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

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.

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.

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.

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.

We review the literature on mHealth applications for childhood anxiety disorders, highlighting current use, limitations, and future directions.

Although mHealth apps targeting childhood anxiety disorders have recently increased, most have not been evaluated for clinical effectiveness, data security, or quality standards. Many apps do not contain scientifically based content and do not adequately incorporate the principles of exposure-based cognitive behavioral therapy. In addition, many apps have significant deficiencies in age-appropriateness, data security, privacy, cultural sensitivity, and accessibility. Limitations remain in terms of the standards for evaluating apps in pediatric populations. While interest in mHealth applications for childhood anxiety disorders is increasing, more research is needed to develop effective, safe, and age-appropriate digital interventions. Priorities include scientific grounding, privacy, equitable access, gamification, and parental involvement. Studies in this direction will increase the quality of applications and strengthen equality in access to mental health services.

Major depressive disorder is a common diagnosis among adolescents. Cognitive behavioral therapy is recommended as the first line of treatment. Digital health interventions, such as apps, could contribute to treatment. Advantages could be easy accessibility and availability, reduced time for face-to-face therapy, and the ability to intensify therapy by incorporating it into the patients' everyday lives. Challenges such as low adherence rates are common in digital health interventions. Therefore, they need to undergo rigorous testing for feasibility and effectiveness.

An evaluated, cognitive behavioral therapy-based face-to-face therapy program for depression in adolescents was transformed into an app called e-MICHI. This study examined its feasibility and efficacy for use in blended therapy in outpatient settings.

Adolescents aged 12 to 18 years with major depressive disorder receiving outpatient care were recruited from 2 university hospitals (n=36 included in analysis). The e-MICHI intervention combined daily app engagement over 6 weeks with 3 face-to-face sessions with a therapist. Feasibility was measured using various variables, including an adherence score (0=no or little patient engagement to 3=excellent engagement) and engagement rates (number of modules completed, number of messages sent by participants via the in-app messenger), satisfaction ratings from both participants and therapists, as well as participants' ratings of the usefulness of the antidepressant strategies covered in the app and the transfer of these strategies to everyday practice. Trends of efficacy were evaluated from multiple perspectives (participant self-rating, independent rater, or therapist), using the Beck Depression Inventory-II, the Children's Depression Rating Scale-Revised, and the Clinical Global Impressions-Severity Scale. Feasibility metrics were assessed by analyzing their central tendency and dispersion, efficacy data were analyzed using a repeated measures ANOVA.

e-MICHI was positively evaluated by both participants and therapists (participants: mean 7.3, SD 1.2 and therapists: mean 7.3, SD 1.1, on a scale from 0=bad to 10=excellent). Participants demonstrated high adherence rates (nearly 80%, n=25, received a "good" or "excellent" adherence score) and showed overall good engagement (app modules completed [maximum 6]: mean 5.03, SD 1.27 and messages sent via messenger: mean 23, SD 22.1). Participants rated the psychoeducational content of the app as particularly useful and reported consistent practice of the e-MICHI strategies in everyday life. Use of the app was associated with a significant reduction of depressive symptoms (before app use vs 3-month follow-up, Beck Depression Inventory-II: mean -6.76, SD 11.49, P=.01; Children's Depression Rating Scale-Revised: mean -16.45, SD 16.76, P<.001; Clinical Global Impressions-Severity Scale: mean -1.1, SD 1.24, P<.001).

While acknowledging its limitations, such as the small number of participants and the limited validity concerning efficacy, this study confirms the feasibility of e-MICHI for treating adolescent depression in outpatient settings.

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.

Body dysmorphic disorder (BDD) is particularly prevalent yet highly understudied and undertreated in adolescence. This study evaluates the efficacy of an internet-based, therapist-guided cognitive behavioral therapy (CBT) for adolescents and young adults with BDD compared to supportive online therapy as an active control condition.

In a single-blind, randomized controlled trial, N = 45 adolescents (aged 15-21 years) of all genders from German-speaking countries were assigned to 12 sessions of internet-based CBT (iCBT) or 12 weeks of supportive online therapy. The primary outcome was change in expert-rated BDD symptom severity from pre- to post-intervention (Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder, BDD-YBOCS). Secondary outcomes included the remission and responder rate, changes in delusionality of appearance beliefs (BABS), self-rated BDD symptom severity (FKS), BDD cognitions (FKDK), quality of life (KINDL-R), and depressive symptoms (PHQ-9) from pre to post and to a 4-week follow-up.

iCBT was more efficient than supportive online therapy on the BDD-YBOCS (p =.002), with a large between-group effect size at post-intervention (Hedges' g (SE) = 0.93 (0.42)), and on all secondary measures (p <.05), except for depressive symptoms (p =.068). All secondary outcome measures also showed significant improvements from pre to post iCBT, with moderate to large effect sizes, and gains were stable until the 4-week follow-up period. iCBT participants showed higher remission (61.5%) and responder rates (66.7%), compared to controls (0% and 26.7%), but only the difference in remission reached significance.

The results indicate the efficacy of internet-based CBT in comparison to an active control condition, thus contributing to the limited intervention research in adolescent BDD and adding a much-needed treatment option.

The trial was pre-registered on 2020/06/08 at the German Clinical Trials Register, DRKS00022055.

Depression represents a major global public health challenge, particularly among young individuals aged between 10 and 25. This age bracket is notably critical, as the onset of depression during these years tends to be more severe and consequential. In response to the growing demand for mental health services, internet-based psychological interventions have gained traction as a flexible and convenient alternative to traditional face-to-face treatment. This systematic review and network meta-analysis aims to rigorously assess the comparative efficacy and acceptability of internet-based psychological interventions in addressing depression within the young population over the past three decades.

We conducted a comprehensive search of seven electronic databases for eligible randomized controlled trials published from January 1995 to July 2024. The literature screening process adhered to the principles of population, intervention, comparator, outcome, and study design. The quality of the included studies was assessed using the Cochrane Risk of Bias Assessment Tool. To evaluate the ranking probability of each intervention, we calculated the surface under the cumulative ranking curve values. Network meta-analysis (NMA) was conducted using RStudio and Stata software.

