TY - JOUR
T1 - Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being
T2 - Systematic Review and Meta-Analysis
AU - Brinsley, Jacinta
AU - O'Connor, Edward J
AU - Singh, Ben
AU - McKeon, Grace
AU - Curtis, Rachel
AU - Ferguson, Ty
AU - Gosse, Georgia
AU - Willems, Iris
AU - Marent, Pieter-Jan
AU - Szeto, Kimberley
AU - Firth, Joseph
AU - Maher, Carol
N1 - ©Jacinta Brinsley, Edward J O'Connor, Ben Singh, Grace McKeon, Rachel Curtis, Ty Ferguson, Georgia Gosse, Iris Willems, Pieter-Jan Marent, Kimberley Szeto, Joseph Firth, Carol Maher. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.03.2025.
PY - 2025/3/20
Y1 - 2025/3/20
N2 - BACKGROUND: There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior.OBJECTIVE: The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes.METHODS: A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics.RESULTS: Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] -0.37; P<.001), a small effect on anxiety (SMD -0.29; P<.001) and stress (SMD -0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted.CONCLUSIONS: Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity.TRIAL REGISTRATION: PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908.
AB - BACKGROUND: There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior.OBJECTIVE: The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes.METHODS: A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics.RESULTS: Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] -0.37; P<.001), a small effect on anxiety (SMD -0.29; P<.001) and stress (SMD -0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted.CONCLUSIONS: Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity.TRIAL REGISTRATION: PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908.
KW - Humans
KW - Depression/therapy
KW - Anxiety/therapy
KW - Stress, Psychological/therapy
KW - Life Style
KW - Adult
KW - Randomized Controlled Trials as Topic
U2 - 10.2196/56975
DO - 10.2196/56975
M3 - Review article
C2 - 40112295
SN - 1439-4456
VL - 27
SP - e56975
JO - JOURNAL OF MEDICAL INTERNET RESEARCH
JF - JOURNAL OF MEDICAL INTERNET RESEARCH
ER -