Copyright: Luisella Planeta Leoni
License: Licensed by JMIR
April 29, 2021: An increasing number of digital mental health interventions are being designed for adolescents and young people with a range of mental health issues, but the evidence regarding their effectiveness is mixed, research by Columbia University Mailman School of Public Health and Spark Street Advisors has found.
According to researchers, computerized cognitive behavioral therapy was found to be effective for anxiety and depression in adolescents and young people, holding promise for increasing access to mental health treatment for these conditions. However, the effectiveness of other digital interventions, including therapeutic video games, mobile apps, and social networking sites, and addressing a range of other mental health outcomes remain inconclusive. The findings are being published on the web in the open access journal JMIR Mental Health.
“While there is evidence that some interventions can be effective when delivered digitally, it is still somewhat of a Wild West when it comes to digital mental health apps,” said Nina Schwalbe, adjunct assistant professor of Population and Family Health at Columbia Mailman School.
The researchers conducted a systematic overview of 18 systematic reviews and meta-analyses of digital health interventions. In addition to the findings on computerized cognitive behavioral therapy, some therapeutic areas of digital interventions improved outcomes relative to controls who were on the waitlist for services, suggesting that the interventions can be used for supplementing and supplanting traditional mental health treatment in cases when access to care is limited or wait times to access care are long.
The researchers point out that the vast majority of interventions studied—over 90%—are implemented in high-income countries, and very little information is provided about the background of the participants. Therefore, the generalizability of the findings to young people from different socioeconomic, cultural, racial, or other communities is weak.
“There was also no indication of costs of developing the tools or long-term benefits,” noted Susanna Lehtimaki of Spark Street Advisors. “Moving forward with effective digital health interventions, it will be important to understand how they fit within the public health ecosystem and to what extent they are effective across a range of settings with different resources or populations.”
According to the research, digital mental health interventions were well accepted by people 10-24 years of age; however, dropout was common and adherence was weak. Engagement of a health professional, peer, or parent as part of a digital intervention was found to strengthen its effectiveness.
Schwalbe notes, “We were surprised that there was so little reporting of how these applications are developed, cost or cost-benefit analysis, or whether or not they had even engaged adolescents in the design and evaluation of the tool.” She advises: “As ‘digital natives,’ adolescents and young people are considered to prefer digital health services over in-person. However, we also need to ask from them whether this is true and better consider what type of services they actually prefer.”
Coauthors include Jana Martic, Spark Street Advisors; Brian Wahl, Spark Street Advisors and Bloomberg School of Public Health; and Katherine Foster, University of Washington.
Lehtimaki S, Martic J, Wahl B, Foster KT, Schwalbe N
Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview
JMIR Ment Health 2021;8(4):e25847