JMH JMIR Ment Health JMIR Mental Health 2368-7959 JMIR Publications Toronto, Canada v12i1e68296 40846319 10.2196/68296 Review Review Digital Health Interventions for Depression and Anxiety in Low- and Middle-Income Countries: Rapid Scoping Review Torous John Åhs Jill Davison Neve Chau Leena W MSc 1
Faculty of Health Sciences Simon Fraser University 8888 University Drive West Burnaby, BC, V5A 1S6 Canada 1 778 782 3111 leena_chau@sfu.ca
https://orcid.org/0000-0001-8557-3542 Lam Raymond W MD 2 https://orcid.org/0000-0001-7142-4669 Minas Harry MD 3 https://orcid.org/0000-0003-1719-7367 Hayashi Kanna PhD 1 https://orcid.org/0000-0003-3843-2928 Nguyen Vu Cong MD 4 https://orcid.org/0000-0002-4486-4535 O'Neil John PhD 1 https://orcid.org/0000-0001-6370-4564 Faculty of Health Sciences Simon Fraser University Burnaby, BC Canada Department of Psychiatry Faculty of Medicine University of British Columbia Vancouver, BC Canada School of Population and Global Health The University of Melbourne Melbourne Australia Institute of Population, Health and Development Hanoi Vietnam Corresponding Author: Leena W Chau leena_chau@sfu.ca 2025 22 8 2025 12 e68296 12 3 2025 2 6 2025 19 6 2025 4 7 2025 ©Leena W Chau, Raymond W Lam, Harry Minas, Kanna Hayashi, Vu Cong Nguyen, John O'Neil. Originally published in JMIR Mental Health (https://mental.jmir.org), 22.08.2025. 2025

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on https://mental.jmir.org/, as well as this copyright and license information must be included.

 Background

Low- and middle-income countries (LMICs), which bear a larger proportion of the global mental illness burden, have been disproportionately impacted by the COVID-19 pandemic due to preexisting mental health care system deficiencies. The pandemic has also led to a considerable increase in care delivered through digital mental health interventions (DMHIs), many of which have been adapted from in-person formats. Thus, there is a need to examine their fidelity to the original format along with issues regarding usability and other challenges to and facilitators of their uptake in LMICs. As most DMHIs have been developed in high-income countries, examining their cultural adaptation to LMIC settings is also critical.

 Objective

The purpose of this research was to conduct a rapid scoping review of the available evidence on DMHIs for depression and anxiety, two of the most common mental disorders, in LMICs.

 Methods

A rapid scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and processes for rapid reviews by Tricco et al. The PubMed and PsycINFO databases were searched for records published between January 2020 (when COVID-19 was declared a public health emergency) and January 2025 using a search strategy developed in consultation with a liaison librarian. The pandemic accelerated the development and application of DMHIs, and this time frame was used to capture the recent literature that may have incorporated new methods of application. The search strategy was developed across three domains: (1) digital health interventions, (2) depression or anxiety, and (3) LMICs. Data were charted from the final records according to (1) intervention type; (2) discussions on fidelity, usability, and cultural adaptation; and (3) challenges to and facilitators of their uptake in LMICs.

 Results

A total of 80 records were included in the final analysis, with reasons for exclusion (eg, focused on mental health in general, not being a DMHI, or not focused on LMICs) reported. Six DMHI platforms were identified: (1) mobile app, (2) the web, (3) virtual reality, (4) videoconferencing, (5) telemedicine, and (6) social media. Less than half of the records referenced fidelity (16/80, 20%), usability (29/80, 36%), and cultural adaptation (31/80, 39%). Challenges pertained to the technological system, engagement issues, structural barriers, and concerns regarding privacy and confidentiality. Facilitators included widespread mobile phone use, built-in supervision and training features, and convenience.

 Conclusions

Despite the opportunities that DMHIs offer for reducing the mental health treatment gap, further work examining and improving their fidelity, usability, and cultural adaptation is required. In addition, various challenges to the uptake of DMHIs in LMICs, including contextual issues, structural barriers, and privacy concerns, must be mitigated to avoid contributing further to the digital divide.

 digital health mobile health mHealth mental health depression anxiety low- and middle-income countries LMICs fidelity usability cultural adaptation COVID-19 implementation science Introduction Background

Mental illnesses are a leading contributor to the global burden of disease [1]. The COVID-19 pandemic has contributed to further deteriorations in population mental health and exposed critical and persisting gaps in mental health care [2,3]. The Global Burden of Disease 2020 study estimated that the COVID-19 pandemic has led to increases of 28% in major depressive disorders and 26% in anxiety disorders [4], 2 of the most common mental disorders [5]. Depression and anxiety disorders are associated with profound disease and socioeconomic burden to individuals and their relatives [6]. Low- and middle-income countries (LMICs; countries with a gross national income per capita of ≤US $14,005 [7]), which bear a larger proportion of the global mental illness burden [8], have been disproportionately impacted due to preexisting mental health care system deficiencies [8,9]. Increased mental health issues have, in turn, placed additional substantial pressures on strained mental health care systems [2]. This is particularly concerning in LMICs, where 75% of people lacked access to mental health care before the COVID-19 pandemic [10]. Persistent and growing barriers to treatment in LMICs include low mental health awareness, stigma that impacts help seeking, a shortage and maldistribution of mental health specialists, and care that is concentrated in specialized and tertiary settings with little to nonexisting care at the community level [11,12].

Worldwide, the pandemic has also impacted the delivery of mental health care, leading to a considerable increase in care delivered through digital health interventions to address the widespread reduction of in-person care imposed by public health constraints. These include interventions delivered via telephone, videoconferencing, messaging, web-based programs, and smartphone or other mobile device apps [13], collectively referred to herein as digital mental health interventions (DMHIs). Many of these DMHIs target depression or anxiety. For example, there has been a considerable increase in smartphone apps since the onset of COVID-19. Estimates indicate that >10,000 mental health–related apps are available [14], with most focused on depression and anxiety [6,15]. Digital interventions for depression and anxiety can help with health promotion and literacy at the population level, prevention by targeting high-risk individuals or subpopulations, and treatment and preventive services for people with mental health conditions [16].

Active components of these DMHIs are often based on evidence-based psychological interventions developed for in-person delivery [17]. While it is critical that the interventions are implemented with high fidelity, there is limited evidence on which considerations are most relevant and what should be included in guidance for fidelity of digital adaptations from evidence-based in-person formats. There is a need to evaluate if and how the theoretical and technical components are applied in the new modus or can be enhanced by drawing on the unique interactive features of a digital format (eg, videos and animations) [18]. There has also been limited attention paid to methods for adaptation and evaluations of adaptations across contexts to ensure cultural appropriateness for relevance; applicability; and, ultimately, effectiveness [19-21], particularly for the adaptation of digital interventions [22]. Cultural adaptation can be defined as “the process of systematically modifying an evidence-based intervention to be congruent with the language, values, beliefs, and context corresponding to clients’ cultural backgrounds” [23].

While DMHIs have been used for 2 decades, their development and uptake has been greatly accelerated by the COVID-19 pandemic and hold promise as a feasible way to address the growing mental health needs of populations amidst the persistent and growing mental health treatment gap [12]. This might have been a “black swan” moment as described by Wind et al [24], acting as a catalyst in the marked shift from in-person mental health care provision to digital health. Challenges that have slowed their implementation into routine care include a lack of acceptance by mental health professionals, who may be concerned about threats to the therapeutic alliance, which they believe can only be established in person [25,26]. Other challenges include digital and language literacy [27]; data privacy and security concerns [28], especially as LMICs have seen an increasing number of cyberattacks [29]; and structural issues such as underdeveloped technological infrastructure [12]. There is a need to ensure that all those who need digital mental health care, especially the traditionally underserved groups such as those who live in rural and remote areas, with low income, and from culturally diverse communities, have the digital literacy and opportunity to engage with DMHIs to reduce the digital divide [2]. Another key concern for implementation is usability, the extent to which a product can be used easily, efficiently, and with satisfaction to achieve specified goals [30]. Usability has been identified as a prerequisite for the success of mobile apps [31]. Conversely, poor usability is a primary reason for low user engagement, limiting clinical utility and resulting in the failed adoption of DMHIs [32,33].

 Rationale and Objectives of This Review

Active components of these DMHIs are often adapted from in-person formats [17], most commonly developed and tested in high-income countries [12]. Despite this, there is a paucity of evidence on their fidelity to the original format and limited examination of the cultural adaptation process. Furthermore, although there has been increasing research on DMHIs from LMICs [34,35], where >85% of the global population lives [36], most DMHIs have been developed and studied in high-income countries [12,37], leading to potential biases and limiting generalizability. Knowledge gathered from LMICs will be critical for these countries. Thus, the purpose of this research was to conduct a rapid scoping review of the available evidence on digital health interventions for depression and anxiety, the 2 most common mental disorders, in LMICs.

The specific objectives of this rapid scoping review were to: (1) identify the types of digital health interventions for depression and anxiety being used and studied in LMICs; (2) explore their fidelity, usability, and cultural adaptation to a digital format in LMICs; and (3) examine the challenges to and facilitators of their uptake in LMICs.

This rapid scoping review contributes important evidence on the growing adaptation, use of, and challenges to DMHI applications for mental health in the context of the constantly changing landscape of the COVID-19 pandemic and beyond. While some scoping reviews have focused on digital health interventions for mental health in general [38-40] and others have incorporated a focus on LMICs [11], to our knowledge, this is the first review that focuses on digital health interventions in LMICs specifically for depression and anxiety and includes an in-depth review of their fidelity, usability, and cultural adaptation.

 Methods Data Sources and Search Strategy

Considering the need for a timely review, a rapid scoping review was conducted, and a protocol was not registered. We used the following definition of a rapid scoping review as proposed by Tricco et al [41]: “a type of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a short period of time.” Furthermore, scoping reviews seek to provide a broad mapping overview of the extent, range, and nature of the existing evidence base, focusing on breadth regardless of quality [42-44]. For these reasons, appraisal of the methodological quality of the individual studies was not conducted. This rapid scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and using a search strategy developed in consultation with a liaison librarian at Simon Fraser University. Processes for rapid reviews as outlined by Tricco et al [45] were followed.

Two databases were searched (PubMed and PsycINFO) following common search methodologies for rapid reviews, which advise the search of at least one electronic database (PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] standards [46]), with most published rapid reviews using ≥2 [45]. The PubMed and PsycINFO databases were searched for records published between January 2020, when COVID-19 was declared a public health emergency of international concern by the World Health Organization (WHO; declared a pandemic on March 11, 2020), and January 2025. The COVID-19 pandemic accelerated the development of DMHIs, and a rapid review within this time frame was conducted to capture the recent literature that may have incorporated new methods of development and application.

The search strategy was developed across the following three domains: (1) digital health interventions, (2) depression or anxiety, and (3) LMICs. While we were interested in articles related to the COVID-19 pandemic, we made the decision not to include COVID-19 as a search domain as we were interested not only in DMHIs developed to respond specifically to COVID-19–related anxiety and depression but also in DMHIs developed for anxiety and depression in general during the search time frame. Instead, the search included the aforementioned 3 domains and the time frame of the COVID-19 pandemic (2020-2025). A combination of search terms was applied for the automatic search of publications in the aforementioned databases: (“digital” OR “technology” OR “e-health” OR “telemedicine” OR “internet” OR “online”) AND (“depress*” OR “anxi*” OR “mood disorders” OR “anxiety disorders”) AND (“low and middle income countries” OR “developing countries”). Searches included both subject headings and keywords. Search terms for LMICs were taken from the University of Alberta’s Health Sciences Search Filters resource [47]. Multimedia Appendix 1 provides the full search strategy for PubMed, and Multimedia Appendix 2 provides the full search strategy for PsycINFO.

 Screening Strategy and Inclusion and Exclusion Criteria

Records identified in the database search process were screened using titles and abstracts by one researcher (the first author, LWC). Records were selected for full-text review if they: (1) reported on quantitative or qualitative evidence related to DMHIs for depression and anxiety; (2) were from LMICs; (3) were written in the English language; (4) were published between January 1, 2020, and January 31, 2025; and (5) had the full text available. In addition to original research articles, other types of articles (eg, protocol papers and scoping and systematic reviews) were included if they provided information on DMHIs being used in LMICs and included depression or anxiety as a primary focus. We included all articles on depression and anxiety regardless of other conditions or specific patient groups (eg, pregnancy or cancer) as long as the primary outcome included either depression or anxiety.

We excluded articles that did not include depression or anxiety as a primary focus. Any articles that presented data from multiple countries (eg, literature reviews) were included if data from LMICs and non-LMICs were disaggregated and reported separately; in these instances, only data related to LMICs were reported in this review. Duplicates were removed across the 2 databases. Records included for full-text review were cross-checked for relevance and inclusion by an additional researcher (senior author JO).

 Data Extraction and Synthesis

Data were extracted from the records that were eligible through full-text review and charted into 2 tables according to the following headings: author, year of publication, participant characteristics (study location and study population), intervention characteristics (platform and techniques and functions), and study characteristics (design, mental health conditions, and outcomes) in the first table and discussions on fidelity (either in relation to the original in-person or paper-based format or ensuring adherence by lay health workers to the intervention protocol), usability (both quantitative and qualitative explorations), cultural adaptation (of DMHIs to the local cultural context), and challenges to and facilitators of the interventions’ uptake in LMICs in the second table. Findings across the discussions are presented using numerical counts accompanied by descriptive text. See Multimedia Appendix 3 for the PRISMA-ScR checklist.

 Results Article Selection

The searches of PubMed and PsycINFO were conducted on March 13, 2025. Figure 1 shows the PRISMA flowchart for the full record selection process. A total of 1010 records were returned, and after the removal of 6 (0.59%) duplicates, 1004 (99.41%) were included for screening. After performing a title and abstract review, 20.92% (210/1004) of the articles were included for full-text review based on our inclusion criteria. A total of 79.08% (794/1004) of the articles, which did not meet the inclusion criteria, were excluded from full-text review. Of the 210 articles included for full-text review, 2 (1%) were not retrieved as the full text was not available.

After completing the full-text review of the 208 available articles, a total of 80 (38.5%) records were included in the final analysis. This included 80% (64/80) original research articles, 15% (12/80) protocol papers, and 5% (4/80) literature reviews (1/4, 25% scoping reviews [48] and 3/4, 75% systematic reviews [49-51]). Reasons for exclusion of articles at full-text review that did not meet the inclusion criteria (128/280, 45.7%) were recorded and reported in Multimedia Appendix 4. The most common reasons for exclusion were focus on another topic (eg, app use in general), lack of a DMHI (eg, therapists using video or telephone to deliver regular counseling without an accompanying app or online platform), results from reviews (global focused) combined without data from LMICs being reported separately, focus on mental health in general, and no description of the use of a DMHI. A quality appraisal was not conducted considering the nature of this rapid scoping review, which did not focus on an examination of the effectiveness of the DMHIs, along with the emergent nature of the literature. The examinations of fidelity and usability were reviewed and described independent of whether there was an exploration of intervention effectiveness and, if there was, whether the intervention was effective.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart for this rapid scoping review. DMHI: digital mental health intervention; LMIC: low- and middle-income country.

 Study Characteristics

Table 1 presents the main characteristics of the studies included in the rapid scoping review. Six main DMHI platforms were identified: (1) mobile app (software app used on a mobile device such as a smartphone or tablet), (2) web-based program (intervention delivered on the web through an internet-connected device), (3) virtual reality (VR; involved the immersion of the user in simulated and controlled computer environments [52]), (4) videoconferencing (intervention delivered via video through an online platform; eg, Google Meet and Zoom), (5) telemedicine (intervention delivered via phone calls or text through an instant messaging app [eg, WhatsApp] that went beyond the usual psychoeducation delivered by therapists by incorporating additional components such as educational videos and relaxation music), and (6) social media–based interventions (delivered through a social media platform; eg, Facebook).

Summary of the included articles (participant characteristics, intervention characteristics, and study characteristics).

