Aha! moments during brief digital mental health interventions: a mixed methods study of randomized controlled trials

ImportanceHealth care workers (HCWs) face significant mental health challenges when delivering care and over the span of their careers. Despite growing recognition of these issues, barriers such as stigma, structural limitations, and individual obstacles continue to impede progress in supporting HCWs mental health needs. Digital mental health platforms continue to expand in health systems as they offer novel approaches to address these gaps, but more evidence is needed to understand their reception among HCWs.ObjectiveTo examine the perceptions of HCWs regarding their mental health, explore barriers and facilitators to accessing mental health care, and assess their experiences with digital mental health interventions within the context of the pandemic.DesignA qualitative study using semi-structured interviews with HCWs who participated in a prior randomized controlled trial (RCT) assessing the impact of a digital mental health platform on anxiety and depression.SettingA large, urban, academic health system.ParticipantsA purposive sample of 64 HCWs, including physicians, nurses, technicians, administrative staff, and social workers, was recruited. Participants were selected from the upper and lower quartiles of anxiety and depression scores from the parent RCT to capture a range of mental health symptomatology.Outcomes and measuresThe study aimed to identify HCWs’ attitudes toward mental health care, barriers to utilizing professional resources, and their experiences with the digital mental health platform at the local institution. A thematic content analysis was used to analyze the interview data.ResultsFive major themes were identified: (1) the evolving mental health challenges during and after the pandemic, (2) individual barriers to accessing care, such as personal coping strategies and familial responsibilities, (3) structural barriers like workload and limited access to mental health clinicians, (4) experiences with digital mental health interventions, including text message-based assessments, and (5) recommendations for future digital health strategies to improve access and reduce stigma.ConclusionDigital mental health interventions provide a promising avenue to support HCWs by reducing stigma and improving access to mental health resources and clinicians. However, personalized and system-level changes are necessary to address the ongoing mental health challenges faced by the workforce.

BackgroundAnxiety and depression are common in adolescents, but adolescents are often uninterested in formal mental health treatments or are unable to access them. Digital interventions can be delivered at scale to bridge critical gaps in mental health care but must address the needs and preferences of adolescents.ObjectiveThis study aims to conduct qualitative research involving adolescents aged 18 years to inform both the design of digital mental health interventions for adolescents broadly and new features and refinements to incorporate in an automated SMS text messaging intervention, Small Steps SMS, that was originally designed for young adults.MethodsWe recruited non–treatment-engaged older adolescents who were aged 18 years, lived in the United States, and had experienced depression or anxiety. In total, 12 participants were recruited through social media advertising and online self-screeners hosted by Mental Health America, a mental health advocacy organization. For 24 days, participants answered researcher prompts and engaged with one another in an asynchronous online discussion group, with a new discussion prompt released every 3 days. In parallel, partway through the discussion group, participants received interactive messages from Small Steps SMS, an automated SMS text messaging intervention that delivers daily dialogues supporting mental health self-management. Questions in the discussion group pertained to mental health challenges, help-seeking attitudes, perceptions of Small Steps SMS, and ways the program and other digital mental health interventions could meet the needs of older adolescents. A subset of participants (n=4, 33%) also completed interviews to elaborate on their responses. Thematic analysis was applied to transcripts of the discussion group and interviews to characterize user needs and design priorities when making Small Steps SMS and similar interventions available to adolescents.ResultsParticipants reported factors that contributed to their experience of mental health symptoms, including the transition from adolescence to adulthood, fears that the world is unstable and their futures are uncertain, and ineffective use of social media to cope with symptoms. Participants were proud of their generation’s mental health acceptance but also observed a generational divide in mental health stigma and literacy that could impede seeking help from parents and other adults. Participants appreciated that Small Steps SMS allowed them to pursue mental health self-management conveniently and independently. They suggested that the program and similar interventions address adolescent-specific challenges and facilitate intergenerational communication about mental health. They also recommended possible ways to increase engagement through peer-to-peer communication, gamification, and greater explanation of self-management strategies.ConclusionsMajor life transitions affected adolescent participants’ mental health needs and preferences for digital mental health tools. While interactive automated messaging programs have the potential to support self-management in this population, program content and features should be adapted to adolescents’ needs.