The NMA incorporated a total of 27 studies involving 3,451 participants. Among these studies, 18 assessed internet-based cognitive behavioral therapy (iCBT) interventions, whereas 12 employed a waitlist as a control group. At the end of the interventions, internet-based acceptance and commitment therapy (iACT), iCBT, internet-based dialectical behavior therapy (iDBT), and internet-based psychodynamic therapy (iPDT) all demonstrated statistically significant reductions in depression scores. Notably, no intervention measure was found to be statistically more acceptable than the others.

Our NMA indicated that iDBT appeared to be more effective, whereas internet-based mindfulness-based therapy (iMBT) may be more acceptable. These findings offered preliminary evidence regarding the comparative effectiveness and acceptability of internet-based psychological interventions in treating depression among young people. However, the limited number of eligible studies underscored the importance and necessity of further research to evaluate novel intervention measures.

The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO), with the registration number CRD42024580958.

Depression and anxiety are prevalent among older adults. However, most older adults have poor access to age-specific mental health services. While Information technology-based Cognitive Behavioral Therapy (ICBT) has shown promise as an accessible alternative to face-to-face interventions, its effectiveness specifically within the older adults warrants further investigation.

To evaluate the effectiveness of ICBT on depression and anxiety symptoms among older adults.

Research articles retrieved from PubMed, EMBASE, the Cochrane Library, Web of Science, PsycINFO, and MEDLINE from inception to April 10, 2024, were reviewed. The search was designed to identify Randomized Controlled Trials (RCTs) that examined the efficacy of ICBT in reducing self-reported depression or anxiety symptoms in older adults. The quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2.0. Posttreatment means and standard deviations (SDs) were compared between intervention and control groups, and pooled effect sizes (Hedges' g) were calculated.

A total of 11 RCTs were eligible for inclusion in this review. Compared to control groups, ICBT yielded small to medium post-treatment pooled effect sizes regarding depressive symptoms (Hedges' g = -0.65, 95 % CI -0.95 to -0.35; P < 0.001) and anxiety symptoms (Hedges' g = -0.47, 95 % CI -0.74 to -0.19; P < 0.001). Subgroup analyses showed that: (1) interventions lasting ≥8 weeks (Hedges' g = -0.88, 95 % CI -1.37 to -0.39; P < 0.001) were more effective than <8 weeks for depressive symptoms; however, <8 weeks (Hedges' g = -0.52, 95 % CI -0.93 to -0.10; P = 0.014) was more effective for anxiety symptoms; (2) ICBT delivered through slideshows was more effective than through other digital platforms for both depressive (Hedges' g = -1.36, 95 % CI -2.40 to -0.31; P = 0.011) and anxiety symptoms (Hedges' g = -1.00, 95 % CI -1.30 to -0.70; P < 0.001); and (3) non-tailored ICBT was more effective than tailored versions for both depressive (Hedges' g = -1.06, 95 % CI -2.03 to -0.09; P = 0.032) and anxiety symptoms (Hedges' g = -0.70, 95 % CI -1.14 to -0.27; P = 0.001).

This meta-analysis reinforces the effectiveness of ICBT in relieving depression and anxiety symptoms among older adults. Future research should identify the most effective components of ICBT to optimize their development.

The Non-adoption, Abandonment, Scale-up, Spread, Sustainability (NASSS) framework (2017) was established as an evidence-based, theory-informed tool to predict and evaluate the success of implementing health and care technologies. While the NASSS is gaining popularity, its use has not been systematically described. Literature reviews on the applications of popular implementation frameworks, such as the RE-AIM and the CFIR, have enabled their advancement in implementation science. Similarly, we sought to advance the science of implementation and application of theories, models, and frameworks (TMFs) in research by exploring the application of the NASSS in the five years since its inception. We aim to understand the characteristics of studies that used the NASSS, how it was used, and the lessons learned from its application. We conducted a scoping review following the JBI methodology. On December 20, 2022, we searched the following databases: Ovid MEDLINE, EMBASE, PsychINFO, CINAHL, Scopus, Web of Science, and LISTA. We used typologies and frameworks to characterize evidence to address our aim. This review included 57 studies that were qualitative (n=28), mixed/multi-methods (n=13), case studies (n=6), observational (n=3), experimental (n=3), and other designs (e.g., quality improvement) (n=4). The four most common types of digital applications being implemented were telemedicine/virtual care (n=24), personal health devices (n=10), digital interventions such as internet Cognitive Behavioural Therapies (n=10), and knowledge generation applications (n=9). Studies used the NASSS to inform study design (n=9), data collection (n=35), analysis (n=41), data presentation (n=33), and interpretation (n=39). Most studies applied the NASSS retrospectively to implementation (n=33). The remainder applied the NASSS prospectively (n=15) or concurrently (n=8) with implementation. We also collated reported barriers and enablers to implementation. We found the most reported barriers fell within the Organization and Adopter System domains, and the most frequently reported enablers fell within the Value Proposition domain. Eighteen studies highlighted the NASSS as a valuable and practical resource, particularly for unravelling complexities, comprehending implementation context, understanding contextual relevance in implementing health technology, and recognizing its adaptable nature to cater to researchers' requirements. Most studies used the NASSS retrospectively, which may be attributed to the framework's novelty. However, this finding highlights the need for prospective and concurrent application of the NASSS within the implementation process. In addition, almost all included studies reported multiple domains as barriers and enablers to implementation, indicating that implementation is a highly complex process that requires careful preparation to ensure implementation success. Finally, we identified a need for better reporting when using the NASSS in implementation research to contribute to the collective knowledge in the field.

This study aimed to evaluate the effectiveness of vigorous physical activity as an intervention for alleviating depressive symptoms among adolescents and young adults.

A comprehensive search on systematically reliable databases was carried out, and studies running till August 2023 were considered in this study. The articles included in this meta-analysis assessed the impact of exercise interventions on depressive symptomatology in adolescents and young adults. Two independent investigators screened the studies, extracted data, and evaluated quality.

Physical activity produced an important reduction in depressive symptoms [SMD] = -4.23, 95% CI: -7.02, -1.44, p = 0.0001; a moderate effect size in both the adolescent population with clinical depression and adolescents who presented with subclinical depressive symptoms. Notably, vigorous physical exercise worked most favorably for adolescent depressive symptomatology, while moderate-intensity exercise was the best choice for adolescents with diagnosed clinical depression.

