Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study.

BACKGROUND Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. OBJECTIVE To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. METHODS This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). RESULTS Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; <i>χ</i><sup>2</sup><sub>1</sub>=1.2; <i>P</i>=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; <i>χ</i><sup>2</sup><sub>1</sub>=0; <i>P</i>=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (<i>t</i><sub>80.20</sub>=1.37; <i>P</i>=.28) and depressive (<i>t</i><sub>83.75</sub>=–0.08; <i>P</i>=.99) symptoms. CONCLUSIONS This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents.

Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ21=1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ21=0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t80.20=1.37; P=.28) and depressive (t83.75=-0.08; P=.99) symptoms. This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents.

With the proliferation of digital mental health interventions (DMHIs) guided by relational agents, little is known about the behavioral, cognitive, and affective engagement components associated with symptom improvement over time. Obtaining a better understanding could lend clues about recommended use for particular subgroups of the population, the potency of different intervention components, and the mechanisms underlying the intervention's success. This exploratory study applied clustering techniques to a range of engagement indicators, which were mapped to the intervention's active components and the connect, attend, participate, and enact (CAPE) model, to examine the prevalence and characterization of each identified cluster among users of a relational agent-guided DMHI. We invited adults aged 18 years or older who were interested in using digital support to help with mood management or stress reduction through social media to participate in an 8-week DMHI guided by a natural language processing-supported relational agent, Woebot. Users completed assessments of affective and cognitive engagement, working alliance as measured by goal and task working alliance subscale scores, and enactment (ie, application of therapeutic recommendations in real-world settings). The app passively collected data on behavioral engagement (ie, utilization). We applied agglomerative hierarchical clustering analysis to the engagement indicators to identify the number of clusters that provided the best fit to the data collected, characterized the clusters, and then examined associations with baseline demographic and clinical characteristics as well as mental health outcomes at week 8. Exploratory analyses (n=202) supported 3 clusters: (1) "typical utilizers" (n=81, 40%), who had intermediate levels of behavioral engagement; (2) "early utilizers" (n=58, 29%), who had the nominally highest levels of behavioral engagement in week 1; and (3) "efficient engagers" (n=63, 31%), who had significantly higher levels of affective and cognitive engagement but the lowest level of behavioral engagement. With respect to mental health baseline and outcome measures, efficient engagers had significantly higher levels of baseline resilience (P<.001) and greater declines in depressive symptoms (P=.01) and stress (P=.01) from baseline to week 8 compared to typical utilizers. Significant differences across clusters were found by age, gender identity, race and ethnicity, sexual orientation, education, and insurance coverage. The main analytic findings remained robust in sensitivity analyses. There were 3 distinct engagement clusters found, each with distinct baseline demographic and clinical traits and mental health outcomes. Additional research is needed to inform fine-grained recommendations regarding optimal engagement and to determine the best sequence of particular intervention components with known potency. The findings represent an important first step in disentangling the complex interplay between different affective, cognitive, and behavioral engagement indicators and outcomes associated with use of a DMHI incorporating a natural language processing-supported relational agent. ClinicalTrials.gov NCT05672745; https://classic.clinicaltrials.gov/ct2/show/NCT05672745.

Purpose: This review aimed to investigate the effectiveness of digital school-based mental health interventions for adolescents in Sub-Saharan Africa. Method: The authors conducted a comprehensive search of digital school-based mental health interventions to identify studies conducted in Sub-Saharan Africa targeting adolescents between the ages of (10–19) years. Peer-reviewed studies published in English between 2009 and May 2023 were obtained through electronic bibliographic databases. Result: Only one study met the full inclusion criteria for this review. The included study tested a digital mental health intervention (“Shamiri Digital”) for treating depression, anxiety, and well-being in adolescents. The “Shamiri Digital” intervention demonstrated positive outcomes on depressive symptoms within the full sample. Discussion: The dearth of studies investigating digital mental health solutions for adolescents in low-income countries demonstrates a critical gap in intervention and research for adolescent mental health in resource constrictive settings