Although many digital mental health interventions are available, clinicians do not routinely use them in clinical practice. In this pilot survey, we review the factors that supported the rapid transition to televisits during the COVID-19 pandemic, and we explore the barriers that continue to prevent clinicians from using other digital mental health interventions, such as mindfulness applications, mood trackers, and digital therapy programs. We conducted a pilot survey of mental health clinicians in different practice environments in the USA. Survey respondents (n = 51) were primarily psychiatrists working in academic medical centers. Results indicated that systemic factors, including workplace facilitation and insurance reimbursement, were primary reasons motivating clinicians to use televisits to provide remote patient care. The shift to televisits during the pandemic was not accompanied by increased use of other digital mental health interventions in patient care. Nine clinicians reported that they have never used digital interventions with patients. Among the 42 clinicians who did report some experience using digital interventions, the majority reported no change in the use of digital applications since transitioning to televisits. Our preliminary findings lend insight into the perspective of mental health clinicians regarding the factors that supported their transition to televisits, including institutional support and insurance reimbursement, and indicate that this shift to virtual patient care has not been accompanied by increased use of other digital mental health interventions. We contend that the same systemic factors that supported the shift toward virtual visits in the COVID-19 pandemic may be applied to support the incorporation of other digital interventions in mental healthcare.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41347-022-00260-8.

BACKGROUND Racialized immigrant youth face a multitude of challenges that heighten their vulnerability to mental illness. Digital mental health has increasingly been recognized as an effective method to improve accessibility to mental health services for communities with limited access to inclusive care, particularly among youth. However, despite the growing emphasis on cultural inclusivity in interventions targeting racialized and marginalized populations, there remains a gap in empirical evidence regarding how culturally inclusive elements are integrated into digital mental health practices and their impact on the effectiveness of these interventions. OBJECTIVE Focusing on Asian immigrant youth in Canada, this protocol outlines our community-engaged project, which aims to assess whether current digital mental health interventions provide effective and culturally accessible support, and how we can collaboratively develop a framework for creating innovative, inclusive, and effective digital interventions to promote youth mental health. METHODS A two-phase community-engaged approach will be used to involve Asian immigrant youth facing mental health challenges, youth leaders, service providers, and stakeholders from East, Southeast, and South Asian communities. Phase one includes scoping reviews on the technology, access, and cultural inclusivity of digital mental health interventions for Asian and racialized newcomer youth in Canada. In phase two, 15 diverse Asian youth leaders and 15 service providers will participate in a 3.5-hour online session to discuss the need for effective digital mental health interventions, share results from the reviews, co-identify key elements of an inclusive and innovative intervention, and outline next steps for forming a community-campus research partnership focused on mental health promotion for Asian immigrant youth. RESULTS This project is expected to yield a co-developed framework outlining key elements of culturally inclusive and effective digital mental health interventions for Asian immigrant youth in Canada. Anticipated outcomes include enhanced understanding of cultural accessibility gaps in existing digital interventions and strengthened community-campus partnerships to support youth mental health. CONCLUSIONS This research aims to improve access to culturally safe and effective digital mental health interventions for Asian immigrant youth. Benefits include enhanced mental health support for this population, increased awareness of mental health issues among stakeholders, and the development of a framework for culturally inclusive mental health services

BackgroundDigital mental health interventions stand to play a critical role in managing the mental health impact of the COVID-19 pandemic. Thus, enhancing their uptake is a key priority. General practitioners (GPs) are well positioned to facilitate access to digital interventions, but tools that assist GPs in identifying suitable patients are lacking.ObjectiveThis study aims to evaluate the suitability of a web-based mental health screening and treatment recommendation tool (StepCare) for improving the identification of anxiety and depression in general practice and, subsequently, uptake of digital mental health interventions.MethodsStepCare screens patients for symptoms of depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder scale) in the GP waiting room. It provides GPs with stepped treatment recommendations that include digital mental health interventions for patients with mild to moderate symptoms. Patients (N=5138) from 85 general practices across Australia were invited to participate in screening.ResultsScreening identified depressive or anxious symptoms in 43.09% (1428/3314) of patients (one-quarter were previously unidentified or untreated). The majority (300/335, 89.6%) of previously unidentified or untreated patients had mild to moderate symptoms and were candidates for digital mental health interventions. Although less than half were prescribed a digital intervention by their GP, when a digital intervention was prescribed, more than two-thirds of patients reported using it.ConclusionsImplementing web-based mental health screening in general practices can provide important opportunities for GPs to improve the identification of symptoms of mental illness and increase patient access to digital mental health interventions. Although GPs prescribed digital interventions less frequently than in-person psychotherapy or medication, the promising rates of uptake by GP-referred patients suggest that GPs can play a critical role in championing digital interventions and maximizing the associated benefits.