Study Participant characteristics Intervention characteristics Study characteristics
Location Population Platform Techniques and functions Design Mental health condition, with results where applicable
Aalaei et al [53], 2021 Iran Hospitalized patients who tested positive for COVID-19 at Imam Reza Hospital in Mashhad (N=112) Mobile phone app Mobile-based psychological counseling and health status monitoring Protocol RCTa—2 parallel groups Depression and anxiety
Abbasalizadeh et al [54], 2024 Iran ICUb nurses from 2 Tehran hospitals (N=60) Android smartphone app Resilience training developed based on the microlearning educational method RCT—single blinded Anxiety and stress; significant reductions in stress from 10.77 on DASS-21c (SD 3.33) to 9.00 (SD 1.66; P=.001) and in anxiety from 9.43 on DASS-21s (SD 3.35) to 7.93 (SD 0.98; P<.001)
Abi Ramia et al [55], 2023 Lebanon Participants from 2 previous RCTs that demonstrated effectiveness of the intervention, staff members, and external stakeholders Digital intervention (SbSd) delivered through an app or website Guided self-help intervention Qualitative study involving key informant interviews Depression; high level of acceptability of SbS among Lebanese and Syrian participants
Akbari et al [56], 2022 Iran Home-isolated patients with COVID-19 visiting Sina Hospital, Hamadan (N=60) WhatsApp messages and instructional videos Virtual training of relaxation techniques via WhatsApp messages and instructional videos in the form of 8 educational messages, delivered online RCT—2 group, parallel Anxiety; relaxation techniques were effective in reducing anxiety among patients with COVID-19
Akhtar et al [57], 2024 Pakistan Community health workers (LHWse; N=44) Mobile app (mPareshan) 3 segments: tracking, counseling, and referral; LHWs facilitated psychoeducation through audio and video features Qualitative study involving focus groups and interviews Depression
Alavi and Hirji [58], 2020 Iran General population with a Generalized Anxiety Disorder diagnosis from a psychiatrist (N=152) Computer-based intervention delivered via email Weekly (×12) e-CBTf intervention modules and homework assignments delivered via email, with structured support from trained clinicians RCT Anxiety (generalized); a mixed model ANOVA showed a significant difference between the groups and BAIg evaluation periods (F3,57=101.5, P<.001).
Al-Badiri et al [59], 2024 Iraq Registered nurses at Al-Alhamzeh General Hospital (N=72) iMBSRh Guided mindfulness exercises, reflective discussions, and educational materials delivered over 8 sessions Semiexperiment with a pretest-posttest design Depression; a nonsignificant decrease in PHQ-15i mean scores in the iMBSR group from 9.19 (SD 3.07) to 7.58 (SD 3.61; P=.17)
Alishahi et al [60], 2025 Iran Patients undergoing hemodialysis at Montaserieh Hospital (N=72) Mobile app Recreational therapy mobile app comprising programs such as music, comedy movies, exercise routines, and educational question-and-answer games RCT Depression; the intervention group showed a significant decrease in depression scores compared to the control group (mean BDI-IIj score reduction in the intervention group 10.3, SD 4.1; mean score reduction in the control group 4.6, SD 3.8; P<.001)
Amer et al [61], 2023 Egypt Adults aged ≥18 y from Mansoura University’s Faculty of Computers and Information (N=5) Mobile app (Sokoon) Gamified CBT app focused on 7 intervention skills: relaxation, gratitude, self-compassion, problem-solving, social skills, BAk, and cognitive restructuring Pilot study Depression and anxiety; anxiety symptoms decreased from the pretest (mean GAD-7l score of 10, SD 0.7) to the posttest (mean 4.2, SD 1.5), and depressive symptoms decreased from a mean PHQ-9m score of 10 (SD 2.05) to a mean of 6 (SD 1.7)
Amer et al [62], 2024 Egypt Adults aged ≥18 y from Mansoura University’s Faculty of Computers and Information (N=30) Mobile app (Sokoon) CBT app that incorporated techniques such as Hexad theory, gamification, and dynamic difficulty adjustment Single-group pretest-posttest design Depression and anxiety; positive impact on reducing symptoms of depression and anxiety
Araya et al [63], 2021 Brazil Patients with depressive symptoms with comorbid hypertension or diabetes (n=880 in Brazil; n=432 in Peru) Smartphone intervention Low-intensity smartphone intervention delivered through 18 sessions over 6 wk; based on BA and supported by nurse assistants 2 RCTs; 1 cluster randomized in Brazil and 1 individual-level randomized in Peru Depression; significantly improved depression symptoms at 3 mo; effect size small in Brazil, and effects were not sustained at 6 mo
Atif et al [64], 2022 Pakistan Women living in resource-poor rural communities (n=3) and peer delivery agents (n=3) Tablet- or smartphone-based app (Thinking Healthy Programme) CBT intervention delivered by a virtual avatar therapist that was operated by a lay peer; the peer and the avatar acted as cotherapists Usability testing study Depression (perinatal)
Bhardwaj et al [65], 2025 India Family caregivers of persons living with dementia Mobile app CBT-based psychoeducational intervention developed based on the WHOn iSupport program delivered in 10 weekly sessions; ASHAso will be trained to deliver the intervention Protocol community-based cluster RCT Depression
Bhargav et al [66], 2024 India Individuals with a COVID-19 positive test from an NABLp-approved laboratory who also reported at least a moderate level of stress (a score of ≥14 on the PSSq; N=86) Tele-yoga Tele-yoga intervention delivered via videoconference supervised by trained yoga therapists Prospective, multicenter, open-label single-arm study Depression and anxiety; anxiety improved significantly at wk 4, and the improvements were sustained at wk 16
Bhat et al [67], 2023 India Women in self-help groups Tablet app (MITHRAr) MITHRA for depression screening (PHQ-9m and brief intervention [HAPs modules]) Protocol—focus groups Depression
van Heerden et al [68], 2021 Nepal Lay counselors caring for adolescent mothers with depression Platform (StandStrong) comprising the StandStrong counselor mobile app and a cloud-based processing system App visualized passively collected GPS, proximity, and activity data; lay counselors used the app to discuss mothers’ behavioral patterns and clinical progress over the 5-wk intervention App development paper Depression (maternal)
Chand et al [69], 2024 India Individuals from the Indian Institute of Technology Mandi (N=44) VRt—music Raga Bhairavi, an Indian classical music, administered via 360° video in a VR environment for 6 d (each session lasting 15 min) RCT—between-group repeated measures Depression and anxiety; all DASS-21 subscales significantly improved; a post hoc test showed that the anxiety and depression levels were significantly lower for the treatment group after 6 d of treatment (anxiety: t21=5.77, P<.001, and Cohen dz=1.04; depression: t21=5.16, P<.001, and Cohen dz=1.16)
Chau et al [70], 2023 Vietnam Adults aged ≥18 y in community-based settings Smartphone app (Vmood) Supported self-management based on CBT principles with supportive coaching from a social worker delivered via chat through an app Protocol RCT—stepped wedge Depression and anxiety
Cuijpers et al [71], 2022 Lebanon People with depression residing in Lebanon (N=680) Internet-connected device (SbS) 5-session depression intervention; provided psychoeducation and training in BA through an illustrated narrative delivered with guidance from nonspecialist helpers RCT—single blind, 2 arm, pragmatic Depression; ITTu analyses showed effects on depression (SMDv 0.71, 95% CI 0.45-0.97) and impaired functioning (SMD 0.43, 95% CI 0.21-0.65)
Cuijpers et al [72], 2022 Lebanon Syrian refugees living in Lebanon (N=569) Internet-connected device (SbS) 5-session depression intervention; provided psychoeducation and training in BA through an illustrated narrative delivered with guidance from nonspecialist helpers RCT—single blind, 2 arm, pragmatic Depression; ITT analyses showed significant treatment effects for both primary outcomes, depression (moderate) and functional impairment (moderate), and significant effects on anxiety
Dambi et al [73], 2022 Zimbabwe General population (N=176) Digital intervention delivered via web application or mobile app (Inuka) A chat-based digital application; participants received 6 problem-solving therapy sessions delivered by lay counselors Feasibility study—pragmatic quasi-experimental design CMDsw, including depression and anxiety
Doosti et al [74], 2024 Iran Patients with gynecological cancer referred to educational and therapeutic centers affiliated with the Shahrekord University of Medical Sciences (N=70) Mobile app Main menu featured various options (eg, entering clinical data, receiving weekly patient status reports, and virtual consultations with nurses); users could easily interact with the researcher through a message box icon RCT—2 group, pretest-posttest Anxiety; state anxiety scores significantly decreased in the intervention group from 51.64 (SD 14.97) to 40.20 (SD 11.70) at the follow-up, and trait anxiety scores in the intervention group decreased significantly from 49.91 (SD 14.96) to 39.82 (SD 10.28), whereas the scores of the control group worsened
Dosani et al [48], 2020 LMICsx Women Various Various Scoping review Depression (perinatal); 12 articles met the inclusion criteria; results revealed that minimal literature is currently available on the use of mHealthy for perinatal depression in LMICs
Ebrahimi et al [75], 2025 Iran Patients with ailurophobia referred to the outpatient clinic of Ibn Sina Specialized Hospital and psychiatry and psychology clinics in Mashhad (N=28) Two interventions: (1) VR and (2) metacognitive sessions VR sessions with images of cats; metacognitive sessions that evaluated symptoms, recognized cognitive errors, and corrected beliefs RCT Anxiety (ailurophobia); statistically significant difference between the average anxiety score of the 2 groups (VR and metacognitive therapy; P˂.001); anxiety score was significantly reduced in the VR group
Fu et al [49], 2020 LMICs Various mHealth Various Systematic review and meta-analysis 22 studies were included; digital psychological interventions, which have been mostly studied with depression and substance misuse, were superior to control conditions, including usual care, and were moderately effective in LMICs
Ganjekar et al [76], 2024 India Pregnant women from 3 tertiary care hospitals (N=162) Web-based pregnancy tele-yoga module Tele-yoga delivered and monitored through an online platform over 4 wk Multicentric, open-label, exploratory study Depression and anxiety; anxiety symptoms persisted in 19 (19.78%) women, and depression persisted in 10 (10.41%) women; after the intervention, none of the pregnant women reported severe symptoms
Gautama et al [77], 2024 Indonesia Patients with cancer undergoing chemotherapy (N=99) SVRz relaxation intervention 10-min immersive VR experience featuring 360° natural scenery videos with relaxing sounds delivered through YouTube via a smartphone RCT—prospective, 2 arm Anxiety; the SVR group reported significantly reduced anxiety (P=.01; Cohen d=0.50) compared to the control group
Ghanbari et al [78], 2021 Iran Women with nonmetastatic breast cancer aged 20-60 y (N=82) Smartphone app (BCSzone) and online support group Guided self-management psychoeducational intervention delivered through BCSzone along with nurse-assisted online mobile support sessions delivered through WhatsApp over a total of 4 wk RCT—unblinded Anxiety; statistically significant differences between the mobile psychoeducation group and controls (P<.001); the paired t test for mean scores of anxiety showed significant reductions
Gonsalves et al [79], 2022 India Secondary school students (N=11) Smartphone app (POD Adventures) Gamified problem-solving intervention supported by nonspecialist counselors via phone Parallel, 2-arm, individually randomized controlled pilot trial Depression and anxiety; no intervention arm participants completed the intervention because participants could not be reached
Green et al [80], 2020 Kenya Pregnant women and new mothers recruited from public hospitals (N=41) Tablet or smartphone app (Healthy Moms) Task-sharing Thinking Healthy program adapted for automated delivery via a mobile phone or tablet; used an existing AIaa system called Tess (Zuri in Kenya) to drive conversations with users Prepilot study; single-case experimental design Depression (perinatal); authors estimated that using the alpha version of the app may have led to a 7% improvement in mood
Gupta et al [81], 2022 India Health care providers from a tertiary care medical center (N=202) Web based Two groups: (1) Raja yoga meditation—structured module of Raja yoga for 3 mo taught by a qualified teacher and (2) stress management counseling—dedicated trainer who counseled and taught 7 steps for managing stress for 3 mo Prospective observational study Depression and anxiety; practice of Raja yoga meditation for 12 wk resulted in significant decrease in DASS-21 score (−45.00 at baseline and −24.2 at 12 wk; P<.001); no significant decrease was observed in the DASS-21 score in the stress management counseling group at 12 wk of follow-up
Iravani et al [82], 2023 Iran Pregnant women from health centers (N=104) Telemedicine Counseling services delivered by a researcher through telephone conversations; SMS text messages; and apps such as WhatsApp, Telegram, and Instagram over a 2-mo period; educational video clips were provided through a mobile app Quasi-experimental study Anxiety; health anxiety scores of pregnant women in the control group were significantly higher than those of pregnant women in the experimental group; the mean scores of pregnancy-related anxiety in the control group were significantly higher than those in the intervention group
Jannati et al [83], 2020 Iran Women aged ≥18 y who attended health care centers in Kerman, Iran (N=75) Mobile phone app (Happy Mom) CBT app consisting of 8 lessons conducted over 8 wk; participants followed the story of women with PPDab and learned how they managed their symptoms, which they could apply to their own lives Nonblinded parallel-group RCT Depression (post partum); average Edinburgh Postnatal Depression Scale score after the intervention was 8.18 in the intervention group and 15.05 in the control group, which was statistically significantly different (P<.001)
Kanuri et al [84], 2020 India College students Online intervention (Mana Maali Digital Anxiety Program) Culturally and digitally adapted evidence-based CBT intervention delivered over 20 sessions for anxiety Initial usability, acceptability, and feasibility examination GAD; results indicated high usability, with the average rating ranking in the top 10% of general usability scores
Kim et al [50], 2023 LMICs General population Digital mental health tools Various Systematic review and meta-analysis Depression and anxiety; 80 studies included in the meta-analysis and 96 studies included in the systematic review; digital mental health tools were moderately to highly effective in reducing depression and anxiety symptoms in LMICs
Kola et al [85], 2022 Nigeria Adolescent mothers (n=17) and maternal health care providers with experience in perinatal depression (n=25) who were participants of a previous clinical trial called EXPONATEac Mobile phone intervention Design of the EXPONATE intervention, which incorporated the treatment specifications of the WHO mhGAP-IGad; 4 components: parenting skill training, problem-solving, psychoeducation, and use of available social support Focus groups Depression (perinatal); focus group discussions showed that 70% of the barriers identified related to the inner setting and the characteristics of individuals in the intervention (eg, clinicians’ knowledge deficit on the care of young mothers with depression and young mothers’ lack of interest in motherhood)
Kusumadewi et al [86], 2025 Indonesia Medical students from Gadjah Mada University, Yogyakarta (N=66) Smartphone app App using asynchronous digital cognitive education divided into 3 parts, including information, therapy (based on Beckian cognitive therapy), and daily journal sections RCT—nonblinded Anxiety; significant effect on reducing anxiety scores from the second to the eighth wk
Lahti et al [87], 2020 South Africa and Zambia Higher education institute academics and PHCae practitioners in 3 provinces in South Africa and 2 provinces in Zambia Mobile app Screening tool to be used in PHC settings Protocol; mixed methods multisite design Depression
Logie et al [88], 2021 Uganda Urban refugee and displaced youths aged 16-24 y VR and GPM+af VR-only arm: immersive, interactive 15-min VR session that integrated mental health literacy, psychological first aid, and mindful self-compassion; VR and GPM+ intervention: VR intervention and GPM+, (WHO brief psychological intervention) delivered over 5 group sessions by peer navigators Protocol; 3-arm cluster RCT Depression
Luitel et al [89], 2023 Nepal Primary HCWsag trained in using the WHO mhGAPah mobile app in Jhapa (N=15) Smartphone app (WHO e-version of the mhGAP) The WHO launched the e-version of the mhGAP in 2017; 8 modules to address key priority mental health conditions, including depression Qualitative Mental health, including depression; HCWs found the app helpful to verify and confirm their assessment and diagnosis
Maharjan et al [90], 2021 Nepal Adolescent and young mothers with (n=11) and without (n=27) depression Smartphone app (StandStrong) Through a (1) smartphone app and (2) Bluetooth beacon, sensing data were passively collected on mothers’ geographic movement, physical activity, and audio environment and mother-infant proximity Feasibility study Depression
Mazhari et al [91], 2022 Iran Inpatients with COVID-19 at Afzalipour Hospital (N=200) Web-based eHealth intervention A questionnaire administered via WhatsApp; after 2 d, the psychiatric resident video called those who completed the questionnaire to assess depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale) Cross-sectional descriptive study Depression and anxiety; this study examined the agreement between the online self-assessment and psychiatric telephone interview among survivors of COVID-19 regarding depression and anxiety; agreement between the online self-assessment and telephone interview was not significant
Moulaei et al [92], 2023 Iran Patients with depression and anxiety disorders from Kerman University of Medical Sciences Mobile app Self-management of depression and anxiety disorders App development paper Depression and anxiety
Mukherjee et al [93], 2024 India Adolescents living in 60 slum clusters spread across New Delhi and Vijayawada Mobile app Two components: (1) antistigma campaign and (2) mobile-based self-care app App development paper Depression and anxiety
Muniswamy et al [94], 2022 India Remotely working software professionals in IT firms who were low in physical and mental health (N=160) Social media (Facebook)–based FIITai Modules provided via weekly Facebook messages focused on factors affecting sedentary behavior and mental health delivered over 8 wk; personal telehealth consultations delivered by experts via a chat box RCT—2 phases, pragmatic Anxiety and depression; significant difference in the scores for stress and anxiety within and between the groups but only within the groups for depression
Nabunya et al [95], 2024 Uganda Youths aged 14-17 y who were HIV positive and receiving care and ARTaj from one of the participating clinics and living within a family Mobile intervention (Suubi-Mhealth) Educational content incorporated recommendations for CBT for ART adherence and depression as applied to HIV medication adherence; content was broken down into 20 modules Protocol—pilot RCT Depression
Najafi et al [96], 2023 Iran Female individuals with RRMSak recruited through the local MSal association (N=45) Online visual platforms: Google Meet, Zoom, and Instagram Online supervised tele-yoga and tele-Pilates intervention sessions delivered 3 times a wk over 8 wk; certified instructors provided supervision RCT—single blind Depression; significant improvements were observed in depression (P=.001)
Najafi et al [97], 2023 Iran 82 people with either RRMS or SPMSam from the Shiraz University of Medical Sciences (N=82) Tele-Pilates and tele-yoga training Online supervised tele-yoga and tele-Pilates intervention sessions delivered 3 times a wk over 8 wk; certified instructors provided supervision RCT Depression; significant time × group interactions were observed for mental health (P=.05), as well as a decline in depression (P=.002); post hoc analysis showed depression improvements for both interventions, but these were not statistically significant (P>.05)
Naveen et al [98], 2024 India HCWs working at AIIMSan, Jodhpur on COVID-19 duty (N=90) Tele-yoga Module contained loosening practices, breathing practices, Surya Namaskar, Kapalabhati Kriya, pranayama, and relaxation techniques RCT Depression and anxiety; no significant difference in depression scores at endline; anxiety scores were significantly lower among the tele-yoga group than among control group participants (P<.05) at endline; the effect size was medium (r=0.3-0.5), favoring the intervention group
Njoroge et al [99], 2023 Kenya HCWs from 5 health care facilities Mobile app Weighted sensor stream signatures that predicted near-term risk of a major depressive episode and future mood; deployment of a mobile app platform and use of novel analytic approaches (AI and machine learning) Feasibility study Depression
Nurbaeti et al [100], 2021 Indonesia Convenience sample of postpartum mothers Smartphone app (IMSDao) IMSD app sought to detect PPD symptoms early App development and RCT Depression (PPD)
Nwaogu et al [101], 2021 Nigeria Construction personnel—site supervisors and project managers based on a log collected from the Nigerian Institute of Building (N=62) DMHIap (various) Various Open-ended survey—qualitative technique Anxiety and depression; DMHIs used by respondents included mobile-based apps (14/24, 58%) and web-based applications (10/24, 42%) for stress, depression, anxiety management, and mental fitness
Ofoegbu et al [102], 2020 Nigeria Educational technology students of Nigerian universities identified as having depression (N=192) Internet-delivered intervention (GIAIaq) Initial support session via telephone and regular guidance from the therapists (clinical staff of the federal universities) via telephone and the internet over 10 wk Group-randomized trial Depression; significant reduction in depression among students in the treatment group when compared to those in the usual care control group
Pasyar et al [103], 2023 Iran Patients with systemic lupus erythematosus referred to the Hafez clinic affiliated with Shiraz University of Medical Sciences (N=124) Smartphone-based supportive counseling Daily supportive counseling using text and multimedia messages for 8 wk delivered via a WhatsApp channel; feedback and questions could be sent to research team members RCT—pretest-posttest Anxiety (health); the level of health anxiety (MDar 11.34; P<.001) of the experimental group was significantly lower than that of the control group
Patel et al [104], 2021 Fiji CHNsas (N=48) mHealth app (ASRaDAat) Guidelines from the CES-Dau and the SBQ-Rav for suicide were programmed into ASRaDA and provided online Experimental design Depression; CHNs took less time to process patient information with more accurate diagnostic and therapeutic decisions compared with the paper-based or no-guideline conditions
Pozuelo et al [105], 2023 South Africa and Uganda Adolescents in rural South Africa and Uganda (N=160) Smartphone app (Kuamsha) App delivered BA using storytelling techniques and game design; each story consisted of 6 modules, with each covering different BA skills; included support via phone calls App development paper—iterative user-centered agile design Depression
Putri et al [106], 2022 Indonesia Participants who used 8 of the most popular Android mHealth platforms mHealth platforms Teleconsultation focus Mysterious shopping approach Depression
Rabbani et al [107], 2024 Pakistan LHWs (n=72) and screen-positive participants (residents who were aged ≥18 y; n=366) Mobile app Counseling intervention consisting of tracking, counseling, and referral segments delivered by LHWs Protocol single-arm, pretest-posttest implementation research trial Depression and anxiety
Ramnath and Suri [108], 2021 India General population of patients both with and without COVID-19 Smartphone app Online survey explored the needs of individuals with depression in India, and a systematic evaluation of depression apps currently available investigated user needs Online survey+systematic evaluation Depression
Roshid et al [109], 2024 Bangladesh Informal female caregivers of patients with cancer in Bangladesh mHealth psychoeducation and BRTaw Used self-determination theory and the BRT; included 6 sessions over 6 mo where recorded videos would be provided face-to-face or via a digital device Protocol RCT—prospective, open label, 2 arm (1:1) Anxiety and depression
Safaei et al [110], 2024 Iran Patients undergoing angiography from 2 hospitals affiliated with Kerman University of Medical Sciences (N=70) Mobile app App with 13 sections that addressed various aspects of the patient journey, providing comprehensive support and guidance throughout and after the angiography process Interventional study Anxiety; significant decrease in average anxiety scores (P<.001)
Saleem et al [111], 2025 Pakistan LHWs (N=40) Mobile app (TA-PM+ax) App that guided LHWs to deliver the intervention in a systematic manner; included 5 informational videos Coproduction and usability study Depression and anxiety; usability testing results: the mean MAUQay score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2, demonstrating the system’s overall usefulness
Taylor Salisbury et al [112], 2021 Nepal and Nigeria Primary care workers and patients from approximately 20 PHC clinics in Nepal and 6 PHC clinics in Nigeria Mobile app (WHO-updated e-mhGAP-IG) App for diagnosis and management of depression; featured a reference mode for training and a patient mode for assessments Feasibility study Depression
Sarpourian et al [52], 2022 Iran Students at the undergraduate, postgraduate, and PhD levels from the Kerman University of Medical Sciences and Shiraz University of Medical Sciences (N=30) VR and counseling therapy Participants observed 4 virtual classroom scenarios in a 30‐min session, which included a virtual classroom and comprised 4 parts Quasi-experimental study Anxiety (public speaking); VR and counseling did not affect students’ SAaz, but they reduced PSAba
Seddigh et al [113], 2023 Iran Adolescent girls with type 1 diabetes who had a clinical record at Shiraz’s Imam Reza diabetes clinic (N=62) Yoga therapy via virtual training Eight 60-min sessions (1 online and 7 offline) of yogic practices held for 8 consecutive wk through Adobe Connect Reader for 90 min RCT Depression; the mean of the depression total score was significantly lower in the experimental arm; the reduction in mean change from baseline to the trial end was significantly higher in the experimental arm
Setiawan et al [114], 2025 Indonesia Patients diagnosed with thalassemia from a general hospital in the Priangan Timur region (N=80) Mobile app (Cyber Gen) Genetic counseling delivered through the chat feature on an Android-based mobile app (Cyber Gen) conducted in 3 separate sessions RCT Depression and anxiety; depression and anxiety in the intervention group showed significant changes across all observed periods (P<.001), with a large effect size (Cohen d>0.8)
Shania et al [115], 2023 Indonesia Adolescents Mobile app App included a mood tracker, activity target, and meditation, along with supporting features (educational articles) and early detection features Mixed methods to design an mHealth intervention Depression
Shaygan et al [116], 2023 Iran Patients with COVID-19 in home quarantine (N=72) Telephone intervention Videos, audio files, and educational texts regarding mental health, coping strategies, positive thinking, hope, and spiritual well‑being; interventions were provided daily for 14 d RCT Anxiety; state‑trait anxiety was significantly lower in the interactive psychoeducational intervention group; the mean score of state anxiety was 34.69 (SD 10.75) in the intervention group and 45.75 (SD 13.01) in the control group after the intervention, with a large effect size
Singla et al [117], 2024 India Embedded in 3 programs to scale up the HAP; included participants from those programs Smartphone app (PEERSbb) PEERS app aimed to facilitate remote registering and scheduling patients, collecting patient outcomes, rating therapy quality, and assessing supervision quality among frontline treatment providers delivering BA for depression Mixed methods Depression
Sinha et al [118], 2023 United Kingdom, United States, and India General population Digital mental health app (Wysa) Wysa was an AI-enabled, chat-based app aimed at building resilience; it included a conversational agent and various evidence-based intervention tools and techniques, such as CBT and mindfulness Retrospective observational design Depression and anxiety
Soltani et al [119], 2024 Iran Patients with MDDbc referred to Razi Hospital and the psychiatry clinic of Madani Hospital (N=64) Smartphone app (Yara) Included a section with 3 tests for the daily report of patients’ sleep quality, suicidal thoughts, and anxiety; content included a daily exercise video; the client received motivational sentences daily and recorded their daily activities RCT—pretest-posttest design Depression and associated symptoms
Than et al [120], 2023 Vietnam Family caregivers of people with dementia living in the community who attended the Department of Geriatrics at Gia Dinh People’s Hospital Smartphone app App will include weekly online psychoeducational group sessions hosted on the Zalo app; caregivers will be added to a “Caregiver Support Group” room in Zalo; weekly, the administrator will post 1 topic for discussion Protocol pilot RCT Depression and anxiety
Torrey et al [121], 2020 Colombia Patients from 2 primary care clinics, 1 urban and 1 rural, in a small town (N=2656 screened) Technology-supported care Included waiting room kiosks to screen primary care patients, decision support tablets to guide doctors in diagnosis and treatment, and access to digital therapeutics Descriptive study Depression; primary care physicians increased the percentage of patients diagnosed as having depression and alcohol use disorder from next to 0% to 17% and 2%, respectively
van der Watt et al [51], 2020 Chile, Denmark, South Africa, and the United States Various Various Remote mood monitoring that included distant support in participants with mood disorders Systematic review Depression; distant mood monitoring was effective in improving depression scores but not mania scores; feasibility varied
van Heerden et al [122], 2024 Nepal Counselors and adolescent mothers from postnatal clinics and immunization camps in Chitwan (N=24) Mobile app (StandStrong; Sensing Technologies for Maternal Depression Treatment in Low Resource Settings) For lay counselors offering a 5-session BA intervention (HAP) to visualize the passive sensing data of young mothers with depression for counseling sessions Proof-of-concept study (single-arm intervention) PHQ-9 scores at screening averaged 12.13 (SD 2.85); no statistically significant change reported
Vera Cruz Dos Santos et al [123], 2021 Brazil and Peru Patients of public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880), and Lima, Peru (n=442) Smartphone app (CONEMObd) mHealth intervention based on BA with minimal support from a nurse or nurse assistant (with weekly supervision from a psychiatrist); included 18 brief, automated mini sessions delivered over a 6-wk period Protocol—economic evaluation alongside 2 RCTs Depression
Watanabe et al [124], 2024 Vietnam and Thailand Nurses working in hospitals in Vietnam and Thailand Mobile app (ABC Stress Management–COVID-19 version) 7-wk smartphone-based self-guided iCBTbe program for nurses; consisted of texts and static visuals of cartoon characters talking about the study topic and guiding participants RCT—2 arm, parallel group Depression; in both groups, the average scores of depression at the 3- and 6-mo follow-ups were lower than those at baseline; Cohen d values were –0.13 (95% CI –0.26 to –0.02) at the 3-mo follow-up and –0.05 (95% CI –0.17 to –0.02) at the 6-mo follow-up
Weierstall et al [125], 2021 Burundi Burundian AMISOMbf (UNbg-approved mission) soldiers (N=463) Tablet app Structured clinical interviews (in person) for assessments of clinical symptom profiles by rating symptoms and responses in field research (diagnostic procedure) via tablets Feasibility study Depression; findings demonstrated that tablet-supported assessments can provide a useful application of mobile technology in large-scale studies, especially in resource-poor settings
Zamanifard et al [126], 2022 Iran Children with type 1 diabetes aged 8-12 y who were referred to Imam Reza diabetes clinic in Shiraz (N=40) Virtual painting therapy Six 2-h group therapy sessions delivered over 6 wk via WhatsApp video call by the main researcher; children were encouraged to draw anything, those who showed anxiety and depression in their paintings were identified, and reports were sent to their parents for follow-ups RCT Depression and anxiety; significant difference between the groups regarding anxiety (P=.02) and depression (P<.001); however, the difference in self-efficacy was not significant (P=.20)
Zuccolo et al [127], 2021 Brazil Pregnant women aged between 16 and 40 y with depression Smartphone app (Motherly) On the basis of 3 concepts to deliver BA: psychoeducation, behavior monitoring, and gaming elements; package of interventions comprised various modules, such as mental health and sleep; included 4 online sessions of brief CBT in 8 wk Protocol—2-arm RCT Depression (in pregnant women)

