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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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Cites
The Cochrane Collaboration's tool for assessing risk of bias in randomised trials
Higgins, J. P. T., Altman, D. G., Gotzsche, P. C., Juni, P., Moher, D., Oxman, A. D., Savovic, J., Schulz, K. F., Weeks, L., Sterne, J. A. C., et al. (2011) · BMJ · doi:10.1136/bmj.d5928 · Cited by 33,817
The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020) · doi:10.2139/ssrn.3532534 · Cited by 16,394
The psychological impact of quarantine and how to reduce it: Rapid review of the evidence
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30460-8 · Cited by 16,378
GRADE guidelines: 3. Rating the quality of evidence
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., & Norris, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.015 · Cited by 8,285
Holmes, E. A., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30168-1 · Cited by 5,715
Stanaway, J. D., Afshin, A., Gakidou, E., Lim, S. S., Abate, D., Abate, K. H., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., et al. (2018) · The Lancet · doi:10.1016/s0140-6736(18)32225-6 · Cited by 4,943
No health without mental health
Prince, M. J., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., & Rahman, A. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61238-0 · Cited by 4,028
Resources for mental health: scarcity, inequity, and inefficiency
Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007) · The Lancet · doi:10.1016/s0140-6736(07)61239-2 · Cited by 1,789
Scaling-up treatment of depression and anxiety: a global return on investment analysis
Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30024-4 · Cited by 1,451
Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2008) · Journal of Technology in Human Services · doi:10.1080/15228830802094429 · Cited by 1,283
The impact of guidance on Internet-based mental health interventions — A systematic review
Baumeister, H., Reichler, L., Munzinger, M., & Lin, J. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.08.003 · Cited by 1,037
World Development Report, 2016: digital dividends
(2016) · Choice Reviews Online · doi:10.5860/choice.196952 · Cited by 969
Psychological Treatments for the World: Lessons from Low- and Middle-Income Countries
Singla, D. R., Kohrt, B. A., Murray, L. K., Anand, A., Chorpita, B. F., & Patel, V. (2017) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032816-045217 · Cited by 913
Naslund, J. A., Aschbrenner, K. A., Araya, R., Marsch, L. A., Unützer, J., Patel, V., & Bartels, S. J. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30096-2 · Cited by 638
The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science
Holmes, E. A., Ghaderi, A., Harmer, C. J., Ramchandani, P. G., Cuijpers, P., Morrison, A. P., Roiser, J. P., Bockting, C. L. H., O'Connor, R. C., Shafran, R., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30513-8 · Cited by 624
Self-citationInternet-Delivered Psychological Treatments
Andersson, G. (2016) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-021815-093006 · Cited by 595
Mental health in low- and middle-income countries
Patel, V. (2007) · British Medical Bulletin · doi:10.1093/bmb/ldm010 · Cited by 555
Huckvale, K., Prieto, J. T., Tilney, M., Benghozi, P.-J., & Car, J. (2015) · BMC Medicine · doi:10.1186/s12916-015-0444-y · Cited by 376
Barbui, C., Purgato, M., Abdulmalik, J., Acarturk, C., Eaton, J., Gastaldon, C., Gureje, O., Hanlon, C., Jordans, M., Lund, C., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30511-5 · Cited by 349
Păsărelu, C. R., Andersson, G., Bergman Nordgren, L., & Dobrean, A. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1231219 · Cited by 335
Sander, L., Rausch, L., & Baumeister, H. (2016) · JMIR Mental Health · doi:10.2196/mental.6061 · Cited by 218
Knaevelsrud, C., Brand, J., Lange, A., Ruwaard, J., & Wagner, B. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3582 · Cited by 183 · cited 1×
“(2 ) A total of 12 studies 27,29–32, 38,40–42 ,44,46,47 were considered to have a low Using data from the 22 studies (figure 2), we compared the effects of digital psychological interventions with a control group (including assessment only, wait-list control, treatment as usual, and active control…”
Xiang, Y.-T., Jin, Y., & Cheung, T. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.1057 · Cited by 136
Marasinghe, R. B., Edirippulige, S., Kavanagh, D. J., Smith, A. C., & Jiffry, M. T. M. (2012) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2012.sft107 · Cited by 134
Arjadi, R., Nauta, M. H., Scholte, W. F., Hollon, S. D., Chowdhary, N., Suryani, A. O., Uiterwaal, C. S. P. M., & Bockting, C. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30223-2 · Cited by 128
Burton, C., Szentagotai Tatar, A., McKinstry, B., Matheson, C., Matu, S., Moldovan, R., Macnab, M., Farrow, E., David, D., Pagliari, C., et al. (2016) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x15609793 · Cited by 125
Clarke, K., King, M., & Prost, A. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001541 · Cited by 122
Su, W., Fang, X., Miller, J. K., & Wang, Y. (2011) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2010.0167 · Cited by 114
Yang, M., Jia, G., Sun, S., Ye, C., Zhang, R., & Yu, X. (2019) · Journal of Midwifery & Women's Health · doi:10.1111/jmwh.12944 · Cited by 99 · cited 1×
“Eight studies 28,32,33,42,44,47–49 in our meta-analysis compared the effectiveness of digital psychological interventions with treatment as usual (reflecting local routine care).”
Arjadi, R., Nauta, M. H., Chowdhary, N., & Bockting, C. L. H. (2015) · Global Mental Health · doi:10.1017/gmh.2015.10 · Cited by 98
Christoff, A. D. O., & Boerngen-Lacerda, R. (2015) · Addictive Behaviors · doi:10.1016/j.addbeh.2015.01.019 · Cited by 87
Jiménez-Molina, Á., Franco, P., Martínez, V., Martínez, P., Rojas, G., & Araya, R. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00664 · Cited by 85 · cited 1×
“19 A comprehensive umbrella review 20 published in 2020, established robust evidence for the efficacy of psychosocial interventions for common mental health conditions in LMICs.”
