IntroductionBackground

Mental illnesses are a leading contributor to the global burden of disease []. The COVID-19 pandemic has contributed to further deteriorations in population mental health and exposed critical and persisting gaps in mental health care [,]. The Global Burden of Disease 2020 study estimated that the COVID-19 pandemic has led to increases of 28% in major depressive disorders and 26% in anxiety disorders [], 2 of the most common mental disorders []. Depression and anxiety disorders are associated with profound disease and socioeconomic burden to individuals and their relatives []. Low- and middle-income countries (LMICs; countries with a gross national income per capita of ≤US $14,005 []), which bear a larger proportion of the global mental illness burden [], have been disproportionately impacted due to preexisting mental health care system deficiencies [,]. Increased mental health issues have, in turn, placed additional substantial pressures on strained mental health care systems []. This is particularly concerning in LMICs, where 75% of people lacked access to mental health care before the COVID-19 pandemic []. Persistent and growing barriers to treatment in LMICs include low mental health awareness, stigma that impacts help seeking, a shortage and maldistribution of mental health specialists, and care that is concentrated in specialized and tertiary settings with little to nonexisting care at the community level [,].

Worldwide, the pandemic has also impacted the delivery of mental health care, leading to a considerable increase in care delivered through digital health interventions to address the widespread reduction of in-person care imposed by public health constraints. These include interventions delivered via telephone, videoconferencing, messaging, web-based programs, and smartphone or other mobile device apps [], collectively referred to herein as digital mental health interventions (DMHIs). Many of these DMHIs target depression or anxiety. For example, there has been a considerable increase in smartphone apps since the onset of COVID-19. Estimates indicate that >10,000 mental health–related apps are available [], with most focused on depression and anxiety [,]. Digital interventions for depression and anxiety can help with health promotion and literacy at the population level, prevention by targeting high-risk individuals or subpopulations, and treatment and preventive services for people with mental health conditions [].

Active components of these DMHIs are often based on evidence-based psychological interventions developed for in-person delivery []. While it is critical that the interventions are implemented with high fidelity, there is limited evidence on which considerations are most relevant and what should be included in guidance for fidelity of digital adaptations from evidence-based in-person formats. There is a need to evaluate if and how the theoretical and technical components are applied in the new modus or can be enhanced by drawing on the unique interactive features of a digital format (eg, videos and animations) []. There has also been limited attention paid to methods for adaptation and evaluations of adaptations across contexts to ensure cultural appropriateness for relevance; applicability; and, ultimately, effectiveness [-], particularly for the adaptation of digital interventions []. Cultural adaptation can be defined as “the process of systematically modifying an evidence-based intervention to be congruent with the language, values, beliefs, and context corresponding to clients’ cultural backgrounds” [].

While DMHIs have been used for 2 decades, their development and uptake has been greatly accelerated by the COVID-19 pandemic and hold promise as a feasible way to address the growing mental health needs of populations amidst the persistent and growing mental health treatment gap []. This might have been a “black swan” moment as described by Wind et al [], acting as a catalyst in the marked shift from in-person mental health care provision to digital health. Challenges that have slowed their implementation into routine care include a lack of acceptance by mental health professionals, who may be concerned about threats to the therapeutic alliance, which they believe can only be established in person [,]. Other challenges include digital and language literacy []; data privacy and security concerns [], especially as LMICs have seen an increasing number of cyberattacks []; and structural issues such as underdeveloped technological infrastructure []. There is a need to ensure that all those who need digital mental health care, especially the traditionally underserved groups such as those who live in rural and remote areas, with low income, and from culturally diverse communities, have the digital literacy and opportunity to engage with DMHIs to reduce the digital divide []. Another key concern for implementation is usability, the extent to which a product can be used easily, efficiently, and with satisfaction to achieve specified goals []. Usability has been identified as a prerequisite for the success of mobile apps []. Conversely, poor usability is a primary reason for low user engagement, limiting clinical utility and resulting in the failed adoption of DMHIs [,].

Rationale and Objectives of This Review

Active components of these DMHIs are often adapted from in-person formats [], most commonly developed and tested in high-income countries []. Despite this, there is a paucity of evidence on their fidelity to the original format and limited examination of the cultural adaptation process. Furthermore, although there has been increasing research on DMHIs from LMICs [,], where >85% of the global population lives [], most DMHIs have been developed and studied in high-income countries [,], leading to potential biases and limiting generalizability. Knowledge gathered from LMICs will be critical for these countries. Thus, the purpose of this research was to conduct a rapid scoping review of the available evidence on digital health interventions for depression and anxiety, the 2 most common mental disorders, in LMICs.