aRCT: randomized controlled trial.

bICU: intensive care unit.

cDASS-21: Depression, Anxiety, and Stress Scales–21.

dSbS: Step-by-Step.

eLHW: lady health worker.

fCBT: cognitive behavioral therapy.

gBAI: Beck Anxiety Inventory.

hiMBSR: internet-delivered mindfulness-based stress reduction.

iPHQ-15: Patient Health Questionnaire-15.

jBDI-II: Beck Depression Inventory–II.

kBA: behavioral activation.

lGAD-7: General Anxiety Disorder-7.

mPHQ-9: 9-item Patient Health Questionnaire.

nWHO: World Health Organization.

oASHA: accredited social health activist.

pNABL: National Accreditation Board for Testing and Calibration Laboratories.

qPSS: Perceived Stress Scale.

rMITHRA: Multiuser Interactive Health Response App.

sHAP: healthy activity program.

tVR: virtual reality.

uITT: intention to treat.

vSMD: standardized mean difference.

wCMD: common mental disorder.

xLMIC: low- and middle-income country.

ymHealth: mobile health.

zSVR: smartphone-based virtual reality.

aaAI: artificial intelligence.

abPPD: postpartum depression.

acEXPONATE: Expanding Care for Perinatal Women With Depression.

admhGAP-IG: Mental Health Gap Action Programme Intervention Guide.

aePHC: primary health care.

afGPM+: group problem management plus.

agHCW: health care worker.

ahmhGAP: Mental Health Gap Action Programme.

aiFIIT: fitness intervention.

ajART: antiretroviral therapy.

akRRMS: relapsing-remitting multiple sclerosis.

alMS: multiple sclerosis.

amSPMS: secondary progressive multiple sclerosis.

anAIIMS: All India Institute of Medical Science.

aoIMSD: Initiative Maternal Screening Depression.

apDMHI: digital mental health intervention.

aqGIAI: guided internet-assisted intervention.

arMD: mean difference.

asCHN: community health nurse.

atASRaDA: Application for Suicide Risk and Depression Assessment.

auCES-D: Center for Epidemiologic Studies Depression Scale.

avSBQ-R: Suicide Behaviors Questionnaire–Revised.

awBRT: Benson relaxation technique.

axTA-PM+: technology-assisted problem management plus.

ayMAUQ: mHealth App Usability Questionnaire.

azSA: social anxiety.

baPSA: public speaking anxiety.

bbPEERS: Promoting effective mental healthcare through peer supervision.

bcMDD: major depressive disorder.

bdCONEMO: Control and Emotional.

beiCBT: internet-delivered cognitive behavioral therapy.

bfAMISOM: African Union Mission in Somalia.

bgUN: United Nations.

