Accepted for/Published in: JMIR Mental Health
Date Submitted: Sep 29, 2022
Date Accepted: Jan 30, 2023
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Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low-and Middle-Income Countries: Systematic Review and Meta-Analysis
ABSTRACT
Background:
Depression and anxiety contribute to an estimated 74.6 million years lived with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care.
Objective:
We aimed to systematically synthesize the available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs.
Methods:
In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included Randomized Controlled Trials (RCTs) conducted in LMICs that compared groups who received digital health interventions to controls (active control, treat as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the articles and performed study quality assessments. The outcomes were post-intervention measures of depression or anxiety symptoms (Hedges’ g). We calculated pooled effect size weighted by inverse variance. PROSPERO (CRD42021289709).
Results:
Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants: 6,052 in intervention and 6,018 in control) and 96 studies in the systematic review. Pooled effect sizes were -0.61 (-0.78 to -0.44; n = 67 comparisons) for depression and -0.73 (-0.93 to -0.53; n = 65 comparisons) for anxiety, indicating that digital health intervention groups had lower post-intervention depression and anxiety symptoms compared to controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found significant sources of variability between studies, including intervention content, depression/anxiety symptom severity, control type, and age. Grading of Recommendations Assessments, Development, and Evaluation (GRADE) showed the evidence quality was overall high.
Conclusions:
Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression/anxiety care in LMICs, where the usual mental health care is minimal. Clinical Trial: N/A
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