Smartphone and computer-based treatments are effective at reducing symptoms of depression.
Research published in the Psychological Bulletin found that digital interventions could be effectively used as a treatment for depression for a variety of groups with different levels of depression.
“Depression is one of the leading causes of disability worldwide and this has only gotten worse since the start of the COVID-19 pandemic. Less than 1 in 5 people receive appropriate treatment right now (and less than 1 in 27 in low income countries). A major reason for this is the lack of trained healthcare providers,” Isaac Moshe, MA lead author of the study and a doctoral candidate at the University of Helsinki told Theravive.
“Digital interventions have been proposed as a way of meeting the unmet demand for psychological treatment. As digital interventions are becoming increasingly adopted within both private and public healthcare systems, we set out to understand whether digital interventions are as effective as traditional face-to-face therapy, to what extent human support has an impact on outcomes and whether the benefits found in lab settings transfer to real world (public healthcare) settings.”
In undertaking the research, Moshe and colleagues underwent a meta-analysis of 83 different studies that tested digital interventions in treating depression. More than 15 thousand participants were involved in the studies.
80 percent of them were adults and 69.5% women The studies were randomized controlled trials that examined a digital intervention treatment, and compared it to either an inactive control (like a waitlist or not having any treatment at all) or an active condition (like face-to-face psychotherapy).
The studies primarily focused on people with mild to moderate depression.
Moshe found the digital interventions in the meta-analysis that involved some kind of human aspect, such as receiving feedback or being given technical assistance, provided the most effective means of reducing depression symptoms.
“For digital interventions to generate outcomes on par with face-to-face therapy they have to be accompanied by some human support (even if that’s just a weekly email or short phone call). Another important finding was that adherence to digital interventions remains a major challenge, with little over 50% of individuals completing the full intervention,” Moshe said.
“The effectiveness of digital interventions is a lot lower in real-world settings, where adherence to digital interventions is an even bigger challenge. On average, only 25% of patients in healthcare settings completed the full intervention.”
The reason digital interventions that involves human contact may have been more effective could be due to the fact having human involvement increased the chance a participant would complete their full program.
Typically, a digital intervention requires users to log into a program, website or app. They then read, listen, watch or interact with content via modules or lessons. They might have homework assignments or have to complete questionnaires.
Whilst they undertake their program, a clinician monitors their progress.
Digital interventions are not the same as teletherapy, but could prove to be an important tool in addressing the mental healthcare needs of more people.
“They provide an opportunity to help meet the growing need for treatment and reach people that otherwise may not be able to access mental healthcare. Especially those suffering from mild-to-moderate depression and anxiety where the evidence base is strongest,” Moshe said.
“As technology develops and the number of people with smartphone and wearable devices increases, we have the potential to use these devices to identify people who may be at-risk of developing a mental illness. We can then use this data to intervene early on with interventions targeted at the individual to reduce symptoms or prevent the onset of full-blown disorder. There is a growing area of research around this “digital phenotyping” and whilst I don’t think we are there yet, I do think it is one of the most exciting areas in terms of the potential to increase the efficacy of treatment and reduce the burden of disease.”
Now that the efficacy of digital interventions in the mental health space has been established, Moshe says the next challenge is addressing issues related to compliance.
“It’s time to focus more research efforts on “implementation science”. That is, how do we successfully implement these interventions in the real world and within existing healthcare settings. Part of this is solving the challenge of low adherence,” he told Theravive.
“If we can use developments in technology to improve adherence and outcomes in unguided interventions, I think the potential to scale these interventions could be even greater and open up the possibility to address sub-clinical cases and deliver preventative measures.”