Guided digital health intervention for depression in Lebanon: randomised trial
Open accessAbstract
BACKGROUND: Most people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic. OBJECTIVE: To examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic. METHODS: We conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment. FINDINGS: 680 people with depression (PHQ-9>10) and impaired functioning (WHODAS>16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up. CONCLUSIONS: Guided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition. CLINICAL IMPLICATIONS: Guided digital mental health interventions should be considered for implementation in LMICs. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT03720769.
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Initial studies on a guided self-help version of SbS with weekly phone contacts in Lebanon found positive treatment effects on indicators of psychological distress and functioning in Syrian refugees and Lebanese local populations.
“Initial studies on a guided self-help version of SbS with weekly phone contacts in Lebanon found positive treatment effects on indicators of psychological distress and functioning in Syrian refugees and Lebanese local populations [23,37,38].”
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 [37]
The Discussion reports improvements in psychological symptoms and functioning, and Methods > Study arms describes weekly support by phone or message. But the Results > Participants table lists 619 Lebanese participants and only two Syrian participants, without identifying them as refugees or reporting effects for that group. The paper therefore supports the finding for the trial population, not a treatment effect in Syrian refugees specifically. (LLM, conf=0.88)
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- Authors
- Cuijpers, P., Heim, E., Ramia, J. A., Burchert, S., Carswell, K., Cornelisz, I., Knaevelsrud, C., Noun, P., van Klaveren, C., van’t Hof, E., Zoghbi, E., van Ommeren, M., & El Chammay, R.
- Affiliations
- Babeș-Bolyai University (RO)
- University of Zurich (CH)
- Ministry of Public Health (LB)
- Freie Universität Berlin (DE)
- World Health Organization (CH)
- Vrije Universiteit Amsterdam (NL)
- Department of Educational, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
- World Health Organization, Geneva, Switzerland
- National Mental Health Programme, Ministry of Public Health of Lebanon, Beirut, Lebanon
- Corresponding author
- Cuijpers, Pim
- ORCID
- Venue
- Evidence-Based Mental Health
- Publisher
- BMJ
- Published
- 2022-05-16
- Volume
- 25
- Issue
- e1
- Pages
- e34-e40
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC9811068
- OpenAlex
- W4280504610
- Cited by
- 60
- References
- 28
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 13 · 2023: 8 · 2022: 16
- FWCI
- 11.23
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Evidence-Based Mental Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- IRIS (submittedVersion, cc-by-nc)
- Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by-nc)
- SERVAL (Université de Lausanne) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Universitätsbibliothek der FU Berlin Hochschulschriftenstelle u. Dokumentenserver
- Funders
- Freie Universität Berlin (R2HC)
- Research for Health in Humanitarian Crises (N/A)
- European Union (733337)
- 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
- depression, digital mental health interventions, guided intervention, impaired functioning, post-traumatic stress, anxiety, subjective well-being, WHO guidelines, Lebanon, humanitarian crisis, COVID-19 pandemic, low- and middle-income countries, attrition
- MeSH terms
- COVID-19, Depression, Humans, Lebanon, Single-Blind Method, Pandemics
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