The COVID-19 pandemic has had a major impact on mental health across the globe. Depression is predicted to be the leading cause of lost life years due to illness by 2030. At the same time, less than 1 in 5 people receive appropriate treatment.
Digital interventions – which package up psychotherapeutic components into a computer program or mobile app – 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, researchers asked if digital interventions are as effective as traditional face-to-face therapy, whether the benefits are also found in public healthcare settings and what is the role of human support.
A global team of researchers from the University of Helsinki (Finland), University of Freiburg and Ulm University (Germany), Vrije Universiteit Amsterdam (The Netherlands) and the University of Pavia (Italy) carried out a systematic review and meta-analysis of randomized controlled trials of digital interventions for the treatment of depression. In total, 83 unique studies published between 1990 and 2020 and reporting on 15,530 individuals were included in the final analysis, making this the largest and most comprehensive analysis of digital interventions for depression conduct to-date.
The results of the meta-analysis are published in Psychological Bulletin.
"Software alone just isn't enough for many people"
Overall, the researchers found that digital interventions are effective in the treatment of depression. However, support from a human is still required to maximize adherence and deliver outcomes similar to face-to-face therapy.
Digital interventions could provide a viable, evidence-based method of meeting the growing demand for mental health care, especially where people are unable to access face-to-face therapy due to long waiting lists, financial constraints or other barriers. However, despite the advances in technology, our research showed that human support is still required to achieve outcomes similar to face-to-face therapy. Software alone just isn't enough for many people, especially individuals who suffer from moderate or more severe symptoms."
Isaac Moshe, PhD researcher, University of Helsinki and lead author of the study
Although support of a human is necessary to achieve effective outcomes, the study found that there was no difference in outcomes when support was provided by highly qualified clinicians and when it was provided by those with lower qualification levels, such as students or trainees. Moshe says that this opens up lots of possibilities to scale these interventions by training support workers.
AI and new technological devices can help preventing mental illness
The rise of artificial intelligence and new technological devices may also have a key role to play in the prevention of mental illness.
"Over 3 billion people now own a smartphone and wearable devices are growing in popularity. These devices produce a continuous stream of data related to a person's behavior and physiology. With new developments in artificial intelligence and machine learning, we now have promising methods of using this data to identify if someone is at risk of developing a mental illness. We can then use that data to deliver personalized interventions early on to prevent symptoms from worsening", says Dr. Lasse Sander from the University of Freiburg, who led the international research team.
Despite the promising opportunities for technology to help tackle the growing mental health crisis, Moshe advises some caution:
"It is important to note that the majority of studies conducted to-date have included people with mild-to-moderate depression. There are very few studies involving people with severe depression or individuals at risk of suicide, leaving the evidence unclear for the role of digital interventions for the treatment of severe and complex depression. Another area where more research is desperately needed is with smartphone apps. Despite over 10,000 smartphone apps targeting mental health available for download, we found only 4 properly conducted randomized control trials assessing their efficacy."
Moshe, I., et al. (2021) Digital interventions for the treatment of depression: A meta-analytic review. Psychological Bulletin. doi.org/10.1037/bul0000334.