Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov 4:3:764079.
doi: 10.3389/fdgth.2021.764079. eCollection 2021.

Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis

Daniel Z Q Gan  1 , Lauren McGillivray  1 , Jin Han  1 , Helen Christensen  1 , Michelle Torok  1
Affiliations

Effect of Engagement With Digital Interventions on Mental Health Outcomes: A Systematic Review and Meta-Analysis

Daniel Z Q Gan et al. Front Digit Health. .

Abstract

Digital mental health interventions (DMHIs) present a promising way to address gaps in mental health service provision. However, the relationship between user engagement and outcomes in the context of these interventions has not been established. This study addressed the current state of evidence on the relationship between engagement with DMHIs and mental health outcomes. MEDLINE, PsycINFO, and EmBASE databases were searched from inception to August 1, 2021. Original or secondary analyses of randomized controlled trials (RCTs) were included if they examined the relationship between DMHI engagement and post-intervention outcome(s). Thirty-five studies were eligible for inclusion in the narrative review and 25 studies had sufficient data for meta-analysis. Random-effects meta-analyses indicated that greater engagement was significantly associated with post-intervention mental health improvements, regardless of whether this relationship was explored using correlational [r = 0.24, 95% CI (0.17, 0.32), Z = 6.29, p < 0.001] or between-groups designs [Hedges' g = 0.40, 95% CI (0.097, 0.705), p = 0.010]. This association was also consistent regardless of intervention type (unguided/guided), diagnostic status, or mental health condition targeted. This is the first review providing empirical evidence that engagement with DMHIs is associated with therapeutic gains. Implications and future directions are discussed. Systematic Review Registration: PROSPERO, identifier: CRD 42020184706.

Keywords: digital mental health; eHealth; mHealth; meta-analysis; systematic review.

PubMed Disclaimer

Conflict of interest statement

MT, LM, JH, and HC are employed by the Black Dog Institute (University of New South Wales, Sydney, NSW, Australia), a not-for-profit research institute that develops and tests digital interventions for mental health. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA diagram for study selection process.
Figure 2
Figure 2
Association between engagement and primary mental health outcomes at post-intervention for studies employing correlational designs (n = 20).
Figure 3
Figure 3
Effect of engagement on primary mental health outcomes at post-intervention for studies employing between-groups designs (n = 5).
See this image and copyright information in PMC

References

    1. Rehm J, Shield KD. Global burden of disease and the impact of mental and addictive disorders. Curr Psychiatry Rep. (2019) 21:10. 10.1007/s11920-019-0997-0 - DOI - PubMed
    1. Murray CJL, Barber RM, Foreman KJ, Ozgoren AA, Abd-Allah F, Abera SF, et al. . Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet. (2015) 386:2145–91. 10.1016/S0140-6736(15)61340-X - DOI - PMC - PubMed
    1. Aboujaoude E, Gega L, Parish MB, Hilty DM. Editorial: digital interventions in mental health: current status and future directions. Front Psychiatry. (2020) 11:111. 10.3389/fpsyt.2020.00111 - DOI - PMC - PubMed
    1. Andersson G, Titov N. Advantages and limitations of Internet-based interventions for common mental disorders. World Psychiatry. (2014) 13:4–11. 10.1002/wps.20083 - DOI - PMC - PubMed
    1. Hom MA, Stanley IH, Joiner TE, Jr. Evaluating factors and interventions that influence help-seeking and mental health service utilization among suicidal individuals: a review of the literature. Clin Psychol Rev. (2015) 40:28–39. 10.1016/j.cpr.2015.05.006 - DOI - PubMed

Publication types