Ecological momentary interventions for depression: A systematic review and meta-analysis

Depression remains a prevalent condition with many individuals experiencing residual symptoms despite standard treatments. Ecological momentary interventions (EMIs) offer real-time, ecologically-valid microinterventions, yet their clinical utility and implementation challenges in depression remain underexplored.

A systematic search of six databases (inception to 25 July 2025) identified randomised controlled trials (RCTs) evaluating EMIs for depression. Pooled effect sizes assessed differences relative to comparator conditions.

Sixteen RCTs involving 1258 participants were included. EMIs significantly reduced depressive symptoms at posttest (Hedges' g = 0.57; 95% CI = 0.33-0.80; p < 0.001) and at follow-up ranging from 10 to 32 weeks (Hedges' g = 0.43). High heterogeneity reflected variability in EMI formats. EMIs also showed a statistically significant improvement in quality of life (Hedges' g = 0.44; 95% CI = 0.17-0.71; p < 0.01), supporting their broader impact beyond symptom reduction. Engagement averaged 64.91% (SD = 17.18), ranging 37.5%- 88.0%, with variation across reporting methods. Acceptability and usability ratings were consistently high. Intervention dosage and risk of bias were significant moderators of treatment efficacy. Subgroup analyses revealed greater benefits from EMIs incorporating psychoeducation and active practice, and fully-automated formats.

The review highlights EMI efficacy in reducing depressive symptoms and improving quality of life, with intervention dosage and methodological rigor emerging as key moderating factors. Reporting engagement remains a challenge, and substantial heterogeneity underscores the need for refined trial designs to isolate the active EMI components to best optimise treatment outcomes in depression. Future studies should prioritise strategies strengthen methodological rigor and optimising user engagement. PROSPERO No. CRD420251105663.