The potential of digital mental health interventions

Ellie Roberts
18 Feb 2022

            With the COVID-19 pandemic came the phenomenal increase in technology usage across the world, from online video calls to innovative apps. What became particularly apparent was the potential of technology to reach and connect a great number of people – globally. As many health consultations and routine appointments were forced to move online, the department that showed perhaps the most promising shift in service delivery was that of mental health (Torous et al., 2020).

            The digital world tends to have more negative associations with mental health, especially when concerning the effects of screen time, addiction, and sedentary behaviour (Browne et al., 2021). Despite these drawbacks, digital technologies can offer great benefit to mental health when used responsibly. Digital mental health interventions (DMHIs) are a growing collection of services offering help and support for mental health issues through technological means. These interventions include online therapy sessions such as those provided by BetterHelp, as well as self-help apps like Headspace and Intellect.

            One of the greatest benefits of DMHIs is the widespread availability and accessibility of these services. Although geographical and income-based disparities regarding digital access do exist, 43% of people in low and middle-income countries (LMICs) use the internet, and 72% of those in low-income countries have access to phones (Naslund et al., 2017). Poor mental health is a global issue that remains under-addressed, however this is most notable for LMICs where it is estimated that 80% of global mental health problems reside (Rathod et al., 2017).

            Currently 1 in 4 young adults experience mental health difficulties each year, yet due to a lack of access to care services, the majority of cases remain unresolved (Pretorius and Coyle, 2021). Adolescents and young adults represent age categories at the highest risk of experiencing mental health issues, with 50% of such issues present by the age of 14, and 75% by 24 (Lehtimaki, 2021). However, these groups also demonstrate the greatest usage of digital technologies, suggesting that DMHIs may work most effectively for them (Pretorius and Coyle, 2021). Being able to address these issues during such crucial stages of development could cause a significant reduction in the prevalence of poor mental health in later life.

            In addition to widespread access, DMHIs involving self-help practices have particular strengths that conventional therapies may lack. Many self-help apps allow the user to track their progress through recording their feelings and behaviours; this enables the effective development of awareness, regulation and coping skills by allowing the user to manage and monitor themselves (Golden et al., 2021). The anonymity provided by these apps also increases positive engagement and outcomes, especially for those who suffer from anxiety-related issues, or struggle with interpersonal interactions (O’Bree et al., 2021).

            Anyone who has tried to use an app such as Headspace may find it unsurprising that the main drawback to DMHIs is the prevalence of low user engagement. There are collectively low rates of DMHI completion by users, with more than 70% failing to complete designated activities, and over 50% disengaging before even completing half (Karyotaki, 2015). Staying disciplined or motivated is hard enough, especially when the desired outcome may take a long time to achieve. It has been found that reminders and tailored feedback correlate with increased user engagement (Borghouts et al., 2021), however it appears that low engagement is the predominant reason as to why DMHIs remain unrealised in healthcare settings.  

            It is clear that DMHIs have potential, and more research is taking place in order to optimise user engagement (Borghouts, 2021). Although DMHIs are not comparable to face-to-face therapy, they allow global access to mental health resources at a much lower cost, especially to those in LMICs who are severely deprived of such services. DMHIs can help users learn effective coping skills through self-monitoring, and their service delivery is suited to at-risk age groups. We can expect to see an increase in the prevalence and usage of these services over the coming years, and hopefully, better management of mental health problems worldwide.

References 

Borghouts, J., Eikey, E., Mark, G., De Leon, C., Schueller, S. M., Schneider, M., Stadnick, N., Zheng, K., Mukamel, D., & Sorkin, D. H. (2021). Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. Journal of medical Internet research, 23(3), e24387.

Browne, D. T., May, S. S., Colucci, L., Hurst-Della Pietra, P., Christakis, D., Asamoah, T., Hale, L., Delrahim-Howlett, K., Emond, J. A., Fiks, A. G., Madigan, S., Perlman, G., Rumpf, H. J., Thompson, D., Uzzo, S., Stapleton, J., Neville, R., Prime, H., & MIST Working Group (2021). From screen time to the digital level of analysis: a scoping review of measures for digital media use in children and adolescents. BMJ open, 11(5), e046367.

Golden, E. A., Zweig, M., Danieletto, M., Landell, K., Nadkarni, G., Bottinger, E., Katz, L., Somarriba, R., Sharma, V., Katz, C. L., Marin, D. B., DePierro, J., & Charney, D. S. (2021). A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation. JMIR formative research, 5(5), e26590.

Karyotaki, E., Kleiboer, A., Smit, F., Turner, D. T., Pastor, A. M., Andersson, G., Berger, T., Botella, C., Breton, J. M., Carlbring, P., Christensen, H., de Graaf, E., Griffiths, K., Donker, T., Farrer, L., Huibers, M. J. H., Lenndin, J., Mackinnon, A., Meyer, B., Moritz, S., Riper, H., Spek, V., Vernmark, K. and Cuijpers, P. (2015). Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘individual patient data’ meta-analysis. Psychological Medicine, 45(13), 2717–2726.

Lehtimaki, S., Martic, J., Wahl, B., Foster, K. T., & Schwalbe, N. (2021). Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview. JMIR mental health, 8(4), e25847.

Naslund, J. A., Aschbrenner, K. A., Araya, R., Marsch, L. A., Unützer, J., Patel, V., & Bartels, S. J. (2017). Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. The Lancet Psychiatry, 4(6), 486–500.

O'Bree, B., Walton, C. C., Bendall, S., Wilson, M., Valentine, L., McEnery, C., D'Alfonso, S., Alvarez-Jimenez, M., & Rice, S. (2021). Perceived Helpfulness of a Moderated Online Social Therapy Network for Young People Experiencing Social Anxiety. International journal of environmental research and public health, 18(6), 2796.

Pretorius, C., & Coyle, D. (2021). Young People's Use of Digital Tools to Support Their Mental Health During Covid-19 Restrictions. Frontiers in digital health, 3, 763876.

Rathod, S., Pinninti, N., Irfan, M., Gorczynski, P., Rathod, P., Gega, L., & Naeem, F. (2017). Mental Health Service Provision in Low- and Middle-Income Countries. Health services insights, 10, 1178632917694350.

Torous, J., Jän Myrick, K., Rauseo-Ricupero, N., & Firth, J. (2020). Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow. JMIR mental health, 7(3), e18848.