This meta-analysis suggests that vigorous physical activity could reduce depressive symptoms in adolescents and young adults. However, further studies are needed to provide clearer recommendations regarding the type, duration, and intensity of exercise necessary to treat clinical depression in this population.

Depression is a significant global public health issue, and in China, access to mental health services remains limited despite high demand. Research has shown that mindfulness can effectively alleviate depressive symptoms and that telehealth solutions offer a promising avenue for addressing this service gap. Despite this potential, there are currently few studies in China focusing on short-term online mindfulness training. Most existing online mindfulness studies relied on traditional 8-week programs, which can be challenging for participant adherence due to limited accessibility and high dropout rates. Additionally, limited research exists on short-term online mindfulness interventions, and findings remain inconsistent.

This study aimed to develop and evaluate an internet-based, self-guided, short-term mindfulness training (ISSMT) program based on the Monitor and Acceptance Theory (MAT) to reduce depression symptoms.

The ISSMT program was delivered via an online platform, "Hi Emotion," and was accessible to the general public. Interested individuals aged 18 years and older were randomized into either the ISSMT group or a wait-list control group. Participants in the ISSMT group received daily reminders to participate in a 15- to 20-minute session over a 14-day training period. Measurements, including mindfulness and depressive symptoms, were collected at baseline and weekly for the subsequent 3 weeks.

A total of 205 adults participated in the 14-day online intervention. Linear mixed models were used to analyze both per-protocol (PP) and intention-to-treat (ITT) samples. Compared with the wait-list control group, participants in the ISSMT group showed significant improvements in mindfulness (Cohen d=0.44 for ITT; Cohen d=0.55 for PP) and reductions in depressive symptoms (Cohen d=0.50 for ITT; Cohen d=0.53 for PP). Furthermore, participants expressed high acceptance of this training format with a relatively low dropout rate (<40%).

The ISSMT program based on the MAT effectively enhanced mindfulness and alleviated depressive symptoms. This intervention could be considered for integration into psychosocial service systems to improve mental health outcomes and help bridge the gap between limited resources and the high demand for services in China. Future research should focus on personalizing these programs and incorporating advanced technologies to enhance their effectiveness and user engagement.

Open Science Framework; https://doi.org/10.17605/OSF.IO/8P4V6.

Anxiety disorders are common in children and among the most prevalent psychiatric issues. Untreated preoperative anxiety can lead to increased complications and a higher risk for future anxiety disorders and major depression. Therefore, addressing preoperative anxiety in children is crucial to prevent perioperative and long-term adverse effects.

This review aimed to evaluate various articles and develop a management plan based on evidence for the prevention of preoperative anxiety in children using non-pharmacological approaches in areas with limited resources.

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Databases, such as PubMed, Cochrane Library, and Google Scholar, were searched for high-quality evidence to draw appropriate conclusions.

A total of 7669 articles were retrieved from the search engines. These articles were then filtered based on intervention, outcome, population data, inclusion and exclusion criteria, and methodological quality. After the filtration process, only 35 studies met the inclusion criteria for comprehensive review.

The Children's Emotional Manifestation Scale (CEMS) effectively assesses preoperative anxiety in children. Evidence suggests that non-pharmacological interventions such as clowning, music therapy, audiovisuals, virtual reality, and cognitive-behavioral therapy are effective in preventing preoperative anxiety. Practitioners can choose a suitable non-pharmacological approach based on availability and cost.

Schools can play an important role in addressing growing concerns about adolescent mental health. Mental health of high school students has predominantly been the focus in literature with less emphasis on younger adolescents. This review identified articles published in the last decade that described evaluations of middle school-based mental health interventions and randomized participants to an intervention or control condition. Fourteen interventions met the inclusion criteria. About two-thirds of interventions were based on mindfulness or cognitive behavioral therapy. Many trials utilized racially diverse, low-income samples. All interventions were delivered to groups, and three contained a parent component. Five trials increased rigor by using an active control condition. Almost two-thirds of the interventions were effective (p < .10) in reducing at least one depression, anxiety, affect, or internalizing symptom outcome compared to a control group. This article provides information about intervention characteristics, efficacy, theoretical framework, and acceptability/feasibility.

Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter.

COMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period.

We conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist.

Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD -1.31, 95% CI -2.51 to -0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD -1.33, 95% CI -2.10 to -0.57; P<.001). Overall, participants were satisfied with COMET, with the majority endorsing the intervention and its modules as acceptable, appropriate, and exhibiting high utility. The self-compassion module was most often reported as the participants' favorite module and the behavioral activation module was their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects.

This study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but study attrition was high. Participant feedback indicated a high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement.

ClinicalTrials.gov NCT05718141; https://clinicaltrials.gov/ct2/show/NCT05718141.

Mental disorders, most commonly anxiety disorders and fourth most common depression, are prevalent in children and adolescents. Internet- and mobile-based interventions might represent a scalable approach to improve mental health care, however, evidence so far is inconclusive and systematic reports on negative effects are missing. Four data-bases were searched for randomized controlled trials evaluating internet- and mobile-based interventions (IMIs) targeting anxiety disorders or depression in children and adolescents up to 18 years exhibiting clinically relevant symptoms. Meta-analytic evaluations were conducted in comparison to active and passive control groups, furthermore, pre-defined sub-groups were explored and reported negative effects examined. Pooled estimates showed a moderate positive effect for IMIs targeting anxiety disorders compared to passive control groups (g = -0.69; CI -0.94 to -0.45; k = 8; n = 559; p ≤ 0,001), but not for depression. Pooled estimates compared to active control groups remained non-significant. Subgroup analyses were largely omitted due to an insufficient number of trials or were non-significant. Negative effects were mainly reported as drop-out rates and (non)-response rates, while additional negative effects, such as deterioration rates or the development of additional symptoms, were reported by only one third of included studies. The focus on children and adolescents with clinically relevant symptoms allowed the present findings to complement previous work, however, the limited amount of trials hindered many planned comparisons. The overview of reported negative effects highlighted that negative effects are being neglected in the majority of RCTs. Hence, in the future RCTs should include more information about potential negative effects, at best a combination of quantitative and qualitative information. Open Science Framework (osf.io/ch5nj).