Adolescents with type 1 diabetes (T1D) experience higher rates of psychological disorders compared with their healthy peers. As poor psychological health has been associated with suboptimal glycaemic control and more frequent complications, there is an urgent need to develop more 'clinically usable' interventions. Digital mental health interventions offer unique advantages compared with in-person interventions; however, what adolescents with T1D want in terms of content and functionality is poorly understood. Accordingly, the current study conducted focus groups to examine the views of adolescents with T1D regarding digital mental health interventions. Four focus groups were conducted, including 16 adolescents with T1D, ranging from 13 to 17years in age (69% female). Transcripts were analysed using directed content analysis to examine (1) 'what adolescents dislike about existing digital mental health interventions?' and (2) 'what adolescents want in future digital mental health interventions?'. Findings provide a preliminary understanding of what adolescents dislike and also the type of content and functional features, which may be important to include in digital mental health programs for this population, such as a peer support feature (reported by 16 of 16), emotion and diabetes check-in feature (11 of 16) and diabetes-relevant content (12 of 16). Early data suggest that digital mental health interventions should include a significant peer support element, diabetes-relevant content and examples, and check-in on their mental health and diabetes self-management regularly, while avoiding fixed responses or modules and non-age-appropriate content. Based on these findings, a digital intervention is currently being developed.

BackgroundDigital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility.ObjectiveThis systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions.MethodsFour databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions.ResultsThirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions.ConclusionsIntegrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226

Digital mental health interventions (DMHIs) offer scalable solutions for addressing mental health needs, but low adherence remains a significant challenge. Single session DMHIs may offer a feasible alternative to address this issue, providing an accessible and low-effort option for users. The present study examines whether adding the choice of a single session DMHI in addition to a multi-session DMHI provides a feasible alternative for users who might otherwise disengage. This study examined naturalistic data from 509 university students who registered for a 12-session DMHI, single session DMHI, or both. The majority (58%) chose only the multi-session DMHI, while 24.2% chose only the single-session option, and 17.5% registered for both. Rates of completing one session of the chosen DMHI were highest for the single session DMHI (56.1%), with the lowest rates among those who registered for both programs. Users who chose the single session DMHI reported lower motivation and less frequent intentions to address mental health. Satisfaction with the single-session program was high. These results highlight the promise of single-session DMHIs as a feasible and acceptable intervention to help navigate adherence challenges with longer programs, while raising questions about the effectiveness of having users choose between single-session and multi-session DMHIs.

BackgroundPregnancy and the postnatal period can be a time of increased psychological distress, which can be detrimental to both the mother and the developing child. Digital interventions are cost-effective and accessible tools to support positive mental health in women during the perinatal period. Although studies report efficacy, a key concern regarding web-based interventions is the lack of engagement leading to drop out, lack of participation, or reduced potential intervention benefits.ObjectiveThis systematic review aimed to understand the reporting and levels of engagement in studies of digital psychological mental health or well-being interventions administered during the perinatal period. Specific objectives were to understand how studies report engagement across 4 domains specified in the Connect, Attend, Participate, and Enact (CAPE) model, make recommendations on best practices to report engagement in digital mental health interventions (DMHIs), and understand levels of engagement in intervention studies in this area. To maximize the utility of this systematic review, we intended to develop practical tools for public health use: to develop a logic model to reference the theory of change, evaluate the studies using the CAPE framework, and develop a guide for future data collection to enable consistent reporting in digital interventions.MethodsThis systematic review used the Cochrane Synthesis Without Meta-analysis reporting guidelines. This study aimed to identify studies reporting DMHIs delivered during the perinatal period in women with subclinical mood symptoms. A systematic database search was used to identify relevant papers using the Ovid Platform for MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, and Medical Subject Headings on Demand for all English-language articles published in the past 10 years.ResultsSearches generated a database of 3473 potentially eligible studies, with a final selection of 16 (0.46%) studies grouped by study design. Participant engagement was evaluated using the CAPE framework and comparable variables were described. All studies reported at least one engagement metric. However, the measures used were inconsistent, which may have contributed to the wide-ranging results. There was insufficient reporting for enactment (ie, participants’ real-world use of intervention skills), with only 38% (6/16) of studies clearly recording longer-term practice through postintervention interviews. The logic model proposes ways of conceptualizing and reporting engagement details in DMHIs more consistently in the future.ConclusionsThe perinatal period is the optimal time to intervene with strength-based digital tools to build positive mental health. Despite the growing number of studies on digital interventions, few robustly explore engagement, and there is limited evidence of long-term skill use beyond the intervention period. Our results indicate variability in the reporting of both short- and long-term participant engagement behaviors, and we recommend the adoption of standardized reporting metrics in future digital interventions.Trial RegistrationPROSPERO CRD42020162283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162283