The specific objectives of this rapid scoping review were to: (1) identify the types of digital health interventions for depression and anxiety being used and studied in LMICs; (2) explore their fidelity, usability, and cultural adaptation to a digital format in LMICs; and (3) examine the challenges to and facilitators of their uptake in LMICs.

This rapid scoping review contributes important evidence on the growing adaptation, use of, and challenges to DMHI applications for mental health in the context of the constantly changing landscape of the COVID-19 pandemic and beyond. While some scoping reviews have focused on digital health interventions for mental health in general [-] and others have incorporated a focus on LMICs [], to our knowledge, this is the first review that focuses on digital health interventions in LMICs specifically for depression and anxiety and includes an in-depth review of their fidelity, usability, and cultural adaptation.

MethodsData Sources and Search Strategy

Considering the need for a timely review, a rapid scoping review was conducted, and a protocol was not registered. We used the following definition of a rapid scoping review as proposed by Tricco et al []: “a type of knowledge synthesis in which components of the systematic review process are simplified or omitted to produce information in a short period of time.” Furthermore, scoping reviews seek to provide a broad mapping overview of the extent, range, and nature of the existing evidence base, focusing on breadth regardless of quality [-]. For these reasons, appraisal of the methodological quality of the individual studies was not conducted. This rapid scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and using a search strategy developed in consultation with a liaison librarian at Simon Fraser University. Processes for rapid reviews as outlined by Tricco et al [] were followed.

Two databases were searched (PubMed and PsycINFO) following common search methodologies for rapid reviews, which advise the search of at least one electronic database (PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] standards []), with most published rapid reviews using ≥2 []. The PubMed and PsycINFO databases were searched for records published between January 2020, when COVID-19 was declared a public health emergency of international concern by the World Health Organization (WHO; declared a pandemic on March 11, 2020), and January 2025. The COVID-19 pandemic accelerated the development of DMHIs, and a rapid review within this time frame was conducted to capture the recent literature that may have incorporated new methods of development and application.

The search strategy was developed across the following three domains: (1) digital health interventions, (2) depression or anxiety, and (3) LMICs. While we were interested in articles related to the COVID-19 pandemic, we made the decision not to include COVID-19 as a search domain as we were interested not only in DMHIs developed to respond specifically to COVID-19–related anxiety and depression but also in DMHIs developed for anxiety and depression in general during the search time frame. Instead, the search included the aforementioned 3 domains and the time frame of the COVID-19 pandemic (2020-2025). A combination of search terms was applied for the automatic search of publications in the aforementioned databases: (“digital” OR “technology” OR “e-health” OR “telemedicine” OR “internet” OR “online”) AND (“depress*” OR “anxi*” OR “mood disorders” OR “anxiety disorders”) AND (“low and middle income countries” OR “developing countries”). Searches included both subject headings and keywords. Search terms for LMICs were taken from the University of Alberta’s Health Sciences Search Filters resource []. provides the full search strategy for PubMed, and provides the full search strategy for PsycINFO.

Screening Strategy and Inclusion and Exclusion Criteria

Records identified in the database search process were screened using titles and abstracts by one researcher (the first author, LWC). Records were selected for full-text review if they: (1) reported on quantitative or qualitative evidence related to DMHIs for depression and anxiety; (2) were from LMICs; (3) were written in the English language; (4) were published between January 1, 2020, and January 31, 2025; and (5) had the full text available. In addition to original research articles, other types of articles (eg, protocol papers and scoping and systematic reviews) were included if they provided information on DMHIs being used in LMICs and included depression or anxiety as a primary focus. We included all articles on depression and anxiety regardless of other conditions or specific patient groups (eg, pregnancy or cancer) as long as the primary outcome included either depression or anxiety.

We excluded articles that did not include depression or anxiety as a primary focus. Any articles that presented data from multiple countries (eg, literature reviews) were included if data from LMICs and non-LMICs were disaggregated and reported separately; in these instances, only data related to LMICs were reported in this review. Duplicates were removed across the 2 databases. Records included for full-text review were cross-checked for relevance and inclusion by an additional researcher (senior author JO).

Data Extraction and Synthesis

Data were extracted from the records that were eligible through full-text review and charted into 2 tables according to the following headings: author, year of publication, participant characteristics (study location and study population), intervention characteristics (platform and techniques and functions), and study characteristics (design, mental health conditions, and outcomes) in the first table and discussions on fidelity (either in relation to the original in-person or paper-based format or ensuring adherence by lay health workers to the intervention protocol), usability (both quantitative and qualitative explorations), cultural adaptation (of DMHIs to the local cultural context), and challenges to and facilitators of the interventions’ uptake in LMICs in the second table. Findings across the discussions are presented using numerical counts accompanied by descriptive text. See for the PRISMA-ScR checklist.

