Cited by 336Digital Mental Health InterventionsMental Health Treatment and AccessTelemedicine and Telehealth Implementation

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Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: a systematic review and meta-analysis

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Fu, Zhongfang, Burger, Huibert, Arjadi, Retha, Bockting, Claudi L H·2020·The Lancet Psychiatry

DOI 10.1016/s2215-0366(20)30256-xPMC PMC7455253

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Abstract

Background The effectiveness of digital psychological interventions in low-income and middle-income countries (LMICs) remains unclear. We aimed to systematically investigate the available evidence for digital psychological interventions in reducing mental health problems in LMICs. Methods In this systematic review and meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane databases for articles published in English from database inception to March 9, 2020. We included randomised controlled trials investigating digital psychological interventions in individuals with mental health problems in LMICs. We extracted data on demographics, inclusion and exclusion criteria, details of the intervention, including the setting, digital delivery method, control group conditions, number of sessions, therapeutic orientation (eg, cognitive therapy or behaviour therapy), presence or absence of guidance, and length of follow-up, and statistical information to calculate effect sizes. If a study reported insufficient data to calculate effect sizes, the corresponding authors were contacted to provide data that could be aggregated. We did random-effects meta-analyses, and calculated the standardised mean difference in scores of digital psychological interventions versus control conditions (Hedges' g ). Quality of evidence was assessed by use of the Grading of Recommendations Assessment, Development, and Evaluation approach. The primary outcome was post-intervention mental health problems, as measured by self-reporting instruments or clinical interviews. This study is registered with PROSPERO, CRD42019137755. Findings We identified 22 eligible studies that were included in the meta-analysis. The included studies involved a total of 4104 participants (2351 who received a digital psychological intervention and 1753 who were in the control group), and mainly focused on young adults (mean age of the study population was 20–35 years) with depression or substance misuse. The results showed that digital psychological interventions are moderately effective when compared with control interventions (Hedges' g 0·60 [95% CI 0·45–0·75]; Hedges' g with treatment as usual subgroup for comparison 0·54 [0·35–0·73]). Heterogeneity between studies was substantial ( I 2 =74% [95% CI 60–83]). There was no evidence of publication bias, and the quality of evidence according to the GRADE criteria was generally high. Interpretation Digital psychological interventions, which have been mostly studied in individuals with depression and substance misuse, are superior to control conditions, including usual care, and are moderately effective in LMICs. However, the considerable heterogeneity observed in our analysis highlights the need for more studies to be done, with standardised implementation of digital psychological intervention programmes to improve their reproducibility and efficiency. Digital psychological interventions should be considered for regions where usual care for mental health problems is minimal or absent. Funding None. Translations For the Persian, Chinese, Hindi, Portuguese, Bahasa, Turkish, Romanian, Spanish and Thai translations of the abstract see Supplementary Materials section.