 Synthesis of Results Overview

This section presents a summary of the findings from the 80 articles that reported on fidelity, usability, and cultural adaptation of DMHIs, along with the challenges to and facilitators of their uptake in LMICs. The synthesis was organized by the three research objectives: (1) type of DMHI intervention platform; (2) discussions on their fidelity, usability, and cultural adaptation; and (3) identified challenges to and facilitators of their uptake in LMICs. A summary is presented in Table 2 organized according to the type of DMHI intervention platform used, along with other articles that reported the use of more than one type of DMHI.

Summary of fidelity, usability, cultural adaptation, and challenges and facilitators by type of intervention.

Fidelity Usability Cultural adaptation Challenges Facilitators
Summary (N=80) A total of 16 articles reported on fidelity. A total of 29 articles reported on usability. A total of 31 articles reported on cultural adaptation. A total of 22 articles reported on challenges to the uptake of DMHIsa in LMICsb. A total of 17 articles reported on facilitators of the uptake of DMHIs in LMICs.
Mobile apps (n=46) A total of 12 articles reported on fidelity [57,64,70,79,80,83, 89,95,111,112,119,127]. A total of 23 articles reported on usability [53,57,62,64,65,67, 70,80,86,89, 90,93, 95,100,104,105,110-112, 115,117,119,120]. A total of 24 articles reported on cultural adaptation [48,53,64,67,68, 70,80,87,89,90,92, 93,95,104,105,108,110, 112,117,119,122,124,125]. A total of 13 articles reported on challenges [48,57,62,64,79, 80, 89,90,107,111,117,125, 127]. A total of 12 articles reported on facilitators [53,57,64,67,79, 83, 89,90,105,111,117,125].
Web-based programs (n=10) One article reported on fidelity [55]. Two articles reported on usability [55,84]. Three articles reported on cultural adaptation [55,58,84]. Three articles reported on challenges [55,58,84]. Two articles reported on facilitators [55,58].
Virtual reality (n=5) —c — One article reported on cultural adaptation [88]. — —
Videoconferencing (n=4) — — — Two articles reported on challenges [66,98]. —
Telemedicine (n=4) — — — — —
Social media–based interventions (n=1) — — — — —
More than one delivery platform type (eg, delivered via app or the web or reviews that included various DMHIs; n=10) Three articles reported on fidelity [71-73]. Four articles reported on usability [51,73,78,101]. Three articles reported on cultural adaptation [71,72,101]. Four articles reported on challenges [72,73,78,101]. Three articles reported on facilitators [49,73,101].

aDMHI: digital mental health intervention.

bLMIC: low- and middle-income country.

cNot applicable.

 Types of Digital Health Interventions for Depression and Anxiety Being Used in LMICs

This search and review of the 80 articles showed that, of the DMHIs identified, the largest category was mobile apps (n=46, 58%). Other DMHIs involved web-based programs (n=10, 12%), VR (n=5, 6%), videoconferencing (n=4, 5%), telemedicine (interventions delivered via an instant messaging app; n=4, 5%), and social media–based interventions (n=1, 1%). A total of 12% (10/80) of the articles reported on delivery of mental health care using more than one platform (eg, delivered via app or the web or reviews that included various DMHIs). DMHIs can be stand-alone self-guided programs or incorporate a hybrid model whereby human assistance, either from a therapist (ie, mental health specialist) or a lay health worker to augment their care, is available with varying levels of support.

Most of the articles (64/80, 80%) reported strengths of DMHIs either on improving symptoms of depression or anxiety or other factors such as high level of usability, acceptability, and satisfaction during usability and pilot-testing. Overall, DMHIs show promise as a way to bridge the mental health treatment gap for depression and anxiety in LMICs.

 Fidelity, Usability, and Cultural Adaptation Fidelity

Despite the accelerated increase in the development and application of DMHIs in recent years, with many being adapted from existing in-person interventions, only 20% (16/80) of the articles reported on fidelity. Of these 16 articles, only 4 (25%) discussed fidelity in relation to the original in-person or paper-based intervention format. One of these articles mentioned adherence to the original intervention structure and format in the adapted digital format [80]. Another article described the process of involving psychologists and psychiatrists to ensure theoretical alignment of app content with psychosocial components [83]. The third article mentioned the development of 1 video per session to deliver the therapeutic ingredients with fidelity and at the right dose [57]. The last of the 4 articles mentioned that the intervention delivery format (mobile app) ensured that key therapeutic elements were delivered with fidelity and at the appropriate dose using the app’s automated features [64].

Most of the articles that discussed fidelity (13/80, 16%) described the process for ensuring fidelity or adherence by lay health workers to the intervention protocol. This included fidelity and audit checks of lay health workers by supervisors and reviews of case notes [55,70-73,79] and use of various tools (eg, fidelity checklist [71,72,79] or the practical robust implementation and sustainability model framework [95]). Regarding those reporting on the use of a tool, 2% (2/80) of the articles provided further information, indicating that 5% of the guidance calls and messages were rated (no additional information was provided on who performed the rating) [71,72]. Another article reported that the structured steps on the app made it easier for lay workers to adhere to fidelity when navigating the sessions [73], whereas another article indicated that the intervention itself, which was used for detection and treatment, could increase consistency in diagnosis and treatment [89]. Finally, one article stated that fidelity to the intervention protocol was demonstrated by lay health workers delivering the intervention adapting easily to the technology (smartphones) due to familiarity with the protocol [57]. Regarding the articles that reported on measuring fidelity of lay health workers to the intervention protocol, overall, it was shown that lay counselors adhered to the intervention delivery components.

 Usability

Less than half (29/80, 36%) of the articles described usability in some manner, including through usability testing or qualitative exploration. Most of the articles (23/29, 79%) were related to mobile apps. Of the 29 articles, only 7 (24%) reported the use of measures, either standardized (eg, the System Usability Scale or mHealth App Usability Questionnaire [MAUQ]) or created by the authors for the study (eg, satisfaction survey), to capture usability [73,78,84,95,111,115]. In addition, only 31% (9/29) of the articles described the usability testing process along with findings in detail, with most (7/9, 78%) related to mobile apps [62,64,65,80,95,105,110,111,115] and the rest (2/9, 22%) pertaining to web-based programs [55,84]. In total, 10% (3/29) of the articles were protocol papers that indicated how app development would follow a user-centered iterative design.

Most of the articles that described usability testing outcomes (19/80, 24%) reported high satisfaction. For example, the study by Nurbaeti et al [100] showed that the evaluation of an app for postpartum depression symptoms in Indonesia was mostly positive, with a large percentage of the participants reporting the following: appearance of the app being adequate (92.7%) and the app being easy to download (89.9%), understandable (96.3%), easy to fill in (94.5%), and beneficial (96.3%) and reflecting psychological conditions (90.8%). Another article reporting the protocol for a feasibility cluster randomized controlled trial to be conducted in Nepal and Nigeria indicated that health workers found the prototypes of the app for the adapted WHO electronic Mental Health Gap Action Programme Intervention Guide to be intuitive, appropriate, and feasible for clinical work [112].

Of the 10 articles that reported more than one delivery platform, 4 (40%) reported on usability testing [51,73,78,101]. In total, 75% (3/4) of these articles indicated the evaluation of a usability-related construct using particular measures—a usability questionnaire (MAUQ) [73], satisfaction survey [78], and completion rates with participant feedback [51]. The remaining article mentioned that piloting had been conducted to evaluate the appropriateness of the intervention without describing this in detail [101]. Usability was reported as being high (eg, the MAUQ score was 78.5, and the satisfaction survey showed that 92% of participants were very satisfied).

 Cultural Adaptation

Finally, 39% (31/80) of the articles described a process for adapting the DMHIs to the local cultural context. Of these 31 articles, 23 (74%) reported on mobile apps. Various methods were used, including a narrative approach involving local women, a participatory approach, identification of measures that had been validated in the implementation country or working with local partners to enhance cultural validity where needed, and the intervention being led by a local partner. Many of the articles (13/80, 16%) discussed the involvement of a broad range of stakeholders in the adaptation process using a “participatory approach” [67]. For example, one article mentioned how “the vignettes were developed in consultation with local women who had suffered from depression” [64]. Another article described that, to improve cultural fit, “a team of clinical psychologists, psychiatrists, and researchers from the U.S. and India adapted the intervention,” and “modifications were informed by student feedback” [84].

A few articles (7/80, 9%) described the cultural adaptation process in detail. For example, one article described how the VR space was designed to be similar to the environment of the end users (urban refugee youths in Kampala) and presented in their language of choice combined with training materials and content adapted with peer navigators to enhance relevance [88]. Another article detailed the extensive cultural adaption process conducted by the WHO and the Lebanon National Mental Health Programme to develop relevant content (story, local idioms, and illustrations) for the Lebanese population, displaced Syrians, and other groups in Lebanon. The article also included descriptions of piloting for face and content validity, clarifying language, assessing readability, and establishing content appropriateness within the intended context [55].

Most of the articles (18/80, 20%) were vaguer, indicating simply the importance of identifying what would be culturally acceptable, that the app was designed for the specific population, or the use of a guide adapted for the health system of the target country. A total of 2% (2/80) of the articles, which reported on web-based DMHIs, indicated that cultural adaptation was conducted with the intervention or culturally adapted approaches were used, resulting in high cultural relevance and acceptability; however, the process was not described in detail [58,84]. Similarly, 67% (2/3) of the articles that reported more than one delivery platform mentioned cultural adaptation but did not describe the process in detail [71,72]. These 2 articles pertained to the same intervention. Another article mentioned that the narrative was adapted to the local context considering cultural and linguistic nuances among displaced Syrians and that participants could choose the appearance of the avatar used in the program, reflecting the main cultural groups in Lebanon (Lebanese, Syrians, and Palestinians) [64].

 Challenges to and Facilitators of Intervention Uptake in LMICs Challenges to Uptake

A total of 28% (22/80) of the articles reported on challenges. In total, 59% (13/22) of these articles were related to mobile apps, describing challenges that pertained to the technological system (eg, system lags, app navigation challenges, and bugs); user engagement issues (sustained engagement of individuals who are depressed and may have low motivation, high churn, and issues with adherence to treatment), which are linked to poor usability; contextual issues (eg, illiteracy, technological proficiency, accessibility of mobile phones, data limits, battery charging issues, and lack of family involvement); structural barriers (eg, network connectivity issues and resource constraints); and concerns about privacy and confidentiality [48,57,62,64,79,80,89,90,107,111,117,125,127]. Of the 22 articles, 2 (9%) highlighted how many of these challenges contribute to the digital divide, or the division between individuals or populations who have access to and use digital technology and those who do not [64,117]. Other challenges mentioned included that of a practice gap between health care providers and application developers [48] and challenges with the online delivery method where participants complete tasks in their own time [79].

In addition to similar challenges described previously, other challenges reported in relation to web-based programs and those delivered via more than one platform included individuals forgetting their log-in credentials, time constraints due to busy schedule of the participants, retention of lay health workers, sustained engagement, and stigma [55,66,84]. There were also concerns reported about the interventions’ efficacy, effectiveness, and usability [73].

 Facilitators of Uptake

In total, 21% (17/80) of the articles reported on facilitators. Of these 17 articles, 12 (71%) were related to mobile apps, describing various facilitators that supported their uptake and scale-up, including widespread mobile phone use, built-in supervision and training features, and an app’s convenience and integration into existing social (eg, schools) and health care systems [53,57,64,67,79,83,89,90,105,111,117,125]. One of these studies suggested a web-based delivery platform rather than an app-based one as the former does not require regular updating and tailored interventions or distinct adaptations that account for the unique needs of the target population [79]. Other articles (3/80, 4%) reported on the importance of orientation and training programs and mobilization of community health volunteers [89,111] and how an understanding of the intervention and its potential benefits will likely support its uptake [90]. In line with some of the concerns that clinicians expressed, described previously, one article reported on the importance of buy-in from frontline health care providers and clinical experts, which may be facilitated by demonstrated clinical utility and efficiency [117]. Other facilitators reported in relation to web-based programs or interventions involving more than one delivery platform included facilitators at the individual level, such as being technologically savvy and literate and having access to devices [55], and incorporating features to boost user engagement [101]. Finally, the importance of cultural appropriateness was emphasized by a number of the articles (11/80, 14%; see, eg, the studies by Alavi and Hirji [58] and Pozuelo et al [105]).

 Discussion Principal Findings

The 80 articles identified in this rapid scoping review reported the use of mobile apps, web-based programs, VR, videoconferencing, telemedicine (interventions delivered via instant messaging apps) platforms, and social media, in addition to instances in which the DMHIs were delivered via more than one platform (eg, delivered via app or the web). To our knowledge, this rapid scoping review is the most comprehensive presentation of articles examining DMHIs for depression and anxiety and their fidelity, usability, and cultural adaptation, along with challenges to and facilitators of their uptake in LMICs.

Fidelity

Active elements of these DMHIs are often modeled on evidence-based psychological interventions developed for in-person delivery [17], offering further promise to provide scalable effective mental health care. As such, it is critical that the interventions are implemented with high fidelity while balancing the need for necessary adaptations to the digital context, including the different motivational needs and preferences of digital users. However, inconsistencies regarding treatment fidelity have been identified as a main contributor to the mixed evidence on the effectiveness of many DMHIs [128]. Similarly, results from this review showed that less than a fifth (16/80, 20%) of the articles reported on fidelity, with heterogeneity in process and presentation format. Most of these articles (13/80, 16%) described the process for ensuring adherence by lay health workers to the intervention protocol rather than for ensuring fidelity of the DMHI to its original in-person or paper-based format. Furthermore, only 1% (1/80) of the articles mentioned specifically adherence of the DMHI to the original intervention structure albeit delivered in an automated digital format [80]. Interestingly, 2% (2/80) of the articles mentioned that the delivery format of the intervention (app) supported fidelity via the nature of its automated and structured format [64,89]. This is consistent with previous research demonstrating that less complex interventions are easier to implement with high fidelity [129]. As more DHMIs are being developed and adapted from in-person or paper-based formats, it is crucial to ensure intervention fidelity to maintain consistency in intervention delivery across platforms while balancing necessary adaptations to suit digital modes of delivery and the local context [130,131].

 Usability

Poor usability has been cited as a primary reason for failed adoption of and engagement with digital health apps [31,32], where approximately one-third of users who download health apps stop using them after a short time, often no more than 2 weeks [132]. Hurdles to app usability include being difficult to set up or use or being buggy, not working well, requiring too much time to enter data, or having small screens that display limited information at a time [32,133]. Other challenges include concerns about privacy. An additional consideration for individuals with depression include specific symptoms such as low motivation, concentration difficulties, and behavioral avoidance that may make it more difficult for them to engage with DMHIs, posing further challenges to real-world efficacy [133]. Although usability testing is understood increasingly as an important component of app development and evaluation [134], usability currently remains underexplored in depression app development [135,136]. Findings from this review reflect this as only 36% (29/80) of the articles described usability testing in some manner despite overwhelming evidence highlighting how the efficacy of mobile apps can be greatly enhanced by conducting usability testing to determine factors impacting user adherence and satisfaction [137-139].