ResultsArticle Selection

The searches of PubMed and PsycINFO were conducted on March 13, 2025. shows the PRISMA flowchart for the full record selection process. A total of 1010 records were returned, and after the removal of 6 (0.59%) duplicates, 1004 (99.41%) were included for screening. After performing a title and abstract review, 20.92% (210/1004) of the articles were included for full-text review based on our inclusion criteria. A total of 79.08% (794/1004) of the articles, which did not meet the inclusion criteria, were excluded from full-text review. Of the 210 articles included for full-text review, 2 (1%) were not retrieved as the full text was not available.

After completing the full-text review of the 208 available articles, a total of 80 (38.5%) records were included in the final analysis. This included 80% (64/80) original research articles, 15% (12/80) protocol papers, and 5% (4/80) literature reviews (1/4, 25% scoping reviews [] and 3/4, 75% systematic reviews [-]). Reasons for exclusion of articles at full-text review that did not meet the inclusion criteria (128/280, 45.7%) were recorded and reported in . The most common reasons for exclusion were focus on another topic (eg, app use in general), lack of a DMHI (eg, therapists using video or telephone to deliver regular counseling without an accompanying app or online platform), results from reviews (global focused) combined without data from LMICs being reported separately, focus on mental health in general, and no description of the use of a DMHI. A quality appraisal was not conducted considering the nature of this rapid scoping review, which did not focus on an examination of the effectiveness of the DMHIs, along with the emergent nature of the literature. The examinations of fidelity and usability were reviewed and described independent of whether there was an exploration of intervention effectiveness and, if there was, whether the intervention was effective.

‎Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart for this rapid scoping review. DMHI: digital mental health intervention; LMIC: low- and middle-income country. Study Characteristics

presents the main characteristics of the studies included in the rapid scoping review. Six main DMHI platforms were identified: (1) mobile app (software app used on a mobile device such as a smartphone or tablet), (2) web-based program (intervention delivered on the web through an internet-connected device), (3) virtual reality (VR; involved the immersion of the user in simulated and controlled computer environments []), (4) videoconferencing (intervention delivered via video through an online platform; eg, Google Meet and Zoom), (5) telemedicine (intervention delivered via phone calls or text through an instant messaging app [eg, WhatsApp] that went beyond the usual psychoeducation delivered by therapists by incorporating additional components such as educational videos and relaxation music), and (6) social media–based interventions (delivered through a social media platform; eg, Facebook).