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Nakimuli‐Mpungu, E., Kwesiga, J. M., Bwanika, J. M., Musinguzi, D., Nakanyike, C., Iya, J., Kitaka, S. B., Akimana, B., Hawkins, C., Cavazos‐Rehg, P. A., et al. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1515193 · Cited by 5
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Vavani, B., van Luenen, S., Garnefski, N., Spinhoven, P., Amone‐P’Olak, K., Witlox, M., & Kraaij, V. (2025) · International Journal of Mental Health · doi:10.1080/00207411.2025.2498765 · Cited by 4
“Thus far, most studies have been conducted in high-income countries, but there is increasing research on self-help interventions in LMICs with promising findings (Arjadi et al., 2015; Fu et al., 2020; Martinez et al., 2018; Naslund et al., 2017).”
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“16,18,19 Therefore, the present study aims to evaluate the efficacy of different modalities of remote psychological interventions in improving symptoms of anxiety and depression.”
Influential
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Mustafa, S. H., Mohammed, E. A., CII SBPM Residency Program, R., Salih, A. M., Palani, K., CII SBPM Residency Program, R., Albushra, M. M. O., Makkawi, S. T., CII SBPM Residency Program, R., & Mustafa, A. H. (2024) · International Journal of Medical Sciences and Nursing Research · doi:10.55349/ijmsnr.2024411623 · Cited by 2
“[14, 15] In line with this emerging literature, our study seeks to contribute by exploring the acceptability of a mental health chatbot prototype among university students in Sudan.”
Background
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“36 Speci ﬁ c to the Colombian context, studies have demonstrated the value of technology to support the implementation of best practice clinical recommendations for adults with schizophrenia, 37 to facilitate screening, treatment planning and access to digital therapeutics for depression and…”
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“(Asosiasi Penyelenggara Jasa Internet Indonesia, 2020), a web-based psychoeducation intervention may be a viable solution to facilitate access to mental health services and reduce the treatment gap by providing low-cost and safe services (Arjadi et al., 2018; Fu et al., 2020).”
Practice-informed guidance for undertaking remotely delivered mental health research
McCarthy, L., Teague, B., Rowe, K. J., Janes, K., Rhodes, T., Hackmann, C., Samad, L., & Wilson, J. (2021) · Nurse Researcher · doi:10.7748/nr.2021.e1770 · Cited by 2
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Listiyandini, R. A. (2023) · Jurnal Psikologi Ulayat · doi:10.24854/jpu789 · Cited by 5
Participants’ and nurses’ experiences with a digital intervention for patients with depressive symptoms and comorbid hypertension or diabetes in Peru: A qualitative post-randomized controlled trial study (Preprint)Preprint
Toyama, M., Cavero, V., Araya, R., Menezes, P. R., Mohr, D. C., Miranda, J. J., & Diez‐Canseco, F. (2021) · doi:10.2196/preprints.35486 · Cited by 2
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Moffett, B., Pozuelo, J. R., Musenge, E., Makhanya, Z., O’Mahen, H., Craske, M. G., van Heerden, A. C., Lund, C., Orkin, K., Sodi, T., et al. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.5020643 · Cited by 2
Current status of Tele-speech language therapy by type and support for patients with post-stroke aphasia: A scoping review
Kodani, Y., Nagami, S., Yokozeki, A., Fukunaga, S., Nakamura, K., & Nakamura, H. (2025) · PLOS ONE · doi:10.1371/journal.pone.0319805 · Cited by 1
“In this context, tele-lingual therapy (Tele-SLT) has become increasingly important for PWA [11].”
Kaleidoscope
Tracy, D. K., Joyce, D. W., Albertson, D. N., & Shergill, S. S. (2020) · The British Journal of Psychiatry · doi:10.1192/bjp.2020.217 · Cited by 1

Authors: Fu, Z., Burger, H., Arjadi, R., & Bockting, C. L. H.
Affiliations: Beijing Normal University (CN)
University Medical Center Groningen (NL)
Atma Jaya Catholic University of Indonesia (ID)
Amsterdam UMC Location University of Amsterdam (NL)
Corresponding author: Bockting, Claudi L H
ORCID: Fu, Zhongfang
Burger, Huibert
Arjadi, Retha
Bockting, Claudi L H
Venue: The Lancet Psychiatry
Publisher: Elsevier BV
Published: 2020-10
Volume: 7
Issue: 10
Pages: 851-864
ISSN: 2215-0366 (ISSN-L)
DOI: 10.1016/s2215-0366(20)30256-x
PMC: PMC7455253
OpenAlex: W3082767440
Cited by: 336
References: 49
Citations by year: 2026: 39 · 2025: 73 · 2024: 73 · 2023: 57 · 2022: 52 · 2021: 38 · 2020: 4
FWCI: 5.94
Type: journal article
Language: en
Update notices: erratum (2021-11-01)
Open access: hybrid
doi.org
Licence: other-oa
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Lancet Psychiatry (publishedVersion, other-oa)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Pure Amsterdam UMC (submittedVersion, other-oa)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords: digital psychological interventions, mental illness, low- and middle-income countries, depression, substance abuse, young adults, usual care, cognitive therapy, behavior therapy, intervention effectiveness, usual care comparison, publication bias, quality of evidence, study heterogeneity, GRADE quality assessment, effect size, clinical interview, follow-up duration
MeSH terms: Depressive Disorder, Developing Countries, Humans, Psychotherapy, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Telemedicine, Substance-Related Disorders

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Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: a systematic review and meta-analysis

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