Objective: This review identifies the characteristic features of artificial intelligence (AI) chatbots and their therapeutic effect; assesses their efficacy in treatment of depression, anxiety, and other mental health disorders; and establishes levels of user engagement and satisfaction. Method : Searches were conducted on the PubMed, Embase, MEDLINE, CENTRAL, CINAHL, PsycINFO, and Google Scholar databases using a set of keywords such as, not limited to, AI cognitive behavioral therapy (AI CBT), Youper, Wysa, Woebot, and other related terms. We included studies that were empirical, peer-reviewed, conducted between January 2017 and June 2024, and primarily focused on efficacy regarding the interventions and therapeutic outcomes. Data were then extracted and analyzed using both qualitative and quantitative methods concerning the mental health outcome. Results: Our review identified large improvements across the three chatbots in symptoms of mental health, as supported by the 10 included studies: five on Woebot, four on Wysa, and one on Youper. Woebot showed remarkable reductions in depression and anxiety with high user engagement; Wysa demonstrated similar improvements, especially in users with chronic pain or maternal mental health challenges; Youper also presented a significant symptom reduction, including a 48% decrease in depression and a 43% decrease in anxiety. Common benefits of all chatbots were the therapeutic alliance and a high rate of satisfaction among users. We have also discussed the included studies' limitations; that is, study design shortcomings and lack of sample diversity. Conclusion: AI CBT chatbots, including but not limited to Woebot, Wysa, and Youper, are highly promising because of their availability and effectiveness in mental health support. They provide a useful complement to standard therapy when professional help is unavailable, and offer constant engagement with tailored interventions. However, it is necessary that further studies investigate their potential impact as long-term intervention models and explore how they may be integrated into holistic mental health care systems.

Anxiety disorders are common in children and adolescents, with many youths experiencing functional impairment in multiple domains because of these conditions. Biologic and cognitive-behavioral models provide a basis for the development and maintenance of these disorders. Cognitive behavioral therapy (CBT) with exposures and selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors are empirically supported treatments for childhood anxiety disorders. Exposures are a key component of CBT treatment and a case vignette demonstrates how to tailor exposures to the unique fears of the child.

Over the past two decades, the development of internet-based treatments for adolescents with anxiety and depressive disorders has advanced rapidly. To date, adolescents' preferences and perceived barriers for internet-based treatment remain largely unknown, especially in clinical samples. Therefore, this study explored the preferences and perceived barriers of adolescents with anxiety or depression regarding internet-based treatment.

This qualitative study included 21 adolescent patients with anxiety or depressive disorder, and varied levels of experience with internet-based treatment. Two focus groups (N1 = 5, N2 = 6) and semi-structured interviews (N = 10) were conducted, recorded, transcribed, and analyzed using a reflexive thematic analysis approach.

The thematic analysis yielded five main themes, and 12 subthemes. The main themes were: independence, accessibility, content, therapist contact, and appearance. Adolescents highlighted self-direction as a benefit of internet-based treatment, and motivational challenges as a drawback. They found internet-based interventions convenient and particularly fitting for implementation during waiting periods before formal treatment. Guided interventions were preferred over mere self-help. Furthermore, adolescents stressed the importance of a clear, organized design, and recommended accessibility on both mobile phones and computers.

Findings provide a clear overview of the needs and preferences of adolescents with anxiety or depressive disorder regarding internet-based treatment. To address their diverse needs, internet-based interventions should be tailorable, should incorporate therapist guidance, and should already be available during the treatment waiting period. Results of this study can guide the development and implementation of new internet-based interventions, and may thereby help to further optimize their uptake among adolescent patients.

There has been tremendous interest in utilizing digital interventions to assist in the treatment of anxiety disorders. Anxiety disorders are widely prevalent and often characterized by avoidance, intolerance of uncertainty, interpersonal concerns, and worry. Digital mental health interventions, given their flexibility, may be particularly suited to this population. The authors review the literature on the use of videoconference, virtual reality, website self-help, and mobile applications in the treatment of anxiety disorders. Empirical evidence, advantages, and disadvantages of each format are considered. Additionally, we identify clinical and social challenges unique to the use of these technologies for intervention purposes.

Inuit youth in Nunavut (NU) are resilient but face a protracted suicide crisis. The SPARX serious game and e-intervention, developed originally in New Zealand, teaches youth cognitive behavioural therapy (CBT) skills to ameliorate stress and depression. Inuit youth in NU reviewed and culturally adapted SPARX and an existing wellness outcome measure for Inuit. One hundred and twenty-one youth, aged 13 to 24, across NU then tested, played, and evaluated I(nuit)-SPARX, showing improvement in several areas of wellbeing post-play. Youth completed a CBT skills survey, engaged in sharing circles to assess CBT skill retention, and shared their thoughts about the usefulness and cultural fit of I-SPARX with Inuit Qaujimajatuqangit (IQ). Communication Skills, Listening Skills, and Problem Solving emerged as the most helpful learned CBT skills, and NU youth provided real-world examples of using I-SPARX skills to support their mental wellness. Several principles of IQ were exemplified and upheld in the content of the adapted SPARX tool and the process of the project as a whole. Empirically grounded, asynchronous e-tools, developed in collaboration with Inuit communities to ensure cultural specificity, may support psychological wellness in communities where mental health resources are scarce.

The prevalence of anxiety and depressive symptoms in young people have increased in many countries around the world. Web-based mental health interventions (or W-MHIs) have the potential to reduce anxiety and depression symptoms for young people. Although W-MHIs have become more widely used by young people since the coronavirus disease 2019 (COVID-19) pandemic, real-world engagement in these W-MHIs has remained low compared with engagement reported in research studies. Moreover, there are limited studies examining factors influencing engagement with W-MHIs in the post-COVID-19 pandemic years.

This study aims to explore barriers and facilitators of engagement with W-MHIs for anxiety and depression among young people.

Seventeen semi-structured interviews and one focus group with three participants were conducted online via Zoom between February and March 2023. Participants were young people aged 18-25 years who had self-reported experience of anxiety and/or depression in the past 6 months, lived in Australia, and considered using W-MHIs to manage their anxiety and/or depression symptoms. Inductive thematic analysis was performed to understand the key barriers and facilitators of young people's engagement with W-MHIs.