Table 1. Summary of the included articles (participant characteristics, intervention characteristics, and study characteristics).StudyParticipant characteristicsIntervention characteristicsStudy characteristics
LocationPopulationPlatformTechniques and functionsDesignMental health condition, with results where applicableAalaei et al [], 2021IranHospitalized patients who tested positive for COVID-19 at Imam Reza Hospital in Mashhad (N=112)Mobile phone appMobile-based psychological counseling and health status monitoringProtocol RCTa—2 parallel groupsDepression and anxietyAbbasalizadeh et al [], 2024IranICUb nurses from 2 Tehran hospitals (N=60)Android smartphone appResilience training developed based on the microlearning educational methodRCT—single blindedAnxiety and stress; significant reductions in stress from 10.77 on DASS-21c (SD 3.33) to 9.00 (SD 1.66; P=.001) and in anxiety from 9.43 on DASS-21s (SD 3.35) to 7.93 (SD 0.98; P<.001)Abi Ramia et al [], 2023LebanonParticipants from 2 previous RCTs that demonstrated effectiveness of the intervention, staff members, and external stakeholdersDigital intervention (SbSd) delivered through an app or websiteGuided self-help interventionQualitative study involving key informant interviewsDepression; high level of acceptability of SbS among Lebanese and Syrian participantsAkbari et al [], 2022IranHome-isolated patients with COVID-19 visiting Sina Hospital, Hamadan (N=60)WhatsApp messages and instructional videosVirtual training of relaxation techniques via WhatsApp messages and instructional videos in the form of 8 educational messages, delivered onlineRCT—2 group, parallelAnxiety; relaxation techniques were effective in reducing anxiety among patients with COVID-19Akhtar et al [], 2024PakistanCommunity health workers (LHWse; N=44)Mobile app (mPareshan)3 segments: tracking, counseling, and referral; LHWs facilitated psychoeducation through audio and video featuresQualitative study involving focus groups and interviewsDepressionAlavi and Hirji [], 2020IranGeneral population with a Generalized Anxiety Disorder diagnosis from a psychiatrist (N=152)Computer-based intervention delivered via emailWeekly (×12) e-CBTf intervention modules and homework assignments delivered via email, with structured support from trained cliniciansRCTAnxiety (generalized); a mixed model ANOVA showed a significant difference between the groups and BAIg evaluation periods (F3,57=101.5, P<.001).Al-Badiri et al [], 2024IraqRegistered nurses at Al-Alhamzeh General Hospital (N=72)iMBSRhGuided mindfulness exercises, reflective discussions, and educational materials delivered over 8 sessionsSemiexperiment with a pretest-posttest designDepression; a nonsignificant decrease in PHQ-15i mean scores in the iMBSR group from 9.19 (SD 3.07) to 7.58 (SD 3.61; P=.17)Alishahi et al [], 2025IranPatients undergoing hemodialysis at Montaserieh Hospital (N=72)Mobile appRecreational therapy mobile app comprising programs such as music, comedy movies, exercise routines, and educational question-and-answer gamesRCTDepression; the intervention group showed a significant decrease in depression scores compared to the control group (mean BDI-IIj score reduction in the intervention group 10.3, SD 4.1; mean score reduction in the control group 4.6, SD 3.8; P<.001)Amer et al [], 2023EgyptAdults aged ≥18 y from Mansoura University’s Faculty of Computers and Information (N=5)Mobile app (Sokoon)Gamified CBT app focused on 7 intervention skills: relaxation, gratitude, self-compassion, problem-solving, social skills, BAk, and cognitive restructuringPilot studyDepression and anxiety; anxiety symptoms decreased from the pretest (mean GAD-7l score of 10, SD 0.7) to the posttest (mean 4.2, SD 1.5), and depressive symptoms decreased from a mean PHQ-9m score of 10 (SD 2.05) to a mean of 6 (SD 1.7)Amer et al [], 2024EgyptAdults aged ≥18 y from Mansoura University’s Faculty of Computers and Information (N=30)Mobile app (Sokoon)CBT app that incorporated techniques such as Hexad theory, gamification, and dynamic difficulty adjustmentSingle-group pretest-posttest designDepression and anxiety; positive impact on reducing symptoms of depression and anxietyAraya et al [], 2021BrazilPatients with depressive symptoms with comorbid hypertension or diabetes (n=880 in Brazil; n=432 in Peru)Smartphone interventionLow-intensity smartphone intervention delivered through 18 sessions over 6 wk; based on BA and supported by nurse assistants2 RCTs; 1 cluster randomized in Brazil and 1 individual-level randomized in PeruDepression; significantly improved depression symptoms at 3 mo; effect size small in Brazil, and effects were not sustained at 6 moAtif et al [], 2022PakistanWomen living in resource-poor rural communities (n=3) and peer delivery agents (n=3)Tablet- or smartphone-based app (Thinking Healthy Programme)CBT intervention delivered by a virtual avatar therapist that was operated by a lay peer; the peer and the avatar acted as cotherapistsUsability testing studyDepression (perinatal)Bhardwaj et al [], 2025IndiaFamily caregivers of persons living with dementiaMobile appCBT-based psychoeducational intervention developed based on the WHOn iSupport program delivered in 10 weekly sessions; ASHAso will be trained to deliver the interventionProtocol community-based cluster RCTDepressionBhargav et al [], 2024IndiaIndividuals with a COVID-19 positive test from an NABLp-approved laboratory who also reported at least a moderate level of stress (a score of ≥14 on the PSSq; N=86)Tele-yogaTele-yoga intervention delivered via videoconference