BackgroundThere is a high prevalence of children and young people (CYP) experiencing mental health (MH) problems. Owing to accessibility, affordability, and scalability, an increasing number of digital health interventions (DHIs) have been developed and incorporated into MH treatment. Studies have shown the potential of DHIs to improve MH outcomes. However, the modes of delivery used to engage CYP in digital MH interventions may differ, with implications for the extent to which findings pertain to the level of engagement with the DHI. Knowledge of the various modalities could aid in the development of interventions that are acceptable and feasible.ObjectiveThis review aimed to (1) identify modes of delivery used in CYP digital MH interventions, (2) explore influencing factors to usage and implementation, and (3) investigate ways in which the interventions have been evaluated and whether CYP engage in DHIs.MethodsA literature search was performed in the Cochrane Library, Excerpta Medica dataBASE (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and PsycINFO databases using 3 key concepts “child and adolescent mental health,” “digital intervention,” and “engagement.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least two reviewers. The selected articles were assessed for quality using the mixed methods appraisal tool, and data were extracted to address the review aims. Data aggregation and synthesis were conducted and presented as descriptive numerical summaries and a narrative synthesis, respectively.ResultsThis study identified 6 modes of delivery from 83 articles and 71 interventions for engaging CYP: (1) websites, (2) games and computer-assisted programs, (3) apps, (4) robots and digital devices, (5) virtual reality, and (6) mobile text messaging. Overall, 2 themes emerged highlighting intervention-specific and person-specific barriers and facilitators to CYP’s engagement. These themes encompassed factors such as suitability, usability, and acceptability of the DHIs and motivation, capability, and opportunity for the CYP using DHIs. The literature highlighted that CYP prefer DHIs with features such as videos, limited text, ability to personalize, ability to connect with others, and options to receive text message reminders. The findings of this review suggest a high average retention rate of 79% in studies involving various DHIs.ConclusionsThe development of DHIs is increasing and may be of interest to CYP, particularly in the area of MH treatment. With continuous technological advancements, it is important to know which modalities may increase engagement and help CYP who are facing MH problems. This review identified the existing modalities and highlighted the influencing factors from the perspective of CYP. This knowledge provides information that can be used to design and evaluate new interventions and offers important theoretical insights into how and why CYP engage in DHIs.

Digital interventions for depression and anxiety in older adults: a systematic review of randomised controlled trials

