A systematic review of the efficacy of internet-based interventions for depression and anxiety disorders: the possibilities and limitations for feasibility within South Africa

Technological advances may alleviate the burden on South Africa’s mental healthcare system. This study is a systematic review of literature that assesses the efficacy of high quality online interventions for depression and anxiety, and that compares the reviewed studies’ characteristics to the South African context to assist in future developments of online interventions for depression and anxiety within South Africa. This was achieved through using a 2010 systematic review of Griffiths, Farrer, and Christensen as point of departure. This research had two aims: to provide an updated systematic review of the literature reporting on the efficacy of internet-based interventions for depression and anxiety disorders; and to evaluate the possibilities and limitations for the feasibility of implementing internet-based interventions for depression and anxiety disorders in the South African context. Databases accessed were PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials. Included studies must: (i) report on one or more internet-based intervention, (ii) target depression or anxiety or both, (iii) report the effect size or provide enough information to calculate it, (iv) report a measure of symptoms outcome, (v) be a Randomised Controlled Trial, (vi) include a control group that received no active intervention, (vii) be published and peer-reviewed, (viii) have been published after January 2010. The search yielded 2999 potential studies of which 20 full texts were reviewed. Of these, 75% (n=15) of the studies report effect sizes above 0.20, and 25% (n=5) of the studies report effect sizes above 0.80. Themes emergent from literature and included studies distinguished effective from non-effective studies included the use of cognitive behavioural therapy, therapist input and reminders to engage with the intervention, and duration of over 6 weeks. Attrition rates did not differ between experimental and control groups. Sample characteristics between the reviewed interventions and South Africa’s population were found to be different and is discussed. Unfortunately, 37 potential studies could not be accessed and thus not included, although several attempts were made. The majority of studies had effect sizes equal to that of face-to-face therapeutic interventions. Implications of application in South Africa’s context with limited technological familiarity, insufficiency of professionally trained therapists, poor literacy, and high costs of internet data are discussed. It is concluded that with appropriate adaptation, online internet interventions for depression and anxiety would be beneficial to South Africa’s people and assist in lowering the country’s burden of mental health disorders