Mental health interventions disseminated via, or accessed using, digital technologies are an innovative new treatment modality for managing co-morbid depression and substance use disorder. The present systematic review assessed the current state of this literature.
Methods
A search of the Cochrane Library, Embase, Pubmed, PsycInfo and Scopus databases identified six eligible studies (Nparticipants = 862), utilising quasi-experimental or randomised controlled designs. Reporting quality was evaluated and Hedges’ g effect sizes (with 95% confidence intervals and p-values) were calculated to determine treatment effectiveness. Process outcomes (e.g. treatment satisfaction, attrition rates) were also examined.
Results
Quality ratings demonstrated high internal validity, although external validity was low. Effect size data revealed medium to large and short-term improvements in severity of depression and substance use symptoms in addition to global improvement in social, occupational and psychological functioning. Longer-term treatment effectiveness could not be established, due to the limited available data. Preliminary findings suggest that there was high client satisfaction, therapeutic alliance and client engagement.
Discussion
Mobile phone devices and the Internet can help to increase access to care for those with mental health co-morbidity. Large-scale and longitudinal research is, however, needed before digital mental healthcare becomes standard practice. This includes establishing critical therapeutic factors including optimum levels of assistance from clinicians.
Australian Bureau of Statistics (ABS). National survey of mental health and wellbeing: summary of results, Canberra: Australian Bureau of Statistics, 2007.
2.
AndrewsGHendersonSHallW. Prevalence, comorbidity, disability and service utilisation. The Br J Psychiatry2001; 178: 145–153.
3.
Mathers C, Fat DM and Boerma JT. The global burden of disease: 2004 update. World Health Organization, Geneva, Switzerland 2008.
4.
BoucheryEEHarwoodHJSacksJJet al.Economic costs of excessive alcohol consumption in the US, 2006. Am J Prev Med2011; 41: 516–524.
5.
GreenbergPEKesslerRCBirnbaumHGet al.The economic burden of depression in the United States: how did it change between 1990 and 2000?J Clin Psychiatry2003; 64: 1465–1475.
6.
Lahtinen E, Lehtinen V, Riikonen E, Ahonen J. (Eds.) Framework for promoting mental health in Europe. STAKES National Research and Development Center for Welfare and Health, Hamina, 1999.
7.
DavisLRushJWisniewskiSet al.Substance use disorder comorbidity in major depressive disorder: an exploratory analysis of the Sequenced Treatment Alternatives to Relieve Depression cohort. Compr Psychiatry2005; 46: 81–89.
8.
DavisLLFrazierEHusainMMet al.Substance use disorder comorbidity in major depressive disorder: a confirmatory analysis of the STAR* D cohort. Am J Addict2006; 15: 278–285.
9.
SullivanLEFiellinDAO’ConnorPG. The prevalence and impact of alcohol problems in major depression: a systematic review. Am J Med2005; 118: 330–341.
10.
SherL. Risk and protective factors for suicide in patients with alcoholism. Sci World J2006; 6: 1405–1411.
11.
MannJJ. Neurobiology of suicidal behaviour. Nat Rev Neurosci2003; 4: 819–828.
12.
Slade T, Johnston A, Teesson M, et al. The mental health of Australians 2. Report on the 2007 National Survey of Mental Health and Wellbeing. Canberra: Department of Health and Ageing, 2007.
13.
Jane-LlopisEJané-LlopisEMatytsinaIet al.Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs. Drug Alcohol Rev2006; 25: 515–536.
14.
WoodyG. The challenge of dual diagnosis. Alcohol Res Health1996; 20: 76–76.
15.
RushB. Best practices, concurrent mental health and substance use disorders, Ottawa: Health Canada, 2002.
16.
KavanaghDJConnollyJM. Interventions for co-occurring addictive and other mental disorders (AMDs). Addict Behav2009; 34: 838–845.
17.
DrakeREBartelsSJTeagueGBet al.Treatment of substance abuse in severely mentally ill patients. J Nerv Ment Dis1993; 181: 606–611.
18.
CareyKB. Substance use reduction in the context of outpatient psychiatric treatment: a collaborative, motivational, harm reduction approach. Community Ment Health J1996; 32: 291–306.
19.
MinkoffK. An integrated treatment model for dual diagnosis of psychosis and addiction. Psychiatr Serv1989; 40: 1031–1036.
20.
