Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part I. A Systematic Review of Socioemotional Outcomes and Recommendations

Updates on digital mental health interventions for children and young people: systematic overview of reviews

Digital mental health interventions (DMHIs) are increasingly recommended for children and young people (CYP) as a promising way to prevent and treat mental health problems. Here, we summarised and consolidated findings from existing systematic reviews to provide an overview of what is known, and which areas need further investigation. Systematic searches were conducted until January 2024 using PubMed, PsycINFO, MEDLINE, CINAHL, Scopus and Google Scholar. Records were screened against predefined criteria and quality assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews. A study protocol was co-developed with key stakeholders and registered on the Open Science Framework. From 941 records, 51 systematic reviews published between 2000 and 2023 of generally moderate quality, targeting CYP 0 to 25 years, were included in our narrative summary. DMHIs were delivered in a variety of ways, including online video calls, apps and various combinations, underpinned mostly by cognitive behaviour therapy. DMHIs supported different mental health problems, but mostly symptoms of anxiety and/or depression. Although generally effective, some studies reported mixed results with limited evidence when focusing on longer-term outcomes. Other benefits of DMHIs included reduced costs and time investments for families, and increased accessibility and acceptability of support. Practitioner preparedness and unclear ethics/safety measures were identified as factors impacting engagement and potential effectiveness. The findings suggest that DMHIs can be a valuable tool for supporting CYP. However, realising the full potential of DMHIs for all CYP may require more high-quality research utilising DMHIs that are diverse in theoretical underpinnings and target audiences.

Foundations of Pediatric Lifestyle Medicine

Background: Lifestyle medicine utilizes therapeutic interventions to prevent, treat, and reverse chronic diseases by promoting healthy habits. While extensively studied in adults, its application in pediatrics remains underexplored. Given that many chronic diseases originate in early life, establishing the foundations of Pediatric Lifestyle Medicine is essential. Methods: This paper presents a comprehensive literature review and clinical insights to assess the evidence supporting Pediatric Lifestyle Medicine and provide age-appropriate, evidence-based guidelines for children and adolescents. Results: Pediatric Lifestyle Medicine is an evidence-based healthcare discipline focused on promoting and maintaining children's health by encouraging healthy habits from an early age. This approach prevents chronic diseases, supports physical and emotional well-being, and fosters long-term quality of life. Findings show that applying its principles in childhood can prevent obesity, improve mental health, and aid in disease management, while also reducing the risk of adult-onset conditions and benefiting planetary health. Pediatric Lifestyle Medicine is based on six pillars: preventive nutrition, physical activity, sleep, stress management, positive social connections, and risk prevention, the last of which includes toxin avoidance and other childhood-specific risks, such as accident prevention and screen overuse. Conclusions: Pediatric Lifestyle Medicine provides a cost-effective, evidence-based framework for improving childhood health and preventing chronic conditions. Integrating these principles into pediatric care can foster lifelong health benefits, emphasizing the need for further research and implementation in medical education.

Exploring the Potential and Challenges of Digital and AI-Driven Psychotherapy for ADHD, OCD, Schizophrenia, and Substance Use Disorders: A Comprehensive Narrative Review

PURPOSE OF THE REVIEW

Psychotherapy remains a fundamental component of mental health treatment, yet it encounters significant barriers to accessibility and efficacy. The integration of digital therapies, encompassing e-Health, m-Health, and artificial intelligence (AI) offers the transformative potential to enhance therapeutic processes through automated systems that improve access and personalize treatment. This integration, however, involves complex considerations, including health-related quality of life (HRQoL) and the dynamics of the therapeutic alliance. This narrative review synthesizes current literature on the application of digital therapies in psychotherapy, with a focus on attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), schizophrenia, and substance use disorders (SUDs). The review evaluates the effectiveness of these interventions, their impact on HRQoL, therapeutic relationships, and the associated ethical considerations.

COLLECTION AND ANALYSIS OF DATA

Following Green's checklist for narrative reviews, a systematic literature review was conducted on studies published from January 2009 to May 2024. Inclusion criteria centered on digital therapies, including AI-based, Internet-based, and mobile-based interventions in psychotherapy. A total of 23 studies were analyzed.

