The impact of technology systems and professional support in digital mental health interventions: a secondary meta-analysis

Background A rapid review of systematic reviews was conducted to assess the effectiveness of digital mental health interventions for people with a chronic disease. Although it provided an overview of the evidence, it offered limited understanding of ethe types of interventions that were the most effective. The aim of this study was to perform a meta-analysis of primary studies identified in this rapid review of systematic reviews by focusing on the needs of knowledge users. Methods This secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods. We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression. Results 708 primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered. Conclusions While our meta-analysis identifies digital intervention’s characteristics that are more effective, all technologies and levels of support can be used considering implementation context and population. Review registration The protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75). ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This review was funded by the Canadian Institute for Health Research in the Operating Grant: Knowledge Synthesis: COVID-19 in Mental Health & Substance Use. Grant number: 202005CMS-442711-CMV-CFBA-111141 ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Not applicable All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.