Efficacy of smartphone-based treatment of bipolar disorders not (yet) validated

Smartphone-based interventions, e.g. for bipolar disorder, are a current hype in mental healthcare. However, evidence regarding the effectiveness of these interventions is still lacking, results from a meta-analysis show.

Bipolar disorder is a complex disease with both high intra- and inter-individual variability in clinical presentation. In addition, several patients have low illness insight, especially during phases. At routine medical visits, patients might have recall bias, which makes it difficult for the caregiver to evaluate their clinical condition. In recent years, smartphones have been welcomed as a useful tool for the monitoring and treatment of patients. Dr Maria Faurholt-Jepsen (Rigshospitalet, Denmark) reviewed the current evidence regarding the effectiveness of smartphone-based treatment of bipolar disorder [1].

Although the number of publications on the use of smartphones in mental health has increased rapidly in recent years (not in the least due to the COVID-19 pandemic), the number of publications on treatment effects is still very limited, Dr Faurholt-Jepsen explained [2]. To examine the efficacy of smartphone-based interventions in bipolar disorder, the researchers performed a meta-analysis of 13 articles, of which 7 were randomised-controlled trials including 479 individuals [3]. In these trials, the effects of smartphone-based interventions were compared with the effects of usual treatment, control smartphone, paper-pencil monitoring, or a waiting list. Interventions were self-monitoring, cognitive behaviour therapy, skill training, psychoeducation, medical reminders, and more. Outcome measures of the studies included symptoms, functioning, perceived stress, quality-of-life, relapse, and psychiatric readmission.

In these 7 studies, the smartphone-based intervention had overall no significant effect, Dr Faurholt-Jepsen concluded. “In light of the hype of smartphone-based interventions, it is important to be aware that there is no clear evidence that these actually work.” On the contrary, in some studies, smartphone-based interventions even had a negative effect on patients, she remarked.

Dr Faurholt-Jepsen called upon researchers to carefully design future trials, including the use of well-defined parameters (like adherence, usability, acceptability, and feasibility), well-defined patient populations, and well-defined baseline symptoms.

1. Faurholt-Jespen M, et al. Smartphone-based treatment in bipolar disorders. Abstract S08.04, ECNP Congress 2022, 15–18 October, Vienna, Austria.
2. Torous J, et al. World Psychiatry. 2021;20:318–335.
3. Anmella G, et al. Bipolar Disord. 2022;24:580–614.

 

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Posted on 28 November, 2022