JMIR Publications

ABSTRACT

Background:

Low-and middle-income countries (LMICs), which bear a larger proportion of the global mental illness burden, have been disproportionately impacted by the COVID-19 pandemic due to pre-existing mental health care system deficiencies. The pandemic has also led to a considerable increase in care delivered through digital mental health interventions (DMHIs), many of which have been adapted from in-person formats. There is thus a need to examine their fidelity to the original format, along with issues around usability and other challenges and facilitators to their uptake in LMICs. As most DMHIs have been developed in high-income countries, an examination of their cultural adaptation to LMIC settings will be critical.

Objective:

The purpose of this research is to conduct a rapid scoping review of the available evidence for DMHIs for depression and anxiety, two of the most common mental disorders, in LMICs.

Methods:

A rapid scoping review was conducted following the PRISMA Extension for Scoping Reviews and processes for rapid reviews by Tricco et al., (2017). PubMed and PsychInfo databases were searched for records published between January 2020, when COVID-19 was declared a public health emergency, and June 2024 using a search strategy developed in consultation with a liaison librarian. The pandemic accelerated the development of DMHIs, and this timeframe was utilized to capture the recent literature that may have incorporated new methods of application. The search strategy was developed across three domains: 1) digital health interventions; 2) depression or anxiety; and 3) LMICs. Data were charted from the final records according to intervention type, and 1) discussions around fidelity, usability, cultural adaptation, and 2) challenges and facilitators to their uptake in LMICs.

Results:

A total of 64 records were included in the final analysis, with reasons for exclusion (e.g., focused on mental health in general, not being a DMHI, not focused on LMICs) reported. Six DMHI platforms were identified: 1) mobile app; 2) telemedicine; 3) web-based programs; 4) videoconferencing; 5) virtual reality; and 6) social media-based interventions. Less than half of the included records referenced fidelity, usability, and cultural adaptation, with most of the discussions related to mobile apps. Challenges pertained to the technological system, engagement issues, structural barriers, and concerns around privacy and confidentiality. Facilitators included widespread mobile phone usage, built in supervision and training features, and convenience. Many records emphasized the importance of cultural appropriateness.

Conclusions:

Despite the opportunities DMHIs offer for reducing the mental health treatment gap, further work examining fidelity, user engagement, and cultural adaptation is required. Given the rapidly changing landscape of development and delivery of DMHIs, further research is also warranted to capture emergent changes, including the potential for harms in their unrestrained development and ethical implications around the increasing integration of artificial intelligence. Clinical Trial: n/a