Digital interventions for depression and anxiety in older adults: a systematic review of randomised controlled trials

Riadi, Indira; Kervin, Lucy; Dhillon, Sandeep; Teo, Kelly; Churchill, Ryan; Card, Kiffer G.; Sixsmith, Andrew; Moreno, Sylvain; Fortuna, Karen L.; Torous, John; Cosco, Theodore D.

doi:10.1016/s2666-7568(22)00121-0

Cited by 25 publications

(17 citation statements)

References 47 publications

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“…One potential explanation for our null findings is the absence of contact with professionals or peers, which has been reported as an important feature by authors of a systematic review of digital interventions for older adults. 7 Our programme was fully automated, whereby participants only interacted with a ‘quick reply’ tool. Standardised and automated messages were then sent to participants based on their responses.…”

Section: Discussionmentioning

confidence: 99%

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A self-help fully automated digital intervention to improve subthreshold depressive symptoms among older adults in a socioeconomically deprived region of Brazil (PRODIGITAL): a pragmatic, two-arm randomised controlled trial

Nakamura,

Seward,

Peters

et al. 2023

Preprint

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SummaryBackgroundSubthreshold depression is a risk factor for major depression and is associated with increased morbidity and mortality, especially in poorly resourced settings. There is emerging evidence that digital interventions may be effective at improving depressive symptoms in High Income Countries but not Low-and Middle-Income settings. We aimed to evaluate the effectiveness of the Viva Vida digital intervention at improving symptoms of subthreshold depression among older adults in socioeconomically deprived settings in Brazil.MethodsPRODIGITAL was a single blind, two-arm, individually randomised controlled trial conducted in 46 primary care clinics in Guarulhos, Brazil. Individuals aged 60+ years were randomly contacted by phone for a screening assessment. Those who presented with anhedonia and/or depressed mood (Patient Health Questionnaire (PHQ)-2), and who subsequently scored between 5 and 9 on the PHQ-9 were invited to participate. The intervention (Viva Vida) arm received a self-help fully automated programme sent via WhatsApp with no support from healthcare professionals. Forty-eight audio and visual messages based on psychoeducation and behavioural activation approaches were delivered over six weeks. The control arm received a single message with information about depression. The primary outcome was the PHQ-9 at three months’ follow-up. All primary analyses were performed according to allocated arm with imputed data. The trial is registered with ReBEC, RBR-6c7ghfd.FindingsParticipants were recruited between 8 September 2021 and 19 August 2022. Of the 454 participants enrolled, 223 were randomised to the intervention arm and 231 to receive the single message. A total of 385 (84·8%) completed the three-month follow-up assessment; no difference in mean PHQ-9 scores between the arms (adjusted difference: -0·61; 95% CI: -1·76, 0·53;p=0·290) was observed.InterpretationThese results demonstrate that a fully automated digital programme did not help to improve subthreshold depressive symptoms amongst older adults. More research is needed to understand how such interventions can be adapted to reduce depressive symptoms as well as prevent against major depression in low-resourced settings.FundingSão Paulo Research Foundation and Joint Global Health TrialsResearch in contextEvidence before this studyWe searched PubMed for randomised controlled trials on Oct 20, 2023, using the search terms (((((((digital) OR (internet)) OR (web)) OR (mobile)) OR (e-health) OR (technology) AND (((subthreshold) OR (subclinical)) OR (subsyndromal))) AND (((depression) OR (depressive)))) AND (((older) OR (elderly) OR (senior))). We did not apply any restrictions on languages or date of publication. Two studies assessing a fully automated digital intervention for subthreshold depression were found. An internet-based cognitive behavioural therapy (iCBT) was delivered to adults aged 50+ years in the Netherlands, whilst automated emails using self-help behaviour strategies (Mood Memos) was sent to adults from 18 to 78 years (mean age of 36 years) in Australia. The interventions showed improvement on depressive symptoms at ten (iCBT) and six weeks (Mood Memos). Like the Viva Vida, one study conducted with adults in China used a messaging application (WeChat). However, WeChat offers more features, and the iCBT programme was guided by clinical psychologists.Added value of this studyWe report a self-help fully automated digital psychosocial intervention for subthreshold depression among older adults in Brazil. To the best of our knowledge, this is the first psychosocial intervention of this kind in a low-and middle-income country. The intervention was designed to be user-friendly and accessible to a population with low literacy and limited digital skills. While a significant portion of participants engaged with the programme by opening most of the messages, we did not observe any difference in improving depressive symptoms.Implications of all the available evidenceFully automated digital interventions with no support of health or lay professionals are usually low cost and can easily be scaled up. Consequently, they have the potential to improve access to care and help reduce the mental health treatment gap in an affordable way. When tailored to socioeconomically vulnerable individuals, these interventions can also help promote more equitable access to care. Future studies should focus on understanding how to adapt such interventions to be effective for subthreshold depression.

