Digital Health Interventions for Depression and Anxiety Among People With Chronic Conditions: Scoping Review

Abstract

Background Chronic conditions are characterized by their long duration (≥1 year), need for ongoing medical attention, and limitations in activities of daily living. These can often co-occur with depression and anxiety as common and detrimental comorbidities among the growing population living with chronic conditions. Digital health interventions (DHIs) hold promise in overcoming barriers to accessing mental health support for these individuals; however, the design and implementation of DHIs for depression and anxiety in people with chronic conditions are yet to be explored. Objective This study aimed to explore what is known in the literature regarding DHIs for the prevention, detection, or treatment of depression and anxiety among people with chronic conditions. Methods A scoping review of the literature was conducted using the Arksey and O’Malley framework. Searches of the literature published in 5 databases between 1990 and 2019 were conducted in April 2019 and updated in March 2021. To be included, studies must have described a DHI tested with, or designed for, the prevention, detection, or treatment of depression or anxiety in people with common chronic conditions (arthritis, asthma, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, cancer, stroke, and Alzheimer disease or dementia). Studies were independently screened by 2 reviewers against the inclusion and exclusion criteria. Both quantitative and qualitative data were extracted, charted, and synthesized to provide a descriptive summary of the trends and considerations for future research. Results Database searches yielded 11,422 articles across the initial and updated searches, 53 (0.46%) of which were included in this review. DHIs predominantly sought to provide treatment (44/53, 83%), followed by detection (5/53, 9%) and prevention (4/53, 8%). Most DHIs were focused on depression (36/53, 68%), guided (32/53, 60%), tailored to chronic physical conditions (19/53, 36%), and delivered through web-based platforms (20/53, 38%). Only 2 studies described the implementation of a DHI. Conclusions As a growing research area, DHIs offer the potential to address the gap in care for depression and anxiety among people with chronic conditions; however, their implementation in standard care is scarce. Although stepped care has been identified as a promising model to implement efficacious DHIs, few studies have investigated the use of DHIs for depression and anxiety among chronic conditions using such models. In developing stepped care, we outlined DHI tailoring, guidance, and intensity as key considerations that require further research.

Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

“…A meta analysis of RCTs of digital interventions reported a sig nificant moderate effect on depressive outcomes (g=-0.37, 95% CI: -0.60 to -0.14) 371 . Key predictors of significant effects were a two way "clinician patient communication loop", coupled with progress mon itoring and adjustment of treatment as well as self manage ment strategies over time 362,371 . Successful interventions ranged from those delivered via phone to more complex ones delivered via web platforms, highlighting the adaptability of digital approach es 371 .…”

“…At this stage, however, the number of trials on each comorbid physical disease varies, and results are inconsistent 371,372 . More at tention also needs to be paid to the scalability and validation of dig ital interventions and how they can be better integrated into health services 362,372 .…”

“…Having MDD, as well as subthreshold depressive symptoms, that are comorbid with a physical health condition amplifies barriers to accessing and engaging in potentially helpful treatments and self‐management strategies 16 . Treatment needs are often multiplied, diverse and chronic, placing strain on health services and families, especially in low‐ and middle‐income countries, cultural and linguistic minorities, and First Nations people, and those in rural areas with scarce resources 362 . Innovative strategies to overcome these barriers, incorporating integrated care for physical health conditions (particularly cardiometabolic diseases) in MDD, are required 363 .…”

Implementation of digital home monitoring and management of respiratory disease

“…Table 1 summarizes some existing digital home monitoring interventions in a number of respiratory conditions that have benefit in supporting patients to manage their conditions, reducing hospitalization, and facilitating remote consultation [10 ▪ ,13,18,27–59]. These interventions have proved to be feasible and effective in research contexts and potentially could be developed for implementation in routine practice.…”

“…Self-checking AI-mediated smart inhaler technique, augmented reality (AR), smartphone camera and microphone, and smart inhaler [53--55] Psychological support Monitoring the mental health conditions of the COPD patients and provide digital support and education [56].…”