Cited by 135Digital Mental Health InterventionsMobile Health and mHealth ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

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Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms

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Hornstein, Silvan, Zantvoort, Kirsten, Lueken, Ulrike, Funk, Burkhardt, Hilbert, Kevin·2023·Frontiers in Digital Health

DOI 10.3389/fdgth.2023.1170002PMC PMC10239832

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Abstract

Introduction: Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods: We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results: Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion: We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed. Systematic Review Registration: Identifier: CRD42022357408.

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An Internet-based program for depressive symptoms using human and automated support: a randomized controlled trial
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A Mobile-Based Intervention to Increase Self-esteem in Students with Depressive Symptoms: Randomized Controlled Trial
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Effectiveness of an internet intervention (Deprexis) for depression in a United States adult sample: A parallel-group pragmatic randomized controlled trial.
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Effectiveness of a Web-Based Guided Self-help Intervention for Outpatients With a Depressive Disorder: Short-term Results From a Randomized Controlled Trial
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Recommender System in eLearning: A Survey
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“Additionally, three related reviews (13, 14, 32) were screened, and studies not yet included were added.”
Background
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Individualized Web-Based Exercise for the Treatment of Depression: Randomized Controlled Trial
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Effectiveness of a Web-Based Intervention in Reducing Depression and Sickness Absence: Randomized Controlled Trial
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Pilot randomized controlled trial of a Spanish-language Behavioral Activation mobile app (¡Aptívate!) for the treatment of depressive symptoms among united states Latinx adults with limited English proficiency
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Predicting patients who will drop out of out-patient psychotherapy using machine learning algorithms
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Outcomes of an online computerized cognitive behavioral treatment program for treating chinese patients with depression: A pilot study
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The more I got, the less I need? Efficacy of internet-based guided self-help compared to online psychoeducation for major depressive disorder
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The Gamification of Meditation: A Randomized-Controlled Study of a Prescribed Mobile Mindfulness Meditation Application in Reducing College Students’ Depression
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Step-by-step: Feasibility randomised controlled trial of a mobile-based intervention for depression among populations affected by adversity in Lebanon
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Guided digital health intervention for depression in Lebanon: randomised trial
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MUBS: A Personalized Recommender System for Behavioral Activation in Mental Health
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Acceptability, satisfaction and perceived efficacy of “ Space from Depression ” an internet-delivered treatment for depression
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Behavioral and cognitive intervention strategies delivered via coached apps for depression: Pilot trial.
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A randomized noninferiority trial evaluating remotely-delivered stepped care for depression using internet cognitive behavioral therapy (CBT) and telephone CBT
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Feasibility and Efficacy of the Addition of Heart Rate Variability Biofeedback to a Remote Digital Health Intervention for Depression
Economides, M., Lehrer, P. M., Ranta, K., Nazander, A., Hilgert, O., Raevuori, A., Gevirtz, R., Khazan, I., & Forman‐Hoffman, V. L. (2020) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-020-09458-z · Cited by 55
Effectiveness of tailored digital health interventions for mental health at the workplace: A systematic review of randomised controlled trials
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Cognitive behaviour therapy via the internet for depression: A useful strategy to reduce suicidal ideation
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Untitled work
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Predicting Outcome in Internet-Based Cognitive Behaviour Therapy for Major Depression: A Large Cohort Study of Adult Patients in Routine Psychiatric Care
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Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial
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Adapting an internet-delivered intervention for depression for a Colombian college student population: an illustration of an integrative empirical approach
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A Gamified Smartphone-Based Intervention for Depression: Randomized Controlled Pilot Trial
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Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial.
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Assessing the critical parameters of eSMART-MH: a promising avatar-based digital therapeutic intervention to reduce depressive symptoms
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Effectiveness of guided internet-delivered cognitive behavior therapy for depression in routine psychiatry: A randomized controlled trial
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Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial
