Pilot evaluation to assess the effectiveness of youth peer community support via the Kooth online mental wellbeing website

Digital Mental Health Interventions for Young People Aged 16-25 Years: Scoping Review

BACKGROUND

Digital mental health interventions for young people offer a promising avenue for promoting mental well-being and addressing mental health issues in this population.

OBJECTIVE

This scoping review aims to explore the range of digital mental health interventions available for young people aged 16-25 years, with a particular focus on digital tool types, modalities, delivery formats, target populations, and study retention rates.

METHODS

The scoping review was conducted in 6 databases (PubMed, Web of Science, Scopus, MEDLINE, Cochrane Library, and PsychInfo). Studies were included if they were published from 2019 to 2024 in English, reported on a population of young people aged 16-25 years, and included validated mental health or well-being outcome measures. All types of digital interventions from promotion and prevention to treatment of mental health were included.

RESULTS

After screening 13,306 articles, 145 articles were included in the final review. The findings reveal a diverse landscape of studies, equally focusing on the prevention and promotion of mental health and the treatment of mental ill health, most commonly using cognitive behavioral therapy (63/145, 43.4%). The most common digital tools were apps (51/135, 37.8%), web-based resources (45/135, 33.3%), and websites (19/135, 14.1%). The results highlight the over emphasis on convenience sampling (140/145, 96.6%), with participants mainly recruited from universities or colleges, and a lack of representation from marginalized groups, including lesbian, gay, bisexual, transgender, and queer youth; those from socioeconomically deprived backgrounds; and those who are neurodivergent. Moreover, the focus on anxiety and depression leaves other mental health conditions underrepresented. Retention rates ranged from 16% to 100% and averaged 66% across all studies.

CONCLUSIONS

There is a need for more research on mental health promotion and prevention measures among those aged younger than 25 years as young people are at increased risk of mental health issues. This includes exploring different intervention approaches and modalities beyond cognitive behavioral therapy and ensuring inclusivity in study populations. Standardizing intervention durations and incorporating long-term follow-up data could provide valuable insights into the efficacy and effectiveness of digital interventions. Future studies should aim for greater inclusivity, ensuring representation from marginalized groups to address the diverse mental health needs of young people effectively. By adopting these approaches, digital mental health interventions can become more accessible, engaging, and impactful for young people worldwide.

Delving into the world of webCHAT - an e-mental health support service for distressed youths in Singapore

Background

Young people face high rates of mental health issues, yet many do not seek professional help. In 2017, CHAT launched webCHAT - a free, anonymous, one-on-one synchronous web-based text service managed by case managers (CMs) to support young people aged 16 to 30 who may be hesitant about engaging in face-to-face mental health services.

Objective

This study aimed to explore the perspectives and experiences of users who accessed webCHAT for mental health support in Singapore.

Methods

A qualitative thematic analysis was conducted using transcripts of webCHAT sessions to identify main themes.

Results

Many users accessed webCHAT to seek support with emotional and behavioural concerns, valuing its immediacy and anonymity over traditional appointment-based services. A desire to 'get better' and self-realisation emerged as important motivators for seeking help, with webCHAT offering a supportive space for reflection. Key barriers to seeking additional support included fear of stigma, concerns about leaving a 'medical record', potential hospitalisation, and treatment costs.

Conclusions

webCHAT appears to be a viable early intervention and preventive approach, providing young people with a pathway towards in-person support services. Professional guidance from CMs is essential in encouraging users to pursue further support, emphasising the importance of human expertise in digital mental health platforms. By fostering early help-seeking and self-realisation, webCHAT has the potential to reduce the long-term impact of mental health challenges. Future research could explore webCHAT's long-term effects and identify improvements to facilitate users' transitions to in-person support.

Types and aspects of support that young carers need and value, and barriers and enablers to access: the REBIAS-YC qualitative study

Background

Many children and young people in England provide support to family members who are disabled, have mental or physical ill health, or misuse drugs or alcohol. Providing care can negatively impact children and young people's education, employment, health and social participation, with associated costs. Support is needed to prevent and reduce these negative impacts. The study sought to provide new knowledge and address prior research gaps regarding how best to support young carers from their perspective and that of the people they care for.

Objectives

To address the following questions: What types, components or features of services and other support are seen as helpful, valued, and acceptable to young people who look after someone at home and the people they support? Conversely, what is found to be less or unhelpful? What additional support is perceived as needed? What are the barriers experienced by young and young adult carers in seeking and accessing services for themselves or the person they support? What are the barriers and facilitators for practitioners in providing support and services perceived as valued, helpful and needed by young and young adult carers and the people they support?

