April 29, 2021 -An increasing number of digital mental health interventions are designed for adolescents and young people with a range of mental health issues, but the evidence on their effectiveness is mixed, according to research by Columbia University Mailman School of Public Health and Spark Street Advisors.
Computerized cognitive behavioral therapy was found effective for anxiety and depression in adolescents and young people holding promise for increasing access to mental health treatment for these conditions. However, the effectiveness of other digital interventions, including therapeutic video games, mobile apps, or social networking sites, and addressing a range of other mental health outcomes remain inconclusive. The findings are published online in the journal JMIR Mental Health.
According to UNICEF, nearly 1 in 5 adolescents experience a mental health disorder each year but because of barriers to accessing and seeking care, most remain undiagnosed and untreated.
"While there is evidence that some interventions can be effective when delivered digitally, it is still somewhat of a wild west when it comes to digital mental health apps," said Nina Schwalbe, adjunct assistant professor of Population and Family Health at Columbia Mailman School.
The researchers conducted an analysis of 18 systematic reviews and meta-analyses of digital health interventions. In addition to the findings on computerized cognitive behavioral therapy, some therapeutic areas of digital interventions improved outcomes relative to controls for those who are on the waitlist for services, suggesting that the interventions can be used for supplementing and supplanting traditional mental health treatment in cases where access to care is limited or wait times to access are long.
The Investigators point out that the vast majority - over 90 percent - of interventions studied are implemented in high-income countries, with very little information about the background of participants. Therefore, the generalizability of the findings to young people from different socioeconomic, cultural, racial, or other communities is weak. ""It is critical to assess the effectiveness among different racial and ethnic groups and across geographies," observed Susanna Lehtimaki of Spark Street Advisors.
"There was also no indication of costs of developing the tools or long-term benefits," noted Susanna Lehtimaki of Spark Street Advisors. "Moving forward with effective digital health interventions, it will be important to understand how they fit within the public health ecosystem and to what extent they are effective across a range of settings with different resources or populations."
According to the research, digital mental health interventions were well accepted by those 10 to 24 years of age, however, dropout was common and adherence weak. Engagement of a health professional, peer, or parent as part of the digital intervention were found to strengthen the effectiveness.
Schwalbe notes, "In the spirit of "do no harm" it is really important that the excitement over the promise of digital mental health interventions does not cloud the need for high quality effectiveness studies in a range of settings and with a diverse group of youth." She also notes, "it should go without saying that adolescents also need to be consulted in every stage of the design process and while it may be assumed that young people prefer digital services, we need to continually challenge whether this is true."
Co-authors include Jana Martic, Spark Street Advisors; Brian Wahl, Spark Street Advisors and Bloomberg School of Public Health; and Katherine Foster, University of Washington.
Columbia University Mailman School of Public Health
Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the seventh largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master's and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit http://www.
The study was supported by Fondation Botnar.