Social Activity Monitoring Through Smartphones May Predict Relapse in Schizophrenia

woman on cellphone
woman on cellphone
Researchers of a small cohort of patients with schizophrenia discovered that using the CrossCheck behavioral sensing system to remotely monitor participants’ smartphones provided insight into social behavior with results showing that a decrease in outgoing text messages and phone calls indicated a potential relapse.

Changes in social functioning indicated by smartphone-enabled social activity monitors could help determine relapse risk for patients with schizophrenia spectrum disorders, according to a study published in Schizophrenia Research.

Researchers evaluated the use of CrossCheck, a behavioral sensing system for smartphones, in patients with schizophrenia spectrum disorder to identify social behavior changes 30 days prior to psychiatric hospitalizations, suicidal ideation, and significant psychiatric symptom exacerbation, with hopes of developing early behavioral indicators to reduce the risk of imminent relapses. This year-long study included data on incoming and outgoing text messages and phone calls from participants’ smartphones, results from the Brief Psychiatric Rating Scale administered by clinical assessors, and instances of psychiatric care from electronic health records.

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Of the 61 participants included in this study, 20 experienced 27 relapses over the year-long course of monitoring. Relapses nonexclusively included psychiatric hospitalization (81.48%), increases in services (25.93%), increases in medication (22.22%), and suicidal ideation (14.81%). When analyzing the entire day, relapses were significantly associated with a shorter duration of outgoing calls (P =.03), a decrease in the number of incoming text messages (P =.014), and a decrease in the number of outgoing text messages (P =.019). Relapses were significantly associated with a decrease in the number of outgoing calls from 6 AM to 12 PM (P =.002), from 12 PM to 6 PM (P =.006), and from 12 AM to 6 AM (P =.043).

Limitations of this study include the use of multiple statistical tests in an exploratory fashion, inability to detect if the provided phone was the only phone used for communication, and inability to assess specific causality.

The researchers concluded that “[s]martphone enabled social activity may provide an important metric in determining relapse risk in schizophrenia and provide access to sensitive, meaningful and ecologically valid data streams never before available in routine care.”

Please see the original reference for a full list of authors’ disclosures.


Buck B, Scherer E, Brian R, et al. Relationships between smartphone social behavior and relapse in schizophrenia: a preliminary report [published online March 30, 2019]. Schizophr Res. doi: 10.1016/j.schres.2019.03.014