Design and setting

In-depth qualitative methodology using focus groups, in-depth semistructured interviews and workshops in four localities in England.

Participants

One hundred and thirty-three carers aged 9-25 years with a range of caring and life circumstances and sociodemographic characteristics. Seventeen adult care recipients (parents) with a range of physical and/or mental healthcare and support needs. Nineteen practitioners from schools, colleges, young carers organisations, voluntary sector services, mental health services, the National Health Service, adult social care and local authority adult and children's social care commissioners.

Results

The types and aspects of support that young carers and their families need, and value when received, include: support that reduces or removes their practical and emotional caring responsibilities; support to mitigate the negative impacts of care and help with other life issues; information and advice about services and wider resources and support; someone trusted available to talk to; greater awareness, recognition and understanding; and choice, flexibility, and co-development of plans and solutions. We found a great deal of unmet need for support, and variation in type and quality of support received, including geographically.

Limitations

Potential limitations are that we were not able to engage with, or recruit, young carers from some intended subgroups, meaning some perspectives are missing. Partly because of COVID-19 measures during the study, we mainly recruited through young carers organisations and their family projects, although this was balanced by recruitment through schools and extensive outreach and engagement by the collaborating organisations prior to the project starting.

Conclusions

Action is now needed to consistently and sustainably implement the types of support that young carers and the people they care for say they need and value.

Future work

Future work should include more research from the perspectives of young carers and the people they care for, especially from particularly marginalised groups; and research to understand what works and how to improve implementation of the support needed and valued.

Study registration

This study is registered as Current Controlled Trials ISRCTN13478876. https://doi.org/10.1186/ISRCTN13478876.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129645) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 36. See the NIHR Funding and Awards website for further award information.

Online Mental Health Peer-support Forums for Youth: An Exploratory Study on Stakeholder Perspectives

Background

Youth in India carry a large proportion of the global burden of mental health disorders and subclinical distress. They prefer to seek mental health support from informal sources. One such source-online mental health peer-support forums (OMHPSFs)-is under-researched. This study aims to explore the perspectives of youth and mental health professionals and counselors (MHP&Cs) in terms of the scope and utility of and inclination to use OMHPSFs for maintaining youth mental well-being.

Methods

An exploratory, cross-sectional, mixed-methods study was conducted. A total of 141 Indian nationals aged 18-29 years were enrolled using convenience sampling and administered a survey. In the qualitative phase, six youth and seven MHP&Cs were interviewed.

Results

Ninety (63.8%) and 106 (75.2%) participants indicated a high inclination to use OMHPSFs to seek and provide support, respectively. More than three-quarters of the surveyed youth stated that OMHPSFs should be a space for emotional and informational support to deal with life challenges. A total of 127 (90.1%) participants reported that OMHPSFs would be useful to find out how others their age deal with similar life challenges. A thematic analysis of interviews revealed that anonymity, accessibility, appeal, and ease of use enhance youth inclination toward OMHPSFs. The role of MHP&Cs in training, supervision, and moderation and strategies to popularize OMHPSFs were outlined and recommended.

Conclusion

Sampled youth showed a high inclination to use OMHPSFs to seek and provide mental health support to their peers. Stakeholders consider OMHPSFs as relevant in scope and utility to alleviate mental health concerns among Indian youth.

An early economic evaluation of Kooth, a web-based mental health platform for children and young people with emerging mental health needs

Background

"Kooth" is a web-based mental health platform commissioned by the National Health Service (NHS), local authorities, charities, and businesses in the UK. The platform gives children and young people (CYP) access to an online community of peers and a team of counsellors. This study reports an early economic evaluation of the potential benefits of Kooth in the UK.

Methods

An early evidence cost calculator was built to estimate the potential costs and savings of implementing Kooth from a UK NHS and crime sector perspective. A decision tree structure was used to track the progress of CYP with emerging mental health needs (EMHN), comparing CYP with access to Kooth to CYP without access to Kooth. The model implemented a 12-month time horizon and followed a typical Kooth contract in relation to costing, engagement, and CYP demographics.