BackgroundHealthcare workers face burnout from high job demands and prolonged working conditions. While mental health services are available, barriers to access persist. Evidence suggests digital platforms can enhance accessibility. However, there is a lack of systematic reviews on the effectiveness of digital mental health interventions (DMHIs) for healthcare professionals. This review aims to synthesize evidence on DMHIs’ effectiveness in reducing burnout, their acceptability by users, and implementation lessons learned.MethodThis Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA)-guided review included 12 RCTs on DMHIs for healthcare professionals, published before 31 May 2024. The primary focus was on burnout, with secondary outcomes related to mental health and occupation. Quality appraisal used Cochrane risk of bias tools. A narrative synthesis explored DMHIs’ effectiveness, acceptability, utilization, and implementation lessons.ResultsSignificant improvements in mental health outcomes were observed in 10 out of 16 RCTs. Burnout and its constructs showed significant improvement in five RCTs. Studies that measured the acceptability of the interventions reported good acceptability. Factors such as attrition, intervention design and duration, cultural sensitivities, flexibility and ease of use, and support availability were identified as key implementation considerations.ConclusionsWeb-based DMHIs positively impact burnout, mental health, and occupational outcomes among healthcare professionals, as shown in most RCTs. Future research should enhance DMHIs’ effectiveness and acceptability by addressing identified factors. Increasing awareness of DMHIs’ benefits will foster acceptance and positive attitudes. Lessons indicate that improving user engagement and effectiveness requires a multifaceted approach.

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

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

Aim: Informal caregivers have an important role in bridging the gap between the assistance care recipients need and what can be provided by the health care systems across Europe. The burden of the caregiving role places a significant threat to caregiver health, and the vast majority of caregiver's report stress and emotional strain, depression, and increased rates of chronic diseases. In line with this, strengthening the caregiver's mental health is one of the main goals for optimal caregiving. Caregivers already struggle with the demand of their role while coping with health problems, social, family, and work obligations. The solution for the caregiver's mental health needs to be accessible, low cost, and time-effective. This scoping review investigates digital mental health tools available as a mean of supporting the mental health of caregivers.Method: Databases searched include Summon search box, the Cochrane Library, and PubMed. Three groups of keywords were combined: relating to digital mental health interventions for caregivers, digital mental health interventions and stress in elderly care, and digital mental health interventions and burden in elderly care.Results: Caregivers reported that digital mental health tools have an overall positive role in their health. Coping skills, emotion regulation, skill building, and education are found to be important aspects of digital mental health tools. There was a noted lack of digital mental health apps available specifically for the caregiver of older adults. Furthermore, the digital mental health tools, divided into three categories in this review, focused either on building skills or educating caregivers and assisting with the duties rather than the mental health of the caregiver itself. As repeatedly suggested in the reviewed studies, digital mental health interventions overall contribute to reducing the caregiver burden with a limitation of addressing one aspect of caregiver needs –i.e., specific coping skills or education regarding illnesses such as Alzheimer's disease and Dementia. The lack of all-encompassing, data and theory-driven digital mental health tools for addressing and supporting the caregiver's mental health is evident.

Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and is associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing multimorbidity are effective, particularly given that this patient population faces more treatment resistance. The goal of the current study was to examine the impact of smartphone-delivered DMH interventions for patients presenting with elevated internalizing symptoms that have reported multiple lifetime medical conditions. This preregistered (see https://osf.io/vh2et/ ) retrospective cohort intent-to-treat study with 2819 patients enrolled in a therapist-supported DMH intervention examined the associations between medical multimorbidity (MMB) and mental health outcomes. Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment. Overall, the Meru Health Program was associated with large effect size decreases in depressive and anxiety symptoms regardless of the number of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.

Adolescents and young people (AYP) aged 10-24 years in Africa experience a high burden of mental health disorders but face significant barriers to accessing care, including a severe shortage of mental health professionals, stigma, and limited integration of mental health services into primary healthcare. Digital mental health interventions (DMHIs) offer a promising avenue to bridge these gaps by providing accessible, scalable, and potentially equitable support. However, little is known about the effectiveness, acceptability, and equity impacts of these interventions among African AYP. This systematic review aims to identify, characterize, and synthesize evidence on DMHIs targeting adolescents and young people in Africa, focusing on mental health outcomes, engagement, feasibility, and equity considerations. We will search PubMed, Scopus, Web of Science, and EBSCOhost databases, as well as the PsyberGuide repository, for empirical studies published between January 1, 2015, and April 3, 2025. Eligible studies must evaluate a digital mental health intervention among AYP aged 10-24 years living in Africa. Study designs will include randomized controlled trials, quasi-experimental studies, observational studies, and mixed-methods studies. Outcomes of interest include mental health symptom reduction (depression, anxiety, stress), psychological well-being, engagement, feasibility, acceptability, and equity-related factors such as gender inclusivity and digital access. Risk of bias will be assessed using RoB 2 and ROBINS-I tools, and evidence quality will be rated using the GRADE approach. Quantitative synthesis will be conducted where feasible, otherwise narrative synthesis will be employed. This review will provide a comprehensive synthesis of available evidence on DMHIs for adolescents and young people in Africa, offering critical insights into their effectiveness, feasibility, and contribution to promoting mental health equity. The findings aim to inform the development, implementation, and policy integration of digital mental health strategies tailored to young populations in diverse African contexts.

