Digital interventions may improve mental health in low- and middle-income countries

Digital psychological interventions appeared effective for individuals living in regions that lack usual care for mental health problems, according to results of a systematic review and meta-analysis published in The Lancet.

“An analysis published in 2016 estimated that 79–93% of people with depression and 85-95% of people with anxiety are not covered by treatment in [low-income and middle-income countries],” Zhongfang Fu, MSc, of the faculty of psychology at Beijing Normal University, and colleagues wrote. “Inadequate access to mental health care can lead to considerable distress, chronicity and increased cost of care at the individual level, as well as low productivity and low participation in the workforce at the country level. The scale of this problem is illustrated by the fact that more than 80% of the world population lives in [these regions].”

Over the past several years, digital technology use in low- and middle-income countries has quickly risen, with results of a previous study suggesting that 80% of the population in these regions have mobile phones and nearly half can access the internet. Because evidence has shown the short-term effectiveness of digital psychological interventions among high-income countries, Fu and colleagues hypothesized that they might help reduce the mental health gap in low- and middle-income countries.

To test this hypothesis, the investigators searched four databases for randomized controlled trials that investigated digital psychological interventions among those with mental health problems in low-income and middle-income countries. They included articles published in English from database inception to March 9. Specifically, they extracted data on intervention details, such as the setting, digital delivery method, control group conditions, therapeutic orientation, number of sessions, presence or absence of guidance and length of follow-up, as well as on demographics, inclusion and exclusion criteria, and statistical information to determine effect sizes. Post-intervention mental health problems according to self-reporting instruments or clinical interviews served as the primary outcome. The meta-analysis included 22 eligible studies that involved 4,104 participants, of whom 2,351 received a digital psychological intervention and 1,753 who were in the control group. The analysis focused primarily on young adults, with a mean study population age of 20 to 35 years, who had depression or substance misuse.

Results showed moderate effectiveness of digital psychological interventions compared with control interventions (Hedges’ g = 0.6; 95% CI, 0.45-0.75; Hedges’ g with treatment as usual subgroup for comparison = 0.54; 95% CI, 0.35-0.73). The researchers reported substantial heterogeneity between studies and no evidence of publication bias.

“Digital psychological interventions in mental health care hold promise in bridging the mental health-care gap in low-resource countries,” they wrote. “This is particularly relevant during and after the COVID-19 pandemic, when physical distancing, the socioeconomic consequences of quarantine measures, and the loss of social support threaten public mental health.”