supervised by trained yoga therapistsProspective, multicenter, open-label single-arm studyDepression and anxiety; anxiety improved significantly at wk 4, and the improvements were sustained at wk 16Bhat et al [], 2023IndiaWomen in self-help groupsTablet app (MITHRAr)MITHRA for depression screening (PHQ-9m and brief intervention [HAPs modules])Protocol—focus groupsDepressionvan Heerden et al [], 2021NepalLay counselors caring for adolescent mothers with depressionPlatform (StandStrong) comprising the StandStrong counselor mobile app and a cloud-based processing systemApp visualized passively collected GPS, proximity, and activity data; lay counselors used the app to discuss mothers’ behavioral patterns and clinical progress over the 5-wk interventionApp development paperDepression (maternal)Chand et al [], 2024IndiaIndividuals from the Indian Institute of Technology Mandi (N=44)VRt—musicRaga Bhairavi, an Indian classical music, administered via 360° video in a VR environment for 6 d (each session lasting 15 min)RCT—between-group repeated measuresDepression and anxiety; all DASS-21 subscales significantly improved; a post hoc test showed that the anxiety and depression levels were significantly lower for the treatment group after 6 d of treatment (anxiety: t21=5.77, P<.001, and Cohen dz=1.04; depression: t21=5.16, P<.001, and Cohen dz=1.16)Chau et al [], 2023VietnamAdults aged ≥18 y in community-based settingsSmartphone app (Vmood)Supported self-management based on CBT principles with supportive coaching from a social worker delivered via chat through an appProtocol RCT—stepped wedgeDepression and anxietyCuijpers et al [], 2022LebanonPeople with depression residing in Lebanon (N=680)Internet-connected device (SbS)5-session depression intervention; provided psychoeducation and training in BA through an illustrated narrative delivered with guidance from nonspecialist helpersRCT—single blind, 2 arm, pragmaticDepression; ITTu analyses showed effects on depression (SMDv 0.71, 95% CI 0.45-0.97) and impaired functioning (SMD 0.43, 95% CI 0.21-0.65)Cuijpers et al [], 2022LebanonSyrian refugees living in Lebanon (N=569)Internet-connected device (SbS)5-session depression intervention; provided psychoeducation and training in BA through an illustrated narrative delivered with guidance from nonspecialist helpersRCT—single blind, 2 arm, pragmaticDepression; ITT analyses showed significant treatment effects for both primary outcomes, depression (moderate) and functional impairment (moderate), and significant effects on anxietyDambi et al [], 2022ZimbabweGeneral population (N=176)Digital intervention delivered via web application or mobile app (Inuka)A chat-based digital application; participants received 6 problem-solving therapy sessions delivered by lay counselorsFeasibility study—pragmatic quasi-experimental designCMDsw, including depression and anxietyDoosti et al [], 2024IranPatients with gynecological cancer referred to educational and therapeutic centers affiliated with the Shahrekord University of Medical Sciences (N=70)Mobile appMain menu featured various options (eg, entering clinical data, receiving weekly patient status reports, and virtual consultations with nurses); users could easily interact with the researcher through a message box iconRCT—2 group, pretest-posttestAnxiety; state anxiety scores significantly decreased in the intervention group from 51.64 (SD 14.97) to 40.20 (SD 11.70) at the follow-up, and trait anxiety scores in the intervention group decreased significantly from 49.91 (SD 14.96) to 39.82 (SD 10.28), whereas the scores of the control group worsenedDosani et al [], 2020LMICsxWomenVariousVariousScoping reviewDepression (perinatal); 12 articles met the inclusion criteria; results revealed that minimal literature is currently available on the use of mHealthy for perinatal depression in LMICsEbrahimi et al [], 2025IranPatients with ailurophobia referred to the outpatient clinic of Ibn Sina Specialized Hospital and psychiatry and psychology clinics in Mashhad (N=28)Two interventions: (1) VR and (2) metacognitive sessionsVR sessions with images of cats; metacognitive sessions that evaluated symptoms, recognized cognitive errors, and corrected beliefsRCTAnxiety (ailurophobia); statistically significant difference between the average anxiety score of the 2 groups (VR and metacognitive therapy; P˂.001); anxiety score was significantly reduced in the VR groupFu et al [], 2020LMICsVariousmHealthVariousSystematic review and meta-analysis22 studies were included; digital psychological interventions, which have been mostly studied with depression and substance misuse, were superior to control conditions, including usual care, and were moderately effective in LMICsGanjekar et al [], 2024IndiaPregnant women from 3 tertiary care hospitals (N=162)Web-based pregnancy tele-yoga moduleTele-yoga delivered and monitored through an online platform over 4 wkMulticentric, open-label, exploratory studyDepression and anxiety; anxiety symptoms persisted in 19 (19.78%) women, and depression persisted in 10 (10.41%) women; after the intervention, none of the pregnant women reported severe symptomsGautama et al [], 2024IndonesiaPatients with cancer undergoing chemotherapy (N=99)SVRz relaxation intervention10-min immersive VR experience featuring 360° natural scenery videos with relaxing sounds delivered through YouTube via a smartphoneRCT—prospective, 2 armAnxiety; the SVR group reported significantly reduced anxiety (P=.01; Cohen d=0.50) compared to the control groupGhanbari et al [], 