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Meta-Analysis
. 2025 Mar 20:27:e56975.
doi: 10.2196/56975.

Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis

Jacinta Brinsley  1 , Edward J O'Connor  2 , Ben Singh  1 , Grace McKeon  3 , Rachel Curtis  1 , Ty Ferguson  1 , Georgia Gosse  4 , Iris Willems  5   6 , Pieter-Jan Marent  5   7 , Kimberley Szeto  1 , Joseph Firth  8   9 , Carol Maher  1
Affiliations
Meta-Analysis

Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis

Jacinta Brinsley et al. J Med Internet Res. .

Abstract

Background: There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior.

Objective: The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes.

Methods: A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics.

Results: Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] -0.37; P<.001), a small effect on anxiety (SMD -0.29; P<.001) and stress (SMD -0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted.

Conclusions: Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity.

Trial registration: PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908.

Keywords: anxiety; depression; diet; digital health; lifestyle intervention; mental health; mobile phone; physical activity; sleep; stress; well-being.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA flowchart of study selection.
Figure 2
Figure 2
Meta-analysis of the effects of digital lifestyle interventions on symptoms of depression [40-42,44-58,60-69,71-83,85,86,88-90,92-95,97,98,100]. SMD: standardized mean difference.
Figure 3
Figure 3
Meta-analysis of the effects of digital lifestyle interventions on symptoms of anxiety [45,46,50-52,57,58,60,61,63,65-68,72,73,75-83,86,88,89,92,93,95,97-100]. SMD: standardized mean difference.
Figure 4
Figure 4
Meta-analysis of the effects of digital lifestyle interventions on stress [44,46,57,59,65,78,80,82,83,93,96]. SMD: standardized mean difference.
Figure 5
Figure 5
Meta-analysis of the effects of digital lifestyle interventions on well-being [43,46,61,84,91,96]. SMD: standardized mean difference.
See this image and copyright information in PMC

References

    1. GBD 2019 Mental Disorders Collaborators Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022 Feb;9(2):137–50. doi: 10.1016/S2215-0366(21)00395-3. https://linkinghub.elsevier.com/retrieve/pii/S2215-0366(21)00395-3 S2215-0366(21)00395-3 - DOI - PMC - PubMed
    1. O'Connor RC, Worthman CM, Abanga M, Athanassopoulou N, Boyce N, Chan LF, Christensen H, Das-Munshi J, Downs J, Koenen KC, Moutier CY, Templeton P, Batterham P, Brakspear K, Frank RG, Gilbody S, Gureje O, Henderson D, John A, Kabagambe W, Khan M, Kessler D, Kirtley OJ, Kline S, Kohrt B, Lincoln AK, Lund C, Mendenhall E, Miranda R, Mondelli V, Niederkrotenthaler T, Osborn D, Pirkis J, Pisani AR, Prawira B, Rachidi H, Seedat S, Siskind D, Vijayakumar L, Yip PS. Gone too soon: priorities for action to prevent premature mortality associated with mental illness and mental distress. Lancet Psychiatry. 2023 Jun;10(6):452–64. doi: 10.1016/s2215-0366(23)00058-5. https://doi.org/10.1016/S2215-0366(23)00058-5 - DOI - DOI - PubMed
    1. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016 Feb;3(2):171–8. doi: 10.1016/S2215-0366(15)00505-2.S2215-0366(15)00505-2 - DOI - PubMed
    1. Arias D, Saxena S, Verguet S. Quantifying the global burden of mental disorders and their economic value. EClinicalMedicine. 2022 Dec;54:101675. doi: 10.1016/j.eclinm.2022.101675. https://linkinghub.elsevier.com/retrieve/pii/S2589-5370(22)00405-9 S2589-5370(22)00405-9 - DOI - PMC - PubMed
    1. Hoang D, Kristoffersen I, Li IW. All in the mind? Estimating the effect of mental health on health behaviours. Soc Sci Med. 2019 Mar;225:69–84. doi: 10.1016/j.socscimed.2019.02.017.S0277-9536(19)30084-X - DOI - PubMed