Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 20, 2021
Date Accepted: Jul 27, 2021
Date Submitted to PubMed: Nov 29, 2021
Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: A Systematic Review
ABSTRACT
Background:
Digital health interventions (DHIs) are found to be efficacious for several mental disorders in youth. However, integrated evidence-based knowledge about the mechanisms of change in these interventions is pending.
Objective:
With this systematic review we aimed to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents.
Methods:
A systematic literature search within the electronic databases CENTRAL, Embase, MEDLINE and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data and rated the methodological quality of eligible studies (i.e., risk of bias and eight quality criteria for process research).
Results:
A total of 25 studies were included, evaluating 39 potential mediators. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional/affective, interpersonal, parenting-behavior and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4) and combined cognitive mediators (13/19). Although more than three quarters of eligible studies met five or more quality criteria, causal conclusions are precluded widely so far.
Conclusions:
The findings of this review might guide the empirically-informed advancement of DHIs, contributing to improved intervention outcomes; and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future. Clinical Trial: Pre-registration with Open Science Framework (OSF): https://osf.io/vds4e
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