2021IranWomen with nonmetastatic breast cancer aged 20-60 y (N=82)Smartphone app (BCSzone) and online support groupGuided self-management psychoeducational intervention delivered through BCSzone along with nurse-assisted online mobile support sessions delivered through WhatsApp over a total of 4 wkRCT—unblindedAnxiety; statistically significant differences between the mobile psychoeducation group and controls (P<.001); the paired t test for mean scores of anxiety showed significant reductionsGonsalves et al [], 2022IndiaSecondary school students (N=11)Smartphone app (POD Adventures)Gamified problem-solving intervention supported by nonspecialist counselors via phoneParallel, 2-arm, individually randomized controlled pilot trialDepression and anxiety; no intervention arm participants completed the intervention because participants could not be reachedGreen et al [], 2020KenyaPregnant women and new mothers recruited from public hospitals (N=41)Tablet or smartphone app (Healthy Moms)Task-sharing Thinking Healthy program adapted for automated delivery via a mobile phone or tablet; used an existing AIaa system called Tess (Zuri in Kenya) to drive conversations with usersPrepilot study; single-case experimental designDepression (perinatal); authors estimated that using the alpha version of the app may have led to a 7% improvement in moodGupta et al [], 2022IndiaHealth care providers from a tertiary care medical center (N=202)Web basedTwo groups: (1) Raja yoga meditation—structured module of Raja yoga for 3 mo taught by a qualified teacher and (2) stress management counseling—dedicated trainer who counseled and taught 7 steps for managing stress for 3 moProspective observational studyDepression and anxiety; practice of Raja yoga meditation for 12 wk resulted in significant decrease in DASS-21 score (−45.00 at baseline and −24.2 at 12 wk; P<.001); no significant decrease was observed in the DASS-21 score in the stress management counseling group at 12 wk of follow-upIravani et al [], 2023IranPregnant women from health centers (N=104)TelemedicineCounseling services delivered by a researcher through telephone conversations; SMS text messages; and apps such as WhatsApp, Telegram, and Instagram over a 2-mo period; educational video clips were provided through a mobile appQuasi-experimental studyAnxiety; health anxiety scores of pregnant women in the control group were significantly higher than those of pregnant women in the experimental group; the mean scores of pregnancy-related anxiety in the control group were significantly higher than those in the intervention groupJannati et al [], 2020IranWomen aged ≥18 y who attended health care centers in Kerman, Iran (N=75)Mobile phone app (Happy Mom)CBT app consisting of 8 lessons conducted over 8 wk; participants followed the story of women with PPDab and learned how they managed their symptoms, which they could apply to their own livesNonblinded parallel-group RCTDepression (post partum); average Edinburgh Postnatal Depression Scale score after the intervention was 8.18 in the intervention group and 15.05 in the control group, which was statistically significantly different (P<.001)Kanuri et al [], 2020IndiaCollege studentsOnline intervention (Mana Maali Digital Anxiety Program)Culturally and digitally adapted evidence-based CBT intervention delivered over 20 sessions for anxietyInitial usability, acceptability, and feasibility examinationGAD; results indicated high usability, with the average rating ranking in the top 10% of general usability scoresKim et al [], 2023LMICsGeneral populationDigital mental health toolsVariousSystematic review and meta-analysisDepression and anxiety; 80 studies included in the meta-analysis and 96 studies included in the systematic review; digital mental health tools were moderately to highly effective in reducing depression and anxiety symptoms in LMICsKola et al [], 2022NigeriaAdolescent mothers (n=17) and maternal health care providers with experience in perinatal depression (n=25) who were participants of a previous clinical trial called EXPONATEacMobile phone interventionDesign of the EXPONATE intervention, which incorporated the treatment specifications of the WHO mhGAP-IGad; 4 components: parenting skill training, problem-solving, psychoeducation, and use of available social supportFocus groupsDepression (perinatal); focus group discussions showed that 70% of the barriers identified related to the inner setting and the characteristics of individuals in the intervention (eg, clinicians’ knowledge deficit on the care of young mothers with depression and young mothers’ lack of interest in motherhood)Kusumadewi et al [], 2025IndonesiaMedical students from Gadjah Mada University, Yogyakarta (N=66)Smartphone appApp using asynchronous digital cognitive education divided into 3 parts, including information, therapy (based on Beckian cognitive therapy), and daily journal sectionsRCT—nonblindedAnxiety; significant effect on reducing anxiety scores from the second to the eighth wkLahti et al [], 2020South Africa and ZambiaHigher education institute academics and PHCae practitioners in 3 provinces in South Africa and 2 provinces in ZambiaMobile appScreening tool to be used in PHC settingsProtocol; mixed methods multisite designDepressionLogie et al [], 2021UgandaUrban refugee and displaced youths aged 16-24 yVR and GPM+afVR-only arm: immersive, interactive 15-min VR session that integrated mental health literacy, psychological first aid, and mindful self-compassion; VR and GPM+ intervention: VR intervention and GPM+, (WHO brief