Internet- and mobile-based aftercare and relapse prevention in mental disorders: A systematic review and recommendations for future research.

ABSTRACT: Background:Mental disorders are characterized by a high likelihood of recurrence. Thus, aftercare and follow-up interventions aim to maintain treatment gains and to prevent relapse. Internet- and mobile-based interventions (IMIs) may represent promising instruments in tertiary prevention. This systematic review summarizes and evaluates the research on the efficacy of IMIs as aftercare or follow-up interventions for adults with mental health issues. Methods:A systematic database search (PsycInfo, MEDLINE, CENTRAL) was conducted and studies selected according to predefined eligibility criteria (RCTs, adult population, clinical symptoms/disorder, assessed with validated instruments, clinical-psychological intervention rationale, aftercare/follow-up intervention, web-/mobile-based, minimum follow-up measurement of three months, inclusion of a control group). Inspected outcomes were symptom severity, recurrence- and rehospitalization rates, functioning, quality of life and adherence to primary treatment.Systematic review registration: PROSPERO CRD42017055289. Results:Sixteen RCTs met the inclusion criteria, covering trials on depression (n?=?5), eating disorders (n?=?4) and transdiagnostic interventions (n?=?7). The majority of the interventions were based on Cognitive Behavioral Therapy (CBT) principles and were web-based (n?=?11). Methodological quality of included studies was suboptimal. Limitations included attrition bias and non-specification of routine care co-interventions. IMIs yielded small to medium post-treatment effects for symptom severity (d?=?-0.08 - d?=?-0.45) in comparison to control groups. Best evidence base was found for symptom severity of depression and anxiety. Study results regarding recurrence and rehospitalization were inconsistent. Discussion:There is some evidence, that IMIs are feasible instruments for maintaining treatment gains for some mental disorders. However, further high quality, large-scale trials are needed to expand research fields, improve adherence to and uptake of IMIs and facilitate implementation of effective interventions into routine care.

SUBMITTER: Hennemann S 

PROVIDER: S-EPMC6205252 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature