All technology-based interventions substantially improved mental health, but those partially supported by health care providers were shown to be most effective.
A broad range of digital health technologies were effective for managing mental health issues in adults living with a chronic disease, according to an international meta-analysis published in Systemic Reviews.
Further, when guided by health care providers, technology systems were even more effective in lessening anxiety and depression, the authors wrote.
Most people with a chronic disease, such as diabetes, hypertension, or cancer, have more than 1 concurrent condition and are at higher risk for developing comorbidities in mental health, the authors explained. Previous research suggests the prevalence of depression or anxiety, together with a chronic disease, is approximately 27%.
“There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services,” study investigators said.
The aim of the study was to assess what types of digital health interventions were most effective in managing concomitant mental health and chronic diseases.
At the start, the researchers convened a panel of knowledge users (clinicians, decision makers), lived experience experts (patients), review methodologists, and researchers to assist with the investigation. They then analyzed data from a rapid review of systemic reviews, identified knowledge gaps, held a virtual workshop with knowledge users to discuss their preliminary findings and gather suggestions, and conducted a secondary meta-analysis of primary studies, which included an outcome measurement of anxiety or depression, identified through the rapid review process.
Eighty-four primary studies conducted in 12 countries and published between 2010 and 2019 met the meta-analysis inclusion criteria. The studies comprised a sample of 11,037 participants.
Most of the studies compared technology-based interventions to usual care (76%), and some compared 2 or more digital interventions (24%). Eight percent were based on cognitive behavioral therapy.
To classify specific types of technological tools, researchers consulted WHO Classification of Digital Health Interventions and previous reviews on digital mental health systems. However, given the limitations of existing classifications, they ultimately developed their own, which included 10 categories: internet or website, computer software, mobile application, electronic messaging (email, SMS), electronic health record, telehealth (telemedicine, telepsychiatry), virtual reality/augmented reality, robot, connected devices, and other system.
In addition to studying the effectiveness of different digital health technologies, the investigators considered characteristics of various delivery methods, comparing self-administered systems with those guided by a health care provider (partial support).
Systems that offered partial support from a health care provider, identified in 29 studies reporting anxiety outcomes and 33 studies reporting depression outcomes, showed a significant decrease in anxiety scores, of –0.46 (95% CI, –0.39 to –0.53), and depression scores, –0.43 (95% CI, –0.36 to –0.50).
Self-administration delivery methods, identified in 30 studies with anxiety outcomes and 40 studies reporting depression outcomes, also showed a significant decrease in anxiety scores, at –0.35 (95% CI, –0.30 to –0.41), and depression scores, at –0.28 (95% CI, –0.23 to –0.33).
Although the study found varying levels of effectiveness, the researchers emphasized that all technology-based interventions and levels of support were effective in managing mental health issues. In addition, digital technologies were more effective than in-person care for both depression and anxiety conditions, they noted.
However, the findings should be interpreted with caution. Heterogenicity between studies was generally high, although the results were consistent across studies, and some studies used multiple systems in the same intervention, which could have overestimated the effect size.
Still, the authors emphasize that their results demonstrate that digital technologies can significantly reduce anxiety and depression in persons living with a chronic disease. Technology-based interventions could also save clinical time and resources, as well as care engagement, the authors suggested.
The study identified electronic messaging as the most effective digital health intervention to improve mental health conditions.
“While our meta-analysis indicates different levels of effectiveness associated with digital interventions’ characteristics, all technologies and levels of support can be used,” the study authors concluded. “Indeed, as our results show that all types of technologies are equally or more effective than usual care, stakeholders could choose and implement interventions in relation with the needs of the population.”
Sasseville M, LeBlanc A, Tchuente J, et al. The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis. Systemic Reviews. Published online May 4, 2023. doi:10.1186/s13643-023-02241-1