psychological intervention) delivered over 5 group sessions by peer navigatorsProtocol; 3-arm cluster RCTDepressionLuitel et al [], 2023NepalPrimary HCWsag trained in using the WHO mhGAPah mobile app in Jhapa (N=15)Smartphone app (WHO e-version of the mhGAP)The WHO launched the e-version of the mhGAP in 2017; 8 modules to address key priority mental health conditions, including depressionQualitativeMental health, including depression; HCWs found the app helpful to verify and confirm their assessment and diagnosisMaharjan et al [], 2021NepalAdolescent and young mothers with (n=11) and without (n=27) depressionSmartphone app (StandStrong)Through a (1) smartphone app and (2) Bluetooth beacon, sensing data were passively collected on mothers’ geographic movement, physical activity, and audio environment and mother-infant proximityFeasibility studyDepressionMazhari et al [], 2022IranInpatients with COVID-19 at Afzalipour Hospital (N=200)Web-based eHealth interventionA questionnaire administered via WhatsApp; after 2 d, the psychiatric resident video called those who completed the questionnaire to assess depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale)Cross-sectional descriptive studyDepression and anxiety; this study examined the agreement between the online self-assessment and psychiatric telephone interview among survivors of COVID-19 regarding depression and anxiety; agreement between the online self-assessment and telephone interview was not significantMoulaei et al [], 2023IranPatients with depression and anxiety disorders from Kerman University of Medical SciencesMobile appSelf-management of depression and anxiety disordersApp development paperDepression and anxietyMukherjee et al [], 2024IndiaAdolescents living in 60 slum clusters spread across New Delhi and VijayawadaMobile appTwo components: (1) antistigma campaign and (2) mobile-based self-care appApp development paperDepression and anxietyMuniswamy et al [], 2022IndiaRemotely working software professionals in IT firms who were low in physical and mental health (N=160)Social media (Facebook)–based FIITaiModules provided via weekly Facebook messages focused on factors affecting sedentary behavior and mental health delivered over 8 wk; personal telehealth consultations delivered by experts via a chat boxRCT—2 phases, pragmaticAnxiety and depression; significant difference in the scores for stress and anxiety within and between the groups but only within the groups for depressionNabunya et al [], 2024UgandaYouths aged 14-17 y who were HIV positive and receiving care and ARTaj from one of the participating clinics and living within a familyMobile intervention (Suubi-Mhealth)Educational content incorporated recommendations for CBT for ART adherence and depression as applied to HIV medication adherence; content was broken down into 20 modulesProtocol—pilot RCTDepressionNajafi et al [], 2023IranFemale individuals with RRMSak recruited through the local MSal association (N=45)Online visual platforms: Google Meet, Zoom, and InstagramOnline supervised tele-yoga and tele-Pilates intervention sessions delivered 3 times a wk over 8 wk; certified instructors provided supervisionRCT—single blindDepression; significant improvements were observed in depression (P=.001)Najafi et al [], 2023Iran82 people with either RRMS or SPMSam from the Shiraz University of Medical Sciences (N=82)Tele-Pilates and tele-yoga trainingOnline supervised tele-yoga and tele-Pilates intervention sessions delivered 3 times a wk over 8 wk; certified instructors provided supervisionRCTDepression; significant time × group interactions were observed for mental health (P=.05), as well as a decline in depression (P=.002); post hoc analysis showed depression improvements for both interventions, but these were not statistically significant (P>.05)Naveen et al [], 2024IndiaHCWs working at AIIMSan, Jodhpur on COVID-19 duty (N=90)Tele-yogaModule contained loosening practices, breathing practices, Surya Namaskar, Kapalabhati Kriya, pranayama, and relaxation techniquesRCTDepression and anxiety; no significant difference in depression scores at endline; anxiety scores were significantly lower among the tele-yoga group than among control group participants (P<.05) at endline; the effect size was medium (r=0.3-0.5), favoring the intervention groupNjoroge et al [], 2023KenyaHCWs from 5 health care facilitiesMobile appWeighted sensor stream signatures that predicted near-term risk of a major depressive episode and future mood; deployment of a mobile app platform and use of novel analytic approaches (AI and machine learning)Feasibility studyDepressionNurbaeti et al [], 2021IndonesiaConvenience sample of postpartum mothersSmartphone app (IMSDao)IMSD app sought to detect PPD symptoms earlyApp development and RCTDepression (PPD)Nwaogu et al [], 2021NigeriaConstruction personnel—site supervisors and project managers based on a log collected from the Nigerian Institute of Building (N=62)DMHIap (various)VariousOpen-ended survey—qualitative techniqueAnxiety and depression; DMHIs used by respondents included mobile-based apps (14/24, 58%) and web-based applications (10/24, 42%) for stress, depression, anxiety management, and mental fitnessOfoegbu et al [], 2020NigeriaEducational technology students of Nigerian universities identified as having depression (N=192)Internet-delivered intervention (GIAIaq)Initial support session via telephone and regular guidance from the therapists (clinical staff of the federal universities) via telephone and the internet over 10 wkGroup-randomized