JMIR Publications

ABSTRACT

Background:

Over the past 25 years, the development of multi-user applications has seen significant advancements and challenges. The technological development in this field has emerged from simple chatrooms, through videoconferencing tools to the creation of complex, interactive, and often multisensory virtual worlds. These multi-user technologies have gradually found their way into mental health care, where they are used in both dyadic counseling and group interventions. However, some limitations in hardware capabilities, user experience designs, and scalability may have hindered the effectiveness of these applications.

Objective:

The present systematic review aimed at summarizing the progress made and the potential future directions in this field while evaluating various factors and perspectives relevant to remote multi-user interventions.

Methods:

The systematic review was performed based on Web of Science (WoS) and PubMed database search covering articles in the English language published from January 1999 to March 2024 related to multi-user mental health interventions. Several inclusion and exclusion criteria were determined before and during the records screening process performed in several steps.

Results:

We have identified 49 records exploring the multi-user applications in mental health care, ranging from text-based interventions to interventions set in fully immersive environments. The number of publications exploring this topic is growing since 2015, with a large increase during COVID-19 pandemic. The majority of digital interventions were delivered in a form of video-conferencing, with only a few implementing immersive environments. The studies utilized professional or peer supported group interventions or a combination of both approaches. The research studies targeted diverse groups and topics, from nursing mothers to psychiatric disorders or various minority groups. Most group sessions happened weekly, or in case of the peer-suport groups, often with flexible schedule.

Conclusions:

We have identified many benefits to multi-user digital interventions for mental healthcare. These approaches provide distributed, always available and affordable peer support that can be used to deliver necessary help to people living outside of areas where in-person interventions are easily available. While immersive virtual environments have become a common tool in many areas of psychiatric care, such as exposure therapy, our results suggest that this technology in multi-user settings is still in its early stages. Most identified studies investigated mainstream technologies, such as video conferencing or text-based support, substituting immersive experience for convenience and ease of use. While many studies discuss useful features of virtual environments in group interventions, such as anonymity or stronger engagement with the group, we discuss persisting issues with these technologies, which currently prevent their full adoption. Clinical Trial: N/A