Results

The base case results followed a cohort of 2160 CYP. The results of the cost calculator estimated that engagement with Kooth is associated with a cost saving of £469,237 to the NHS across a 12-month time horizon, or £236.15 per CYP with an EMHN. From a combined NHS and UK crime sector perspective, the cost savings increased to £489,897, or £246.54 per CYP with an EMHN. The largest cost savings were provided by an estimated reduction of 5346 GP appointments and 298 antidepressant prescriptions. For this cohort, the model predicted that engagement with Kooth averted 6 hospitalisations due to suicidal ideation and 13 hospitalisations due to self-harm. Furthermore, the number of smokers and binge drinkers was reduced by 20 and 24, respectively. When a crime sector perspective was taken, 3 crimes were averted.

Discussion

This early model demonstrates that Kooth has the potential to be a cost-saving intervention from both an NHS and a combined NHS and UK crime sector perspective. Cost savings were provided through aversion in clinical and social outcomes. The model used a conservative approach to balance the uncertainty around assumptions of the intermediate outcomes (GP and medication use). However, it is limited by a paucity of costing data and published evidence relating to the impact of digital mental health platforms.

Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis

BACKGROUND

Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation.

OBJECTIVE

This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users.

METHODS

We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff.

RESULTS

Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users' perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety.

CONCLUSIONS

This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability.

TRIAL REGISTRATION

PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528.

What are practitioners' views of how digital health interventions may play a role in online child sexual abuse service delivery?

Introduction

Online child sexual abuse (OCSA) affects considerable numbers of children globally and is associated with a variety of mental health problems. Existing practitioner studies suggest that young people are infrequently asked about online abuse and practitioners have a fragmented understanding of the problems experienced or how they might approach them. There are very few evidence-based interventions that guide clinical assessment or practice. Digital Health Interventions (DHIs) have the potential to be an effective option where children and young people's services are challenged, including accessibility and anonymity. The aim of this study was to explore mental health practitioners' views of how DHIs may play a role in supporting young people who have experienced OCSA, and the role they can play in healthcare delivery.

Method

In-depth qualitative interviews and one focus group were conducted with 25 child mental health professionals across two sites (Manchester and Edinburgh). Data was analyzed using reflexive thematic analysis.

Results

Three overarching themes and 9 sub-themes were identified: (1) feeling a little bit lost; (2) seeing potential problems; and (3) knowing what works. Practitioners expressed interest in a DHI to support this client group and saw it as a way of managing waiting lists and complementing existing therapies. They felt that many young people would see this as a preferred medium to in-person therapy, would be empowering, and offers new ways of learning how to stay safe online. However, there were concerns about how much time would be needed by staff to deliver a DHI, anxieties about safety issues in relation to content and data protection, some of which may be unique to this population of young people, and concerns about the absence of a therapeutic relationship with vulnerable children.

Discussion

Our findings indicated that practitioners were uncertain about working with children subjected to OCSA but were receptive to the possibility of using a DHI to support their practice and to reduce waiting lists. Concerns were expressed about the time needed for staff training and support as well as concerns over patient safety and the lack of evidence about the effectiveness of an unsupported DHI.

Effective elements of eHealth interventions for mental health and well-being in children and adolescents: A systematic review

Background

Mental health problems among children and adolescents increased in recent years, while mental health services are overburdened with long waiting lists. eHealth interventions, that is, interventions delivered digitally via apps or websites, offer a promising approach to prevent and efficiently treat emerging mental health problems in youth. Over the past years, rapid technological progress has led to diverse eHealth interventions for youth mental health. However, a structured overview of effective eHealth elements and mechanisms through which interventions aim to improve mental health is lacking. The aim of this pre-registered systematic review is to identify elements of eHealth interventions that improve mental health and well-being in children and adolescents aged 10-25 from both clinical and general populations.

Methods

This systematic review conducted in April 2023 in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines identified 108 studies and 103 distinct interventions between 2011-2023. The overall sample size was 33,435 participants (30.7% male, mean age = 18.4 years, SD = 2.5). Most studies (64.8%) were randomized controlled trials (RCTs) to test the interventions. The remaining studies utilized a pre-post or group-comparison design (non-RCTs).

Results

The interventions were heterogeneous in design, method of delivery, target group and outcome measures. Overall, 77.7% of the studies showed a positive significant association between eHealth intervention and mental health or well-being. Elements that were often related to improved mental health and well-being were cognitive behavioural therapy (CBT) or self-monitoring as therapeutic principles, blended approaches combining eHealth with traditional therapy, peer/parental involvement and technological gamification elements, such as rewards.