CONCLUSIONS

The findings indicate that digital therapies hold substantial promise for enhancing therapeutic interventions across various mental health disorders, particularly through chatbots and Internet-based psychotherapy. However, successful integration requires careful attention to the therapeutic alliance, HRQoL, and ethical implications. This review highlights the significant potential of digital therapies, including AI-driven psychotherapy, in managing diverse mental health disorders. A balanced approach to integration, prioritizing patient well-being and addressing ethical complexities, is essential for optimizing treatment outcomes.

Working mechanisms of the use and acceptability of ecological momentary interventions: a realist evaluation of a guided self-help ecological momentary intervention targeting self-esteem

BACKGROUND

Technology improves accessibility of psychological interventions for youth. An ecological momentary intervention (EMI) is a digital intervention geared toward intervening in daily life to enhance the generalizability and ecological validity, and to be able to intervene in moments most needed. Identifying working mechanisms of the use of ecological momentary interventions might generate insights to improve interventions.

METHODS

The present study investigates the working mechanisms of the use and acceptability of an ecological momentary intervention, named SELFIE, targeting self-esteem in youth exposed to childhood trauma, and evaluates under what circumstances these mechanisms of use and acceptability do or do not come into play. A realist evaluation approach was used for developing initial program theories (data: expert interviews and a stakeholders focus group), and subsequently testing (data: 15 interviews with participants, a focus group with therapists, debriefing questionnaire), and refining them.

RESULTS

The SELFIE intervention is offered through a smartphone application enabling constant availability of the intervention and thereby increasing accessibility and feasibility. When the intervention was offered on their personal smartphone, this enhanced a sense of privacy and less hesitance in engaging with the app, leading to increased disclosure and active participation. Further, the smartphone application facilitates the practice of skills in daily life, supporting the repeated practice of exercises in different situations leading to the generalizability of the effect. Buffering against technical malfunction seemed important to decrease its possible negative effects.

CONCLUSIONS

This study enhanced our understanding of possible working mechanisms in EMIs, such as the constant availability supporting increased accessibility and feasibility, for which the use of the personal smartphone was experienced as a facilitating context. Hereby, the current study contributes to relatively limited research in this field. For the field to move forward, mechanisms of use, and acceptability of EMIs need to be understood. It is strongly recommended that alongside efficacy trials of an EMI on specific target mechanisms, a process evaluation is conducted investigating the working mechanisms of use.

TRIAL REGISTRATION

The current paper reports on a realist evaluation within the SELFIE trial (Netherlands Trial Register NL7129 (NTR7475)).

Outcomes of Best-Practice Guided Digital Mental Health Interventions for Youth and Young Adults with Emerging Symptoms: Part II. A Systematic Review of User Experience Outcomes

Although many young people demonstrate resilience and strength, research and clinical evidence highlight an upward trend in mental health concerns among those aged 12 to 25 years. Youth-specific digital mental health interventions (DMHIs) aim to address this trend by providing timely access to mental health support for young people (12-25 years). However, there is a considerable gap in understanding young people user experiences with digital interventions. This review, co-designed with Australia's leading mental health organization Beyond Blue, utilizes a systematic methodology to synthesize evidence on user experience in youth-oriented digital mental health interventions that are fully or partially guided. Five relevant online databases were searched for articles published from 2018 to 2023, yielding 22,482 articles for screening and 22 studies were included in the present analysis. User experience outcomes relating to satisfaction and engagement were assessed for each included intervention, with experience indicators relating to usefulness, usability, value, credibility, and desirability being examined. Elements associated with positive/negative outcomes were extracted. Elements shown to positively influence user experience included peer engagement, modern app-based delivery, asynchronous support, and personalized content. In contrast, users disliked static content, homework/log-keeping, the requirement for multiple devices, and social media integration. Asynchronous interventions showed high satisfaction but faced engagement issues, with combined asynchronous/synchronous interventions reporting better completion rates. DMHIs offer a promising platform for youth mental health support and has the potential to dramatically increase the reach of interventions through the adoption of technological and user experience best practices. While young people respond positively to many aspects of intervention modernization, such as interactive, app-based design, other concepts, such as social media integration, they need to be adopted by the field more cautiously to ensure trust and engagement.Trial Registration CRD42023405812.