Providing Support for Use of Digital Mental Health Interventions: A Systematic Meta-Review (Preprint)

Abstract

BACKGROUND Human support has been increasingly studied as a means of improving outcomes of digital mental health interventions (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 for its effectiveness across mental health domains remains scant. OBJECTIVE The goal of this study was to summarize the effects of human support and no support for DMHI use across various outcome domains, participant samples, and support providers. METHODS A systematic meta-review of meta-analyses was conducted, comparing the effects of human support to no support for DMHI use, with the goal of summarizing across various outcome domains, participant samples, and support providers. Only meta-analyses that compared effect size of human support with that of no support were included. RESULTS Results from 31 meta-analyses representing 505 unique primary studies were reported. The quality of the evidence for effectiveness of human support was assessed using the AMSTAR 2 review system. The meta-analyses reported 45 effect sizes; almost half (48.89%, N=22) showed that human-supported interventions were significantly more effective than unsupported interventions. Only four (8.89%) effect sizes showed that unsupported were significantly more effective. Evidence emerged for stronger effects of human support for individuals with greater symptom severity. CONCLUSIONS There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered. The results highlight the potential of human support in improving the effects of DMHIs as a way of increasing access to evidence-based mental health tools. We conclude with suggestions for future research.