JMIR Publications

ABSTRACT

Background:

Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in the field of mental health. Although there are many technologies currently being implemented, the research supporting their usability, efficacy and risk required further examination, especially those interventions that can be used independently and without support.

Objective:

This review aims to identify evidence-based, self-directed virtual methods of care that could be used in adult patients after discharge from mental health services. The interventions reviewed had to be automated with no human input required (either at the patient’s or the technology’s end), so patients could implement them independently without any support.

Methods:

A systematic review was conducted broadly following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Prospero guidelines in 3 databases: PubMed, Web of Science and Ovid. Inclusion criteria were: self-directed, automated, technology-based interventions related to mental health, primarily for adults and with a solid evaluation process. Interventions had to be ‘self-directed’, in that the participants could use the technology without external guidance.

Results:

Thirty-four papers were identified that fit the inclusion criteria: 24 Randomized Controlled Trials (RCTs), 9 non-RCT quantitative studies and 1 qualitative study. Technologies employed included websites, automated text messaging, phone applications, videos, computer software and integrated voice response. Twenty studies focused on Internet-based Cognitive Behavioral Therapies (iCBTs) as a therapeutic paradigm compared to waitlist, on- line human delivered therapy and other interventions. Fourteen studies used paradigms other than iCBT. Out of eight studies directly comparing directly guided to unguided digital care, three studies showed no differences, three favored guided interventions and two favored unguided interventions. Research showed dropout rates as high as 80%, citing potential problems with acceptability of the suggested technologies.

Conclusions:

There is limited research on efficacy and suitability of self-directed virtual care options in mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. Interventions may need to be developed collaboratively with users to encourage acceptability and avoid high drop-out rates.