Technological State of the Art of Electronic Mental Health Interventions for Major Depressive Disorder: Systematic Literature Review

Abstract

Background Electronic mental (e-mental) health care for depression aims to overcome barriers to and limitations of face-to-face treatment. Owing to the high and growing demand for mental health care, a large number of such information and communication technology systems have been developed in recent years. Consequently, a diverse system landscape formed. Objective This literature review aims to give an overview of this landscape of e-mental health systems for the prevention and treatment of major depressive disorder, focusing on three main research questions: (1) What types of systems exist? (2) How technologically advanced are these systems? (3) How has the system landscape evolved between 2000 and 2017? Methods Publications eligible for inclusion described e-mental health software for the prevention or treatment of major depressive disorder. Additionally, the software had to have been evaluated with end users and developed since 2000. After screening, 270 records remained for inclusion. We constructed a taxonomy concerning software systems, their functions, how technologized these were in their realization, and how systems were evaluated, and then, we extracted this information from the included records. We define here as functions any component of the system that delivers either treatment or adherence support to the user. For this coding process, an elaborate classification hierarchy for functions was developed yielding a total of 133 systems with 2163 functions. The systems and their functions were analyzed quantitatively, with a focus on technological realization. Results There are various types of systems. However, most are delivered on the World Wide Web (76%), and most implement cognitive behavioral therapy techniques (85%). In terms of content, systems contain twice as many treatment functions as adherence support functions, on average. Furthermore, autonomous systems, those not including human guidance, are equally as technologized and have one-third less functions than guided ones. Therefore, lack of guidance is neither compensated with additional functions nor compensated by technologizing functions to a greater degree. Although several high-tech solutions could be found, the average system falls between a purely informational system and one that allows for data entry but without automatically processing these data. Moreover, no clear increase in the technological capabilities of systems showed in the field, between 2000 and 2017, despite a marked growth in system quantity. Finally, more sophisticated systems were evaluated less often in comparative trials than less sophisticated ones (OR 0.59). Conclusions The findings indicate that when developers create systems, there is a greater focus on implementing therapeutic treatment than adherence support. Although the field is very active, as evidenced by the growing number of systems developed per year, the technological possibilities explored are limited. In addition to allowing developers to compare their system with others, we anticipate that this review will help researchers identify opportunities in the field.

Adherence to Established Treatment Guidelines Among Unguided Digital Interventions for Depression: Quality Evaluation of 28 Web-Based Programs and Mobile Apps

“…They found high variability among the web-based interventions, and that most of these interventions used cognitive behavioral therapy (CBT) as the therapeutic approach with mood assessments and homework sheets implemented as the primary interactive tools. These results are supported by another recent review showing that 85% of the web-based interventions for depression implemented CBT techniques [ 49 ].…”

“…Following this process, we chose CBT components as superordinate categories in our questionnaire because CBT was identified as the most frequent approach in web-based interventions for depression [ 48 , 49 ]. Based on the guidelines and manuals, we expected the following components to occur in web-based interventions that claim to be evidence-based: behavioral activation, cognitive restructuring, psychoeducation, mood tracking, journal keeping, relaxation training, social skills training, resource activation, and crisis management.…”

“…Previous studies have measured the therapeutic quality of web-based interventions only at a general level, reflecting the overall impression of raters, without specific analysis of particular treatment components (eg, behavioral activation, cognitive restructuring) or therapeutic approaches. Although the majority of web-based interventions implement CBT as the therapeutic approach [ 48 , 49 ], we found only one study that examined the realization of a specific component of CBT in web-based interventions in detail (ie, behavioral activation) [ 55 ]. The authors found that the utility of these interventions is questionable, because only a few adhere to the core principles of CBT.…”

Use of Asynchronous Virtual Mental Health Resources for COVID-19 Pandemic–Related Stress Among the General Population in Canada: Cross-Sectional Survey Study

“…Specifically, uptake and retention are significantly higher among users of AVMH resources who receive peer support [27], and automated conversational agents such as chatbots have been shown to effectively support sustained engagement [53]. While clinician and peer support may be logistically challenging and costly, Burger and colleagues [54] note that current AVMH resources "do not get close to the full technological potential of e-mental health" and that enhancing the available features of these resources may lead to greater uptake and retention of users.…”

Italia Ti Ascolto [Italy, I am listening]: an app-based group psychological intervention during the COVID-19 pandemic

“…More specifically, considering online interventions for depressive features, a systematic review by Burger, Neerincx, and Brinkman (2020) highlighted that 76% of the digital interventions are delivered via Web, and 85% of the studies investigated the efficacy of internet-based cognitive behavioral therapy (iCBT) highlighting successful treatments on depressive symptoms' reduction (e.g. Forsell et al, 2017;Hallgren et al, 2015;Schure et al, 2020;Miller et al, 2021).…”