New meta-analysis explores how digital interventions can promote youth well-being

Conley, C. S., Raposa, E. B., Bartolotta, K., Broner, S. E., Hareli, M., Forbes, N., Christensen, K. M., & Assink, M. (2022). The impact of mobile technology-delivered interventions on youth well-being: Systematic review and 3-level meta-analysis. JMIR Mental Health, 9(7). https://doi.org/10.2196/34254

Summarized by Ariel Ervin

Notes of Interest: 

• Although mental health rates are increasing for youth, few actually recieve treatment.
• Mobile technology-delivered interventions ( mTDIs)* are a promising solution to closing the mental health gap.
• This study assesses the impact mTDIs have on youth on a variety of mental health and well-being outcomes.
• Results indicate that mTDIs were notably beneficial for youth at post-test and follow-up for various outcomes.
• Comparison group types significantly moderated effects. However, this finding only applied to higher-quality studies.
• Both pre-existing mental health risk level and gender didn’t moderate effect sizes. On the other hand, effects increased with youth age (this also only applied to higher-quality studies).
• Regarding intervention features, the included mTDIs were successful regardless of support or technological features.
• Only mTDIs with higher quality subsamples and had a clear, frequent use prescription had notable effects.
• mTDIs have the potential to improve various aspects of youth well-being.

*= e.g. mobile-delivered mental health content via smartphones, tablets, mobile VR, and other handheld or wearable devices

Introduction (Reprinted from the Abstract)

Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples.

Objective: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth.

Methods: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies.

Results: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects.

Conclusions: Overall, this study’s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings.

Implications (Reprinted from the Discussion)

To our knowledge, this study represents the first review and meta-analysis of mTDIs for a wide variety of youth well-being outcomes, an area of research that has grown rapidly in the past decade. Rigorous searches of the published and unpublished literature in this area yielded 80 studies evaluating 83 mTDIs for youth. A 3-level meta-analysis revealed an overall Hedges g of 0.27 across all youth outcomes and follow-up assessments, indicating a small effect that is generally consistent with the observed impact of mTDIs in other meta-analyses [42,62,67-69]. This finding addresses a critical gap in the existing literature in that most previous meta-analyses have focused solely on the effects of mTDIs in adult populations [42,53,63], and the few studies focusing specifically on youth have aggregated across diverse types of mobile and nonmobile technologies [64,65] or limited their scope to a specific subset of youth disorders (eg, internalizing disorders [67]).

It is worth noting that our sample included many studies of mTDIs that were still relatively early in their development and were, therefore, primarily interested in evaluating the feasibility and acceptability of the technology, although they also included measures of more distal mental health outcomes that they ultimately aimed to influence. Therefore, our analyses may underestimate, to some extent, the impact that these mTDIs would have had in larger or longer efficacy trials more specifically designed to influence youth mental health outcomes. As this literature continues to mature, it will be important to focus the inclusion criteria more specifically on studies that measure the effects of mTDIs on more distal mental health outcomes as their primary focus.

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