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Section: Discussionmentioning

confidence: 99%

“…The use of digital interventions to manage depressive symptoms has become increasingly popular. 7 There is growing evidence that digital interventions may help to improve symptoms of subthreshold and major depression. 8 However, studies in poorly resourced settings in LMICs are limited.…”

Section: Introductionmentioning

confidence: 99%

A self-help fully automated digital intervention to improve subthreshold depressive symptoms among older adults in a socioeconomically deprived region of Brazil (PRODIGITAL): a pragmatic, two-arm randomised controlled trial

Nakamura,

Seward,

Peters

et al. 2023

Preprint

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“…The advantages of DMHIs include accessibility, cost-effectiveness, and personalization [7], which can address key barriers for mental health recovery, such as low help-seeking and the stigma associated with mental health problems [8]. Effectiveness of DMHIs has been generally reported in diverse populations (eg, children, young people, older adults, university students, health care workers, people with neurodevelopmental disabilities) and on diverse mental health experiences [2,[9][10][11][12]. DMHIs have become an important domain in medical internet research [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Assessing Diversity and Inclusivity is the Next Frontier in Mental Health Recovery Narrative Research and Practice

Kotera¹,

Rennick-Egglestone²,

Ng³

et al. 2023

JMIR Ment Health

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Demand for digital health interventions is increasing in many countries. The use of recorded mental health recovery narratives in digital health interventions is becoming more widespread in clinical practice. Mental health recovery narratives are first-person lived experience accounts of recovery from mental health problems, including struggles and successes over time. Helpful impacts of recorded mental health recovery narratives include connectedness with the narrative and validation of experiences. Possible harms include feeling disconnected and excluded from others. Diverse narrative collections from many types of narrators and describing multiple ways to recover are important to maximize the opportunity for service users to benefit through connection and to minimize the likelihood of harm. Mental health clinicians need to know whether narrative collections are sufficiently diverse to recommend to service users. However, no method exists for assessing the diversity and inclusivity of existing or new narrative collections. We argue that assessing diversity and inclusivity is the next frontier in mental health recovery narrative research and practice. This is important, but methodologically and ethically complex. In this viewpoint, we propose and evaluate one diversity and two inclusivity assessment methods. The diversity assessment method involves use of the Simpson Diversity Index. The two inclusivity assessment methods are based on comparator demographic rates and arbitrary thresholds, respectively. These methods were applied to four narrative collections as a case study. Refinements are needed regarding a narrative assessment tool in terms of its practicality and cultural adaptation.

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“…The availability of remote interventions targeting mental health conditions has been increasing recently [15]. However, the paucity of research evidence worldwide does not allow us to determine which forms of .…”

Section: Introductionmentioning

confidence: 99%

Self-help digital psychosocial intervention for older adults with subthreshold depressive symptoms in primary care in Brazil (PRODIGITAL): Protocol for an individually randomised controlled trial

Didone

Nakamura

Seward

et al. 2023

Preprint

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Background: Subthreshold depression is a substantial risk factor for the development of major depression and is, for example, associated with poorer health in older adults, functional disabilities, and reduced quality of life. There is a paucity of cost-effective psychosocial interventions for this population in primary care worldwide, particularly in low- and middle-income countries. Objective: We will evaluate the effectiveness and cost-effectiveness of the Viva Vida Programme, a 6-week digital psychosocial intervention for treating older adults with subthreshold depression in primary care. Methods: A two-arm, individually randomised controlled trial with a 1:1 allocation ratio with integrated economic and process evaluations. We will recruit 450 individuals 60 years of age and older with subthreshold depression (essentially, at least 5 and below 10 on the 9-item Patient Health Questionnaire (PHQ-9)) registered with one of the 46 primary care clinics in Guarulhos, Brazil. The intervention comprises a 6-week self-help digital psychosocial package delivered via automated WhatsApp messages (audio and visual), with psychoeducation and behavioural activation contents adapted from our previously-evaluated PROACTIVE intervention. It involves 48 messages, delivered twice-daily, four days a week. Participants in the control arm will receive a single message with general information about depression. The primary outcome is PHQ-9 at the three-month follow-up. The cost-effectiveness of the intervention will be assessed at five months. A detailed process evaluation will explore context and implementation outcomes. Discussion: The Viva Vida Programme is an innovative digital psychosocial intervention delivered via WhatsApp messaging without the participation of health professionals. The results of this study will hopefully contribute to the development of simple and cost-effective models of remote self-help interventions for reducing depressive symptoms among older adults with subthreshold depression in primary care. Trial registration: The protocol is registered with Registro Brasileiro de Ensaios Clinicos (ReBEC) (RBR-6c7ghfd).

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Digital interventions for depression and anxiety in older adults: a systematic review of randomised controlled trials

Cited by 25 publications

References 47 publications

A self-help fully automated digital intervention to improve subthreshold depressive symptoms among older adults in a socioeconomically deprived region of Brazil (PRODIGITAL): a pragmatic, two-arm randomised controlled trial

A self-help fully automated digital intervention to improve subthreshold depressive symptoms among older adults in a socioeconomically deprived region of Brazil (PRODIGITAL): a pragmatic, two-arm randomised controlled trial

Assessing Diversity and Inclusivity is the Next Frontier in Mental Health Recovery Narrative Research and Practice

Self-help digital psychosocial intervention for older adults with subthreshold depressive symptoms in primary care in Brazil (PRODIGITAL): Protocol for an individually randomised controlled trial

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