Digital Interventions for Common Mental Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
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Abstract Background In low-resource settings, e-mental health may substantially increase access to evidence-based interventions for common mental disorders. We conducted a systematic literature search to identify randomised trials examining the effects of digital interventions with or without therapeutic guidance compared to control conditions in individuals with anxiety and/or depression symptoms in low- and middle-income countries (LMICs). Methods The main outcome was the reduction in symptoms at the post-test. Secondary outcomes included improvements in quality of life and longer-term effects (≥20 weeks post-randomisation). The effect size Hedges’ g was calculated using the random effects model. Results A total of 21 studies (23 comparisons) with 5.296 participants were included. Digital interventions were more effective than controls in reducing symptoms of common mental disorders at the post-test ( g = −0.89, 95% confidence interval [CI] −1.26 to −0.52, p < 0.001; NNT = 2.91). These significant effects were confirmed when examining depressive ( g = −0.77, 95% CI −1.11; −0.44) and anxiety symptoms separately ( g = −1.02, 95% CI −1.53 to −0.52) and across all other sensitivity analyses. Digital interventions also resulted in a small but significant effect in improving quality of life ( g = 0.32, 95% CI 0.19 to 0.45) at the post-test. Over the longer term, the effects were smaller but remained significant for all examined outcomes. Heterogeneity was moderate to high in all analyses. Subgroup and meta-regression analyses did not result in significant outcomes in any of the examined variables (e.g., guided vs. unguided interventions). Conclusions Digital interventions, with or without guidance, may effectively bridge the gap between treatment supply and demand in LMICs. Nevertheless, more studies are needed to draw firm conclusions regarding the magnitude of the effects of digital interventions.
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There is growing evidence that digital interventions can be successfully implemented in low-resource settings.
“There is growing evidence that digital interventions can be successfully implemented in low-resource settings [20].”
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 [20]
The Impact statement reports a growing number of trials in low- and middle-income countries, and the Discussion reports that digital interventions reduced depression and anxiety symptoms there. But the paper assesses effectiveness rather than whether interventions were successfully implemented at scale; its Discussion also says the eligible studies came only from lower-middle- and upper-middle-income countries, not low-income countries. No page numbers are available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe results add to the growing evidence base for low-threshold digital mental health offers aimed at underserved populations in low- and middle-income countries.
“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 [20]
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- Authors
- Karyotaki, E., Miguel, C., Panagiotopoulou, O. M., Harrer, M., Seward, N., Sijbrandij, M., Araya, R., Patel, V., & Cuijpers, P.
- Affiliations
- Amsterdam Public Health (NL)
- Vrije Universiteit Amsterdam (NL)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- King's College London (GB)
- Harvard University (US)
- Corresponding author
- Karyotaki, Eirini
- ORCID
- Venue
- Cambridge Prisms Global Mental Health
- Publisher
- Cambridge University Press (CUP)
- Published
- 2023
- Volume
- 10
- Pages
- e68-e68
- ISSN
- 2054-4251 (ISSN-L)
- PMC
- PMC10643260
- OpenAlex
- W4386778703
- Cited by
- 56
- References
- 48
- Citations by year
- 2026: 21 · 2025: 14 · 2024: 10 · 2023: 11
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Cambridge Prisms Global Mental Health (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
- VU Research Portal (submittedVersion, other-oa)
- Funders
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek (VI.Veni.201G.053)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- digital interventions, e-mental health, common mental disorders, depression, anxiety, low- and middle-income countries, quality of life, long-term treatment outcomes, access to mental health care
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