Digital and AI-Enabled Psychological Interventions for Depression and Anxiety in Sub-Saharan Africa: A Systematic Review
Keywords:
digital mental health; artificial intelligence; depression; anxiety; sub-Saharan Africa; systematic reviewAbstract
Background: Depression and anxiety are leading causes of disability in sub-Saharan Africa, where specialist care is scarce. Digital and artificial intelligence (AI)-enabled psychological interventions are proposed to widen access, but the regional evidence has not been synthesised.
Objective: To review the effectiveness, engagement and safety of digital and AI-enabled psychological interventions for depression and anxiety in sub-Saharan Africa.
Methods: Twenty-eight targeted web searches were ran (last run 20 October 2026; no bibliographic databases were searched directly) and screened candidate reports against pre-set criteria. One reviewer screened studies, extracted data and made provisional risk-of-bias judgements without independent verification. The review was not registered. Results were synthesised narratively (SWiM), because too few trials had comparable data to pool.
Results: Ten studies from six countries (about 3,157 participants) were included: six randomised and four non-randomised. Delivery modes were smartphone apps (3), web or computer programmes (2), chatbots (2), chat-based therapy (1), live online groups (2 arms in 2 studies) and phone-based counselling (1). Only one study used an AI-enabled component, and a second chatbot was scripted. Among randomised trials, three showed benefit for depression (Kenya, Malawi, South Africa), one pilot showed none (South Africa), one reported benefit with no numbers (Nigeria), and one preprint reported benefit but contained internal inconsistencies (Uganda). Anxiety effects were mostly non-significant. Attrition was high in self-guided tools: only 5% of users in one app study stayed to 12 weeks, and retention was 29–40% in a chatbot trial. Phone counselling by lay counsellors retained 76–83% of participants. Risk of bias was high or serious in most studies, and certainty of evidence was very low.
Conclusions: Evidence on digital interventions for depression and anxiety in sub-Saharan Africa is small, uneven and mostly of low quality, and evidence on AI-enabled tools is almost absent. Human-supported delivery appears to retain users better, but this is not tested directly. Larger preregistered African trials with safety reporting are needed.
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