JMIR Publications

ABSTRACT

Background:

E-mental health care for depression aspires to overcome barriers to and limitations of face-to-face treatment. Due to the high and growing demand for mental health care, a large number of such information and communication technology systems has been developed in recent years. Consequently, a diverse system landscape formed.

Objective:

The aim of this literature survey is to give an overview of this landscape of e-mental health systems for the prevention and treatment of major depressive disorder, focusing on three main research questions: (1) what types of systems exist? (2) how technologically advanced are these systems? (3) how has the system landscape evolved between 2000 and 2017?

Methods:

Publications eligible for inclusion described e-mental health software for the prevention or treatment of major depressive disorder. The software further had to have been evaluated with end users and developed since 2000. After screening, 272 records remained for inclusion. From these, we extracted information concerning systems, their functions, their technological sophistication, and their type of evaluation. The coding process yielded a total of 134 systems with 2172 functions. The systems and functions were analyzed quantitatively with a focus on their technological realization.

Results:

There are various types of systems. However, the majority is delivered on the world wide web (76%) and most implement Cognitive Behavioral Therapy techniques (85%). In terms of content, systems contain on average two times as many intervention as support functions. Furthermore, autonomous systems are equally as technologically advanced and have one-third less functions than guided ones. Lack of guidance is hence neither compensated with additional functions nor with higher technological sophistication. Although several high-tech solutions could be found, the average system falls between a purely informational system and one that allows for data entry but without processing this data. What is more, no clear increase in technological sophistication showed in the field between 2000 and 2017 despite a marked growth in the system quantity.

Conclusions:

The findings indicate that when developers create systems, there is a greater focus on implementing the intervention than the therapeutic support. Although the field is very active as evidenced by the growing number of systems developed per year, there is potential for improvement in terms of technological sophistication. In addition to allowing developers to compare their system with others, we anticipate that this review will help researchers identify opportunities in the field.