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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
Open accessAbstract
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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“The results add to the growing evidence base for low-threshold digital mental health offers aimed at underserved populations in low- and middle-income countries [20,57].”
From Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial (2024) · cites this paper as [57]
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Metadata
- 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
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 7
- Issue
- 10
- Pages
- 851-864
- ISSN
- 2215-0366 (ISSN-L)
- 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
- 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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