Currently submitted to: JMIR Research Protocols
Date Submitted: Aug 6, 2026
Open Peer Review Period: Aug 9, 2026 - Oct 4, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Effectiveness of Telepsychiatry in Depression and Anxiety Disorders in Low- and Middle-Income Countries: A Systematic Review Protocol with Reference Benchmark Values from Comparable Published Cohorts
ABSTRACT
Background:
Background:
Depression and anxiety disorders account for an estimated 74.6 million years lived with disability, and approximately 80% of this burden falls on populations in low- and middle-income countries (LMICs), where coverage by evidence-based mental health care remains minimal 1. Telepsychiatry has matured into a recognised modality for closing this gap, but the magnitude of its effectiveness specifically within LMIC health systems has not been comprehensively synthesised.
Objective:
Objective:
To systematically review and, where feasible, meta-analyse the effectiveness of telepsychiatry for depression and anxiety disorders in adults in LMICs, compare telepsychiatry against face-to-face care and against other telepsychiatry modalities, and evaluate moderators of effect including country income tier, guidance status, and integration with task-shifting.
Methods:
Methods:
This protocol, to be registered prospectively in PROSPERO, will guide a PRISMA 2020-compliant systematic review of randomised, cluster-randomised, and controlled quasi-experimental studies identified across six databases (PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL, PsycINFO, and ProQuest Dissertations & Theses Global) from inception to June 2026. Two reviewers will independently screen and extract data; risk of bias will be assessed using Cochrane RoB 2 and ROBINS-I, and certainty of evidence using GRADE. Random-effects meta-analysis will pool standardised mean differences where data permit, with network meta-analysis if a sufficiently connected evidence base is identified.
Results:
Expected Findings: Benchmark data from comparable published cohorts suggest this review will identify moderate pooled effects of telepsychiatry on depression (Hedges' g ≈ 0.4–0.6) and anxiety (g ≈ 0.5–0.9) in LMICs, with substantial heterogeneity and a likely gradient of superiority favouring guided over unguided and reminder-only modalities.
Conclusions:
Conclusion: This review will provide the first LMIC-specific, equity-focused synthesis of telepsychiatry effectiveness for depression and anxiety, generating evidence to inform WHO mhGAP-aligned scale-up and hybrid specialist–task-shifted care models Clinical Trial: Pending publication of protocol
Citation
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