Both individual- and intervention-related factors influenced young people's engagement with W-MHIs. Facilitators of engagement included personal trust and beliefs in W-MHIs, ability to contact a health professional, programme suitability (e.g., affordability, content aligning with user needs), programme usability (e.g., user interface), and accessibility of the online platform. Barriers included concerns about online security, lack of human interaction and immediate responses from health professionals (if any), and negative experience with mental health programmes. Participants expressed greater willingness to pay if they could contact health professionals during the programme.

Better promotion strategies for mental health and W-MHI awareness are needed to increase the perceived importance and priority of mental health interventions among young people. Young people should be involved in the W-MHI co-design to enhance the programme suitability and usability for young people, fostering their engagement with W-MHIs.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is a well-established transdiagnostic cognitive-behavioral therapy (T-CBT) intervention. The aim of the present study was to examine the efficacy of the program Learn to Manage your Emotions [Aprende a Manejar tus Emociones] (AMtE), a self-applied transdiagnostic internet-delivered program based on the Spanish version of the UP-A. This is the first transdiagnostic internet-based program designed for the treatment of emotional disorders in adolescents.

A sample of Spanish adolescents with a primary diagnosis of an anxiety and/or depressive disorder (n = 58; age range = 12-18 years; 78.3% girls; 90% Caucasian) were randomly allocated to receive AMtE (n = 28) or the UP-A via videocall (n = 30). Pre-treatment, post-treatment and 3-month follow-up data were collected using self-reports and clinician-rated measures of anxiety, depression, positive and negative affect, anxiety sensitivity and emotional avoidance.

Based on generalized estimating equations (GEE) models, both intervention programs were effective in significantly reducing self-reported anxiety and depressive disorder symptoms and clinician-rated severity of anxiety and depression, as well as self-reported transdiagnostic outcome variables.

Data provide empirical support for the efficacy of AMtE as a transdiagnostic online CBT treatment for anxiety and depressive disorders in adolescents. No marked nor consistent differences were observed between the UP-A and AMtE, highlighting the potential usefulness of the online self-administered AMtE program.

The diagnosis of major depressive disorder (MDD) is commonly based on the subjective evaluation by experienced psychiatrists using clinical scales. Hence, it is particularly important to find more objective biomarkers to aid in diagnosis and further treatment. Alpha-band activity (7-13 Hz) is the most prominent component in resting electroencephalogram (EEG), which is also thought to be a potential biomarker. Recent studies have shown the existence of multiple sub-oscillations within the alpha band, with distinct neural underpinnings. However, the specific contribution of these alpha sub-oscillations to the diagnosis and treatment of MDD remains unclear.

In this study, we recorded the resting-state EEG from MDD and HC populations in both open and closed-eye state conditions. We also assessed cognitive processing using the MATRICS Consensus Cognitive Battery (MCCB).

We found that the MDD group showed significantly higher power in the high alpha range (10.5-11.5 Hz) and lower power in the low alpha range (7-8.5 Hz) compared to the HC group. Notably, high alpha power in the MDD group is negatively correlated with working memory performance in MCCB, whereas no such correlation was found in the HC group. Furthermore, using five established classification algorithms, we discovered that combining alpha oscillations with MCCB scores as features yielded the highest classification accuracy compared to using EEG or MCCB scores alone.

Our results demonstrate the potential of sub-oscillations within the alpha frequency band as a potential distinct biomarker. When combined with psychological scales, they may provide guidance relevant for the diagnosis and treatment of MDD.

We conducted a randomized, controlled trial (RCT) to investigate our hypothesis that the interactive chatbot, Vitalk, is more effective in improving mental wellbeing and resilience outcomes of health workers in Malawi than the passive use of Internet resources. For our 2-arm, 8-week, parallel RCT (ISRCTN Registry: trial ID ISRCTN16378480), we recruited participants from 8 professional cadres from public and private healthcare facilities. The treatment arm used Vitalk; the control arm received links to Internet resources. The research team was blinded to the assignment. Of 1,584 participants randomly assigned to the treatment and control arms, 215 participants in the treatment and 296 in the control group completed baseline and endline anxiety assessments. Six assessments provided outcome measures for: anxiety (GAD-7); depression (PHQ-9); burnout (OLBI); loneliness (ULCA); resilience (RS-14); and resilience-building activities. We analyzed effectiveness using mixed-effects linear models, effect size estimates, and reliable change in risk levels. Results support our hypothesis. Difference-in-differences estimators showed that Vitalk reduced: depression (-0.68 [95% CI -1.15 to -0.21]); anxiety (-0.44 [95% CI -0.88 to 0.01]); and burnout (-0.58 [95% CI -1.32 to 0.15]). Changes in resilience (1.47 [95% CI 0.05 to 2.88]) and resilience-building activities (1.22 [95% CI 0.56 to 1.87]) were significantly greater in the treatment group. Our RCT produced a medium effect size for the treatment and a small effect size for the control group. This is the first RCT of a mental health app for healthcare workers during the COVID-19 pandemic in Southern Africa combining multiple mental wellbeing outcomes and measuring resilience and resilience-building activities. A substantial number of participants could have benefited from mental health support (1 in 8 reported anxiety and depression; 3 in 4 suffered burnout; and 1 in 4 had low resilience). Such help is not readily available in Malawi. Vitalk has the potential to fill this gap.

Arsenic is a worldwide environmental pollutant that can impair human health. Previous studies have identified mental disorders induced by arsenic, but the environmental exposure concentrations in the early life stages associated with these disorders are poorly understood. In the present study, early-life stage zebrafish were used to explore the effects on mental disorders under 'environmental standard limit concentrations' arsenic exposures of 5, 10, 50, 150, and 500 μg/L. The results showed that arsenic exposure at these concentrations changed the locomotor behavior in larval zebrafish and was further associated with anxiety, depression, and autism-like behavior in both larval and juvenile zebrafish. Changes were noted at benchmark dose limit (BMDL) concentrations as low as 0.81 μg/L. Transcriptomics showed that immediate early genes (IEGs) fosab, egr1, egr2a, ier2b, egr3, and jund were decreased after arsenic exposure in larval and juvenile zebrafish. Nervous system impairment and anxiety, depression, and autism-like behaviors in early-life stage zebrafish at 'environmental standard limit concentrations' may be attributed to the downregulation of IEGs. These findings in zebrafish provided new experimental support for an arsenic toxicity threshold for mental disorders, and they suggest that low levels of environmental chemicals may be causative developmental factors for mental disorders.