Wang, Z., Wang, J., & Maercker, A. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2690 · Cited by 84 · cited 1×
“(2 ) A total of 12 studies 27,29–32, 38,40–42 ,44,46,47 were considered to have a low Using data from the 22 studies (figure 2), we compared the effects of digital psychological interventions with a control group (including assessment only, wait-list control, treatment as usual, and active control…”
Salamanca-Sanabria, A., Richards, D., Timulak, L., Connell, S., Mojica Perilla, M., Parra-Villa, Y., & Castro-Camacho, L. (2020) · JMIR Mental Health · doi:10.2196/13392 · Cited by 83
Guo, Y., Hong, Y. A., Cai, W., Li, L., Hao, Y., Qiao, J., Xu, Z., Zhang, H., Zeng, C., Liu, C., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/16715 · Cited by 82
Tulbure, B. T., Szentagotai, A., David, O., Ștefan, S., Månsson, K. N. T., David, D., & Andersson, G. (2015) · PLOS ONE · doi:10.1371/journal.pone.0123997 · Cited by 81
D’Souza, D. C., Radhakrishnan, R., Perry, E. B., Bhakta, S. G., Singh, N. M., Yadav, R., Abi‐Saab, D., Pittman, B. P., Chaturvedi, S. K., Sharma, M. P., et al. (2012) · Neuropsychopharmacology · doi:10.1038/npp.2012.208 · Cited by 79
Zhu, Y., Jiang, H., Su, H., Zhong, N., Li, R., Li, X., Chen, T., Tan, H., Du, J., Xu, D., et al. (2018) · JMIR mhealth and uhealth · doi:10.2196/10292 · Cited by 59
Moeini, B., Bashirian, S., Soltanian, A. R., Ghaleiha, A., & Taheri, M. (2019) · PubMed Central · Cited by 52
Martínez, P., Rojas, G., Martínez, V., Lara, M. A., & Pérez, J. C. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.079 · Cited by 51
Durmaz, S., Ergin, I., Durusoy, R., Hassoy, H., Çalışkan, S. A., & Okyay, P. (2019) · BMC Public Health · doi:10.1186/s12889-019-6727-z · Cited by 50
A pilot study of a smartphone application supporting recovery from drug addiction
Liang, D., Han, H., Du, J., Zhao, M., & Hser, Y. (2018) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2018.02.006 · Cited by 47
Tiburcio, M., Lara, M. A., Martínez-Vélez, N. A., Fernández-Torres, M., & Abrego, A. A. (2018) · Substance Use & Misuse · doi:10.1080/10826084.2018.1467452 · Cited by 36
Liao, Y., Wu, Q., Tang, J., Zhang, F., Wang, X., Qi, C., He, H., Long, J., Kelly, B. C., & Cohen, J. E. (2016) · BMC Public Health · doi:10.1186/s12889-016-3528-5 · Cited by 35
Mogoașe, C., Brailean, A., & David, D. (2013) · Cognitive Therapy and Research · doi:10.1007/s10608-012-9514-z · Cited by 31
Religious versus Conventional Internet-based Cognitive Behavioral Therapy for Depression
Tulbure, B. T., Andersson, G., Sălăgean, N., Pearce, M., & Koenig, H. G. (2017) · Journal of Religion and Health · doi:10.1007/s10943-017-0503-0 · Cited by 28
Baldin, Y. C., Sanudo, A., & Sanchez, Z. M. (2018) · Revista de Saúde Pública · doi:10.11606/s1518-8787.2018052000281 · Cited by 15
Sanchez, Z. M., & Sanudo, A. (2018) · Substance Abuse · doi:10.1080/08897077.2018.1437586 · Cited by 15
Thitipitchayanant, K., Somrongthong, R., Kumar, R., & Kanchanakharn, N. (2018) · Pakistan Journal of Medical Sciences · doi:10.12669/pjms.346.15986 · Cited by 15
Darvish, A., Khodadadi‐Hassankiadeh, N., Abdoosti, S., & Kashani, M. G. (2019) · Europe PMC (PubMed Central) · doi:10.30476/ijcbnm.2019.40846 · Cited by 10
Cited by
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Philippe, T. J., Sikder, N., Jackson, A., Koblanski, M. E., Liow, E., Pilarinos, A., & Vasarhelyi, K. (2022) · JMIR Mental Health · doi:10.2196/35159 · Cited by 436
Consequences of visiting restrictions during the COVID‐19 pandemic: An integrative review
Hugelius, K., Harada, N., & Marutani, M. (2021) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2021.104000 · Cited by 378
“The effectiveness of telemedicine has been demonstrated by multiple meta-analyses in various settings (Fu et al., 2020).”
BackgroundTorous, J., Linardon, J., Goldberg, S. B., Sun, S., Bell, I., Nicholas, J., Hassan, L., Hua, Y., Milton, A., & Firth, J. (2025) · World Psychiatry · doi:10.1002/wps.21299 · Cited by 323
“%) and focusing on adults with elevat ed depression, anxiety, PTSD or substance use symptoms 257 .”
Werner‐Seidler, A., Spanos, S., Calear, A. L., Perry, Y., Torok, M. H., O’Dea, B., Christensen, H. M., & Newby, J. M. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2021.102079 · Cited by 364
Public mental health: required actions to address implementation failure in the context of COVID-19
Campion, J., Javed, A., Lund, C., Sartorius, N., Saxena, S., Marmot, M., Allan, J., & Udomratn, P. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00199-1 · Cited by 177
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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