key: cord-1020029-hrbxagb6
authors: Saad, Anthony; Bruno, Deanna; Camara, Bettina; D’Agostino, Josephine; Bolea-Alamanac, Blanca
title: Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review
date: 2021-11-26
journal: JMIR Ment Health
DOI: 10.2196/27404
sha: 196008b2fde42e484d2a5f4df6543f243030f410
doc_id: 1020029
cord_uid: hrbxagb6

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 mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. OBJECTIVE: This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient’s or at the technology’s end), so the patients can implement them without any support. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. RESULTS: We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. CONCLUSIONS: There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates.

All participants used the app for the first 4 weeks. Only 6 used it through 8 weeks. Weekly PHQ-9 and GAD-7 scores response rates ranged from 86 to 100%. 88% of participants completed all measures. Response rate for medication surveys ranged from 30 to 67%. 100% said the app was easy to use. 77% reported satisfaction with the app and 67% said it was useful. 46% reported feeling more connected with their doctor. 13% reported negative views on the app and 56% were neutral on privacy issues. 5

CES-D: Centre for Epidemiologic Studies-Depression Scale; CHF: Congestive Heart Failure; CSQ-8: Client Satisfaction Questionnaire; ED-QOL: Eating-Disorder related Quality of Life; EDE-Q: Eating Disorder Examination Questionnaire; EMA: Ecological Momentary Assessment; FABQ-PA: Fear and Avoidance Beliefs Questionnaire -Physical Activities subscale; GAD-7: Generalized Anxiety Disorder 7-item Scale; HADS: Hospital Anxiety and Depression Scale

Level of Evidence (according to the Oxford Centre for Evidence-based Medicine Levels of Evidence

ODI: Oswestry Disability Index; MHRM: Mental Health Recovery Measure; PAIS: Psychosocial Adjustment to Illness Scale; PAL-C: Profile of Adaptation to Life Clinical Scale; PHQ-4: 4-item Patient Health Questionnaire; PHQ-9: Patient Health Questionnaire 9-item Scale

PTQ: Perseverative Thinking Questionnaire; SDS: Sheehan Disability Scale; SEED: Short Evaluation of Eating Disorders; SHAPS: Snaith-Hamilton Pleasure Scale; SRHS: Self-Report Health Scale

TEPS: Temporal Experience of Pleasure Scale