What factors are related to engagement with digital mental health interventions (DMHIs)? A meta-analysis of 117...

Identifying correlates of engagement with digital mental health interventions (DMHIs) can guide strategies to encourage therapy skill practice in targeted subgroups, supporting precision mental health. This three-level robust variance estimation meta-analysis examined correlates of DMHI engagement across 117 studies (1698 effect sizes; 279,791 participants), classifying engagement as initial uptake, study-specific usage, and intervention completion. Women engaged more than men in both unadjusted (Cohen's d = 0.34, 95% CI [0.06, 0.62]) and adjusted models (r_p = 0.05 [0.01, 0.09]). Other positive correlates were past mental health problems, guided versus self-guided modality delivery, therapeutic relationship, and positive expectancy. Meta-regressions indicated that completion was associated with older age, higher education, employment, and lower stress. Uptake was related to higher socioeconomic status, greater motivation, and lower symptom severity; usage was linked to human guidance and common mental disorders versus other conditions. Longer treatment duration amplified the effects of therapeutic relationship and guidance on engagement. Nearly half (48.7%) of studies had low risk of bias; minimal publication bias did not alter findings. Persuasive design strategies could enhance male engagement. Practitioners and policymakers should prioritize coaching that fosters productive relationships, pre-intervention materials to set realistic expectations, and methods to reduce the high risk of bias in future DMHI research.