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

– Werntz A, et al. J Med Internet Res 2023;65:e42864.¹

ENHANCING DIGITAL INTERVENTIONS

In recent decades, a growing number of digital interventions have harnessed technology to address mental health conditions, including anxiety and major depressive disorder. Digital interventions can include mobile apps and computer-based interventions that deliver on-demand support, ranging from behavioral strategies (e.g. self-monitoring) to more complex therapeutic approaches (e.g. cognitive behavioral therapy).

Digital interventions may help patients manage their mental health symptoms; however, the interventions can be negatively impacted by lack of engagement and high attrition rates. A small number of apps have attracted a substantial number of active users, and market penetrance remains a key challenge for digital interventions.² Ultimately, the potential of digital interventions to bridge the treatment gap in mental health cannot be met if user engagement is low.²

Fortunately, human-supported digital interventions are a promising way to augment the impact of digital interventions and maintain user engagement, potentially bridging some of the current gaps in global mental health care.

DIGITAL INTERVENTIONS MAY BENEFIT BOTH PATIENTS AND PHYSICIANS

Digital interventions are non-consumable; they can be delivered multiple times with high fidelity. Dynamic features such as games and animations can also be incorporated into digital interventions to help retain user engagement and attention. For physicians, digital interventions may provide data-collection features, enabling them to evaluate patient effort. For patients, digital interventions may reduce stigma by providing a sense of privacy that typical therapeutic practices may not be able to offer.

HUMAN SUPPORT COULD EMPOWER DIGITAL INTERVENTIONS

Human augmentation of digital interventions is relatively new; however, research suggests that human support may reduce attrition and increase engagement.

Digital Interventions could be augmented by Human support

Human support may increase patient motivation; it requires less time than providing a direct service, and it can be delivered via synchronous and asynchronous channels.

A PRISMA-Guided Meta-Analysis

A systematic meta-analysis of literature (following PRISMA guidelines) was carried out to assess how human support may impact outcomes of digital interventions. In total, 31 meta-analyses, which analyzed the effectiveness of digital interventions on mental health outcomes with and without human support, were included.

Unveiling the Results: The Influence of Human Support on Digital Mental Health Interventions

Of all 45 effect sizes reported, 48% suggested that human-supported digital interventions were more effective than unsupported digital interventions when treating symptoms across a range of mental health conditions such as anxiety, depression, stress, and posttraumatic stress disorder. In contrast, only 9% of reported effect sizes suggested that unsupported digital interventions were more effective than supported digital interventions.

No clear pattern of results was found when comparing highly trained support providers (e.g. clinicians) with paraprofessional-level support, suggesting that provision of support for digital interventions may not be limited to individuals with extensive mental health training. However, further research that gauges how background characteristics (e.g. symptom severity and patient demographics) interact with types of human support is needed so that more robust conclusions can be drawn.

A key limitation of the meta-analysis was that the analyzed studies varied in terms of the nature of the interventions, patient population, and support delivered, which made it difficult to draw robust conclusions.

Digital interventions offer access to high-fidelity, evidence-based interventions that can be further augmented via human support; users may benefit from assistance and accountability
The combination of paraprofessional coaching and evidence-based digital interventions could bridge some of the current gaps in global mental health care
Future research will allow for an understanding of how models of human support can be matched to individuals’ backgrounds and types of digital interventions

Cite this article as Article in Focus. Could Human Support Augment Digital Interventions? Connecting Psychiatry. Published February 2024. Accessed [month day, year]. [URL].

Abbreviations:

PRISMA, preferred reporting items for systematic reviews and meta-analyses.