There is a great deal of interest in using information and communication technology (ICT) to support and treat people with mental health conditions. In the broadest sense, ICT includes not just computers, but also telephones, TV and radio; essentially any medium that can communicate information in a multimedia format.
ICT interventions can be delivered at a large scale and are relatively cheap to develop and roll-out, so commissioners and policy makers are understandably keen to find out which groups of people they can potentially help.
There’s lots of encouraging research looking at computerised cognitive behavioural therapy for common mental health conditions such as depression and anxiety and I’ve blogged about many of the published papers. However, there seem to be fewer reported studies looking at the effectiveness of ICT for people with more severe conditions such as schizophrenia.
The Cochrane Schizophrenia Group have now added to our knowledge with a new review that looks at the effects of psychoeducational interventions using ICT as a means of educating and supporting people with schizophrenia or related psychosis.
The reviewers conducted a systematic search looking for randomised controlled trials (RCTs) that compared ICT with any other kind of psychoeducation or supportive intervention, or with standard care. They identified 6 RCTs to include in their meta-analysis (including a total of 1,063 patients), running their most recent search in September 2010.
Primary outcomes were patient compliance and global state. Secondary outcomes included compliance/satisfaction, mental state, knowledge/insight, quality of life and social support.
Here’s what they found:
- There was no difference in patient compliance and global state between psychoeducation using ICT and standard care
- Technology-mediated psychoeducation had the following effect:
- It improved mental state in the short-term (n=84, 1 RCT, RR 0.75, 95% CI 0.56 to 1.00; n=30, 1 RCT, MD -0.51, 95% CI -0.90 to -0.12)
- It did not improve global state (n=84, 1 RCT, RR 1.07, 95% CI 0.82 to 1.42)
- It did not improve knowledge and insight (n=84, 1 RCT, RR 0.89, 95% CI 0.68 to 1.15; n=84, 1 RCT, RR 0.77, 95% CI 0.58 to 1.03)
- People receiving this treatment perceived that they got more social support than people allocated to the standard care group (n=30, 1 RCT, MD 0.42, 95% CI 0.04 to 0.80)
- Adding technology-mediated psychoeducation to standard care had the following effect:
- General compliance did not improve in the short term (n=291, 3 RCTs, RR for leaving the study early 0.81, 95% CI 0.55 to 1.19) or in the long term (n=434, 2 RCTs, RR for leaving the study early 0.70, 95% CI 0.39 to 1.25)
- Compliance with medication did improve in the long term (n=71, 1 RCT, RR 0.45, 95% CI 0.27 to 0.77)
- No improvement was seen with general mental state, negative or positive symptoms, global state, level of knowledge or quality of life (but there were some inconsistencies in results relating to level of knowledge and treatment satisfaction)
The reviewers concluded:
Using ICT to deliver psychoeducational interventions has no clear effects compared with standard care, other methods of delivering psychoeducation and support, or both. Researchers used a variety of methods of delivery and outcomes, and studies were few and underpowered. ICT remains a promising method of delivering psychoeducation; the equivocal findings of this review should not postpone high-quality research in this area.
The quality of the studies included in this review is fairly low (e.g. only 2 were clear about allocation, 3 reported no blinding, 4 reported on incomplete data), so there is a risk of bias in these results which may mean that the results overestimate the positive effects of ICT. It’s also worth mentioning that there are a number of ongoing trials that will be added to a future update of this review, so the picture may change as new evidence is published.
For the time being though, this review shows no clear benefit for using ICT to provide psychoeducation or support for people with schizophrenia.
Välimäki M, Hätönen H, Lahti M, Kuosmanen L, Adams CE. Information and communication technology in patient education and support for people with schizophrenia. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD007198. DOI: 10.1002/14651858.CD007198.pub2.