Review articleInternet-based interventions for the prevention and treatment of depression in people living in developing countries: A systematic review
Introduction
Depressive disorders are characterized by marked symptoms of low mood and anhedonia, and can have a recurrent course, impairing functional abilities of the individuals affected (American Psychiatric Association (APA), 2013). According to the recent Global Health Estimates published by the World Health Organization, depressive disorders have been ranked as the single largest cause of global disability, with a worldwide pooled prevalence of 4.4% and an upward trend in low- and middle-income countries (World Health Organization (WHO), 2017).
Although effective and low-cost strategies for the prevention and treatment of depression exist (Patel, 2017), the current treatment gap for this disorder has been estimated to be between 72% and 93% of all depressed people, with those from the poorest countries receiving less coverage (Chisholm et al., 2016). When it is not timely and properly treated, depression may increase the risk of worse health outcomes (Ghio et al., 2014, Rotella and Mannucci, 2013).
Internet-based interventions are defined as “treatments that have been operationalized and transformed for delivery via the Internet… highly structured, self or semi-self-guided; based on effective face-to-face interventions; personalized to the user; interactive; enhanced by graphics, animations, audio, and possibly video; and tailored to provide follow-up and feedback” (Ritterband and Thorndike, 2006). There is evidence that has proven their feasibility and effectiveness in the prevention and treatment of depression (Andersson and Cuijpers, 2010, Richardson and Richardson, 2012).
These programs are usually based on cognitive-behavioral principles, with guided programs providing more positive results than unguided ones thus becoming a promising alternative or complement to face-to-face interventions by helping to reduce the treatment gap (Anderson and Cuijpers, 2010; Anderson et al., 2013; Richardson and Richardson, 2012; Schröder et al., 2016). More recently, meta-analyses have showed that unguided Internet-based interventions are more effective (Karyotaki et al., 2017) and are associated with a reduced risk of symptom deterioration (Ebert et al., 2016), compared with controls. However, methodological problems, such as a lack of blinding, selection bias, and low adherence, may hinder their internal and external validity (Ye et al., 2014).
Moreover, evidence comes mainly from people living in developed countries (Schröder et al., 2016), whereas it may be a valuable resource to reduce the treatment gap for those living in less developed countries, thus ameliorating social health inequalities between regions (Latulippe et al., 2017), there is little knowledge about purposely developed internet based interventions for depression in such countries. The objective of this systematic review was to summarize the evidence regarding internet-based interventions for the prevention or treatment of depression in people living in developing countries.
Section snippets
Methods
The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement was used for the reporting of this systematic review (Moher et al., 2009).
Selection process
As shown in Fig. 1, the study selection process led to the inclusion of 6 articles in this systematic review (Arjadi et al., 2016, Barrera et al., 2015, Espinosa et al., 2016, Lara et al., 2014, Patel et al., 2016, Tiburcio et al., 2016).
Characteristics of the studies included
There were no studies assessing effectiveness. There were five feasibility studies (Barrera et al., 2015, Espinosa et al., 2016, Lara et al., 2014, Patel et al., 2016, Tiburcio et al., 2016), one of which reported on the preliminary effectiveness of an
Discussion
This systematic review identified recent studies that support the feasibility of Internet-based interventions for preventing depression in developing countries. No studies have published results regarding the use of these interventions in depression treatment. Data were mainly collected in the Americas, where most participants were middle-aged adults without severe depressive symptoms and with Internet access or were proficient Internet users. All interventions were based on
Acknowledgements
The authors wish to thank their funding sources, which include: the National Comission for Scientific and Technological Research, and the Millennium Science Initiative.
Abbreviations
All abbreviations provided throughout the text are standard in the field of ‘depression’ and ‘systematic reviews’.
Role of the funding source
This work was supported by the Program of International Cooperation of the National Commission for Scientific and Technological Research, through the project “E-mental Health for Depression: Latin-American Experiences” (Proyecto REDES 150005) of the competition to Support International Networking between Research Centres; and the Fund for Innovation and Competitiveness (FIC) of the
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