BackgroundAdolescents and young people (AYP) aged 10–24 years in Africa experience a high burden of mental health disorders but face significant barriers to accessing care, including a severe shortage of mental health professionals, stigma, and limited integration of mental health services into primary healthcare. Digital mental health interventions (DMHIs) offer a promising avenue to bridge these gaps by providing accessible, scalable, and potentially equitable support. However, little is known about the effectiveness, acceptability, and equity impacts of these interventions among African AYP.ObjectiveThis systematic review aims to identify, characterize, and synthesize evidence on DMHIs targeting adolescents and young people in Africa, focusing on mental health outcomes, engagement, feasibility, and equity considerations.MethodsWe will search PubMed, Scopus, Web of Science, and EBSCOhost databases, as well as the PsyberGuide repository, for empirical studies published between January 1, 2015, and April 3, 2025. Eligible studies must evaluate a digital mental health intervention among AYP aged 10–24 years living in Africa. Study designs will include randomized controlled trials, quasi-experimental studies, observational studies, and mixed-methods studies. Outcomes of interest include mental health symptom reduction (depression, anxiety, stress), psychological well-being, engagement, feasibility, acceptability, and equity-related factors such as gender inclusivity and digital access. Risk of bias will be assessed using RoB 2 and ROBINS-I tools, and evidence quality will be rated using the GRADE approach. Quantitative synthesis will be conducted where feasible, otherwise narrative synthesis will be employed.ConclusionThis review will provide a comprehensive synthesis of available evidence on DMHIs for adolescents and young people in Africa, offering critical insights into their effectiveness, feasibility, and contribution to promoting mental health equity. The findings aim to inform the development, implementation, and policy integration of digital mental health strategies tailored to young populations in diverse African contexts.

Crowdsourcing to design a marketing package to promote a WHO digital mental health intervention among Chinese young adults

BackgroundSexual minority youth, particularly sexual minority youth of color, report elevated mental health challenges and persistent barriers to care. The COVID-19 pandemic exacerbated these disparities and catalyzed a shift toward digital health and digital mental health services. This rapid transition has made it challenging to understand digital exclusion and the digital divide.ObjectiveThis cross-sectional study identified the prevalence of digital health and digital mental health service use among US adolescents during the COVID-19 pandemic and examined heterogeneity by sexual orientation, race and ethnicity, and their intersection.MethodsNationally representative data were obtained from the 2021 Adolescent Behaviors and Experiences Survey (N=7705). Weighted distributions of digital health and digital mental health use were calculated, and modified Poisson regression models estimated adjusted prevalence ratios (aPRs) by sexual orientation, race and ethnicity, and their intersection.ResultsAcross the sample, digital health and digital mental health use were 25.8% and 8.5%, respectively. (All percentages reported are weighted estimates.) Digital mental health use was 5.6% among heterosexual participants and 18.1% among all sexual minority youth. In adjusted models, sexual minority subgroups had higher prevalence of digital mental health use than heterosexual peers (lesbian, gay, and bisexual [LGB]: aPR 2.60; sexually diverse: aPR 2.41; all P≤.05). This pattern held among White, Black or African American, and multiracial LGB participants. Digital mental health use was 10.2% among White participants and ranged from 4.8% to 15% among racially or ethnically minoritized participants. Black or African American, Hispanic or Latino, and Asian or Pacific Islander participants had lower prevalence of digital mental health use than White peers overall (Black or African American: aPR 0.70; Hispanic or Latino: aPR 0.55; Asian or Pacific Islander: aPR 0.48; all P≤.05) and among sexual minority youth (Black or African American: aPR 0.60; Hispanic or Latino: aPR 0.35; Asian or Pacific Islander: aPR 0.23; all P≤.05). Racial and ethnic disparities in digital mental health use were pronounced among LGB (Hispanic or Latino: aPR 0.52; P≤.05) and sexually diverse participants (Black or African American: aPR 0.36; Hispanic or Latino: aPR 0.17; Asian or Pacific Islander: aPR 0.10; all P≤.05), but not heterosexual participants. Digital health use did not differ by sexual orientation. However, Black or African American and Hispanic or Latino participants had lower prevalence of digital health use than White peers (28.8%) overall (Black or African American: aPR 0.76; Hispanic or Latino: aPR 0.78; all P≤.05) and among heterosexual (Black or African American: aPR 0.73; Hispanic or Latino: aPR 0.80; all P≤.05) and sexual minority youth participants (Hispanic or Latino: aPR 0.75).ConclusionsDigital platforms offer promise for expanding access to mental health care among sexual minority youth, but persistent inequities must be addressed. Cocreation with lived-experience experts may be critical to ensure digital services are trusted, inclusive, and accessible for all youth.

