JMIR Publications

ABSTRACT

Background:

Youth experiencing mental health and substance use (MHSU) challenges face notable barriers to accessing adequate care, including limited service availability and a lack of youth-centered, evidence-based treatments. The prevalence of digital device ownership among youth presents an opportunity to help bridge this treatment gap using these accessible tools to deliver scalable evidence-based interventions. Self-guided digital MHSU interventions (ie, self-directed, technology-delivered psychosocial interventions not requiring clinical or technical support) present interesting opportunities for service providers or youth looking for self-help-style interventions. Many self-guided digital interventions have been developed for youth, yet little guidance on the effectiveness of these interventions exists for those looking to leverage evidence-based self-guided tools for these populations.

Objective:

This systematic review aimed to synthesize the evidence for self-guided digital MHSU interventions developed for youth dealing with MHSU disorders.

Methods:

Five major databases were searched for controlled trials of self-guided digital interventions targeting MHSU disorders in youth (12 - 25 years). Search concepts included: youth, mental health/substance use, digital, intervention, effectiveness. Eligible studies included trials with passive controls (determining initial effectiveness) or active comparators (determining superiority). Data describing trial characteristics, intervention characteristics, and MHSU outcomes were extracted. Risk of bias was assessed using Cochrane Risk of Bias 2.0 tool. Findings were synthesized narratively, both by MHSU disorder and by digital modality.

Results:

The search yielded 15,828 unique records; 76 trials met inclusion criteria. Interventions targeted symptoms relating to depression, alcohol use disorder, anxiety, eating disorders, tobacco use disorder, cannabis use disorder, post-traumatic stress disorder (PTSD), suicide, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder (ADHD). Interventions used diverse modalities: web-based interventions, mobile applications, text messages, computers, chatbots, video games, and wearables. Across disorders, 33 of 74 (45%) initial effectiveness evaluations and 3 of 25 (12%) superiority evaluations were positive. Across digital modalities, 33 of 71 (46%) initial effectiveness and 3 of 21 (14%) superiority evaluations were positive. Notably, in superiority evaluations, whether classified by disorder or modality, the majority of digital interventions performed similarly to their active comparators (71% - 72%). Positive evaluations of initial effectiveness were more common for interventions targeting PTSD and tobacco use disorder, and for interventions using chatbot- or computer-based interventions. Positive evaluations were limited for ADHD- or cannabis-focused interventions. Three of 76 trials (4%) were rated as low risk of bias; the remainder had some concerns or high risk of bias.

Conclusions:

This review synthesizes evidence for self-guided digital MHSU interventions and demonstrates their potential to address MHSU disorders in youth. Although more rigorous evaluations are still needed, this review identifies numerous effective self-guided digital interventions that can be used to help youth struggling with MHSU disorders, and identifies trends within modalities that might be considered for future MHSU intervention development.