Table 4.

Summary of remote technology intervention studies for symptom monitoring in persons with SMI

Study	Origin	Design	N	Diagnosis	Study Duration	Intervention	Main Feasibility and Acceptability Findings
Ainsworth et al., (2013)	United Kingdom	Cross-over RCT	24	Schizophrenia; schizoaffective disorder	3 weeks	Diagnostic assessment of symptoms delivered through a smartphone application compared to SMS text messaging.	The smartphone application allowed participants to complete significantly more data points and took less time. No differences in feedback for each modality.
Bauer et al., (2004)	United States; Canada	Single arm prospective study	96	Bipolar disorder	3 months	Participants use the ChronoRecord computer- based system to record mood, medications, sleep, life events, and menstrual data daily and weight weekly.	Participants showed high acceptance of the program, and 83% (N=80) returned 8662 days of data, mean of 114.7 (SD=9.3) days. Self-reported ratings were strongly correlated with clinician ratings.
Ben-Zeev et al., (2012)	United States	Single arm prospective study	24	Schizophrenia	1 week	Ecological Momentary Assessment via PDAs to track self-stigma, psychotic symptoms, negative affect, positive affect, activity, and social and physical environment multiple times daily.	Participants’ activity was associated with self-stigma, and increases in negative affect and psychotic symptom severity predicted greater self-stigma. Complete data for 88% of the observations. Mobile technologies emerged as effective for monitoring self- stigma.
Bopp et al., (2010)	United Kingdom	Single arm prospective study	62	Bipolar disorder	36 weeks	Participants provided mood ratings in response to weekly SMS text messages or email prompts to track trajectory of symptom ratings.	Adherence was 75%. Participants reported depressive symptoms (47.7%), manic symptoms (7%), both depressive and manic symptoms (8.8%), and euthymic mood (36.5%). SMS-based symptom monitoring was acceptable.
Depp et al., (2012)	United States	Pilot RCT	40	Bipolar disorder	12 weeks	Mobile survey of momentary mood and symptoms delivered twice daily on a smartphone compared to paper-and-pencil mood charts completed daily.	Mobile phones were associated with lower compliance, but greater ability to capture variability and clinical validity in symptom ratings compared to paper-and-pencil.
Faurholt-Jepsen et al., (2014)	Denmark	Uncontrolled pilot study	17	Bipolar disorder	3 months	MONARCA Android smartphone application prompted participants to self-monitor mood, symptoms, and other activities each evening, and objective activities such as speech duration, social activity, and physical activity each day.	Objective smartphone measures of physical and social activity correlated with depressive symptoms. Self-monitored depressive symptoms correlated with clinician ratings.
Grunerbl et al., (2012)	Austria	Uncontrolled pilot study	10	Bipolar disorder	8 weeks	Android smartphone application collects data continuously on location and movement, level of activity, and social interaction, and prompts participants to answer questions about activities of daily living, psychological state, physical state, and amount of activity each day.	Feasible to use smartphone sensors for remotely gathering behavioral data on participants with bipolar disorder.
Lieberman et al., (2011) and (2010)	United States	Single arm prospective study	64	Bipolar disorder	90 days	MoodChart is an automated Internet-based program that provides social rhythm therapy by prompting participants daily to rate mood, anxiety, and depression, and to record daily activities.	Adherence to rating was high. Social rhythm stability increased by 31% and decreased symptoms of abnormal mood.
Palmier-Claus et al., (2012), (2013), (2013), and (2014)	United Kingdom	Single arm prospective study	44	Schizophrenia; schizoaffective disorder;	1 week	ClinTouch is an Android smartphone application that prompts participants to complete self-reported assessment of psychotic and other symptoms 6 times daily.	Ambulatory monitoring several times daily emerged as feasible for symptom assessment. 82% of participants completed at least 33% of possible assessments. Several measures collected by ClinTouch including hopelessness, delusions, anxiety, and depression were correlated with clinical assessments supporting the validity of this approach.