MueserRTDrakeRENoordsyDL. Integrated mental health and substance abuse treatment for severe psychiatric disorders. J Psychiatr Pract1998; 4: 129–139.
21.
CrumRMBrownCLiangK-Yet al.The association of depression and problem drinking: analyses from the Baltimore ECA follow-up study. Addict Behav2001; 26: 765–773.
22.
GodleySHFinchMDouganLet al.Case management for dually diagnosed individuals involved in the criminal justice system. J Subst Abuse Treat2000; 18: 137–148.
23.
GreenAIDrakeREBrunetteMFet al.Schizophrenia and co-occurring substance use disorder. Am J Psychiatry2007; 164: 402–408.
24.
DrakeRMorseGBrunetteMet al.Evolving US service model for patients with severe mental illness and co-occurring substance use disorder. Acta Neuropsychiatr2004; 16: 36–40.
25.
BarrowcloughCHaddockGFitzsimmonsMet al.Treatment development for psychosis and co-occurring substance misuse: a descriptive review. J Ment Health2006; 15: 619–632.
26.
KnaevelsrudCMaerckerA. Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients?J Med Internet Res2006; 8: e31–e31.
27.
HesterRKDelaneyHD. Behavioral Self-Control Program for Windows: results of a controlled clinical trial. J Consult Clin Psychol1997; 65: 686–686.
28.
SchneiderSJWalterRO’DonnellR. Computerized communication as a medium for behavioral smoking cessation treatment: controlled evaluation. Comput Human Behav1990; 6: 141–151.
29.
Institute of Medicine. 1993. Access to Health Care in America. Washington, DC: The National Academies Press.
30.
ChristensenHPetrieK. State of the e-mental health field in Australia: where are we now?Aust N Z J Psychiatry2013; 47: 117–120.
31.
AndersenAJWSvenssonT. Internet-based mental health services in Norway and Sweden: characteristics and consequences. Adm Policy Ment Health2013; 40: 145–153.
32.
CookJEDoyleC. Working alliance in online therapy as compared to face-to-face therapy: preliminary results. Cyberpsychol Behav2002; 5: 95–105.
33.
AnderssonGCuijpersP. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther2009; 38: 196–205.
34.
AndrewsGCuijpersPCraskeMGet al.Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PloS One2010; 5: e13196–e13196.
35.
BarakAHenLBoniel-NissimMet al.A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. J Technol Hum Serv2008; 26: 109–160.
36.
GellatlyJBowerPHennessySet al.What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychol Med2007; 37: 1217–1228.
37.
Johansson R and Andersson G. Internet-based psychological treatments for depression. Expert Rev Neurother 2012; 12: 861–869.
38.
SpekVCuijpersPNyklíčekIet al.Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med2007; 37: 319–328.
39.
Miller ET, Kilmer JR, Kim EL, Weingardt KR, & Marlatt GA. (2001). Alcohol skills training for college students. In PM Monti, SM Colby, & TA O’Leary (Eds.), Adolescents, Alcohol, and Substance Abuse: Reaching Teens Through Brief Interventions (pp. 183–215). New York: Guilford Press.
40.
MooreBAFazzinoTGarnetBet al.Computer-based interventions for drug use disorders: a systematic review. J Subst Abuse Treat2011; 40: 215–223.
41.
TaitRJChristensenH. Internet-based interventions for young people with problematic substance use: a systematic review. Med J Aust2010; 192: S15–S15.
42.
HesterRKDelaneyHDCampbellWet al.A web application for moderation training: initial results of a randomized clinical trial. J Subst Abuse Treat2009; 37: 266–276.
43.
FarrerLGulliverAChanJKet al.Technology-based interventions for mental health in tertiary students: systematic review. J Med Internet Res2013; 15: e101–e101.
44.
SugarmanDECampbellANIlesBRet al.Technology-based interventions for substance use and comorbid disorders: an examination of the emerging literature. Harv Rev Psychiatry2017; 25: 123–134.
45.
DeadyMTeessonMKay-LambkinFJ. Treatments for co-occurring depression and substance use in young people: a systematic review. Nutr Hosp2014; 30: 927–934.
46.
Kay-LambkinFJBakerALKellyBet al.Clinician-assisted computerised versus therapist-delivered treatment for depressive and addictive disorders: a randomised controlled trial. Health Technol Assess2011; 15: 1–202.
47.
