JMIR Publications

ABSTRACT

Background:

Young people in Global South countries, and racially and ethnically minoritised young people in Western countries, are underserved by current clinic-based mental health provision. Self-help digital mental health interventions (DMHIs) offer a scalable approach to address the global needs-access gap for young people’s mental health. Most extant research into self-help DMHIs is predominantly with White young people in Western high-income contexts, thus little is known about the acceptability and effectiveness for underserved Global Majority populations.

Objective:

The objective of this mapping review was to (1) examine whether contemporary self-help DMHI research studies have reached and been adopted by young people of the Global Majority, and to summarise available evidence on their acceptability and effectiveness for these populations; and (2) to assess whether self-help DMHIs studies report participant’s race and in line with research reporting standards.

Methods:

A mapping review, registered on the OSF (https://osf.io/ebz3v/files/4k5zx), was conducted using a search of PubMed and APA PsycNet databases with supplementary screening of Google Scholar and the Cochrane Database (from August – December 2024). Peer reviewed intervention studies published from 2019 onwards were eligible if they evaluated self-help DMHIs targeting anxiety, depression, emotional problems or wellbeing among young people aged 10-24 years. Data on study characteristics, sample demographics and implementation features were extracted in line with the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Findings were synthesised the using RE-AIM framework, with extraction and analysis focussed specifically on Global Majority particiapnts. Results were summarised using narrative synthesis and tabular mapping.

Results:

In total, we identified and screened 1882 papers, of which 105 full texts were considered relevant and assessed for eligibility. 37 papers were eligible, including 30,075 participants in total. Only 9.2% of participants were clearly identified as belonging to the Global Majority by ethnicity and just 10.9% of studies were conducted in LMICs. Reporting of race and ethnicity was highly inconsistent; 40% of studies did not report ethnicity and 62% did not report race. Aggregated or binary categories (e.g. “non- White”) were common. Only one study disaggregated effectiveness outcomes by ethnicity, and fewer studies examined differential attrition or engagement. Cultural adaptation or co-design was described in 16% of studies primarily in low-and-middle-income or indigenous contexts. Maintenance outcome beyond six months were rarely reported.

Conclusions:

Despite their promise as scalable interventions, self-help DMHIs have not yet equitably reached young people of the Global Majority, who remain underrepresented and marginalised within the evidence-base. Inconsistent reporting of race and ethnicity, limited cultural adaptation, and a lack of disaggregated effectiveness and maintenance data constrain claims of scalability and equity. Future research must adopt equity centred design, transparent demographic reporting particularly co-design, and long-term implementation evaluation to ensure digital mental health interventions meaningfully serve diverse global populations.