Internet- and mobile-based aftercare and relapse prevention interventions for anxiety and depressive disorders: a systematic review

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Abstract

Background

Digital interventions present potential solutions for aftercare and relapse prevention in anxiety and depressive disorders. This systematic review synthesizes evidence on the efficacy of internet- and mobile-based interventions for post-acute care in these conditions.

Methods

A systematic search was conducted in electronic databases (MEDLINE, CENTRAL, Scopus, Web of Science, PsycINFO, PsycARTICLES, PsycEXTRA, ProQuest Dissertations and Theses Open, Open Access Theses and Dissertations, and Open Grey) for randomized controlled trials evaluating digital aftercare or relapse prevention interventions for adults with anxiety or depressive disorders. Primary outcomes included symptom severity, relapse rates, recurrence rates, and rehospitalization. Secondary outcomes included general quality of life and adherence to primary treatment. Risk of bias was assessed using the Cochrane tool.

Results

Nineteen studies (3,206 participants) met the inclusion criteria. Interventions included cognitive-behavioral therapy, mindfulness-based approaches, and supportive text messaging. Most studies focused on depression, with limited evidence for anxiety disorders. Notably, fourteen studies that reported on depressive symptoms demonstrated significant improvements following digital interventions, with effect sizes ranging from small (Cohen’s d = 0.20) to large (Cohen’s d = 0.80). Five studies investigated relapse or recurrence rates, yielding mixed results. Adherence rates varied significantly across studies, ranging from 50 to 92.3%, highlighting the variability in participant engagement. Methodological quality was also variable, with allocation concealment and blinding being common limitations.

Conclusion

Internet- and mobile-based interventions show promise for aftercare and relapse prevention in depression, with limited evidence for anxiety disorders. Future research should focus on optimizing engagement, personalizing interventions, standardizing outcome measures, and conducting larger trials with longer follow-up periods. These findings have important implications for integrating digital tools into existing care pathways to improve long-term outcomes for individuals with anxiety and depressive disorders.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151336, CRD42020151336.

Related collections

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Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate

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The methods and results of systematic reviews should be reported in sufficient detail to allow users to assess the trustworthiness and applicability of the review findings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was developed to facilitate transparent and complete reporting of systematic reviews and has been updated (to PRISMA 2020) to reflect recent advances in systematic review methodology and terminology. Here, we present the explanation and elaboration paper for PRISMA 2020, where we explain why reporting of each item is recommended, present bullet points that detail the reporting recommendations, and present examples from published reviews. We hope that changes to the content and structure of PRISMA 2020 will facilitate uptake of the guideline and lead to more transparent, complete, and accurate reporting of systematic reviews.

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Author and article information

Contributors

Ligiana Mihaela Petre: URI : https://loop.frontiersin.org/people/1843180/overviewRole: Role:

Paweł Adam Piepiora: URI : https://loop.frontiersin.org/people/1149353/overviewRole: Role:

Maria Gemescu: Role: Role: Role: Role:

Delia Alexandra Gheorghe: URI : https://loop.frontiersin.org/people/2223310/overviewRole: Role:

Journal

Journal ID (nlm-ta): Front Psychol

Journal ID (iso-abbrev): Front Psychol

Journal ID (publisher-id): Front. Psychol.

Title: Frontiers in Psychology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-1078

Publication date (Electronic): 12 December 2024

Publication date Collection: 2024

Volume: 15

Electronic Location Identifier: 1474016

Affiliations

[1] ¹Laboratory of Advanced Studies in Clinical Psychology, Faculty of Psychology and Educational Sciences, University of Bucharest , Bucharest, Romania

[2] ²Faculty of Physical Education and Sports, Wroclaw University of Health and Sport Sciences , Wrocław, Poland

[3] ³Faculty of Psychology and Educational Sciences, University of Bucharest , Bucharest, Romania

[4] ⁴Department of Experimental and Theoretical Neuroscience, Transylvanian Institute of Neuroscience , Cluj-Napoca, Romania

Author notes

Edited by: Simone Battaglia, University of Bologna, Italy

Reviewed by: Masaru Tanaka, University of Szeged, Hungary

Claudio Nazzi, University of Bologna, Italy

*Correspondence: Ligiana Mihaela Petre, ligiana.petre@ 123456fpse.unibuc.ro

Article

DOI: 10.3389/fpsyg.2024.1474016

PMC ID: 11670138

PubMed ID: 39726621

SO-VID: 28ca1b11-ec15-4579-894f-384d38032d86

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 07 August 2024

Date accepted : 27 November 2024

Page count

Figures: 1, Tables: 3, Equations: 0, References: 51, Pages: 20, Words: 13351

Funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. DAG is funded by the Ministry of Research, Innovation and Digitization, CNCS—UEFISCDI, project number PN-III-P1-1.1-PD-2021-0138, within PNCDI III and through HORIZON TMA MSCA Postdoctoral Fellowships - European Fellowships: HORIZON-WIDERA-2022-TALENTS-02, Project number: 101090316 NUCA.

Custom metadata

section-at-acceptance Psychology for Clinical Settings

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: depression,anxiety,digital interventions,aftercare,relapse prevention,internet-based,mobile-based,systematic review

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