Articles that reported on usability outcomes (9/80, 11%) demonstrated mostly positive findings, with above-average usability and satisfaction scores being reported. Certain challenges to usability were also reported, including a confusing registration process and content that could be improved to be more engaging [80], which was a barrier to adherence [55]. Despite the generally positive usability and satisfaction scores reported by the various articles, poor usability has been clearly identified as a barrier to sustained user engagement across various digital health interventions [140,141]. A lack of user engagement with the DMHI regardless of users’ self-reports on satisfaction and utility likely indicates poor usability [142] as usability is a precursor for engagement [143]. This is also reflected in the fact that, despite the large number of medical health apps available, their overall downloads are decreasing [31]. Methods to increase usability include incorporating interactive features (eg, tooltips) [144] and gamification (eg, badges and avatars) [145]. Usability is also intricately linked with acceptability, which includes the intuitive attitudes toward the intervention, use intentions, actual use, and satisfaction after using [146]. Acceptability is intricately linked with prevailing social and cultural norms [147], highlighting further the importance of cultural adaptation.

 Cultural Adaptation

Ensuring that interventions are culturally appropriate and relevant is important to their success [148,149]. While depression and anxiety affect people from all cultures, the experience of these illnesses is culturally bound, shaped by local beliefs, practices, and norms. This cultural variation profoundly influences mental illness expression; patterns of coping and help seeking; the process of recovery; adherence to treatment; and relationships between individuals and their networks of family, friends, and health care providers [150,151]. Cultural adaptations to increase relevance for individuals from ethnic minority groups have been shown to have greater efficacy [152] and more favorable health outcomes [153].

However, there has been limited focus on cultural adaptations of DMHIs to ensure relevance and acceptability [19,20]. Most of the 39% (31/80) of the articles that reported on cultural adaptation only touched on the cultural adaptation process undertaken, for example, “clarify[ing] language, and establish[ing] the appropriateness of the developed content within the intended context of use” [101] and “the narrative was adapted to the local context, considering gender, linguistic, and cultural nuances” [71,72]. Only 9% (7/80) of the articles described the cultural adaptation process in detail. While it is encouraging that many of the articles included in this review (31/80, 39%) discussed cultural adaptation in some form, there is a need for researchers and developers to place more emphasis on the cultural adaptation process to ensure that evidence-based interventions are properly adapted to enhance favorable health outcomes.

Promisingly, a number of the articles (13/80, 16%) discussed the involvement of a broad range of stakeholders in the development and cultural adaptation process. Engaging a broad range of stakeholders, including experts, end users, and community members, has been shown to contribute critical insights for development, implementation, and evaluation [153]. Developing DMHIs that address the culture and context of the diverse groups in LMICs by including necessary cultural adaptations while maintaining intervention fidelity is critical to increasing engagement of historically underserved cultural groups [21].

 Challenges and Facilitators

A total of 28% (22/80) of the articles reported on challenges, whereas 21% (17/80) reported on facilitators. Unlike the topics of fidelity, usability, and cultural adaptation, where most of the articles discussed mobile apps, articles that discussed challenges and facilitators were spread more evenly across the different delivery platforms, highlighting the consistency of challenges and facilitators experienced with different types of DMHIs. Many of the challenges reported in the articles (eg, contextual issues and structural barriers) were perceived as possibly leading to inequitable digital access and contributing further to the digital divide. These findings are consistent with the literature [12], which indicates that, while DMHIs offer an accessible and promising method for delivering mental health care, a number of challenges remain from the end user and developer side that must be addressed. For example, many of the individuals who use these types of DMHIs may live in rural areas where contextual (eg, being busy with multiple responsibilities such as farming, taking care of family, and side jobs) and structural issues (underdeveloped technological infrastructure) may prevent them from engaging fully with DMHIs. Structural issues and digital health literacy have been widely reported in the literature for a number of years [154,155]. A lack of digital literacy, especially among the older adult population and those from lower socioeconomic brackets, is one of the main challenges in scaling up digital health interventions [155,156]. In addition, DMHIs may not be accessible for subpopulations such as racial and ethnic minority groups due to language barriers [157], emphasizing again the importance of ensuring cultural appropriateness. Finally, for DMHIs that incorporate a hybrid model involving human assistance, in particular lay health workers to augment their care, the articles emphasized the heavy burden on the providers, who often have heavy existing workloads and are largely underpaid or even unpaid [158]. This may pose a challenge for sustainability.

Clinician buy-in was reported as a challenge to the overall implementation of DMHIs into routine care and centered on time management, regulatory structures and licensure, lack of nonverbal evidence, and payment. Similar challenges have been reported in the literature, demonstrating that there has been a reticence from mental health professionals to engage with DMHIs due to the perceived threat to the therapeutic alliance, which some believe can only be established in person [25,26]. Research suggests that there is presently limited theoretical and practical training on novel digital tools and interventions in psychiatry, which influences clinicians’ understanding and perceptions of DMHIs [159]. The importance of in-person contact in psychotherapy has also been widely discussed in the literature [160-162]. However, Newman et al [163] showed that, while clinician-assisted treatments are indeed optimal, interventions with reduced in-person contact and at reduced intensity have also been shown to be effective and cost-effective. This has been researched most heavily in the case of mobile apps [164,165]. For example, 2 systematic reviews of mobile apps (both self-guided and hybrid models) demonstrated their effectiveness in reducing depression symptoms [16,139]. Nevertheless, clinician concerns need to be addressed to enhance their acceptance of and engagement with DMHIs, particularly for those that are integrated into standard care and may require their support. One method may be engaging clinicians more throughout the app development process to provide expert input and also increase their understanding and acceptance of DMHIs [13].

Facilitators of the uptake and scale-up of DMHIs in LMICs included widespread mobile phone use, built-in supervision and training features, their convenience, and integration into existing social and health care systems. For the hybrid models that required lay health workers for ongoing implementation, mobilization of community health volunteers, including through training and professional support, was considered an important facilitator. Training and professional support have been shown to increase lay health workers’ satisfaction and enhance their agency and social status [166]. Ensuring cultural appropriateness to the local context by using tailored adaptations was also emphasized. This can increase the reach of and engagement with DMHIs and increase equity by avoiding the systematic exclusion of cultural groups who have been historically underserved [21]. Furthermore, increased mental health awareness was highlighted as an important facilitator to increase understanding of the DMHI and its potential benefits. In addition to demonstrated clinical effectiveness of DMHIs for depression and anxiety, their use has been shown to increase mental health literacy and awareness [154]. Finally, the importance of buy-in from clinicians and other providers was highlighted. In addition to DMHI integration into standard care, clinician behaviors could support adherence. For example, Paxling et al [167] demonstrated that certain clinician behaviors, such as task reinforcement, task prompting, self-efficacy shaping, and empathetic utterances, were correlated with module completion [168].

 Limitations

A limitation of this review is that we only included English-language papers, leading to an unknown number of articles from LMICs published in languages other than English being excluded. However, we believe that this review of 80 articles identified many of the key issues concerning DMHIs in LMICs. A second limitation is that this review focused only on depression and anxiety; examination of DMHIs for other mental health conditions may elucidate additional considerations. However, as depression and anxiety are the 2 most common mental health conditions [5] and many DMHIs are developed for depression and anxiety [6,15,169], the results of this review can inform the further development and delivery of DMHIs for these 2 conditions and provide information on general rather than condition-specific features of DMHIs focusing on other conditions. Finally, research published before the search time frame may have contributed additional findings. Considering the rapid advancement of DMHIs and related research stimulated by the COVID-19 pandemic, we believe that this review of research published during the applied time frame captured the most crucial and timely evidence.

Given the rapidly changing landscape of development and application of DMHIs, further research is warranted to capture emergent changes, including the interventions’ fidelity, usability, and cultural appropriateness and challenges to and facilitators of their uptake in LMICs. Additional future research should also focus on underexplored areas, including an examination of the percentage of DMHIs that have no basis in evidence; the potential for harms in the unrestrained development and delivery of DMHIs; and the threats to privacy and security, such as potential for financial harm through unregulated mobile apps, including those presented as DMHIs. Finally, the accelerated growth of artificial intelligence (AI) and its increasing application in various health care fields in recent years could transform the landscape of digital mental health, including DMHIs [168,170]. While AI represents a potential means to advance mental health care, there will be an ensuing urgent need to examine in detail ethical implications associated with the integration of AI into digital mental health [171].

 Conclusions

DMHIs are one of the most promising ways to better meet population mental health needs and respond in culturally appropriate ways to diverse population groups. Despite the opportunities they offer for reducing the severe and persistent mental health treatment gap, there were several key issues identified in this scoping review that warrant further examination. These include further work on the fidelity, user engagement, and cultural adaptation of DMHIs. In addition, various challenges to the uptake of DMHIs in LMICs, including challenges pertaining to the technological system, contextual issues, structural barriers, and concerns about privacy and confidentiality, must be mitigated in the ongoing implementation of DMHIs in LMICs to avoid contributing further to the digital divide. In summary, DMHIs in isolation are not a solution to address the significant mental health care system deficiencies that are present; rather, they may serve as a low-cost and low-barrier treatment option—especially those DMHIs that are appropriately adapted from evidence-based in-person interventions—in low-resource settings where community-based care is severely limited.

Final PubMed search strategy.

Final PsycINFO search strategy.

PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist.

Summary of the excluded articles after full-text review.

 Abbreviations AI

artificial intelligence

 DMHI

digital mental health intervention

 LMIC

low- and middle-income country

 MAUQ

mHealth App Usability Questionnaire

 PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

 PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews

 VR

virtual reality

 WHO

World Health Organization

The authors would like to acknowledge Hazel Plante, health sciences librarian at Simon Fraser University in British Columbia for her help with developing the search strategy.

RWL has received honoraria for ad hoc speaking, advising, or consulting or received research funds from AbbVie, the Asia-Pacific Economic Cooperation, Bausch, the British Columbia Leading Edge Foundation, Brain Canada, the Canadian Institutes of Health Research, the Canadian Medical Protective Association, the Canadian Network for Mood and Anxiety Treatments, Carnot, CB Solutions, Genome British Columbia, Grand Challenges Canada, Healthy Minds Canada, Janssen, Lundbeck, the Michael Smith Foundation for Health Research, Mitacs, Neurotorium, the Ontario Brain Institute, Otsuka, the Shanghai Mental Health Center, Unity Health, the Vancouver Coastal Health Research Institute, and the Vancouver General Hospital and University of British Columbia Hospital Foundation. All other authors declare no conflicts of interest.