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An evaluation of the efficacy of two add-on ecological momentary intervention modules for depression in a pragmatic randomized controlled trial (ZELF-i)
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Apple HealthKit and Health App: Patient Uptake and Barriers in Primary Care
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Behavioral activation versus physical activity via the internet: A randomized controlled trial
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Long-term effects of internet-delivered cognitive behavioral therapy for depression in primary care - the PRIM-NET controlled trial
Eriksson, M. C. M., Kivi, M., Hange, D., Petersson, E.-L., Ariai, N., Häggblad, P., Ågren, H., Spak, F., Lindblad, U., Johansson, B., et al. (2017) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2017.1333299 · Cited by 43
Exploring blended group interventions for depression: Randomised controlled feasibility study of a blended computer- and multimedia-supported psychoeducational group intervention for adults with depressive symptoms
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CBT MobileWork©: User-Centered Development and Testing of a Mobile Mental Health Application for Depression
Callan, J. A., Jacob, J. D., Siegle, G. J., Dey, A. K., Thase, M. E., Dabbs, A. D., Kazantzis, N., Rotondi, A. J., Tamres, L. K., Slyke, A. V., et al. (2020) · Cognitive Therapy and Research · doi:10.1007/s10608-020-10159-4 · Cited by 41
Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care
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A randomized, controlled pilot trial of the Emotional Faces Memory Task: a digital therapeutic for depression
Iacoviello, B. M., Murrough, J. W., Hoch, M. M., Huryk, K. M., Collins, K. A., Cutter, G. R., Iosifescu, D. V., & Charney, D. S. (2018) · npj Digital Medicine · doi:10.1038/s41746-018-0025-5 · Cited by 40
The efficacy and optimal matching of an Internet‐based acceptance and commitment therapy intervention for depressive symptoms among university students: A randomized controlled trial in China
Zhao, C., Wampold, B. E., Ren, Z., Zhang, L., & Guangrong, J. (2022) · Journal of Clinical Psychology · doi:10.1002/jclp.23329 · Cited by 39
Internet‐based treatment of depressive symptoms in a Kurdish population: A randomized controlled trial
Lindegaard, T., Brohede, D., Koshnaw, K., Osman, S. S., Johansson, R., & Andersson, G. (2019) · Journal of Clinical Psychology · doi:10.1002/jclp.22753 · Cited by 38
Exploring the features of an app-based just-in-time intervention for depression
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The second Randomised Evaluation of the Effectiveness, cost-effectiveness and Acceptability of Computerised Therapy (REEACT-2) trial: does the provision of telephone support enhance the effectiveness of computer-delivered cognitive behaviour therapy? A randomised controlled trial.
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The MARIGOLD study: Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms
Addington, E. L., Cheung, E. O., Bassett, S. M., Kwok, I., Schuette, S., Shiu, E. W., Yang, D., Cohn, M., Leykin, Y., Saslow, L. R., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.07.049 · Cited by 36
Efficacy of Three Low-Intensity, Internet-Based Psychological Interventions for the Treatment of Depression in Primary Care: Randomized Controlled Trial
Gili, M., Castro, A., García‐Palacios, A., García‐Campayo, J., Mayoral, F., Botella, C., Roca, M., Barceló‐Soler, A., Hurtado, M. M., Navarro, M., et al. (2020) · Journal of Medical Internet Research · doi:10.2196/15845 · Cited by 36
How are guide profession and routine care setting related to adherence and symptom change in iCBT for depression? - an explorative log-data analysis
Oehler, C., Scholze, K., Driessen, P., Rummel‐Kluge, C., Görges, F., & Hegerl, U. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100476 · Cited by 36
INTERNET PSYCHOTHERAPY AND THE FUTURE OF PERSONALIZED TREATMENT
Andrews, G., & Williams, A. D. (2014) · Depression and Anxiety · doi:10.1002/da.22302 · Cited by 34
Development and Pilot Testing of an Internet-Based Self-Help Intervention for Depression for Indian Users
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Effectiveness of guided Internet-delivered treatment for major depression in routine mental healthcare - An open study
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Optimizing the context of support of web-based self-help in individuals with mild to moderate depressive symptoms: A randomized full factorial trial
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Effects of video viewing smartphone application intervention involving positive word stimulation in people with subthreshold depression: A pilot randomized controlled trial
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Smartphone-delivered multicomponent lifestyle medicine intervention for depressive symptoms: A randomized controlled trial.
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Personalizing Mental Health: A Feasibility Study of a Mobile Behavioral Activation Tool for Depressed Patients
Rohani, D. A., Tuxen, N., Lopategui, A. Q., Faurholt-Jepsen, M., Kessing, L. V., & Bardram, J. E. (2019) · Proceedings of the 13th EAI International Conference on Pervasive Computing Technologies for Healthcare · doi:10.1145/3329189.3329214 · Cited by 33
Effects of web-based stress and depression literacy intervention on improving symptoms and knowledge of depression among workers: A randomized controlled trial
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Effectiveness of Peer-Supported Computer-Based CBT for Depression Among Veterans in Primary Care
Pfeiffer, P. N., Pope, B., Houck, M. S., Benn-Burton, W., Zivin, K., Ganoczy, D. A., Kim, H. M., Walters, H., Emerson, L., Nelson, C. B., et al. (2020) · Psychiatric Services · doi:10.1176/appi.ps.201900283 · Cited by 31
Efficacy of an internet-based cognitive behavioral therapy for subthreshold depression among Chinese adults: a randomized controlled trial
Ying, Y., Ji, Y., Kong, F., Wang, M., Chen, Q., Wang, L., Hou, Y., Yu, L., Zhu, L., Miao, P., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291722000599 · Cited by 31
The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial