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is associated with anxiety and depression. Few studies have addressed interventions for symptoms of anxiety and depression in this population. To determine the efficacy of interventions for anxiety and depression in patients with AD. PubMed, MEDLINE, EMBASE, and PsycINFO were searched from inception to November 2023. English-language studies published in peer-reviewed journals evaluating the effect of interventions on anxiety and/or depression using validated assessment tools on patients with AD were included. Titles, abstracts, and articles were screened by at least two independent reviewers. Of 1410 references that resulted in the initial search, 17 studies were included. Fourteen of these studies are randomized controlled trials, while the other 3 studies are prospective controlled trials with pre and post-test designs. Data were extracted using a standardized extraction form, and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. To accommodate trials with multiple interventions (each compared to a control group), we conducted a mixed-effects meta-analysis with the trial as a random effect. Prespecified outcomes were changes in symptoms of anxiety and depression in patients with AD as evaluated using standardized assessment tools. Of the 17 studies included in this systematic review, 7 pharmacological intervention studies with 4723 participants examining 5 different medications were included in a meta-analysis. Of these studies, only 1 study evaluated medications prescribed to treat anxiety and/or depression; the rest evaluated medications prescribed to treat AD. Meta-analysis of all the pharmacological interventions resulted in significant improvement in anxiety, depression, and combined anxiety-depression scale scores (standardized mean difference [95% CI]: - 0.29 [- 0.49 to - 0.09], - 0.27 [- 0.45 to - 0.08], - 0.27 [- 0.45 to - 0.08]) respectively. The 10 non-pharmacological studies with 2058 participants showed general improvement in anxiety but not depression. A meta-analysis of the non-pharmacological interventions was not conducted due to variable approaches and limited data. Pharmacological interventions designed to improve AD were found to improve anxiety and depression in patients with moderate-severe disease. More comprehensive studies on non-pharmacological and pharmacological interventions that primarily target anxiety and depression are needed.

Exposure to stress is a risk factor for the development of psychopathology in adolescence. Coping and emotion regulation (ER) mediate and moderate the association between stress exposure and psychopathology, and interventions that teach coping and ER skills to adolescents have demonstrated efficacy for the prevention of psychological symptoms and disorders. Although multiple barriers limit the impact of in-person interventions, digital solutions are promising for delivering interventions in part or whole.

The purpose of the current review is to inform the development of interventions that both work and impact public health. The focus is leveraging technology for the prevention of internalizing and externalizing psychopathology in adolescents, with coping and ER as the mechanisms for change.

A brief overview of the research on coping and ER is provided; extant in-person and digital interventions targeting coping and ER to prevent psychopathology in adolescents are discussed; and a direction for how the field can progress to bridge the gap between research and commercial silos is provided.

Taken together, this review can guide efforts toward technology-based and -enhanced preventive interventions targeting coping and ER to prevent psychopathology in adolescents.

We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

The mental health care available for depression and anxiety has recently undergone a major technological revolution, with growing interest towards the potential of smartphone apps as a scalable tool to treat these conditions. Since the last comprehensive meta-analysis in 2019 established positive yet variable effects of apps on depressive and anxiety symptoms, more than 100 new randomized controlled trials (RCTs) have been carried out. We conducted an updated meta-analysis with the objectives of providing more precise estimates of effects, quantifying generalizability from this evidence base, and understanding whether major app and trial characteristics moderate effect sizes. We included 176 RCTs that aimed to treat depressive or anxiety symptoms. Apps had overall significant although small effects on symptoms of depression (N=33,567, g=0.28, p<0.001; number needed to treat, NNT=11.5) and generalized anxiety (N=22,394, g=0.26, p<0.001, NNT=12.4) as compared to control groups. These effects were robust at different follow-ups and after removing small sample and higher risk of bias trials. There was less variability in outcome scores at post-test in app compared to control conditions (ratio of variance, RoV=-0.14, 95% CI: -0.24 to -0.05 for depressive symptoms; RoV=-0.21, 95% CI: -0.31 to -0.12 for generalized anxiety symptoms). Effect sizes for depression were significantly larger when apps incorporated cognitive behavioral therapy (CBT) features or included chatbot technology. Effect sizes for anxiety were significantly larger when trials had generalized anxiety as a primary target and administered a CBT app or an app with mood monitoring features. We found evidence of moderate effects of apps on social anxiety (g=0.52) and obsessive-compulsive (g=0.51) symptoms, a small effect on post-traumatic stress symptoms (g=0.12), a large effect on acrophobia symptoms (g=0.90), and a non-significant negative effect on panic symptoms (g=-0.12), although these results should be considered with caution, because most trials had high risk of bias and were based on small sample sizes. We conclude that apps have overall small but significant effects on symptoms of depression and generalized anxiety, and that specific features of apps - such as CBT or mood monitoring features and chatbot technology - are associated with larger effect sizes.

Atopic dermatitis (AD) is associated with high levels of psychosocial burden, often resulting in poor mental health outcomes. Despite this association, few studies have evaluated the efficacy of mental health interventions within this population. Utilization of multidisciplinary and peer-led support, in addition to equipping patients with psychological tools, may be beneficial in improving mental health outcomes. Future research is needed to determine which interventions and formats are desired by, effective in and accessible to patients and caregivers with AD.

Internet-based cognitive behavior therapy (ICBT) may provide an accessible alternative to face-to-face treatment, but the evidence base in adolescents is limited. This systematic review and meta-analysis aims to comprehensively assess the efficacy of ICBT in addressing depression among adolescents.

Four electronic databases were searched on June 8, 2023. Randomized controlled trials (RCTs) evaluating the efficacy of ICBT for depression in adolescents were included. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook. Furthermore, the GRADE approach was employed to gauge the certainty of the obtained evidence. Meta-analysis was conducted using RevMan 5.4, and Egger's test was implemented through Stata for assessment of potential publication bias.