trialDepression; significant reduction in depression among students in the treatment group when compared to those in the usual care control groupPasyar et al [], 2023IranPatients with systemic lupus erythematosus referred to the Hafez clinic affiliated with Shiraz University of Medical Sciences (N=124)Smartphone-based supportive counselingDaily supportive counseling using text and multimedia messages for 8 wk delivered via a WhatsApp channel; feedback and questions could be sent to research team membersRCT—pretest-posttestAnxiety (health); the level of health anxiety (MDar 11.34; P<.001) of the experimental group was significantly lower than that of the control groupPatel et al [], 2021FijiCHNsas (N=48)mHealth app (ASRaDAat)Guidelines from the CES-Dau and the SBQ-Rav for suicide were programmed into ASRaDA and provided onlineExperimental designDepression; CHNs took less time to process patient information with more accurate diagnostic and therapeutic decisions compared with the paper-based or no-guideline conditionsPozuelo et al [], 2023South Africa and UgandaAdolescents in rural South Africa and Uganda (N=160)Smartphone app (Kuamsha)App delivered BA using storytelling techniques and game design; each story consisted of 6 modules, with each covering different BA skills; included support via phone callsApp development paper—iterative user-centered agile designDepressionPutri et al [], 2022IndonesiaParticipants who used 8 of the most popular Android mHealth platformsmHealth platformsTeleconsultation focusMysterious shopping approachDepressionRabbani et al [], 2024PakistanLHWs (n=72) and screen-positive participants (residents who were aged ≥18 y; n=366)Mobile appCounseling intervention consisting of tracking, counseling, and referral segments delivered by LHWsProtocol single-arm, pretest-posttest implementation research trialDepression and anxietyRamnath and Suri [], 2021IndiaGeneral population of patients both with and without COVID-19Smartphone appOnline survey explored the needs of individuals with depression in India, and a systematic evaluation of depression apps currently available investigated user needsOnline survey+systematic evaluationDepressionRoshid et al [], 2024BangladeshInformal female caregivers of patients with cancer in BangladeshmHealth psychoeducation and BRTawUsed self-determination theory and the BRT; included 6 sessions over 6 mo where recorded videos would be provided face-to-face or via a digital deviceProtocol RCT—prospective, open label, 2 arm (1:1)Anxiety and depressionSafaei et al [], 2024IranPatients undergoing angiography from 2 hospitals affiliated with Kerman University of Medical Sciences (N=70)Mobile appApp with 13 sections that addressed various aspects of the patient journey, providing comprehensive support and guidance throughout and after the angiography processInterventional studyAnxiety; significant decrease in average anxiety scores (P<.001)Saleem et al [], 2025PakistanLHWs (N=40)Mobile app (TA-PM+ax)App that guided LHWs to deliver the intervention in a systematic manner; included 5 informational videosCoproduction and usability studyDepression and anxiety; usability testing results: the mean MAUQay score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2, demonstrating the system’s overall usefulnessTaylor Salisbury et al [], 2021Nepal and NigeriaPrimary care workers and patients from approximately 20 PHC clinics in Nepal and 6 PHC clinics in NigeriaMobile app (WHO-updated e-mhGAP-IG)App for diagnosis and management of depression; featured a reference mode for training and a patient mode for assessmentsFeasibility studyDepressionSarpourian et al [], 2022IranStudents at the undergraduate, postgraduate, and PhD levels from the Kerman University of Medical Sciences and Shiraz University of Medical Sciences (N=30)VR and counseling therapyParticipants observed 4 virtual classroom scenarios in a 30‐min session, which included a virtual classroom and comprised 4 partsQuasi-experimental studyAnxiety (public speaking); VR and counseling did not affect students’ SAaz, but they reduced PSAbaSeddigh et al [], 2023IranAdolescent girls with type 1 diabetes who had a clinical record at Shiraz’s Imam Reza diabetes clinic (N=62)Yoga therapy via virtual trainingEight 60-min sessions (1 online and 7 offline) of yogic practices held for 8 consecutive wk through Adobe Connect Reader for 90 minRCTDepression; the mean of the depression total score was significantly lower in the experimental arm; the reduction in mean change from baseline to the trial end was significantly higher in the experimental armSetiawan et al [], 2025IndonesiaPatients diagnosed with thalassemia from a general hospital in the Priangan Timur region (N=80)Mobile app (Cyber Gen)Genetic counseling delivered through the chat feature on an Android-based mobile app (Cyber Gen) conducted in 3 separate sessionsRCTDepression and anxiety; depression and anxiety in the intervention group showed significant changes across all observed periods (P<.001), with a large effect size (Cohen d>0.8)Shania et al [], 2023IndonesiaAdolescentsMobile appApp included a mood tracker, activity target, and meditation, along with supporting features (educational articles) and early detection featuresMixed methods to design an mHealth interventionDepressionShaygan et al [], 2023IranPatients with COVID-19 in home quarantine (N=72)Telephone interventionVideos, audio files, and educational texts regarding mental health, coping strategies, positive thinking, hope, and spiritual well‑being; interventions were provided daily for 14 d