JMIR Publications

ABSTRACT

Young people are among the fastest adopters of digital and AI-enabled mental health tools, yet they remain marginal to the research and design processes that shape these technologies. This Viewpoint examines a persistent participation gap in digital youth mental health research (DYMH): while co-production and patient and public involvement (PPI) are widely invoked as best practice, youth involvement is frequently superficial, inconsistent, or confined to late-stage consultation. As a result, digital mental health innovations risk misalignment with young people’s lived realities, priorities, and vulnerabilities. We identify three interrelated drivers of this gap. First, conceptual and linguistic fragmentation obscures what “participation” entails in practice, with terms such as co-design, co-production, user-centred design, and PPI used interchangeably despite reflecting different assumptions about power, influence, and decision-making. Second, participation is often uneven across the research lifecycle, with young people involved in ideation or usability testing but excluded from problem formulation, theory selection, implementation, and evaluation. Third, institutional barriers - including ethics review processes, consent requirements, funding constraints, and adult-centric research norms - systematically limit meaningful youth partnership. We argue that closing the participation gap is both an ethical imperative and a practical necessity. As digital and generative AI tools increasingly shape how young people understand and manage mental health, youth must be recognised as legitimate co-producers of knowledge rather than passive end users. We call for clearer reporting of participatory models, greater attention to youth influence across the research lifecycle, and structural support to normalise meaningful youth involvement. Without such shifts, DYMH innovation risks being scalable but not safe, credible, or trustworthy.