TABLE I. Mobile health intervention studies in serious mental illnesses.^57,78-93 app, application; ARV, antiretroviral; BD, bipolar disorder; HIV, human immunodeficiency virus; ITAREPS, Information Technology Aided Relapse Prevention Program in Schizophrenia; NCT, nonrandomized controlled trial; RCT, randomized controlled trial; SMI, serious mental illness; SZ, schizophrenia; SZA, schizoaffective disorder.

Study	Sample	Study design	Intervention	Duration	Feasibility, acceptability, adherence	Outcome measurement	Outcome findings
Beebe et al,78 2014	N=30 out-patients with SZ or SZA	RCT	Text messaging to promote medication adherence.	3 mo	28 subjects completed the study.	Medication adherence (pill counts) and symptoms.	Significant improvement in symptoms, but not in adherence.
Ben-Zeev et al,79 2014	N=33 out-patients with SZ or SZA	Open trial	Smartphone app (self-initiating and automated) targeting symptom management, mood regulation, medication adherence, social functioning, and improved sleep.	1 mo	Mean daily use rate for app = 86.5% 90% of participants rated intervention as highly acceptable and usable.	Psychiatric symptom severity.	Significant reductions in psychotic symptoms, depression, and general psychopathology.
Ben-Zeev et al,80 2014	N=17 out-patients with SZ or SZA and past or present substance abuse	Open trial	Text messaging to improve illness self-management.	3 mo	87% mean response rate to texts. > 90% found the intervention easy to use and useful.	Working alliance.	Therapeutic ratings provided for the mobile intervention were significantly higher than for community-based treatment-team clinicians.
Depp et al,81 2015	N=82 out-patients with BD and less than severe affective symptoms	RCT	Smartphone app designed to extend 4-session in-person self-management intervention.	6 mo	93% completed the study. 65% mean response rate. High satisfaction.	Affective symptoms.	Smartphone intervention group showed significantly greater reductions in depressive symptoms at 6 (mid) and 12 (posttreatment), but not 24 weeks (follow-up) vs paper-and-pencil control. No significant difference for manic symptoms or functioning.
Faurholt-Jepsen et al,82 2015	N=78 out-patients with BD and less than severe affective symptoms	RCT	Smartphone app for daily self-monitoring app linked with nurse contact.	6 mo	93% response rate.	Affective symptoms.	No significant impact on depressive or manic symptoms compared with control group.
Granholm et al,83 2012	N=55 out-patients with SZ or SZA	Open trial	MATS study: text messaging to promote socialization, symptom management, and medication adherence.	3 mo	77% completed the study. 86% mean response rate. Greater participation increased likelihood of positive ratings for helpfulness.	Device and clinician-rated measures of medication adherence, socialization, and psychiatric symptom severity.	Significant improvement in medication adherence in participants living independently and in social interactions. Significant decrease in hallucinations and dysfunctional beliefs.
Komatsu et al,84 2013	N=45 out-patients with SZ	RCT	ITAREPS study: weekly mobile phone telemonitoring identifying prodromal symptoms of relapse to enable intervention and prevent unnecessary hospitalizations.	12 mo	N/A (excluded user adherence)	No. of rehospitalizations based on worsening of psychiatric symptoms, period until rehospitalization, and total No. of rehospitalization days. BPRS at the time of rehospitalization.	Risk of rehospitalization was lower in the ITA-REPS group than in the control group. The total No. of rehospitalization days was significantly lower in the ITAREPS group (37 d) than in the control group (710 d). No. of inpatient days on each rehospitalization was significantly lower in the ITAREPS group (18.5 d) than in the control group (88.8 d).
Macias et al,85 2015	N=11 out-patients with mixed SMIs	Open trial	Android app promoting physical activity.	1 mo	94% mean daily use rate for app. 73% mean response rate across all electronic messages and prompts.	Physical activity and self-rated health.	Overall improvement in stage of exercise (motivation), with modest improvement in self-health ratings.
Miklowitz et al,86 2012	N=19 out-patients with BD and less than severe affective symptoms	NCT	Text messaging intervention targeting early warning sign identification, sleep-wake cycle regularization, and medication adherence.	17 wk	81% mean response rate for daily messages.	Knowledge of mood-management strategies and affective symptoms.	Significant increase in mood-management strategies. Trend for reduction in depression.
Montes et al,87 2012	N=340 with SZ and self-rated medication non adherence	RCT	Text messaging reminders promoting medication adherence.	6 mo	75% completed the study.	Self-rated medication adherence, illness severity, attitude toward medication, insight, quality of life.	Significant improvement in self-rated medication adherence and attitude toward medication. Significant reduction in negative, cognitive, and global symptoms at month 3.
Moore et al,57 2015	N=58 out-patients with BD and HIV	RCT	Text messaging reminders for psychiatric and HIV medication.	1 mo	90% mean response rate to messages.	Medication adherence and dose timing.	Significant improvement in dose timing for antiretrovirals, but not psychotropics with text message intervention. No difference in adherence for either medication.
Naslund et al,88 2015	N=10 out-patients with mixed SMI and obesity	Open trial	Wearable fitness monitor with goal-setting mobile app.	5 mo	1 subject dropped out of the study due to medical reasons. High satisfaction rate among participants.	Weight loss.	10 participants wore the devices for a mean of 89% of days in study. 5 wore the devices 100% of the time. Mean weight loss = 2.7 kg.
Pijnenborg et al,89 2010	N=62 with mixed psychotic disorders	NCT	Text messaging intervention to enhance recovery goal implementation.	18 wk	18 subjects dropped out of the study. Subject-rated effectiveness of intervention: 41%, effective; 33%, neutral; 26%, ineffective.	% Goals achieved, psychiatric symptom severity, self-esteem, social community functioning.	Overall % of goals achieved increased with prompting and returned to baseline after removing prompts. No change in symptoms, self-esteem, functioning.
Pratt et al,90 2014	N=38 out-patients with mixed SMIs	Open trial	In-home messaging device targeting symptom management and adherence.	6 mo	Participation in mean of 128.5 sessions (71.4%) out of 180 possible.	Psychiatric symptom severity and illness self-management skills.	Significant improvements in psychiatric symptoms and illness self-management skills. 82% decrease in hospital admissions and 75% decrease in emergency room visits compared with before entry.
Spaniel et al,91 2008	N=45 out-patients with mixed psychotic disorders	Open trial	Weekly mobile telehealth monitoring for early warning signs of relapse.	1 y	90% completed the study.	Psychiatric hospitalizations.	Significant 60% decrease in the no. of patient hospitalizations compared with before entry.
Spaniel et al,92 2012	N=146 out-patients with SZ or SZA deemed at higher risk for relapse	RCT	Weekly mobile telehealth monitoring for early warning signs of relapse.	1 y	N/A	Psychiatric hospitalizations and medication adherence.	Significantly lower rate of hospitalizations in active arm.
Wenze et al,93 2014	N=14 out-patients with BD	Open trial	PDA intervention to enhance medication adherence through daily prompts.	2 wk	92% response rate.	Adherence and affective symptom severity.	Significant reduction in depressive symptoms. No change in adherence.