 GBD 2019 Mental Disorders Collaborators Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019 Lancet Psychiatry 2022 02 9 2 137 50 10.1016/S2215-0366(21)00395-3 35026139 S2215-0366(21)00395-3 PMC8776563 Torous J Jän Myrick K Rauseo-Ricupero N Firth J Digital mental health and COVID-19: using technology today to accelerate the curve on access and quality tomorrow JMIR Ment Health 2020 03 26 7 3 e18848 10.2196/18848 32213476 v7i3e18848 PMC7101061 Zheng J Morstead T Sin N Klaiber P Umberson D Kamble S DeLongis A Psychological distress in North America during COVID-19: the role of pandemic-related stressors Soc Sci Med 2021 02 270 113687 10.1016/j.socscimed.2021.113687 33465600 S0277-9536(21)00019-8 PMC9757831 COVID-19 Mental Disorders Collaborators Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic Lancet 2021 11 06 398 10312 1700 12 10.1016/S0140-6736(21)02143-7 34634250 S0140-6736(21)02143-7 PMC8500697 Patel V Saxena S Lund C Thornicroft G Baingana F Bolton P Chisholm D Collins PY Cooper JL Eaton J Herrman H Herzallah MM Huang Y Jordans MJ Kleinman A Medina-Mora ME Morgan E Niaz U Omigbodun O Prince M Rahman A Saraceno B Sarkar BK De Silva M Singh I Stein DJ Sunkel C UnÜtzer J The Lancet Commission on global mental health and sustainable development Lancet 2018 10 27 392 10157 1553 98 10.1016/S0140-6736(18)31612-X 30314863 S0140-6736(18)31612-X Linardon J Torous J Firth J Cuijpers P Messer M Fuller-Tyszkiewicz M Current evidence on the efficacy of mental health smartphone apps for symptoms of depression and anxiety. A meta-analysis of 176 randomized controlled trials World Psychiatry 2024 02 23 1 139 49 10.1002/wps.21183 38214614 PMC10785982 World Bank country and lending groups The World Bank 2025-06-12 https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups Ahmed O Ahmed MZ Alim SM Khan MD Jobe MC COVID-19 outbreak in Bangladesh and associated psychological problems: an online survey Death Stud 2022 46 5 1080 9 10.1080/07481187.2020.1818884 32915701 Mendes-Santos C Andersson G Weiderpass E Santana R Mitigating COVID-19 impact on the Portuguese population mental health: the opportunity that lies in digital mental health Front Public Health 2020 8 553345 10.3389/fpubh.2020.553345 33313033 PMC7701327 Mental Health Gap Action Programme (mhGAP) World Health Organization 2022-03-06 https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme Carter H Araya R Anjur K Deng D Naslund JA The emergence of digital mental health in low-income and middle-income countries: A review of recent advances and implications for the treatment and prevention of mental disorders J Psychiatr Res 2021 01 133 223 46 10.1016/j.jpsychires.2020.12.016 33360867 S0022-3956(20)31124-9 PMC8801979 Chakrabarti S Digital psychiatry in low-and-middle-income countries: new developments and the way forward World J Psychiatry 2024 03 19 14 3 350 61 10.5498/wjp.v14.i3.350 38617977 PMC11008387 Philippe TJ Sikder N Jackson A Koblanski ME Liow E Pilarinos A Vasarhelyi K Digital health interventions for delivery of mental health care: systematic and comprehensive meta-review JMIR Ment Health 2022 05 12 9 5 e35159 10.2196/35159 35551058 v9i5e35159 PMC9109782 Torous J Linardon J Goldberg SB Sun S Bell I Nicholas J Hassan L Hua Y Milton A Firth J The evolving field of digital mental health: current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality World Psychiatry 2025 06 24 2 156 74 10.1002/wps.21299 40371757 PMC12079407 Firth J Torous J Nicholas J Carney R Pratap A Rosenbaum S Sarris J The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials World Psychiatry 2017 10 16 3 287 98 10.1002/wps.20472 28941113 PMC5608852 Massoudi B Holvast F Bockting CL Burger H Blanker MH The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: a systematic review and meta-analysis J Affect Disord 2019 02 15 245 728 43 10.1016/j.jad.2018.11.050 30447572 S0165-0327(17)32153-5 Murray E Hekler EB Andersson G Collins LM Doherty A Hollis C Rivera DE West R Wyatt JC Evaluating digital health interventions: key questions and approaches Am J Prev Med 2016 11 51 5 843 51 10.1016/j.amepre.2016.06.008 27745684 S0749-3797(16)30229-X PMC5324832 Dunst CJ Trivette CM Raab M An implementation science framework for conceptualizing and operationalizing fidelity in early childhood intervention studies J Early Interv 2013 09 03 35 2 85 101 10.1177/1053815113502235 Eustis EH LoPresti J Aguilera A Schueller SM Cultural responsivity in technology-enabled services: integrating culture into technology and service components J Med Internet Res 2023 10 03 25 e45409 10.2196/45409 37788050 v25i1e45409 PMC10582817 Lal S Gleeson J Malla A Rivard L Joober R Chandrasena R Alvarez-Jimenez M Cultural and contextual adaptation of an eHealth intervention for youth receiving services for first-episode psychosis: adaptation framework and protocol for horyzons-Canada phase 1 JMIR Res Protoc 2018 04 23 7 4 e100 10.2196/resprot.8810 29685867 v7i4e100 PMC5938599 Nittas V Daniore P Chavez SJ Wray TB Challenges in implementing cultural adaptations of digital health interventions Commun Med (Lond) 2024 01 05 4 1 7 10.1038/s43856-023-00426-2 38182750 10.1038/s43856-023-00426-2 PMC10770150 Naslund JA Spagnolo J Jacobson N Kowatsch T Marsch L Cultural adaptations of digital therapeutics Digital Therapeutics for Mental Health and Addiction: The State of the Science and Vision for the Future 2022 New York, NY Academic Press 151 64 Bernal G Jiménez-Chafey MI Domenech Rodríguez MM Cultural adaptation of treatments: a resource for considering culture in evidence-based practice Prof Psychol Res Pr 2009 08 40 4 361 8 10.1037/A0016401 Wind TR Rijkeboer M Andersson G Riper H The COVID-19 pandemic: the 'black swan' for mental health care and a turning point for e-health Internet Interv 2020 04 20 100317 10.1016/j.invent.2020.100317 32289019 S2214-7829(20)30046-4 PMC7104190 Topooco N Riper H Araya R Berking M Brunn M Chevreul K Cieslak R Ebert DD Etchmendy E Herrero R Kleiboer A Krieger T García-Palacios A Cerga-Pashoja A Smoktunowicz E Urech A Vis C Andersson G E-COMPARED consortium Attitudes towards digital treatment for depression: a European stakeholder survey Internet Interv 2017 06 8 1 9 10.1016/j.invent.2017.01.001 30135823 S2214-7829(16)30044-6 PMC6096292 Marshall JM Dunstan DA Bartik W Clinical or gimmickal: the use and effectiveness of mobile mental health apps for treating anxiety and depression Aust N Z J Psychiatry 2020 01 54 1 20 8 10.1177/0004867419876700 31552747 Al Dweik R Ajaj R Kotb R Halabi DE Sadier NS Sarsour H Elhadi YA Opportunities and challenges in leveraging digital technology for mental health system strengthening: a systematic review to inform interventions in the United Arab Emirates BMC Public Health 2024 09 27 24 1 2592 10.1186/s12889-024-19980-y 39334131 10.1186/s12889-024-19980-y PMC11429924 Torous J Myrick K Aguilera A The need for a new generation of digital mental health tools to support more accessible, effective and equitable care World Psychiatry 2023 02 22 1 1 2 10.1002/wps.21058 36640397 PMC9840484 Hasegawa K O'Brien N Prendergast M Ajah CA Neves AL Ghafur S Cybersecurity interventions in health care organizations in low- and middle-income countries: scoping review J Med Internet Res 2024 11 20 26 e47311 10.2196/47311 39566062 v26i1e47311 PMC11618010 The V3+ usability validation glossary Datacc 2025-06-17 https://datacc.dimesociety.org/resources/v3-usability-validation-glossary/ Liew MS Zhang J See J Ong YL Usability challenges for health and wellness mobile apps: mixed-methods study among mHealth experts and consumers JMIR Mhealth Uhealth 2019 01 30 7 1 e12160 10.2196/12160 30698528 v7i1e12160 PMC6372932 Torous J Nicholas J Larsen ME Firth J Christensen H Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements Evid Based Ment Health 2018 08 1 21 3 116 9 10.1136/eb-2018-102891 29871870 eb-2018-102891 PMC10270395 Lipschitz JM Van Boxtel R Torous J Firth J Lebovitz JG Burdick KE Hogan TP Digital mental health interventions for depression: scoping review of user engagement J Med Internet Res 2022 10 14 24 10 e39204 10.2196/39204 36240001 v24i10e39204 PMC9617183 Breuer E Hanlon C Bhana A Chisholm D Silva MD Fekadu A Honikman S Jordans M Kathree T Kigozi F Luitel NP Marx M Medhin G Murhar V Ndyanabangi S Patel V Petersen I Prince M Raja S Rathod SD Shidhaye R Ssebunnya J Thornicroft G Tomlinson M Wolde-Giorgis T Lund C Partnerships in a global mental health research programme-the example of PRIME Glob Soc Welf 2019 09 6 3 159 75 10.1007/s40609-018-0128-6 31984205 PMC6980236 Chibanda D Abas M Musesengwa R Merritt C Sorsdahl K Mangezi W Bandawe C Cowan F Araya R Gomo E Gibson L Weiss H Hanlon C Lund C Mental health research capacity building in sub-Saharan Africa: the African Mental Health Research Initiative Glob Ment Health (Camb) 2020 7 e8 10.1017/gmh.2019.32 32346483 S2054425119000323 PMC7176917 Data for lower middle-income, low-income countries The World Bank 2025-05-29 https://data.worldbank.org/country/lower-middle-income Kola L Kohrt BA Hanlon C Naslund JA Sikander S Balaji M Benjet C Cheung EY Eaton J Gonsalves P Hailemariam M Luitel NP Machado DB Misganaw E Omigbodun O Roberts T Salisbury TT Shidhaye R Sunkel C Ugo V van Rensburg AJ Gureje O Pathare S Saxena S Thornicroft G Patel V COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health Lancet Psychiatry 2021 06 8 6 535 50 10.1016/S2215-0366(21)00025-0 33639109 S2215-0366(21)00025-0 PMC9764935 Li J Digital technologies for mental health improvements in the COVID-19 pandemic: a scoping review BMC Public Health 2023 03 01 23 1 413 10.1186/s12889-023-15302-w 36859184 10.1186/s12889-023-15302-w PMC9976664 Zhang M Smith HE Digital tools to ameliorate psychological symptoms associated with COVID-19: scoping review J Med Internet Res 2020 08 21 22 8 e19706 10.2196/19706 32721922 v22i8e19706 PMC7446713 Zhong S Yang X Pan Z Fan Y Chen Y Yu X Zhou L The usability, feasibility, acceptability, and efficacy of digital mental health services in the COVID-19 pandemic: scoping review, systematic review, and meta-analysis JMIR Public Health Surveill 2023 02 13 9 e43730 10.2196/43730 36634261 v9i1e43730 PMC9930923 Tricco AC Antony J Zarin W Strifler L Ghassemi M Ivory J Perrier L Hutton B Moher D Straus SE A scoping review of rapid review methods BMC Med 2015 09 16 13 224 10.1186/s12916-015-0465-6 26377409 10.1186/s12916-015-0465-6 PMC4574114 Peters MD Godfrey CM Khalil H McInerney P Parker D Soares CB Guidance for conducting systematic scoping reviews Int J Evid Based Healthc 2015 09 13 3 141 6 10.1097/XEB.0000000000000050 26134548 Brien SE Lorenzetti DL Lewis S Kennedy J Ghali WA Overview of a formal scoping review on health system report cards Implement Sci 2010 01 15 5 2 10.1186/1748-5908-5-2 20205791 1748-5908-5-2 PMC2823624 Arksey H O'Malley L Scoping studies: towards a methodological framework Int J Soc Res Methodol 2005 02 8 1 19 32 10.1080/1364557032000119616 Tricco AC Langlois EV Straus SE Rapid reviews to strengthen health policy and systems: a practical guide World Health Organization 2017 2025-05-29 https://iris.who.int/bitstream/handle/10665/258698/9789241512763-eng.pdf?sequence=1 Moher D Liberati A Tetzlaff J Altman DG PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement PLoS Med 2009 07 21 6 7 e1000097 10.1371/journal.pmed.1000097 19621072 PMC2707599 Campbell SM A filter to identify countries with low or lower middle income economies in the MEDLINE database Geoffrey & Robyn Sperber Health Sciences Library, University of Alberta 2023 2024-05-20 https://docs.google.com/document/d/1pfn68ZvMEaNdbbmreh-1URWhQwKLTKrlx9FV7FAS4f4/edit#heading=h.ldbxqb34y1kj Dosani A Arora H Mazmudar S mHealth and perinatal depression in low-and middle-income countries: a scoping review of the literature Int J Environ Res Public Health 2020 10 21 17 20 1 18 10.3390/ijerph17207679 33096738 ijerph17207679 PMC7589927 Fu Z Burger H Arjadi R Bockting CL Effectiveness of digital psychological interventions for mental health problems in low-income and middle-income countries: a systematic review and meta-analysis Lancet Psychiatry 2020 10 7 10 851 64 10.1016/S2215-0366(20)30256-X 32866459 S2215-0366(20)30256-X PMC7455253 Kim J Aryee LM Bang H Prajogo S Choi YK Hoch JS Prado EL Effectiveness of digital mental health tools to reduce depressive and anxiety symptoms in low- and middle-income countries: systematic review and meta-analysis JMIR Ment Health 2023 03 20 10 e43066 10.2196/43066 36939820 v10i1e43066 PMC10131603 van der Watt AS Odendaal W Louw K Seedat S Distant mood monitoring for depressive and bipolar disorders: a systematic review BMC Psychiatry 2020 07 22 20 1 383 10.1186/s12888-020-02782-y 32698802 10.1186/s12888-020-02782-y PMC7374077 Sarpourian F Samad-Soltani T Moulaei K Bahaadinbeigy K The effect of virtual reality therapy and counseling on students' public speaking anxiety Health Sci Rep 2022 09 20 5 5 e816 10.1002/hsr2.816 36189405 HSR2816 PMC9489082 Aalaei S Khoshrounejad F Saleh LA Amini M Design of a mobile application and evaluation of its effects on psychological parameters of COVID-19 inpatients: a protocol for a randomized controlled trial Front Psychiatry 2021 12 612384 10.3389/fpsyt.2021.612384 34108892 PMC8180579 Abbasalizadeh M Farsi Z Sajadi SA Atashi A Fournier A The effect of resilience training with mHealth application based on micro-learning method on the stress and anxiety of nurses working in intensive care units: a randomized controlled trial BMC Med Educ 2024 04 24 24 1 442 10.1186/s12909-024-05427-w 38658914 10.1186/s12909-024-05427-w PMC11041025 Abi Ramia J Abi Hana R Noun P Cuijpers P Carswell K Van't Hof E Heim E Zoghbi E Sijbrandij M El Chammay R Feasibility and uptake of a digital mental health intervention for depression among Lebanese and Syrian displaced people in Lebanon: a qualitative study Front Public Health 2023 11 1293187 10.3389/fpubh.2023.1293187 38317685 PMC10840138 Akbari A Dalvand S Ahmadi F Khazaei S Impact of virtual training of Jacobson and Benson relaxation techniques on the anxiety among home-isolated COVID-19 patients Tanaffos 2022 04 21 4 472 9 37583780 Tanaffos-21-472 PMC10423857 Akhtar S Rabbani F Nafis J Siddiqui A Merali Z A qualitative study assessing acceptability and appropriateness of a technology-assisted mental health intervention by community frontline workers: mPareshan implementation research in rural Pakistan BMC Psychiatry 2025 01 06 25 1 16 10.1186/s12888-024-06459-8 39762794 10.1186/s12888-024-06459-8 PMC11706046 Alavi N Hirji A The efficacy of PowerPoint-based CBT delivered through email: breaking the barriers to treatment for generalized anxiety disorder J Psychiatr Pract 2020 03 26 2 89 100 10.1097/PRA.0000000000000455 32134882 00131746-202003000-00003 Al-Badiri MQ Ghadirian F Zahednezhad H Boozari M Hayati M Comparison of the effects of in-person and internet-delivered mindfulness-based stress reduction on the burden of psychosomatic symptoms in nurses Front Psychol 2024 15 1402075 10.3389/fpsyg.2024.1402075 39723400 PMC11669004 Alishahi M Mohajer S Namazinia M Mazloum S The effect of recreational therapy application on depression in hemodialysis patients: a randomized clinical trial Int Urol Nephrol 2025 02 57 2 585 94 10.1007/s11255-024-04201-7 39259395 10.1007/s11255-024-04201-7 Amer NA Shohieb SM Eladrosy WM Elbakry H Elrazek S Sokoon: a gamification-based cognitive behavioral therapy application? An application for depression, stress, and anxiety Int J Gaming Comput Mediat Simul 2023 15 1 1 26 10.4018/IJGCMS.324098 Amer NA Shohieb SM Eladrosy W Liu S Nam Y Abdelrazek S A gamified cognitive behavioral therapy for Arabs to reduce symptoms of depression and anxiety: a case study research Digit Health 2024 06 14 10 20552076241263317 10.1177/20552076241263317 38882250 10.1177_20552076241263317 PMC11179503 Araya R Menezes PR Claro HG Brandt LR Daley KL Quayle J Diez-Canseco F Peters TJ Vera Cruz D Toyama M Aschar S Hidalgo-Padilla L Martins H Cavero V Rocha T Scotton G de Almeida Lopes