Kay-LambkinFJBakerALKellyBJet al.It’s worth a try: the treatment experiences of rural and urban participants in a randomized controlled trial of computerized psychological treatment for comorbid depression and alcohol/other drug use. J Dual Diagn2012; 8: 262–276.
48.
Kay-LambkinFJBakerALLewinTJet al.Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy. Addiction2009; 104: 389–390.
49.
Kay-Lambkin F, Baker A, Lewin T, et al. Acceptability of a clinician-assisted computerized psychological intervention for comorbid mental health and substance use problems: treatment adherence data from a randomized controlled trial. J Med Internet Res. 2011; 13(1): e11.
50.
Kay-LambkinFEdwardsSBakerAet al.The impact of tobacco smoking on treatment for comorbid depression and alcohol misuse. Int J Ment Health Addict2013; 11: 619–633.
51.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.
52.
GulliverAFarrerLChanJKet al.Technology-based interventions for tobacco and other drug use in university and college students: a systematic review and meta-analysis. Addict Sci Clin Pract2015; 10: 5–5.
53.
RaaijmakersLCPouwelsSBerghuisKAet al.Technology-based interventions in the treatment of overweight and obesity: a systematic review. Appetite2015; 95: 138–151.
54.
NewmanMGSzkodnyLELleraSJet al.A review of technology-assisted self-help and minimal contact therapies for drug and alcohol abuse and smoking addiction: Is human contact necessary for therapeutic efficacy?Clin Psychol Rev2011; 31: 178–186.
55.
SchutzLERiversKORatusnikDL. The role of external validity in evidence-based practice for rehabilitation. Rehabil Psychol2008; 53: 294–294.
56.
JüniPHolensteinFSterneJet al.Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol2002; 31: 115–123.
57.
MoherDLiberatiATetzlaffJet al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6: e1000097–e1000097.
58.
McHughML. Interrater reliability: the kappa statistic. Biochemia Medica2012; 22: 276–282.
59.
AgyapongVIAhernSMcLoughlinDMet al.Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. Liver Transpl2012; 18: 828–833.
60.
AgyapongVIMcLoughlinDMFarrenCK. Six-months outcomes of a randomised trial of supportive text messaging for depression and comorbid alcohol use disorder. Indian J Psychiatry2013; 55: 140–143.
61.
AgyapongVIMilnesJMcLoughlinDMet al.Perception of patients with alcohol use disorder and comorbid depression about the usefulness of supportive text messages. Cyberpsychol Behav Soc Netw2013; 16: 272–228.
62.
Agyapong V, McLoughlin D and Farren CK. Usefulness of supportive text messages to patients with alcohol use disorder and comorbid depression – a single-blind randomised trial. Eur Psychiatry 2012; 27.
63.
DeadyMMillsKLTeessonMKay-LambkinF. An online intervention for co-occurring depression and problematic alcohol use in young people: Primary outcomes from a randomized controlled trial. J Med Internet Res2016; 18: e71–e71.
64.
DeadyMTeessonMKay-LambkinFet al.Evaluating a brief, internet-based intervention for co-occurring depression and problematic alcohol use in young people: protocol for a randomized controlled trial. Trials2014; 15: 71–71.
65.
SchaubMPMaierLJWengerAet al.Evaluating the efficacy of a web-based self-help intervention with and without chat counseling in reducing the cocaine use of problematic cocaine users: the study protocol of a pragmatic three-arm randomized controlled trial. BMC Psychiatry2017; 15: 156–156.
66.
Kay-LambkinFJBakerALGeddesJet al.The iTreAD project: a study protocol for a randomised controlled clinical trial of online treatment and social networking for binge drinking and depression in young people. BMC Public Health2015; 15: 1025–1025.
67.
KellyPJKay-LambkinFJBakerALet al.Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substance abuse treatment. Int J Prev Med2012; 3: 122–127.
68.
Agyapong VIO, Mrklas K, Suen VYM, et al. Supportive text messages to reduce mood symptoms and problem drinking in patients with primary depression or alcohol use disorder: protocol for an implementation research study. JMIR Res Protoc 2015; 4(2): e55.
69.
Kavanagh DJ, Connolly J, Klelin B, et al. Comparison of self-guided and therapist-assisted versions of a web program for alcohol misuse and depressed mood (in preparation). 2015.
70.
DownsSHBlackN. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health1998; 52: 377–384.
71.
PannucciCJWilkinsEG. Identifying and avoiding bias in research. Plast Reconstr Surg2010; 126: 619–619.
