- Design
- Pooled service data and literature meta-analysis with indirect comparison
- Population
- More than 282,000 users of three Australian digital mental health services
- Primary outcome
- Change in anxiety and depression symptom scores
- Effect
- Clinician-supported Cohen d 0.95 to 1.42; self-directed d 0.59
This study pooled routinely collected data, published and grey literature, and one service evaluation for three Australian government-funded digital mental health services: Mental Health Online, MindSpot and THIS WAY UP. Between 2013 and 2021 they reached more than 282,000 people with anxiety and depression.
Clinician-supported online courses produced large symptom improvements, with Cohen d of 0.95, 1.42 and 1.04 across the three services. Self-directed treatment in one service gave a moderate reduction in anxiety severity (d 0.59). Clinician-supported results were close to those of face-to-face, telephone and UK stepped-care comparators.
The comparison is indirect: these were different populations treated in different programmes, not a randomised head-to-head trial, and the authors flag substantial heterogeneity. For Indian practice, where waiting lists for psychotherapy are long, it supports guided internet-based CBT as a credible first step for mild to moderate anxiety and depression, provided a clinician stays involved.
- Consider guided internet-based CBT for mild to moderate anxiety or depression while awaiting therapy.
- Prefer programmes with clinician support; self-directed courses showed smaller effects.
- Review progress with a validated scale such as PHQ-9 or GAD-7 at four to six weeks.
- Keep face-to-face care for severe illness, suicidality or poor response.
Why it matters
Digital therapy is often treated as a lesser option, but supported versions performed close to in-person care.
Don't overread it
The comparisons were across different programmes and populations, not randomised against face-to-face therapy.
The statistics, in plain English
Cohen d measures the size of change in standard deviations: about 0.5 is moderate and 0.8 or more is large. Pre-post effect sizes like these include natural recovery and regression to the mean, so they overstate what the treatment itself added.
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