A total of 18 RCTs involving 1683 patients were included. In comparison to control groups like attention control, waiting list, and treatment as usual, our meta-analysis findings elucidate a significant reduction in depression scores (SMD = -0.42, 95 % CI: [-0.74, -0.11], p < .05) as well as anxiety scores (SMD = -0.34, 95 % CI: [-0.60, -0.08], p < .05) in adolescents following ICBT interventions. Furthermore, the analysis indicated no notable distinctions in patient's quality of life (QoL) scores. (SMD = 0.12, 95 % CI: [-0.10, 0.34], p > .05).

Results provide evidence of the efficacy of ICBT to reduce depressive and anxiety symptoms in adolescents. These research findings are of vital significance for the establishment of evidence-based treatment guidelines in the digital era.

PROSPERO registration: CRD42021277562.

The development of serious games for mental wellbeing is a topic of growing interest. The increase in acceptance of games as a mainstream entertainment medium combined with the immersive qualities of games provides opportunities for meaningful support and intervention in mental wellbeing.

We conducted a systematic review and exploratory meta-analysis to examine if aspects of the interventions influenced outcomes as measured via overall effect sizes. We employed a multilevel meta-analytic approach to accommodate the interdependency of effect sizes (18 effect sizes from 14 studies, with 2027 participants).

Overall, the main effect for gaming interventions on any outcome variable was small to medium sized, d = .35 (confidence interval [.23, 47], p < .001). Results revealed that the only significant moderator was the nature of the intervention. Specifically, only interventions that included a rational emotional behavioural focus significantly predicted an improvement in depression and/or anxiety in participants.

The findings reveal promising effects for therapeutic games for mental health, but replications are needed, alongside the addressing of methodological and procedural concerns.

Low self-esteem is common and can be impairing for adolescents. Treatments that primarily target low-esteem are lacking. Internet-delivered cognitive behaviour therapy (ICBT) is a treatment that can be used for adolescents but ICBT is yet to be evaluated for low self-esteem using qualitative methods. The aim of this study was to investigate experiences of participating in a novel ICBT treatment for adolescents suffering from low self-esteem.

Fifteen adolescent girls who had received ICBT consented to participate in a semi-structured qualitative telephone interview at post-treatment. Data were analysed and categorised using inductive Thematic Analysis.

Four overarching themes were identified; (1) Increased awareness and agency in difficult situations, (2) Enhanced self-image, (3) Unique but not alone, and (4) Widened understanding and new perspectives. Participants reported positive changes in their thinking and behaviour, as well as helpful learning experiences in relation to themselves and their self-esteem. For instance, participants described a more self-accepting attitude, learned how to manage negative thoughts, and experienced an increased sense of connection to others.

The results suggest that ICBT is experienced as helpful and will inform further use and development of ICBT for low self-esteem. Future studies should validate and further evaluate experiences of ICBT for low self-esteem in other settings and in particular for boys as the study only include female participants.

Due to several treatment barriers, many individuals with panic disorder do not receive evidence-based treatment. One promising option to narrow this treatment gap is Internet-based psychotherapy, which has been shown particularly effective in guided formats. Still, there remains room for improvement to make these digital therapies more accessible, cost-efficient, and aligned with best practices for in-person interventions (e.g., exposure). The smartphone app "Invirto - Treatment for Anxiety" offers digitally guided, evidence-based treatment of panic disorders including virtual reality (VR) for exposure therapy. The aim present study is to investigate the efficacy, safety, and acceptance of Invirto in comparison to a care-as-usual (CAU) control group.

We plan to conduct a randomized controlled trial with two conditions (intervention vs. CAU), three assessment times via online surveys (t0: baseline; t1: 3 months after baseline; t2: follow-up assessment 6 months after baseline), and a total of 128 participants with a clinical diagnosis of panic disorder (symptoms must be experienced ≥ 1 year). Recruitment will take place via email, phone, and the study website. The primary outcome will be the change in anxiety symptoms as measured by Beck's Anxiety Inventory from t0 to t1. Secondary outcomes will be the change in anxiety symptoms (measured by the Panic and Agoraphobia Scale, PAS; Questionnaire on panic-related Anxieties, Cognitions and Avoidance, ACA), depressive symptoms (measured by the Beck-Depression-Inventory, BDI-II), treatment satisfaction (measured by the Client Satisfaction Questionnaire, CSQ-8; Treatment Adherence Perception Questionnaire, TAPQ-adapt; Positive and Negative Effects of Psychotherapy Scale, PANEPS-I), psychological flexibility (measured by the Acceptance and Action Questionnaire-II, AAQ-II), and dissociation during VR exposure (measured by an adapted version of the Peritraumatic Dissociative Experiences Questionnaire, PDEQ-adapt). Participants in the intervention group will receive access to the intervention (Invirto) right after t0, while the CAU group will receive access to Invirto after t1. We expect a larger change in both the primary and secondary outcomes from t0 to t1 in the intervention group in comparison to the CAU group.

This study is one of the first to evaluate an Internet-based intervention for people with panic disorder that includes self-application of VR exposure therapy. The findings are expected to extend the body of knowledge about effective Internet-based treatment options for people with panic disorder. The empirical and clinical implications and the limitations of the study are discussed.

DRKS00027585 ( www.drks.de/drks_web/ ), date of registration: 13 January 2022.

Anxiety disorders are the most common class of psychiatric conditions among children and adolescents. The cognitive behavioral model of childhood anxiety has a strong theoretic and empirical foundation that provides the basis for effective treatment. Cognitive behavioral therapy (CBT), with an emphasis on exposure therapy, is the gold standard treatment for childhood anxiety disorders, with strong empirical support. A case vignette demonstrating CBT for childhood anxiety disorders in practice, as well as recommendations for clinicians, are also provided.

Social anxiety symptoms are highly prevalent among adolescents and are associated with poor quality of life and low psychosocial functioning. If untreated, social anxiety often persists into adulthood and increases the risk for comorbid disorders. Therefore, early interventions for social anxiety to prevent negative long-term consequences are critical. However, adolescents rarely seek help and often avoid face-to-face psychotherapeutic interventions due to the perceived lack of autonomy and anonymity. Thus, online interventions represent a promising opportunity to reach adolescents who have social anxiety but do not seek help yet.

This study aims to evaluate the efficacy, moderators, and mediators of an online intervention developed to reduce social anxiety in adolescents.