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Behind the Scenes of Online Therapeutic Feedback in Blended Therapy for Depression: Mixed-Methods Observational Study
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Exploring user learnability and learning performance in an app for depression: usability study
Stiles-Shields, C., Montague, E., Lattie, E. G., Schueller, S. M., Kwasny, M. J., & Mohr, D. C. (2017) · JMIR Human Factors · doi:10.2196/humanfactors.7951 · Cited by 29
Developing a Process for the Analysis of User Journeys and the Prediction of Dropout in Digital Health Interventions: Machine Learning Approach (Preprint)
Bremer, V., Chow, P. I., Funk, B., Thorndike, F. P., & Ritterband, L. M. (2020) · doi:10.2196/preprints.17738 · Cited by 29
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Religious versus Conventional Internet-based Cognitive Behavioral Therapy for Depression
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Diminishing Effects After Recurrent Use of Self-Guided Internet-Based Interventions in Depression: Randomized Controlled Trial
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Efficacy of guided internet-assisted intervention on depression reduction among educational technology students of Nigerian universities
Ofoegbu, T. O., Asogwa, U. D., Otu, M. S., Ibenegbu, C. I., Muhammed, A., & Eze, B. (2020) · Medicine · doi:10.1097/md.0000000000018774 · Cited by 28
Developing a data-driven algorithm for guiding selection between cognitive behavioral therapy, fluoxetine, and combination treatment for adolescent depression
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Significant reduction in depressive symptoms among patients with moderately-severe to severe depressive symptoms after participation in a therapist-supported, evidence-based mobile health program delivered via a smartphone app
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Integrating the Digital and the Traditional to Deliver Therapy for Depression
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Effects of five-minute internet-based cognitive behavioral therapy and simplified emotion-focused mindfulness on depressive symptoms: A randomized controlled trial
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Initial Field Trial of a Coach-Supported Web-Based Depression Treatment
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Guided Internet-based cognitive behavioral therapy for mild and moderate depression: A benchmarking study
Jakobsen, H., Andersson, G., Havik, O. E., & Nordgreen, T. (2016) · Internet Interventions · doi:10.1016/j.invent.2016.11.002 · Cited by 25
Brief Web-Based Intervention for Depression: Randomized Controlled Trial on Behavioral Activation
Jelinek, L., Arlt, S., Moritz, S., Schröder, J., Westermann, S., & Cludius, B. (2019) · Journal of Medical Internet Research · doi:10.2196/15312 · Cited by 25
Guided Internet-Based Cognitive Behavioral Therapy for Depression: Implementation Cost-Effectiveness Study
Piera-Jiménez, J., Etzelmueller, A., Kolovos, S., Folkvord, F., & Lupiáñez‐Villanueva, F. (2021) · Journal of Medical Internet Research · doi:10.2196/27410 · Cited by 25
User experience and acceptance of patients and healthy adults testing a personalized self-management app for depression: A non-randomized mixed-methods feasibility study
Mayer, G., Hummel, S., Oetjen, N., Gronewold, N., Bubolz, S., Blankenhagel, K. J., Slawik, M., Zarnekow, R., Hilbel, T., & Schultz, J. (2022) · Digital Health · doi:10.1177/20552076221091353 · Cited by 25
Intervention Use and Symptom Change With Unguided Internet-Based Cognitive Behavioral Therapy for Depression During the COVID-19 Pandemic: Log Data Analysis of a Convenience Sample
Oehler, C., Scholze, K., Reich, H., Sander, C., & Hegerl, U. (2021) · JMIR Mental Health · doi:10.2196/28321 · Cited by 23
A randomised trial comparing a brief online delivery of mindfulness-plus-values versus values only for symptoms of depression: Does baseline severity matter?
Kingston, J., Becker, L., Woeginger, J., & Ellett, L. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.07.087 · Cited by 22
Health economic evaluation of an internet intervention for depression (deprexis), a randomized controlled trial
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Facilitator Contact, Discussion Boards, and Virtual Badges as Adherence Enhancements to a Web-Based, Self-guided, Positive Psychological Intervention for Depression: Randomized Controlled Trial
Moskowitz, J. T., Addington, E. L., Shiu, E. W., Bassett, S. M., Schuette, S., Kwok, I., Freedman, M. E., Leykin, Y., Saslow, L. R., Cohn, M., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/25922 · Cited by 21
Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences
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Authors: Hornstein, S., Zantvoort, K., Lueken, U., Funk, B., & Hilbert, K.
Affiliations: Humboldt-Universität zu Berlin (DE)
Leuphana University of Lüneburg (DE)
Corresponding author: Hornstein, Silvan
ORCID: Hornstein, Silvan
Zantvoort, Kirsten
Lueken, Ulrike
Funk, Burkhardt
Hilbert, Kevin
Venue: Frontiers in Digital Health
Publisher: Frontiers Media SA
Published: 2023-05-22
Volume: 5
Pages: 1170002-1170002
ISSN: 2673-253X (ISSN-L)
DOI: 10.3389/fdgth.2023.1170002
PMC: PMC10239832
OpenAlex: W4377294815
Cited by: 134
References: 187
Citations by year: 2026: 43 · 2025: 50 · 2024: 36 · 2023: 5
FWCI: 4.55
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Frontiers in Digital Health (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
edoc Publication server (Humboldt University of Berlin) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Multilingual Matters (Channel View Publications) (submittedVersion, cc-by)
edoc Publication server (Humboldt University of Berlin) (cc-by)
PubData (cc-by)
Funders: Deutsche Forschungsgemeinschaft (491192747)
Humboldt-Universität zu Berlin
Topics: Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords: personalization, digital mental health interventions, depressive symptoms, depression, user choice, decision rules, machine learning, conceptual framework

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Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms

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