Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview

Abstract

Background An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. Objective This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). Methods We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. Results In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. Conclusions Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

Digital Mental Health Amid COVID-19

“…A systematic overview of meta-analyses and systematic reviews found digital mental health interventions for young people have reasonably positive effects [79]. The evidence of effectiveness was mostly found on anxiety and depression, and to a lesser extent on stress-the main concerns are evidence-based treatment content or in-person elements that may improve engagement [79].…”

“…A systematic overview of meta-analyses and systematic reviews found digital mental health interventions for young people have reasonably positive effects [79]. The evidence of effectiveness was mostly found on anxiety and depression, and to a lesser extent on stress-the main concerns are evidence-based treatment content or in-person elements that may improve engagement [79]. Only a small proportion of digital platforms are evidence-based-more needs to be known about the (cost-)effectiveness of the type of service provided, target subpopulation, and the current standard of care [79].…”

“…The evidence of effectiveness was mostly found on anxiety and depression, and to a lesser extent on stress-the main concerns are evidence-based treatment content or in-person elements that may improve engagement [79]. Only a small proportion of digital platforms are evidence-based-more needs to be known about the (cost-)effectiveness of the type of service provided, target subpopulation, and the current standard of care [79]. A systematic review also concluded there needs to be higher understanding of the (cost-)effectiveness of digital psychological interventions [80].…”

A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial

“…Simultaneously, reviews of digital mental health interventions consistently raise concerns about the accessibility of digital technologies among disadvantaged groups [ 11 ] and difficulties keeping users engaged even among groups with access to technology [ 12 ]. Though promising gamified approaches have recently emerged [ 12 , 13 ], evidence from low-resource settings is especially scare [ 14 , 15 ].…”

TreadWill: Development and pragmatic randomized controlled trial of an unguided, computerized cognitive behavioral therapy intervention in a lower middle-income country

“…Studies on cCBT interventions have been conducted predominantly in high-income countries (Lehtimaki et al, 2021), but see (Martínez et al, 2018) for depression and (Fu et al, 2020) for all mental health disorders in LMICs. A recent meta-analysis reported that 92% of the studies on diagnosed depression had been conducted in Western Europe, North America, or Australia (Köhnen et al, 2021).…”