A total of 222 adolescents aged 11-17 years with subclinical social anxiety (N=166) or with a diagnosis of social anxiety disorder (N=56) are randomly assigned to the online intervention or a care-as-usual control group. The 8-week guided online intervention is based on the Cognitive Model of Social Phobia and evidence-based online interventions for social anxiety adapted to the specific needs of adolescents. The care-as-usual group will be given access to the online intervention after the follow-up assessment. Participants are assessed at baseline, at 4 and 8 weeks post intervention, and at 3-month follow-up assessment on the primary outcome, that is, social anxiety, on secondary outcomes (eg, level of functioning, fear and avoidance, general anxiety, depression, quality of life, self-esteem, and negative effects of the intervention), on potential moderators (eg, therapy motivation, therapy expectancy, and satisfaction with the intervention), and potential mediators (eg, therapeutic alliance and adherence to the intervention). Data will be analyzed based on an intention-to-treat approach and both groups (intervention and care-as-usual) will be compared at each assessment time point. Furthermore, potential mechanisms of change and generalization of intervention effects on daily life are assessed using an ecological momentary assessment procedure that includes items on maintaining mechanisms of social anxiety, social context, and affect. Participants are prompted 3 times a day during the first 8 weeks of the study and again for 2 weeks following the follow-up assessment.

Recruitment is ongoing; initial results are expected in 2024.

Results are discussed considering the potential of online interventions as a low-threshold prevention and treatment option for adolescents with social anxiety and in light of current advances in dynamic modeling of change processes and mechanisms in early intervention and psychotherapy in adolescents.

ClinicalTrials.gov NCT04782102; https://clinicaltrials.gov/ct2/show/NCT04782102.

DERR1-10.2196/44346.

Antisocial behavior during adolescence can have long-lasting negative effects and leads to high societal costs. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles aged 12-21 showing severe antisocial behavior. The intensity, content and duration of FAST can be adjusted to the needs of the juvenile and their caregiver(s), which is considered crucial for effective treatment. Next to the regular version of FAST (FASTr), a blended version (FASTb) in which face-to-face contacts are replaced by minimally 50% online contacts over the duration of intervention was developed during the Covid-19 pandemic. The current study will investigate whether FASTb is equally effective as FASTr, and through which mechanisms of change, for whom, and under which conditions FASTr and FASTb work.

A randomized controlled trial (RCT) will be carried out. Participants (N = 200) will be randomly assigned to FASTb (n = 100) or FASTr (n = 100). Data collection will consist of self-report questionnaires and case file analysis, and include a pre-test at the start of the intervention, a post-test immediately after the intervention, and a six month follow-up. Mechanisms of change will be investigated using monthly questionnaires of key variables during treatment. Official recidivism data will be collected at two-year follow-up.

This study aims to improve the effectiveness and quality of forensic mental health care for juveniles with antisocial behavior by studying the effectiveness of blended care, which has not been studied before in treatment of externalizing behavior. If found to be at least as effective as face-to-face treatment, blended treatment can help meet the urgent need for more flexible and efficient interventions in this field. In addition, the proposed study aims to unravel what works for whom, knowledge urgently needed in mental health care for juveniles with severe antisocial behavior.

This trial was registered at ClinicalTrials.gov on 07/11/2022, registration number NCT05606978.

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.

Digital mental health interventions (DMHIs) have the potential to improve the efficiency, accessibility and effectiveness of mental health services for young people, with the potential to reach socioeconomically and digitally marginalised young people with mental health needs who would otherwise not seek help in person. This review aims to investigate the characteristics, acceptability and efficacy of DMHIs specifically developed for socioeconomically and digitally marginalised youth.

Key databases were searched widely and systematically (EMBASE, MEDLINE, PsycINFO, OpenGrey). Final inclusion in this review required studies to evaluate DMHIs specifically targeting socioeconomically and digitally marginalised children and young people through a broad range of research designs.

Ten studies, describing seven DHMIs, were included in this review. Studies varied in terms of methodology, population, intervention, outcome measures, technologies used and methodological quality. Qualitative and quantitative results are synthesised across three key phenomena of interest: effectiveness, acceptability and feasibility. Findings suggest that there is moderate but limited evidence supporting DMHIs for improving mental health outcomes among these populations.

While there is moderate evidence suggesting that digitally delivered interventions can be effective in improving mental health outcomes among socioeconomically and digitally marginalised youth, more high-quality research is needed in order to determine whether DMHIs can fully bridge the so-called 'digital divide'.

The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting.

A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance.

The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination.

Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.

Internet addiction has become an increasingly serious public health issue, putting young people at particular risk of psychological harm. This study aimed to analyze the interactions between college students' depression, anxiety, and Internet addiction and explore how these interactions differ between men and women.

A 6-month follow-up study was conducted on 234 college students using the Self-Rating Depression Scale, Self-rating Anxiety Scale, and Revised Chen Internet Addiction Scale.

Depression, anxiety, and Internet addiction were positively correlated (p < 0.01). Anxiety can predict Internet addiction and that Internet addiction can predict depression. Moreover, anxiety had a significant predictive effect on Internet addiction among men.

Anxiety predicts Internet addiction, and Internet addiction predicts depression among male college students. These findings may better inform future Internet addiction intervention strategies. Particularly, interventions may better address Internet addiction by focusing on the role of anxiety, especially among men.

Internet-based psychodynamic psychotherapy (iPDT) for adolescents has been found to be effective for treating depression, but not much is known about its active ingredients.

To explore the techniques used in chat sessions in an iPDT program for depressed adolescents, and to investigate whether they predicted improvement in depression symptoms.

The study uses data collected from a pilot study. The iPDT consisted of 8 modules delivered over 10 weeks that included text, video, exercises, and a weekly text-based chat session with a therapeutic support worker (TSW). The participants were 23 adolescents meeting criteria for depression. The TSWs were 9 psychology master's students. A depression inventory QIDS-A17-SR was filled weekly by the participants, and a self-rated techniques inventory (MULTI-30) was filled by the TSWs after each chat session.

Common factor techniques were the most widely used techniques in the chat sessions. Both common factors and psychodynamic techniques predicted improvement in depression, with psychodynamic techniques predicting improvement at the following week. CBT techniques were also used but did not predict improvement in depression.

iPDT seem to work in line with theory, where the mechanisms thought to be important for change in treatment were predictive of outcome.