Effectiveness of digitally delivered lifestyle interventions on depression, anxiety, stress and wellbeing: a systematic review and meta-analysis. (Preprint)

Abstract

There is a growing body of robust evidence to show that lifestyle behaviours influence mental health outcomes. Technology offers an accessible and cost-effective implementation method, yet the effectiveness of interventions to date has been specific to the mode of delivery, population or behaviour.

This review aimed to comprehensively evaluate the effectiveness of all digitally delivered lifestyle interventions for improving symptoms of depression, anxiety, stress, and wellbeing.

A systematic search of MEDLINE, CINAHL, Embase, Emcare, PsycINFO and Scopus was conducted to identify studies published between January 2013 and January 2023. Randomised controlled trials of digital lifestyle (physical activity, sleep, diet) interventions for adults that reported a validated measure of depression, anxiety, stress or wellbeing and were published in English were included. Data were independently extracted and appraised using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence by multiple authors. Inverse-variance random-effects meta-analyses were used for data analysis. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behaviour, delivery method, digital features, design features or population characteristics. The main outcome was changes in symptoms of depression, anxiety, stress and wellbeing measured by validated self-report of clinician administered outcomes from pre- to post-intervention.

Of 14357 studies identified, 61 studies were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (SMD -0.37, p <0.001), a small effect on anxiety (SMD -0.29, p <0.001), and stress (SMD -0.17, p <0.05), and no effect on wellbeing (SMD 0.14, p =0.15). 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 behaviour targeted.

Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression, anxiety and stress for a broad range of populations, while effects on wellbeing are unclear.

This study was registered with PROSPERO (CRD42023428908).