IF Begale M Mohr DC Miranda JJ Effect of a digital intervention on depressive symptoms in patients with comorbid hypertension or diabetes in Brazil and Peru: two randomized clinical trials JAMA 2021 05 11 325 18 1852 62 10.1001/jama.2021.4348 33974019 2779828 PMC8114139 Atif N Nazir H Sultan ZH Rauf R Waqas A Malik A Sikander S Rahman A Technology-assisted peer therapy: a new way of delivering evidence-based psychological interventions BMC Health Serv Res 2022 06 30 22 1 842 10.1186/s12913-022-08233-6 35773677 10.1186/s12913-022-08233-6 PMC9245257 Bhardwaj P Joshi NK Gupta MK Sharma SK Nebhinani N Sinha A Tyrrell M Konradsen H Craftman Å Kabir ZN mHealth-based intervention by community workers to support family caregivers of persons with dementia living at home: study protocol for a cluster randomised controlled trial BMJ Open 2025 01 07 15 1 e087896 10.1136/bmjopen-2024-087896 39773791 bmjopen-2024-087896 PMC11749876 Bhargav H Raghavan V Rao NP Gulati K Binumon KV Anu KN Ravi S Jasti N Holla B Varambally S Ramachandran P Validation and efficacy of a tele-yoga intervention for improving psychological stress, mental health and sleep difficulties of stressed adults diagnosed with long COVID: a prospective, multi-center, open-label single-arm study Front Psychol 2024 15 1436691 10.3389/fpsyg.2024.1436691 39569098 PMC11576161 Bhat A Goud BR Kalidindi B Ruben JP Devadass D Waghmare A Collins PY Raj T Srinivasan K Mobile mental health in women's community-based organizations: protocol for a pilot randomized controlled trial JMIR Res Protoc 2023 02 08 12 e42919 10.2196/42919 36753310 v12i1e42919 PMC9947759 van Heerden A Poudyal A Kohrt BA Maharjan SM Hagaman A Byanjankar P Utilizing passive sensing data to provide personalized psychological care in low-resource settings Gates Open Res 2021 3 2 4 118 10.12688/GATESOPENRES.13117.2 33709058 PMC7940775 Chand K Chandra S Dutt V Raga Bhairavi in virtual reality reduces stress-related psychophysiological markers Sci Rep 2024 10 22 14 1 24816 10.1038/s41598-024-74932-1 39438543 10.1038/s41598-024-74932-1 PMC11496638 Chau LW Murphy JK Nguyen VC Xie H Lam RW Minas H Zheng Y Krebs E Hayashi K Dao S Nguyen X Duong VA Fiume E O'Neil J Evaluating the effectiveness and cost-effectiveness of a digital, app-based intervention for depression (VMood) in community-based settings in Vietnam: protocol for a stepped-wedge randomized controlled trial PLoS One 2023 9 5 18 9 e0290328 10.1371/journal.pone.0290328 37669289 PONE-D-23-13219 PMC10479903 Cuijpers P Heim E Ramia JA Burchert S Carswell K Cornelisz I Knaevelsrud C Noun P van Klaveren C Van't Hof E Zoghbi E van Ommeren M El Chammay R Guided digital health intervention for depression in Lebanon: randomised trial Evid Based Ment Health 2022 12 25 e1 e34 40 10.1136/ebmental-2021-300416 35577536 ebmental-2021-300416 PMC9811068 Cuijpers P Heim E Abi Ramia J Burchert S Carswell K Cornelisz I Knaevelsrud C Noun P van Klaveren C Van't Hof E Zoghbi E van Ommeren M El Chammay R Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: a randomized controlled trial PLoS Med 2022 06 19 6 e1004025 10.1371/journal.pmed.1004025 35737665 PMEDICINE-D-21-04285 PMC9223343 Dambi J Norman C Doukani A Potgieter S Turner J Musesengwa R Verhey R Chibanda D A digital mental health intervention (Inuka) for common mental health disorders in Zimbabwean adults in response to the COVID-19 pandemic: feasibility and acceptability pilot study JMIR Ment Health 2022 10 07 9 10 e37968 10.2196/37968 35960595 v9i10e37968 PMC9555820 Doosti P Etemadifar S Aliakbari F The impact of a continuous care model utilizing a smartphone application on quality of life and anxiety levels among gynecologic cancer patients: a randomized controlled trial BMC Nurs 2024 10 01 23 1 706 10.1186/s12912-024-02391-0 39354541 10.1186/s12912-024-02391-0 PMC11446055 Ebrahimi A Akbarzadeh F Asgharipour N Salehabadi R Arjamandi M Investigating the effectiveness of ailurophobia treatment using virtual reality technique compared to metacognitive therapy: a randomized clinical trial BMC Psychol 2025 01 17 13 1 50 10.1186/s40359-025-02378-9 39825456 10.1186/s40359-025-02378-9 PMC11742211 Ganjekar S Harve VS Bhargav H Kukreti P Dere S Thukral U Thamke P Puri M Krishnamurthy MN The pregnancy tele-yoga module to combat stress, anxiety, and depression associated with pregnancy: an exploratory open-label multicentric study Int J Yoga 2024 17 1 46 52 10.4103/ijoy.ijoy_1_24 38899135 IJY-17-46 PMC11185435 Gautama MS Haryani H Huang T Chen J Chuang Y Effectiveness of smartphone-based virtual reality relaxation (SVR) for enhancing comfort in cancer patients undergoing chemotherapy: a randomized controlled trial Support Care Cancer 2024 11 26 32 12 824 10.1007/s00520-024-09036-7 39589559 10.1007/s00520-024-09036-7 Ghanbari E Yektatalab S Mehrabi M Effects of psychoeducational interventions using mobile apps and mobile-based online group discussions on anxiety and self-esteem in women with breast cancer: randomized controlled trial JMIR Mhealth Uhealth 2021 05 18 9 5 e19262 10.2196/19262 34003138 v9i5e19262 PMC8170553 Gonsalves PP Bhat B Sharma R Jambhale A Chodankar B Verma M Hodgson E Weiss HA Leurent B Cavanagh K Fairburn CG Cuijpers P Michelson D Patel V Pilot randomised controlled trial of a remotely delivered online intervention for adolescent mental health problems in India: lessons learned about low acceptability and feasibility during the COVID-19 pandemic BJPsych Open 2022 12 27 9 1 e7 10.1192/bjo.2022.624 36573376 S205647242200624X PMC9798210 Green EP Lai Y Pearson N Rajasekharan S Rauws M Joerin A Kwobah E Musyimi C Jones RM Bhat C Mulinge A Puffer ES Expanding access to perinatal depression treatment in Kenya through automated psychological support: development and usability study JMIR Form Res 2020 10 05 4 10 e17895 10.2196/17895 33016883 v4i10e17895 PMC7573703 Gupta S Goel L Singh A Prasad A Ullah MA Psychological analysis for depression detection from social networking sites Comput Intell Neurosci 2022 2022 4395358 10.1155/2022/4395358 35432513 PMC9007657 Iravani M Bahmaei H Askari S Ghanbari S Nasab M Masihi S Effect of tele-medicine on health anxiety and pregnancy-related anxiety in pregnant women during the COVID-19 epidemic in Iran Iran J Nurs Midwifery Res 2023 28 4 405 10 10.4103/ijnmr.ijnmr_405_21 37694204 IJNMR-28-405 PMC10484383 Jannati N Mazhari S Ahmadian L Mirzaee M Effectiveness of an app-based cognitive behavioral therapy program for postpartum depression in primary care: a randomized controlled trial Int J Med Inform 2020 09 141 104145 10.1016/j.ijmedinf.2020.104145 32480319 S1386-5056(19)31075-5 Kanuri N Arora P Talluru S Colaco B Dutta R Rawat A Taylor BC Manjula M Newman MG Examining the initial usability, acceptability and feasibility of a digital mental health intervention for college students in India Int J Psychol 2020 08 55 4 657 73 10.1002/ijop.12640 31867730 PMC7359910 Kola L Abiona D Oladeji BD Ayinde O Bello T Gureje O Theory-driven development of a mobile phone supported intervention for adolescents with perinatal depression Soc Psychiatry Psychiatr Epidemiol 2022 06 57 6 1201 10 10.1007/s00127-021-02198-3 34779878 10.1007/s00127-021-02198-3 Kusumadewi AF Marchira CR Widyandana D Wirasto RT Randomized clinical trial comparing the effects of an asynchronous mobile application to guided brief cognitive behavioral therapy for managing anxiety among medical students Trends Psychiatry Psychother 2025 47 e20230713 10.47626/2237-6089-2023-0713 37975875 Lahti M Groen G Mwape L Korhonen J Breet E Chapima F Coetzee M Ellilä H Jansen R Jonker D Jörns-Presentati A Mbanga I Mukwato P Mundenda J Mutagubya J Janse van Rensburg-Bonthuyzen E Seedat S Stein DJ Suliman S Sukwa T Turunen T Valtins K van den Heuvel L Wahila R Grobler G Design and development process of a youth depression screening m-health application for primary health care workers in South Africa and Zambia: an overview of the MEGA project Issues Ment Health Nurs 2020 01 41 1 24 30 10.1080/01612840.2019.1604919 31225763 Logie C Okumu M Hakiza R Kibuuka Musoke D Berry I Mwima S Kyambadde P Kiera UM Loutet M Neema S Newby K McNamee C Baral SD Lester R Musinguzi J Mbuagbaw L Mobile health-supported HIV self-testing strategy among urban refugee and displaced youth in Kampala, Uganda: protocol for a cluster randomized trial (Tushirikiane, supporting each other) JMIR Res Protoc 2021 02 02 10 2 e26192 10.2196/26192 33528378 v10i2e26192 PMC7886618 Luitel NP Neupane V Lamichhane B Koirala GP Gautam K Karki E Adhikari S Votruba N Jordans MJ Kohrt BA Carswell K Thornicroft G Lempp H Experience of primary healthcare workers in using the mobile app-based WHO mhGAP intervention guide in detection and treatment of people with mental disorders: a qualitative study in Nepal SSM Ment Health 2023 12 15 4 100278 10.1016/j.ssmmh.2023.100278 38155812 S2666-5603(23)00093-2 PMC10751533 Maharjan SM Poudyal A van Heerden A Byanjankar P Thapa A Islam C Kohrt BA Hagaman A Passive sensing on mobile devices to improve mental health services with adolescent and young mothers in low-resource settings: the role of families in feasibility and acceptability BMC Med Inform Decis Mak 2021 04 07 21 1 117 10.1186/s12911-021-01473-2 33827552 10.1186/s12911-021-01473-2 PMC8025381 Mazhari S Sabahi A Gilanipour H Keshvardoost S Agreement for diagnosis of depression and anxiety between self-assessment with e-questionnaire and psychiatric telephone interview among post-COVID-19 patients J Educ Health Promot 2022 11 1 413 10.4103/jehp.jehp_1519_21 36824097 JEHP-11-413 PMC9942144 Moulaei K Bahaadinbeigy K Mashoof E Dinari F Design and development of a mobile-based self-care application for patients with depression and anxiety disorders BMC Med Inform Decis Mak 2023 10 02 23 1 199 10.1186/s12911-023-02308-y 37784042 10.1186/s12911-023-02308-y PMC10544565 Mukherjee A Yatirajula SK Kallakuri S Paslawar S Lempp H Raman U Essue BM Sagar R Singh R Peiris D Norton R Thornicroft G Maulik PK Using formative research to inform a mental health intervention for adolescents living in Indian slums: the ARTEMIS study Child Adolesc Psychiatry Ment Health 2024 01 20 18 1 14 10.1186/s13034-024-00704-4 38245796 10.1186/s13034-024-00704-4 PMC10800058 Muniswamy P Gorhe V Parashivakumar L Chandrasekaran B Short-term effects of a social media-based intervention on the physical and mental health of remotely working young software professionals: a randomised controlled trial Appl Psychol Health Well Being 2022 05 14 2 537 54 10.1111/aphw.12318 34750975 Nabunya P Cavazos-Rehg P Mugisha J Kasson E Namuyaba OI Najjuuko C Nsubuga E Filiatreau LM Mwebembezi A Ssewamala FM An mHealth intervention to address depression and improve antiretroviral therapy adherence among youths living with HIV in Uganda: protocol for a pilot randomized controlled trial JMIR Res Protoc 2024 03 08 13 e54635 10.2196/54635 38457202 v13i1e54635 PMC10960218 Najafi P Hadizadeh M Cheong JP Mohafez H Abdullah S Poursadeghfard M Effects of tele-Pilates and tele-yoga on biochemicals, physical, and psychological parameters of females with multiple sclerosis J Clin Med 2023 02 16 12 4 1585 10.3390/jcm12041585 36836119 jcm12041585 PMC9966519 Najafi P Hadizadeh M Cheong JP Motl RW Abdullah S Mohafez H Poursadeghfard M Effects of tele-exercise training on physical and mental health and quality of life in multiple sclerosis: do the effects differ by modality and clinical disease course? Mult Scler Relat Disord 2023 12 80 105129 10.1016/j.msard.2023.105129 37977056 S2211-0348(23)00630-2 Naveen KH Singh D Srinivasan S Bhardwaj P Mitra P Shukla KK Tomo S Dwivedi K Sharma PP Baskaran P Shukla R Vyas H Kumar A Midha N Garg MK Sharma P Misra S Effect of tele-yoga on burnout, mental health and immune markers of health care workers on COVID-19 duty: an open-label parallel group pilot randomized controlled trial Complement Ther Med 2024 12 87 103109 10.1016/j.ctim.2024.103109 39521190 S0965-2299(24)00097-9 Njoroge W Maina R Frank E Atwoli L Wu Z Ngugi AK Sen S Wang J Wong S Baker JA Weinheimer-Haus EM Khakali L Aballa A Orwa J K Nyongesa M Shah J Waljee AK Abubakar A Merali Z Use of mobile technology to identify behavioral mechanisms linked to mental health outcomes in Kenya: protocol for development and validation of a predictive model BMC Res Notes 2023 09 21 16 1 226 10.1186/s13104-023-06498-6 37735439 10.1186/s13104-023-06498-6 PMC10515076 Nurbaeti I Syafii M Lestari KB Developing an android-based application for early detection of postpartum depression symptoms in Indonesia Belitung Nurs J 2021 04 29 7 2 118 24 10.33546/bnj.1308 37469940 BNJ-7-2-118 PMC10353625 Nwaogu JM Chan AP Naslund JA Hon CK Belonwu C Yang J Exploring the barriers to and motivators for using digital mental health interventions among construction personnel in Nigeria: qualitative study JMIR Form Res 2021 11 09 5 11 e18969 10.2196/18969 34751652 v5i11e18969 PMC8663629 Ofoegbu TO Asogwa U Otu MS Ibenegbu C Muhammed A Eze B Efficacy of guided internet-assisted intervention on depression reduction among educational technology students of Nigerian universities Medicine (Baltimore) 2020 02 99 6 e18774 10.1097/MD.0000000000018774 32028389 00005792-202002070-00006 PMC7015631 Pasyar N Sam A Rivaz M Nazarinia M A smartphone-based supportive counseling on health anxiety and acceptance of disability in Systemic Lupus Erythematosus patients: a randomized clinical trial Patient Educ Couns 2023 05 110 107676 10.1016/j.pec.2023.107676 36841083 S0738-3991(23)00056-3 Patel VL Halpern M Nagaraj V Chang O Iyengar S May W Information processing by community health nurses using mobile health (mHealth) tools for early identification of suicide and depression risks in Fiji Islands BMJ Health Care Inform 2021 11 28 1 e513 10.1136/bmjhci-2021-100342 34782390 bmjhci-2021-100342 PMC8593714 Pozuelo JR Moffett BD Davis M Stein A Cohen H Craske MG Maritze M Makhubela P Nabulumba C Sikoti D Kahn K Sodi T van Heerden A O'Mahen HA User-centered design of a gamified mental health app for adolescents in sub-Saharan Africa: multicycle usability testing study JMIR Form Res 2023 11 30 7 e51423 10.2196/51423 38032691 v7i1e51423 PMC10722378 Putri AF Marsetyo FA Atmaja US Fuad A Mental health teleconsultation patterns on the most popular mHealth platforms in Indonesia Stud Health Technol Inform 2022 06 29 295 246 8 10.3233/SHTI220708 35773854 SHTI220708 Rabbani F Nafis J Akhtar S Khan MS Sayani S Siddiqui A Siddiqi S Merali Z Technology-assisted mental health intervention delivered by frontline workers at community doorsteps for reducing anxiety and depression in rural Pakistan: protocol for the mPareshan mixed methods implementation trial JMIR Res Protoc 2024 07 23 13 e54272 10.2196/54272 39042878 v13i1e54272 PMC11303881 Ramnath S Suri G Managing depression in India: opportunities for a targeted smartphone app Int J Soc Psychiatry 2021 12 67 8 1035 45 10.1177/00207640211032253 34348491 Roshid MM Rahman MM Alam MN Banu B Eity KF Shahin RR Shaba S Rahman M Sarker M Okamura H Combined effects of the mobile health (mHealth) psychoeducation and Benson relaxation technique in reducing the caregiving burden of cancer patients in Bangladesh: a protocol for a randomized controlled trial Cureus 2024 03 16 3 e55520 10.7759/cureus.55520 38576646 PMC10993085 Safaei M Mahdavi A Mehdipour-Rabori R Designing and evaluating a mobile app to assist patients undergoing coronary angiography and assessing its impact on anxiety, stress levels, and self-care BMC Med Inform Decis Mak 2024 10 08 24 1 292 10.1186/s12911-024-02703-z 39379898 10.1186/s12911-024-02703-z PMC11460224 Saleem M Zafar S Klein T Koesters M Bashir A Fuhr DC Sikander S Zeeb H A digital tool (technology-assisted problem management plus) for lay health workers to address common mental health disorders: co-production and usability study in Pakistan JMIR Form Res 2025 01 28 9 e59414 10.2196/59414 39874072 v9i1e59414 PMC11815293 Salisbury TT Kohrt BA Bakolis I Jordans MJ Hull L Luitel NP McCrone P Sevdalis N