72.
HedgesLV. Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Behav Stat1981; 6: 107–128.
73.
CohenJ. A power primer. Psychol Bull1992; 112: 155–155.
74.
GeisnerMVarvil-WeldLMittmannAJet al.Brief web-based intervention for college students with comorbid risky alcohol use and depressed mood: does it work and for whom?Compr Psychiatry2015; 57: 132–139.
75.
JohnsonJZlotnickC. Group interpersonal psychotherapy (IPT) for incarcerated women with comorbid substance use and major depressive disorders. Alcohol Clin Exp Res2011; 35: 269–269.
76.
MorrisSBDeShonRP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Method2002; 7: 105–105.
77.
GuptaSK. Intention-to-treat concept: a review. Perspect Clin Res2011; 2: 109–109.
78.
CohenJ. Statistical power analysis for the behavioral sciences, Hillsdale, NJ: Lawrence Earlbaum Associates, 1988, pp. 20–26.
79.
FerrinJMBishopMTanseyTNet al.Conceptual and practical implications for rehabilitation research: effect size estimates, confidence intervals, and power. Rehab Res Policy Educ2007; 21: 87–100.
80.
Gardner MJ and Altman DG. Statistics with confidence: confidence intervals and statistical guidelines. 2000, 2nd edition, BMJ Books, London.
81.
OrwinRG. A fail-safe N for effect size in meta-analysis. J Educ Behav Stat1983; 8: 157–159.
82.
RosenthalR. The file drawer problem and tolerance for null results. Psychol Bull1979; 86: 638–638.
83.
BeckATSteerRABrownGK. Beck depression inventory-II. San Antonio1996; 78: 490–498.
84.
SaundersJBAaslandOGBaborTFet al.Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction1993; 88: 791–804.
85.
SchnurrPP. The rocks and hard places in psychotherapy outcome research. J Trauma Stress2007; 20: 779–792.
86.
Agnew-DaviesRStilesWBHardyGEet al.Alliance structure assessed by the Agnew Relationship Measure (ARM). Br J Clin Psychol1998; 37: 155–172.
87.
ButtonKSIoannidisJPMokryszCet al.Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci2013; 14: 365–376.
88.
BriefDJRubinAEnggasserJLet al.Web-based intervention for returning veterans with symptoms of posttraumatic stress disorder and risky alcohol use. J Contemp Psychother2011; 41(4): 237–246.
89.
RizviSLDimeffLASkutchJet al.A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance use disorder. Behav Ther2011; 42(4): 589–600.
90.
Maples-KellerJLBunnellBEKimSJet al.The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harv Rev Psychiatry2017; 25(3): 103–103.
91.
DobkinPLCivitaMDParaherakisAet al.The role of functional social support in treatment retention and outcomes among outpatient adult substance abusers. Addiction2002; 97: 347–356.
92.
CohenSWillsTA. Stress, social support, and the buffering hypothesis. Psychol Bull1985; 98: 310–310.
93.
MoggiFOuimettePCMoosRHet al.Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-specific coping to 1-year outcomes. Addiction1999; 94: 1805–1816.
94.
Erbe D, Eichert HC, Riper H, Ebert DDBlending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review. J Med Internet Res 2017; 19(9): e306.
95.
AbbottJ-AMKleinBCiechomskiL. Best practices in online therapy. J Technol Hum Serv2008; 26: 360–375.
96.
SchaubMPBlankersMLehrDet al.Efficacy of an internet-based self-help intervention to reduce co-occurring alcohol misuse and depression symptoms in adults: study protocol of a three-arm randomised controlled trial. BMJ Open2016; 6: e011457–e011457.
97.
AhmedISuttonAJRileyRD. Assessment of publication bias, selection bias, and unavailable data in meta-analyses using individual participant data: a database survey. BMJ2012; 344: d7762–d7762.
98.
MahoodQVan EerdDIrvinE. Searching for grey literature for systematic reviews: challenges and benefits. Res Synth Methods2014; 5: 221–234.
99.
FendrichMMackesy-AmitiMEJohnsonTPet al.Tobacco-reporting validity in an epidemiological drug-use survey. Addict Behav2005; 30: 175–181.
100.
CorrubleELegrandJZvenigorowskiHet al.Concordance between self-report and clinician’s assessment of depression. J Psychiatr Res1999; 33: 457–465.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