Introduction Digital mental health interventions (DMHIs) can offer affordable, accessible and anonymous delivery of mental health treatment as an alternative or complement to face-to-face services. To enhance acceptability of, and treatment engagement with, youth DMHIs, they should be co-designed with young people and their caregivers. This study focuses on co-design with caregivers. Objective To explore caregivers’ perspectives, preferences, and ideas to inform the co-design of a digital youth mental health platform for anxiety and depression: ‘Momentum’. Methods and Measures Six group discussions were conducted with 16 caregivers of young people aged 7–17 years. In relation to Momentum, and DMHIs more broadly, participants’ views were sought on purpose and acceptability, access, assessments and feedback, information sharing, caregiver involvement and engagement. Data were thematically analysed using an inductive codebook approach, guided by template analysis. Results Seven themes were identified: (1) providing therapeutic and educational resources; (2) promoting shared and positive communication about mental health; (3) enhancing user experience and understanding; (4) facilitating personalisation and offering customisation of platform features; (5) encouraging end-user engagement through interactivity, incentives, relatability and attracting and maintaining attention; (6) enabling caregivers to provide support while promoting young people's independence; and (7) reducing concerns about, and enhancing trust in, DMHIs. Conclusions Participants expressed favourable views towards DMHIs and Momentum. They shared design ideas for a user-friendly, engaging, interactive, trustworthy, personalised and transparent platform that offered educational resources and mental health treatment. Two sets of recommendations were derived from the study findings: (1) recommendations for co-designing DMHIs with caregivers and (2) recommendations for the design of youth DMHIs.

Rising cancer rates have amplified psychiatric and psychosocial burdens, with 35%-40% of patients exhibiting diagnosable psychiatric disorders. While digital mental health interventions (DMHIs) present potential solutions for improving emotional well-being in this population, evidence remains fragmented and lacks clarity regarding optimal implementation strategies. This study evaluates the efficacy of digital interventions on mental health outcomes in patients with cancer, with particular focus on intervention duration and stakeholder involvement as moderating factors. This study aims to (1) characterize digital interventions targeting mental health outcomes in patients with cancer; (2) quantify their effectiveness in reducing anxiety and depression; and (3) examine whether intervention duration and stakeholder involvement moderate treatment outcomes. This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines and was retrospectively registered in PROSPERO on May 25, 2025 (CRD420251058005). A total of 8 databases (Cochrane Central Trials Registry, Web of Science, Scopus, PubMed, PsycINFO, Global Health, Embase, and Medline) were searched from inception to 2024. Eligible randomized controlled trials evaluated digital interventions for mental health in patients with cancer. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias Tool 2.0. Random-effects meta-analyses calculated standardized mean differences (SMDs). Pooled results were reported as the odds ratio and 95% CI. The heterogeneity was assessed with the I² test (%). Subgroup analyses explored the potential effects of intervention duration and stakeholder involvement. Sensitivity analyses and publication bias assessments were performed to ensure the robustness of findings. Twenty-two randomized controlled trials were included in the review. The geolocation involves 4 continents worldwide: Asia (n=9), Europe (n=5), North America (n=6), and Oceania (n=2). Interventions comprised meditation or mindfulness (n=3), education (n=8), self-management (n=11), physical exercise (n=4), and patient community communication (n=8). Twelve studies were included in the meta-analysis. Overall, digital interventions showed nonsignificant effects on depression (SMD -0.48, 95% CI -1.00 to 0.03; P=.07; 9 studies) or anxiety (SMD -0.61, 95% CI -1.29 to 0.06; P=.08; 8 studies) with substantial heterogeneity (I2>90%). Subgroup analyses revealed interventions (<1 month) significantly reduced anxiety (SMD -0.73, 95% CI -1.42 to -0.04; P=.04), while interventions (1-2 months) reduced depression (SMD -0.18, 95% CI -0.35 to -0.01; P=.04). Interventions showed no statistically significant differences when stratified by stakeholder involvement. Sensitivity analyses excluding 1 outlier yielded significantly lower heterogeneity but preserved unchanged overall and subgroup patterns. While DMHIs overall showed no effect on anxiety or depression interventions, exploratory analyses suggest potential benefits of duration-tailored approaches. High heterogeneity and methodological limitations indicate that DMHIs may be most effective when integrated into personalized care models rather than standalone treatments. Future research should use standardized outcomes and investigate mechanisms underlying potential duration-dependent efficacy.