Abstract
BackgroundDigital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking.ObjectiveThis systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents.MethodsA systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research).ResultsA total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded.ConclusionsThe findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future.
Highlights
Mental disorders in children and adolescents are common, with prevalence rates ranging from 10% to 20% worldwide [1]
Research on Digital health interventions (DHIs) is a fast growing field [36] and might offer intriguing opportunities for psychotherapeutic process research [24,37], we are not aware of any systematic review of the mediators and mechanisms of change in DHIPSY and DHIs with a focus on health promotion (DHIHP) for common mental disorders in youth published to this point
Studies on DHIPSY accounted for 43.2% (2110/4884) of participants, and studies on DHIHP accounted for 56.8% (2774/4884) of participants
Summary
Background Mental disorders in children and adolescents are common, with prevalence rates ranging from 10% to 20% worldwide [1]. Digital health interventions (DHIs), such as internet- and mobile-based interventions with a psychotherapeutic focus (DHIPSY), offer the possibility of addressing some barriers to treatment uptake and might contribute to extending mental health care, given their various presumed advantages, such as possible cost- and time-efficient use, independence from spatial and temporal circumstances, potential anonymity, high degrees of flexibility, and autonomy for users. These assets may be especially important during the COVID-19 pandemic and allow for continued mental health care despite contact restrictions and physical distancing [10]. Digital health interventions (DHIs) are efficacious for several mental disorders in youth; integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking
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