Conclusions

Elements of youth eHealth interventions that appear to positively impact mental health or well-being are (a) CBT-based, (b) self-monitoring (c) blended interventions, (d) peer or parental involvement or (e) gamification. Future directions for the development and implementation of eHealth interventions for youth are discussed.

Digital mental health outcome monitoring for a structured text-based youth counselling intervention: Demographic profile and outcome change

BACKGROUND

Digital mental health interventions comprise a potentially effective and accessible form of support for young people, particularly at times when traditional face-to-face service delivery is reduced, as in the COVID-19 pandemic.

AIMS

This study assessed the demographic profile of young people using a digital mental health support service and evaluated outcome change over the course of a structured online counselling intervention (synchronous text-chat sessions with a practitioner).

MATERIALS AND METHODS

The data were collected from 23,260 young people aged between 10 and 25 years engaging with the intervention between April 2019 and June 2021.

RESULTS

Young people accessing these services had high levels of mental health needs, particularly those identifying with non-binary gender identity. Service users were mostly female, with equitable rates of access for young people from racialised communities. Overall outcome change demonstrated small effect sizes according to the YP-CORE (0.19) and CORE-10 (0.38), which increased to a moderate level when young people remained engaged with a dedicated practitioner for at least seven sessions (0.38, 0.58). Regression analysis illustrated the effect of the number of sessions on outcome change, but this can be also influenced by other variables such as age and gender.

DISCUSSION AND CONCLUSION

Further research is required to explore ways to engage with young people using digital web-based services for a longer period and to collect and analyse single-session outcome data.

Work-life boundary management of peer support workers when engaging in virtual mental health support during the COVID-19 pandemic: a qualitative case study

BACKGROUND

Mental health care needs have increased since the COVID-19 pandemic was declared. Peer support workers (PSWs) and the organizations that employ them have strived to provide services to meet increasing needs. During pandemic lockdowns in Ontario, Canada, these services moved online and were provided by PSWs from their homes. There is paucity of research that examines how providing mental health support by employees working from home influences their work-life boundaries. This research closes the gap by examining experiences of work-life boundary challenges and boundary management strategies of PSWs.

METHODS

A qualitative case study approach was adopted. Interviews with PSWs who held formal, paid positions in a peer support organization were conducted. Data was analyzed thematically using both inductive and deductive approaches. Descriptive coding that closely utilized participants' words was followed by inferential coding that grouped related themes into conceptual categories informed by boundary theory. Member checking was conducted.

RESULTS

PSWs provided accounts of work-life boundary challenges that we grouped into three categories: temporal (work schedule encroachments, continuous online presence), physical (minimal workspace segregation, co-presence of household members and pets) and task-related (intersecting work-home activities). Strategies used by PSWs to manage the boundaries consisted of segmenting the work-life domains by creating separate timescapes, spaces and tasks; and integrating domains by allowing some permeability between the areas of work and life.

CONCLUSION

The findings from this study can help inform management, practices, future research and policy on health care workforce. The study highlights the need to attend to the consequences of greater work-life integration for mental health workers since their successful practice is largely dependent on maintaining self-care. Training regarding work-life boundary management is highlighted as one of the ways to approach situations where work from home is required.

LovesCompany: evaluating the safety and feasibility of a mental health-focused online community for adolescents

Background: Adolescents are at risk for mental health (MH) disorders but are unlikely to seek services and may be reluctant to talk about their MH. An anonymous, online MH-focused community could help reduce suffering. However, online forums can also promote negative behaviours such as cyberbullying. This study aimed to evaluate the safety and feasibility of an online community - LovesCompany - to improve MH outcomes for adolescents.Methods: American adolescents (14-17 years) were recruited through social media. Eligible participants were randomised to LovesCompany or a placebo MH resource site. Outcomes were assessed every other week for six months, and at twelve months. Multilevel models assessed group differences in depression, anxiety, and suicidal ideation. A subgroup of participants participated in qualitative interviews.Results: Participants (N = 202) were mostly female (70%), White non-Hispanic (69%), and cisgender (80%). There were no instances of inappropriate behaviour such as bullying or posting explicit content. Symptoms for both groups improved over time. Participants appreciated hearing others' experiences and valued the opportunity to offer support.Conclusion: Although adolescents are often resistant to MH treatment, they appear to be interested in anonymous, online, MH-focused conversation, and can benefit from giving and seeking support. Finding a balance between an appealing user experience, ethical considerations, and resource needs is challenging.