Pokhrel P Carswell K Ojagbemi A Green EP Chowdhary N Kola L Lempp H Dua T Milenova M Gureje O Thornicroft G Adaptation of the World Health Organization electronic mental health gap action programme intervention guide app for mobile devices in Nepal and Nigeria: protocol for a feasibility cluster randomized controlled trial JMIR Res Protoc 2021 06 15 10 6 e24115 10.2196/24115 34128819 v10i6e24115 PMC8277329 Seddigh S Bagheri S Sharifi N Moravej H Hadian Shirazi Zahra The effect of yoga therapy directed by virtual training on depression of adolescent girls with type 1 diabetes: a randomized controlled trial J Diabetes Metab Disord 2023 12 22 2 1273 81 10.1007/s40200-023-01245-x 37975133 1245 PMC10638158 Setiawan H Xu W Wang C Li C Ariyanto H Firdaus FA Mustopa AH Hidayat N Hu R The effect of mobile application based genetic counseling on the psychosocial well-being of thalassemia patients and caregivers: a randomized controlled trial Patient Educ Couns 2025 01 130 108457 10.1016/j.pec.2024.108457 39418673 S0738-3991(24)00324-0 Shania M Handayani PW Asih S Designing high-fidelity mobile health for depression in Indonesian adolescents using design science research: mixed method approaches JMIR Form Res 2023 07 03 7 e48913 10.2196/48913 37399059 v7i1e48913 PMC10365601 Shaygan M Yazdani Z Rambod M The effect of interactive virtual psycho-educational interventions via social networks on self-efficacy and anxiety among patients infected with COVID-19 and living in home quarantine: a randomized control trial Iran J Nurs Midwifery Res 2023 28 1 65 71 10.4103/ijnmr.ijnmr_451_21 37250934 IJNMR-28-65 PMC10215544 Singla DR Fernandes L Savel K Shah A Agrawal R Bhan A Nadkarni A Sharma A Khan A Lahiri A Tugnawat D Lesh N Patel V Naslund J Erratum: scaling up the task-sharing of psychological therapies: a formative study of the PEERS smartphone application for supervision and quality assurance in rural India - CORRIGENDUM Glob Ment Health (Camb) 2024 05 30 11 e65 10.1017/gmh.2024.61 38827332 S205442512400061X PMC11140487 Sinha C Meheli S Kadaba M Understanding digital mental health needs and usage with an artificial intelligence-led mental health app (Wysa) during the COVID-19 pandemic: retrospective analysis JMIR Form Res 2023 01 26 7 e41913 10.2196/41913 36540052 v7i1e41913 PMC9885755 Soltani Z Parizad N Radfar M Alinejad V Arzanlo M Haghighi M The effect of the Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with major depressive disorder in Iran: a randomized controlled trial BMC Psychiatry 2024 03 27 24 1 231 10.1186/s12888-024-05688-1 38539144 10.1186/s12888-024-05688-1 PMC10967041 Than TN Nguyen TT Nguyen TC Vu LT Vo PT TTruong K Schofield P Nguyen TA Smartphone app-based intervention for reducing stress, depression, and anxiety in caregivers of people with dementia in Vietnam: study protocol for a pilot randomized controlled trial Digit Health 2023 9 20552076231163786 10.1177/20552076231163786 36937692 10.1177_20552076231163786 PMC10014987 Torrey WC Cepeda M Castro S Bartels SM Cubillos L Obando FS Camblor PM Uribe-Restrepo JM Williams M Gómez-Restrepo C Marsch LA Implementing technology-supported care for depression and alcohol use disorder in primary care in Colombia: preliminary findings Psychiatr Serv 2020 07 01 71 7 678 83 10.1176/appi.ps.201900457 32151216 PMC7332379 van Heerden A Poudyal A Hagaman A Maharjan SM Byanjankar P Bemme D Thapa A Kohrt BA Integration of passive sensing technology to enhance delivery of psychological interventions for mothers with depression: the StandStrong study Sci Rep 2024 06 12 14 1 13535 10.1038/s41598-024-63232-3 38866839 10.1038/s41598-024-63232-3 PMC11169515 Vera Cruz Dos Santos D Coelho de Soárez P Cavero V U Rocha TI Aschar S Daley K Garcia Claro H Abud Scotton G Fernandes I Diez-Canseco F Brandt L Toyama M Martins Castro HC Miranda JJ Araya R Quayle J Rossi Menezes P A mobile health intervention for patients with depressive symptoms: protocol for an economic evaluation alongside two randomized trials in Brazil and Peru JMIR Res Protoc 2021 10 13 10 10 e26164 10.2196/26164 34643538 v10i10e26164 PMC8552099 Watanabe K Tran TT Sripo N Sakuraya A Imamura K Boonyamalik P Sasaki N Tienthong T Asaoka H Iida M Nguyen QT Nguyen NT Vu ST Ngo TT Luyen TT Nguyen LD Nguyen NT Nguyen BT Matsuyama Y Takemura Y Nishi D Tsutsumi A Nguyen HT Kaewboonchoo O Kawakami N Effectiveness of a smartphone-based stress management program for depression in hospital nurses during COVID-19 in Vietnam and Thailand: 2-arm parallel-group randomized controlled trial J Med Internet Res 2024 08 30 26 e50071 10.2196/50071 39213033 v26i1e50071 PMC11399744 Weierstall R Crombach A Nandi C Bambonyé Manassé Probst T Pryss R Effective adoption of tablets for psychodiagnostic assessments in rural Burundi: evidence for the usability and validity of mobile technology in the example of differentiating symptom profiles in AMISOM soldiers 1 year after deployment Front Public Health 2021 9 490604 10.3389/fpubh.2021.490604 33937159 PMC8083058 Zamanifard M Soltanian M Edraki M Moravaj H Sharifi N The effects of virtual directed painting therapy on anxiety, depression, and self-efficacy of children with type 1 diabetes: a randomized controlled clinical trial Int J Community Based Nurs Midwifery 2022 07 10 3 210 22 10.30476/IJCBNM.2022.93400.1927 35855382 IJCBNM-10-3 PMC9287569 Zuccolo PF Xavier MO Matijasevich A Polanczyk G Fatori D A smartphone-assisted brief online cognitive-behavioral intervention for pregnant women with depression: a study protocol of a randomized controlled trial Trials 2021 03 23 22 1 227 10.1186/s13063-021-05179-8 33757591 10.1186/s13063-021-05179-8 PMC7985923 Patterson VC Rossi MA Pencer A Wozney L An internet-based cognitive behavioral therapy program for anxiety and depression (tranquility): adaptation co-design and fidelity evaluation study JMIR Form Res 2022 02 02 6 2 e33374 10.2196/33374 34910660 v6i2e33374 PMC8851319 Greenhalgh T Robert G Macfarlane F Bate P Kyriakidou O Diffusion of innovations in service organizations: systematic review and recommendations Milbank Q 2004 82 4 581 629 10.1111/j.0887-378X.2004.00325.x 15595944 MILQ325 PMC2690184 Pérez D Van der Stuyft P Zabala MC Castro M Lefèvre P A modified theoretical framework to assess implementation fidelity of adaptive public health interventions Implement Sci 2016 07 08 11 1 91 10.1186/s13012-016-0457-8 27391959 10.1186/s13012-016-0457-8 PMC4939032 Bonar JR Wright S Yadrich DM Werkowitch M Ridder L Spaulding R Smith CE Maintaining intervention fidelity when using technology delivery across studies Comput Inform Nurs 2020 08 38 8 393 401 10.1097/CIN.0000000000000625 32427610 00024665-202008000-00004 PMC7415554 Arean PA Hallgren KA Jordan JT Gazzaley A Atkins DC Heagerty PJ Anguera JA The use and effectiveness of mobile apps for depression: results from a fully remote clinical trial J Med Internet Res 2016 12 20 18 12 e330 10.2196/jmir.6482 27998876 v18i12e330 PMC5209607 Molloy A Anderson PL Engagement with mobile health interventions for depression: a systematic review Internet Interv 2021 12 26 100454 10.1016/j.invent.2021.100454 34621626 S2214-7829(21)00094-4 PMC8479400 Connolly SL Hogan TP Shimada SL Miller CJ Leveraging implementation science to understand factors influencing sustained use of mental health apps: a narrative review J Technol Behav Sci 2021 09 07 6 2 184 96 10.1007/s41347-020-00165-4 32923580 165 PMC7476675 Stawarz K Preist C Tallon D Wiles N Coyle D User experience of cognitive behavioral therapy apps for depression: an analysis of app functionality and user reviews J Med Internet Res 2018 06 06 20 6 e10120 10.2196/10120 29875087 v20i6e10120 PMC6010839 Chan AH Honey ML User perceptions of mobile digital apps for mental health: acceptability and usability - An integrative review J Psychiatr Ment Health Nurs 2022 02 29 1 147 68 10.1111/jpm.12744 33604946 Abd-Alrazaq A Safi Z Alajlani M Warren J Househ M Denecke K Technical metrics used to evaluate health care chatbots: scoping review J Med Internet Res 2020 06 05 22 6 e18301 10.2196/18301 32442157 v22i6e18301 PMC7305563 Maramba I Chatterjee A Newman C Methods of usability testing in the development of eHealth applications: a scoping review Int J Med Inform 2019 06 126 95 104 10.1016/j.ijmedinf.2019.03.018 31029270 S1386-5056(18)31318-2 Khademian F Aslani A Bastani P The effects of mobile apps on stress, anxiety, and depression: overview of systematic reviews Int J Technol Assess Health Care 2020 12 14 37 e4 10.1017/S0266462320002093 33314997 S0266462320002093 Boucher EM Raiker JS Engagement and retention in digital mental health interventions: a narrative review BMC Digit Health 2024 08 08 2 1 e25 10.1186/S44247-024-00105-9 Borghouts J Eikey E Mark G De Leon C Schueller SM Schneider M Stadnick N Zheng K Mukamel D Sorkin DH Barriers to and facilitators of user engagement with digital mental health interventions: systematic review J Med Internet Res 2021 03 24 23 3 e24387 10.2196/24387 33759801 v23i3e24387 PMC8074985 Lyles CR Sarkar U Osborn CY Getting a technology-based diabetes intervention ready for prime time: a review of usability testing studies Curr Diab Rep 2014 10 14 10 534 10.1007/s11892-014-0534-9 25173689 PMC4164626 O'Brien HL Toms EG What is user engagement? A conceptual framework for defining user engagement with technology J Am Soc Inf Sci 2008 02 28 59 6 938 55 10.1002/ASI.20801 Scheuer L Torous J Usable data visualization for digital biomarkers: an analysis of usability, data sharing, and clinician contact Digit Biomark 2022 9 12 6 3 98 106 10.1159/000525888 36471766 dib-0006-0098 PMC9719035 Mustafa AS Ali N Dhillon JS Alkawsi G Baashar Y User engagement and abandonment of mHealth: a cross-sectional survey Healthcare (Basel) 2022 01 24 10 2 221 10.3390/healthcare10020221 35206837 healthcare10020221 PMC8872344 Nadal C Sas C Doherty G Technology acceptance in mobile health: scoping review of definitions, models, and measurement J Med Internet Res 2020 07 06 22 7 e17256 10.2196/17256 32628122 v22i7e17256 PMC7381045 Perski O Short CE Acceptability of digital health interventions: embracing the complexity Transl Behav Med 2021 07 29 11 7 1473 80 10.1093/tbm/ibab048 33963864 6272497 PMC8320880 Hall GC Ibaraki AY Huang ER Marti CN Stice E A meta-analysis of cultural adaptations of psychological interventions Behav Ther 2016 11 47 6 993 1014 10.1016/j.beth.2016.09.005 27993346 S0005-7894(16)30080-6 Shehadeh MH Heim E Chowdhary N Maercker A Albanese E Cultural adaptation of minimally guided interventions for common mental disorders: a systematic review and meta-analysis JMIR Ment Health 2016 09 26 3 3 e44 10.2196/mental.5776 27670598 v3i3e44 PMC5057065 Kirmayer LJ Jarvis GE Culturally responsive services as a path to equity in mental healthcare Healthc Pap 2019 09 18 2 11 23 10.12927/hcpap.2019.25925 31596698 hcpap.2019.25925 Kirmayer LJ Narasiah L Munoz M Rashid M Ryder AG Guzder J Hassan G Rousseau C Pottie K Canadian Collaboration for ImmigrantRefugee Health (CCIRH) Common mental health problems in immigrants and refugees: general approach in primary care CMAJ 2011 09 06 183 12 E959 67 10.1503/cmaj.090292 20603342 cmaj.090292 PMC3168672 Arora PG Parr KM Khoo O Lim K Coriano V Baker CN Cultural adaptations to youth mental health interventions: a systematic review J Child Fam Stud 2021 08 11 30 10 2539 62 10.1007/S10826-021-02058-3 Naderbagi A Loblay V Zahed IU Ekambareshwar M Poulsen A Song YJ Ospina-Pinillos L Krausz M Mamdouh Kamel M Hickie IB LaMonica HM Cultural and contextual adaptation of digital health interventions: narrative review J Med Internet Res 2024 07 09 26 e55130 10.2196/55130 38980719 v26i1e55130 PMC11267096 Brian RM Ben-Zeev D Mobile health (mHealth) for mental health in Asia: objectives, strategies, and limitations Asian J Psychiatr 2014 08 10 96 100 10.1016/j.ajp.2014.04.006 25042960 S1876-2018(14)00118-X Liem A Natari RB Jimmy Hall BJ Digital health applications in mental health care for immigrants and refugees: a rapid review Telemed J E Health 2021 01 27 1 3 16 10.1089/tmj.2020.0012 32498658 Lim Q Framing the issues: digital mental health in Asia Milken Institute 2022-03-25 https://milkeninstitute.org/report/digital-mental-health-asia Murphy JK Khan A Sun Q Minas H Hatcher S Ng CH Withers M Greenshaw A Michalak EE Chakraborty PA Sandanasamy KS Ibrahim N Ravindran A Chen J Nguyen VC Lam RW Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review Int J Equity Health 2021 07 12 20 1 161 10.1186/s12939-021-01484-5 34253198 10.1186/s12939-021-01484-5 PMC8274266 Musoke D Nyashanu M Bugembe H Lubega GB O'Donovan J Halage AA Gibson L Contested notions of challenges affecting community health workers in low- and middle-income countries informed by the silences framework Hum Resour Health 2022 01 06 20 1 4 10.1186/s12960-021-00701-0 34991590 10.1186/s12960-021-00701-0 PMC8734299 Watts S Mackenzie A Thomas C Griskaitis A Mewton L Williams A Andrews G CBT for depression: a pilot RCT comparing mobile phone vs. computer BMC Psychiatry 2013 02 07 13 49 10.1186/1471-244X-13-49 23391304 1471-244X-13-49 PMC3571935 Leuchtenberg S Gromer D Käthner I Videoconferencing versus face-to-face psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance, empathy and treatment characteristics Couns Psychother Res 2022 05 17 23 2 389 403 10.1002/capr.12538 Ierardi E Bottini M Riva Crugnola C Effectiveness of an online versus face-to-face psychodynamic counselling intervention for university students before and during the COVID-19 period BMC Psychol 2022 02 22 10 1 35 10.1186/s40359-022-00742-7 35193671 10.1186/s40359-022-00742-7 PMC8861610 Cataldo F Chang S Mendoza A Buchanan G A perspective on client-psychologist relationships in videoconferencing psychotherapy: literature review JMIR Ment Health 2021 02 19 8 2 e19004 10.2196/19004 33605891 v8i2e19004 PMC7935652 Newman MG Szkodny LE Llera SJ Przeworski A A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy? Clin Psychol Rev 2011 02 31 1 89 103 10.1016/j.cpr.2010.09.008 21130939 S0272-7358(10)00166-2 Donker T Kleiboer A Special issue: e-health innovations for global mental health Glob Ment Health (Camb) 2018 02 01 5 e5 10.1017/gmh.2018.6 29507741 00006 PMC5827421 Clay RA Mental health apps are gaining traction American Psychological Association 2022-04-07 https://www.apa.org/monitor/2021/01/trends-mental-health-apps#:~:text=Mental Curry D Islam MA Sarker BK Laterra A Khandaker I A novel approach to frontline health worker support: a case study in increasing social power among private, fee-for-service birthing attendants in rural Bangladesh Hum Resour Health 2023 02 07 21 1 7 10.1186/s12960-022-00773-6 36750825 10.1186/s12960-022-00773-6 PMC9906919 Paxling B Lundgren S Norman A Almlöv J Carlbring P Cuijpers P Andersson G Therapist behaviours in internet-delivered cognitive behaviour therapy: analyses of e-mail correspondence in the treatment of generalized anxiety disorder Behav Cogn Psychother 2013 05 41 3 280 9 10.1017/S1352465812000240 22717145 S1352465812000240 Lee EE Torous J De Choudhury M Depp CA Graham SA Kim H Paulus MP Krystal JH Jeste DV Artificial intelligence for mental health care: clinical applications, barriers, facilitators, and artificial wisdom Biol Psychiatry Cogn Neurosci Neuroimaging 2021 09 6 9 856 64 10.1016/j.bpsc.2021.02.001 33571718 S2451-9022(21)00046-X PMC8349367 Camacho E Cohen A Torous J Assessment of mental health services available through smartphone apps JAMA Netw Open 2022 12 01 5 12 e2248784 10.1001/jamanetworkopen.2022.48784 36576737 2799953 PMC9857226 Olawade DB Wada OZ Odetayo A David-Olawade AC Asaolu F Eberhardt J Enhancing mental health with artificial intelligence: current trends and future prospects J Med Surg Public Health 2024 08 3 100099 10.1016/j.glmedi.2024.100099 Saeidnia HR Hashemi Fotami SG Lund B Ghiasi N Ethical considerations in artificial intelligence interventions for mental health and well-being: ensuring responsible implementation and impact Soc Sci 2024 07 22 13 7 381 10.3390/socsci13070381