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Background: A major challenge in providing mental health interventions for young people is making such interventions accessible and appealing to those most in need. Online and app-based forms of therapy for mental health are burgeoning. It is therefore crucial to identify features that are most effective and engaging for young users.Objectives: This study reports a systematic review and meta-analysis of digital mental health interventions and their effectiveness in addressing anxiety and depression in young people to determine factors that relate to outcomes, adherence, and engagement with such interventions.Methods: A mixed methods approach was taken, including a meta-analysis of 9 randomized controlled trials that compared use of a digital intervention for depression in young people to a no-intervention control group, and 6 comparing the intervention to an active control condition. A thematic analysis and narrative synthesis of 41 studies was also performed.Results: The pooled effect size of digital mental health interventions on depression in comparison to a no-intervention control was small (Cohen’s d = 0.33, 95% CI 0.11 to 0.55), while the pooled effect size of studies comparing an intervention group to an active control showed no significant differences (Cohen’s d = 0.14, 95% CI -.04 to 0.31). Pooled effect sizes were higher when supervision was involved (studies with no-intervention controls: Cohen’s d = 0.52, 95% CI 0.23 to 0.80; studies with active control: Cohen’s d = 0.49, 95% CI -0.11, 1.01). Engagement and adherence rates were low. Qualitative analysis revealed that users liked interventions with a game-like feel and relatable, interactive content. Educational materials were perceived as boring, and users were put off by non-appealing interfaces and technical glitches.Conclusions: Digital interventions work better than no intervention to improve depression in young people when results of different studies are pooled together. However, these interventions may only be of clinical significance when use is highly supervised. Digital interventions do not work better than active alternatives regardless of the level of support. Future interventions need to move beyond the use of digital educational materials, considering other ways to attract and engage young people and to ensure relevance and appeal.

Individual differences were investigated in an attempt to explain why some people are attracted to negative emotion (grief, sadness) in music. A 10-item Like Sad Music Scale (LSMS) was developed (Cronbach's a = .802) and compared against subscales measuring absorption, music empathy, rumination, reflectiveness and nostalgia-proneness. This was tested via an online survey, completed by 137 participants. It was hypothesized that absorption and reflectiveness would be correlated with the enjoyment of sad music and rumination would be correlated with an attraction to sad music although not necessarily an enjoyment of it. Consistent with previous findings, absorption was a good predictor of the LSMS and was particularly correlated with the enjoyment of strong emotions in connection with sad music. Rumination correlated with LSMS items 'helps release sadness' and 'can relate to sadness' while reflectiveness correlated with the item 'I often find myself grieving as a result of listening to sad music'. These correlations suggest both adaptive and maladaptive uses of sad music for mood manipulation. The results were presented with respect to the dissociation theory of aesthetic enjoyment, where participants with the capacity to enter states of absorption are able to deactivate displeasure circuits and hence enjoy negative emotion in music.

Despite the paradox inherent in the idea that sad music could make people happier, research indicates that an improved mood is amongst the primary motivations that people give for listening to sad music. However, it is not clear whether listeners are always able to achieve such aims. This article reports a study in which 335 participants listened to a piece of self-selected sad music. Before and aftermeasures of mood were taken, and participants also completed psychometric scales of rumination, absorption and reflectiveness. It was found that both ruminators and non-ruminators had significant increases in depression after listening to self-selected sad music. Furthermore, ruminators did not systematically report that they expected to benefit from listening to sad music, contrary to the literature. Results support the hypothesis that listening to sad music is related to maladaptive mood regulation strategies in some listeners.

D e p r e s s io n is o f t e n a s s o c ia t e d w i t h a r e d u c e d motivation to engage in behavior that will improve one's mood. This paper presents a study in which 175 university students listened to a self-selected piece of music on Youtube that made them sad. Post-and pre listening scores of depressed mood on the Profile of Mood States (POMS) were taken, as were measures of rumination and scores on the Like Sad Music Scale (LSMS). Results indicate that listening to sad music via this medium can significantly increase feelings of depression in people with a tendency to depression (as suggested by high rumination scores). Furthermore, people with a tendency to depression demonstrate a liking for such music despite the potentially unhealthy conse quences of listening to it. Music Perception, volume 32, is s u e 4, pp. 313-321, issn 0730-7829, e l e c t r o n ic issn 1533-8312. © 2015 by t h e r e g e n t s o f t h e u n iv e r s it y o f Ca l if o r n ia all RIGHTS RESERVED. PLEASE DIRECT ALL REQUESTS FOR PERMISSION TO PHOTOCOPY OR REPRODUCE ARTICLE CONTENT THROUGH THE UNIVERSITY OF CALIFORNIA PRESS'S rights and permissions website, http://www.ucpressjournals.com/ reprintinfo.asp.