JMIR Publications

ABSTRACT

Background:

Rates of mental health problems among youth are high and rising, while treatment-seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be one promising avenue for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples primarily have been limited to computer and internet interventions, while meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, primarily have been focused on adult samples.

Objective:

This study evaluates the effectiveness of mTDIs, for a broad range of well-being outcomes, among unselected, at-risk, and clinical samples of youth.

Methods:

A systematic review employed five major search strategies to identify 80 studies evaluating 83 wellness and mental-health focused mTDIs for 19,748 youth (Mage 2.93 to 26.25). We conducted a three-level meta-analysis on the full sample as well as a sub-sample of the 38 highest-quality studies.

Results:

Analyses demonstrated significant benefits of mTDIs for youth both at post-test (g = .27) and follow-up (range: 1.21 to 43.14 weeks; g = .26) for a variety of psychosocial outcomes including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by type of comparison group (strongest for no-intervention, followed by inert placebo/information-only, and only marginal for clinical comparison), but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes, but effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (e.g., tailoring, social elements, gamification) or support features (e.g., orientation, reminders, coaching), though use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer or clinician referral. Only mTDIs with a clear prescription for frequent use (i.e., at least once per week) showed significant effects, although this effect was only evident in the higher-quality sub-sample. Moderation analyses did not detect statistically significant differences in effect sizes based on prescribed duration of mTDI use (weeks, sessions), and reporting issues in primary studies limited analysis of completed duration, thus calling for improved methodology, assessment, and reporting to clarify true effects.

Conclusions:

Overall this study’s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development on mTDIs for youth, particularly in more naturalistic and ecologically valid settings. Clinical Trial: Open Science Framework: https://osf.io/wv685/