkner N, Bengesser SA, Birner A, Queissner R, Sattler M, Pilz R, Kapfhammer HP, Lackner HK, van Poppel M, Reininghaus E. [Symptom Monitoring and Detection of Early Warning Signs in Bipolar Episodes Via App - Views of Patients and Relatives on e-Health Need]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 90:268-279. [PMID: 34359094 DOI: 10.1055/a-1503-4986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The onset and early warning signs of episodes of bipolar disorder are often realized late by those affected. The earlier an incipient episode is treated, the more prognostically favorable the course will be. Symptom monitoring via smartphone application (app) could be an innovative way to recognize and react to early warning signs more swiftly. The aim of this study was to find out whether patients and their relatives consider technical support through an app to be useful and practical in the early warning sign detection and treatment. METHODS In the present study, 51 patients with bipolar disorder and 28 relatives were interviewed. We gathered information on whether participants were able to perceive early warning signs in form of behavioral changes sufficiently and in a timely fashion and also whether they would use an app as treatment support tool. RESULTS Although 94.1% of the surveyed patients and 78.6% of their relatives felt that they were well informed about the disease, 13.7% and 35.7%, respectively were not fully satisfied with the current treatment options. Early warning signs of every depressive development were noticed by 25.5% of the patients (relatives 10.7%). Every (hypo)manic development was only noticed by 11.8% of the patients (relatives 7.1%); 88.2% of the patients and 85.7% of the relatives noticed the same symptoms recurrently at the beginning of a depression and 70.6% and 67.9%, respectively, at the beginning of a (hypo)manic episode (in particular changes in physical activity, communication behavior and the sleep-wake rhythm). 84.3% of the patients and 89.3% of the relatives stated that they considered technical support that draws attention to mood and activity changes as useful and that they would use such an app for the treatment. DISCUSSION The current options for perceiving early warning signs of a depressive or (hypo)manic episode in bipolar disorder are clinically inadequate. Those affected and their relatives desire innovative, technical support. Early detection of symptoms, which often manifest themselves in changes in behavior or activity patterns, is essentiell for managing the course of bipolar disorder. In the future, smartphone apps could be used for clinical treatment and research through objective, continuous and.
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Affiliation(s)
- Frederike T Fellendorf
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Carlo Hamm
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Martina Platzer
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Melanie Lenger
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Nina Dalkner
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Susanne A Bengesser
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Armin Birner
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Robert Queissner
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Matteo Sattler
- Institut für Sportwissenschaften, Karl-Franzens-Universität Graz, Graz, Austria
| | - Rene Pilz
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Hans-Peter Kapfhammer
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
| | - Helmut K Lackner
- Otto Loewi Forschungszentrum, Lehrstuhl für Physiologie, Medizinische Universität Graz Zentrum für Physiologische Medizin, Graz, Austria
| | - Mireille van Poppel
- Institut für Sportwissenschaften, Karl-Franzens-Universität Graz, Graz, Austria
| | - Eva Reininghaus
- Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Austria
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