The effectiveness and cost-effectiveness of e-health interventions for depression and anxiety in primary care: A systematic review and meta-analysis

J Affect Disord. 2019 Feb 15;245:728-743. doi: 10.1016/j.jad.2018.11.050. Epub 2018 Nov 6.


Purpose: Psychological interventions are labor-intensive and expensive, but e-health interventions may support them in primary care. In this study, we systematically reviewed the effectiveness and cost-effectiveness of e-health interventions for depressive and anxiety symptoms and disorders in primary care.

Methods: We searched MEDLINE, Cochrane library, Embase, and PsychINFO until January 2018, for randomized controlled trials of e-health interventions for depression or anxiety in primary care. Two reviewers independently screened the identified publications, extracted data, and assessed risk of bias using the Cochrane Collaboration's tool.

Results: Out of 3617 publications, we included 14 that compared 33 treatments in 4183 participants. Overall, the methodological quality was poor to fair. The pooled effect size of e-health interventions was small (standardized mean difference = -0.19, 95%CI -0.31 to -0.06) for depression compared to control groups in the short-term, but this was maintained in the long-term (standardized mean difference = -0.22, 95%CI -0.35 to -0.09). Further analysis showed that e-health for depression had a small effect compared to care as usual and a moderate effect compared to waiting lists. One trial on anxiety showed no significant results. Four trials reported on cost-effectiveness.

Limitations: The trials studied different types of e-health interventions and had several risks of bias. Moreover, only one study was included for anxiety.

Conclusions: E-health interventions for depression have a small effect in primary care, with a moderate effect compared to waiting lists. The approach also appeared to be cost-effective for depression. However, we found no evidence for its effectiveness for anxiety.

Keywords: Anxiety; Cost-effectiveness; Depression; E-Health; Effectiveness; Primary care.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Anxiety / economics
  • Anxiety / therapy*
  • Cost-Benefit Analysis*
  • Depression / economics
  • Depression / therapy*
  • Humans
  • Primary Health Care / economics*
  • Randomized Controlled Trials as Topic
  • Telemedicine / economics*
  • Waiting Lists