Providing Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review

Abstract

Background Digital mental health interventions (DMHIs) have been increasingly deployed to bridge gaps in mental health care, particularly given their promising efficacy. Nevertheless, attrition among DMHI users remains high. In response, human support has been studied as a means of improving retention to and outcomes of DMHIs. Although a growing number of studies and meta-analyses have investigated the effects of human support for DMHIs on mental health outcomes, systematic empirical evidence of its effectiveness across mental health domains remains scant. Objective We aimed to summarize the results of meta-analyses of human support versus no support for DMHI use across various outcome domains, participant samples, and support providers. Methods We conducted a systematic meta-review of meta-analyses, comparing the effects of human support with those of no support for DMHI use, with the goal of qualitatively summarizing data across various outcome domains, participant samples, and support providers. We used MEDLINE, PubMed, and PsycINFO electronic databases. Articles were included if the study had a quantitative meta-analysis study design; the intervention targeted mental health symptoms and was delivered via a technology platform (excluding person-delivered interventions mediated through telehealth, text messages, or social media); the outcome variables included mental health symptoms such as anxiety, depression, stress, posttraumatic stress disorder symptoms, or a number of these symptoms together; and the study included quantitative comparisons of outcomes in which human support versus those when no or minimal human support was provided. Results The results of 31 meta-analyses (505 unique primary studies) were analyzed. The meta-analyses reported 45 effect sizes; almost half (n=22, 48%) of them showed that human-supported DMHIs were significantly more effective than unsupported DMHIs. A total of 9% (4/45) of effect sizes showed that unsupported DMHIs were significantly more effective. No clear patterns of results emerged regarding the efficacy of human support for the outcomes assessed (including anxiety, depression, posttraumatic stress disorder, stress, and multiple outcomes). Human-supported DMHIs may be more effective than unsupported DMHIs for individuals with elevated mental health symptoms. There were no clear results regarding the type of training for those providing support. Conclusions Our findings highlight the potential of human support in improving the effects of DMHIs. Specifically, evidence emerged for stronger effects of human support for individuals with greater symptom severity. There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered, making it difficult to draw strong conclusions regarding the circumstances under which human support is most effective. Future research should emphasize reporting detailed descriptions of sample and intervention characteristics and describe the mechanism through which they believe the coach will be most useful for the DMHI.

Digitale Technologien zur Verbesserung der psychischen Gesundheit

“…Digitale Interventionen, insbesondere Apps, können entweder „geleitet“ sein (Unterstützung und Feedback durch Therapeut:in in Form von Textnachrichten oder Telefonanrufen) oder sie werden „ungeleitet“ durchgeführt. Die momentane Forschungslage legt nahe, dass geleitete digitale Interventionen effektiver sind als ungeleitete [ 22 ]. Grundsätzlich ist die Abbruchquote bei digitalen Interventionen hoch.…”

“…Strategien, um Patient:innen in einer digitalen Intervention für die psychische Gesundheit zu halten, wurden auch von Wissenschaftler:innen des Leibniz WissenschaftsCampus Digital Public Health (LWC DiPH) untersucht. Diese reichen von Feedback in Bezug auf das eigene Wohlergehen über die Beantwortung von Fragen zu Inhalten der Intervention bis hin zur Einbindung der Teilnehmer:innen in soziale Foren [ 22 , 24 ].…”

“…Es ist deshalb wichtig, Patient:innen, aber auch Therapeut:innen in der digitalen Intervention zu schulen, um deren „digitale Gesundheitskompetenz“ (Digital Health Literacy) und Verständnis für den Ansatz zu erhöhen. Es hat sich zudem gezeigt, dass eine nicht gut angepasste digitale Intervention (die beispielweise nicht zu den kulturellen Werten und Ansichten einer Person passt) häufig nicht bis zum Ende geführt wird [ 22 ]. Deshalb erscheint eine Adaption an die Sprache und die kulturellen Werte der Endnutzer:innen besonders wichtig.…”

Engagement, acceptability, and effectiveness of the Vira digital behavior change platform: A randomized pilot trial comparing self-care and coach-supported versions in young adults at risk for depression and obesity

“…[33] However, some meta-analyses have raised questions about whether self-guided apps are effective in improving mental health [34,35]. Other reviews have concluded that interventions incorporating human support (e.g., coaching, manual adherence prompts, or integration with professional face-to-face care) yield greater effectiveness [36,37] and adherence [38,39] than self-guided apps. If smartphone apps need human support to be effective, this resource limitation must be factored into implementation of digital interventions.…”

Developing the Workforce of the Digital Future: mHealth Competency and Fidelity Measurement in Community-Based Care

“…Research on the efficacy, effectiveness, and implementation of clinician-supported digital applications designed for individuals with mental illness supports the use of a digital interventionist in the administration of mHealth and its integration into treatment plans and delivery (Ben-Zeev et al, 2015 ; Mohr et al, 2021 ; Schueller et al, 2016 ; Wisniewski & Torous, 2020 ; Wisniewski et al, 2020 ). A recent meta-systematic review, which analyzed the results of 31 meta-analyses consisting of 505 independent trials (Werntz et al, 2023 ), found larger effect sizes among digital mental health intervention trials that included human-supported mHealth interventions. Moreover, the meta-systematic review concluded that human-supported mHealth interventions may be more effective than unsupported interventions for individuals with greater symptom severity.…”