BackgroundDepression and anxiety frequently coexist with chronic musculoskeletal pain and can negatively impact patients’ responses to standard orthopedic treatments. Nevertheless, mental health is not routinely addressed in the orthopedic care setting. If effective, a digital mental health intervention may be a feasible and scalable method of addressing mental health in an orthopedic setting.ObjectiveWe aimed to compare 2-month changes in mental and physical health between orthopedic patients who received a digital mental health intervention in addition to usual orthopedic care, those who received usual orthopedic care only (without a specific mental health intervention), and those who received in-person care with a psychologist as part of their orthopedic treatment plan.MethodsIn this single-center retrospective cohort study involving ancillary analysis of a pilot feasibility study, 2-month self-reported health changes were compared between a cohort of orthopedic patients who received access to a digital mental health intervention (Wysa) and 2 convenience sample comparison cohorts (patients who received usual orthopedic care without a specific mental health intervention and patients who received in-person care with a psychologist as part of their orthopedic treatment plan). All patients were 18 years or older and reported elevated symptoms of depression or anxiety at an orthopedic clinic visit (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression or Anxiety score ≥55). The digital intervention was a multi-component mobile app that used chatbot technology and text-based access to human counselors to provide cognitive behavioral therapy, mindfulness training, and sleep tools, among other features, with an emphasis on behavioral activation and pain acceptance. Outcomes of interest were between-cohort differences in the 2-month longitudinal changes in PROMIS Depression and Anxiety scores (primary outcomes) and PROMIS Pain Interference and Physical Function scores (secondary outcomes).ResultsAmong 153 patients (mean age 55, SD 15 years; 128 [83.7%] female; 51 patients per cohort), patients who received the digital mental health intervention showed clinically meaningful improvements at the 2-month follow-up for all PROMIS measures (mean longitudinal improvement 2.8-3.7 points; P≤.02). After controlling for age and BMI, the improvements in PROMIS Depression, Pain Interference, and Physical Function were meaningfully greater than longitudinal changes shown by patients who received usual orthopedic care (mean between-group difference 2.6-4.8 points; P≤.04). Improvements in PROMIS Physical Function were also meaningfully greater than longitudinal changes shown by patients who received in-person psychological counseling (mean between-group difference 2.4 points; P=.04).ConclusionsPatients who received a digital mental health intervention as part of orthopedic care reported greater 2-month mean improvements in depression, pain interference, and physical function than patients who received usual orthopedic care. They also reported a greater mean improvement in physical function and comparable improvements in depression, anxiety, and pain interference compared with orthopedic patients who received in-person psychological counseling.

BackgroundAn estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues.ObjectiveThis review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries).MethodsWe searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews.ResultsIn this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings.ConclusionsAlthough digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

BackgroundThe majority of people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. There is an urgent need for more relevant and accurate data on digital interventions in this area to prepare for an increase demand for mental health services. The aim of this study was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support.MethodsThis secondary meta-analysis follows a rapid review of systematic reviews, a virtual workshop with knowledge users to identify research questions and a modified Delphi study to guide research methods: What types of digital health interventions (according to a recognized categorization) are the most effective for the management of concomitant mental health and chronic disease conditions in adults? We conducted a secondary analysis of the primary studies identified in the rapid review. Two reviewers independently screened the titles and abstracts and applied inclusion criteria: RCT design using a digital mental health intervention in a population of adults with another chronic condition, published after 2010 in French or English, and including an outcome measurement of anxiety or depression.ResultsSeven hundred eight primary studies were extracted from the systematic reviews and 84 primary studies met the inclusion criteria Digital mental health interventions were significantly more effective than in-person care for both anxiety and depression outcomes. Online messaging was the most effective technology to improve anxiety and depression scores; however, all technology types were effective. Interventions partially supported by healthcare professionals were more effective than self-administered.ConclusionsWhile our meta-analysis identifies digital intervention’s characteristics are associated with better effectiveness, all technologies and levels of support could be used considering implementation context and population.Trial registrationThe protocol for this review is registered in the National Collaborating Centre for Methods and Tools (NCCMT) COVID-19 Rapid Evidence Service (ID 75).

Asian American, Native Hawaiian, and Pacific Islander emerging adults significantly underutilize traditional face-to-face mental health services despite experiencing prevalence of mental illness comparable to the general population. Digital mental health interventions offer a promising avenue for improving access for this "digitally native" population. This study utilizes the Seeking Mental Health Care model to examine the individual-level psychological and demographic factors associated with the intention to use digital mental health interventions among a diverse sample of Asian American, Native Hawaiian, and Pacific Islander emerging adults. Using multivariable logistic regression, key predictors included perceived need for support and mental health literacy, while controlling for symptom severity (anxiety and depression) and sociodemographic variables. A higher perceived public stigma was found to be associated with a greater likelihood of intending to use digital mental health interventions. Findings reveal that individual factors, such as higher perceived need and mental health literacy, are significantly associated with a greater intention to use digital mental health interventions, supporting the utility of using the Seeking Mental Health Care model to better understand the adoption of digital interventions in this underserved population, while suggesting other points of intervention such as psychoeducation for greater mental health literacy that could lead to greater treatment engagement.