TABLE 1.
Digital technologies to support adolescents with depression and anxiety
| Digital programme (reference, country) | Mental health difficulties and setting (e.g. clinic, school) | Psychological and other theories | Technological approaches and delivery | Stakeholder involvement in programme development | Evaluation and findings | Access (based on information from authors, papers and online sources) |
|---|---|---|---|---|---|---|
| Structured and modular approaches | ||||||
| MoodGYM (Calear, 2009; Australia | Depression, anxiety. Any setting |
CBT | Interactive modules, workbook. Stand-alone |
Interviews/focus groups: young people | Cluster RCT: 1477 school students. Reduction in levels of anxiety at 6 months (v. waiting list), effects on depressive symptoms less strong | Available for free in Australia, subscription fee elsewhere: moodgym.com.au |
| CATCH-IT (Gladstone 2018; USA) | Depression. Community, clinics |
CBT, IPT | Interactive modules. Supported |
Groups/questionnaires: young people, practitioners | RCT: 369 young people in primary care. Reduction in depression symptoms in both arms, but no difference (v. general health education, attention control), may prevent depressive episodes in those with subsyndromal depression | Information: catchit-public.bsd.uchicago.edu |
| Grasp the Opportunity (Ip 2016; Hong Kong) | Depression. Schools |
CBT | Interactive modules. Stand-alone |
Questionnaires/focus groups/discussions: young people, parents, teachers, practitioners | RCT: 257 students. Reduction in depressive symptoms at 12 months (v. anti-smoking website, attention control) | Not available outside of research projects |
| CURB (Bansa 2018; USA) | Depression. Primary care |
CBT, IPT | Interactive modules. Supported |
Surveys/workshops: young people, parents, practitioners | Feasibility study: challenges and successes in screening and implementing in urban ethnic minority primary care settings | Information: checkbot-201623.appspot.com/index |
| Stressbusters (Smith 2015; Wright 2020; England) | Depression. Schools, community, clinics |
CBT | Interactive sessions, videos. Stand-alone |
Surveys/focus groups: young people, practitioners, designers | Smith 2015: RCT of 112 young people in schools. Improvement in depression and anxiety symptoms at 6 months (v. waiting list) Wright 2020: RCT of 139 young people from community and clinics. Improvement in both arms, but no difference at 12 months (v. self-help websites, attention control). Earlier study showed reduced depressive symptoms at 4 months |
Not available outside of research projects |
| Think, Feel, Do (Stallard 2011; England) | Depression, anxiety. Clinics, schools |
CBT | Interactive sessions, videos. Supported |
Focus groups: children and young people, designers | Pilot RCT: 20 young people, improvement on 7 subscales compared with improvement on 3 subscales in waiting-list control. Moderate to high satisfaction | Not available outside of research projects |
| PST (Hoek 2012; The Netherlands) | Depression, anxiety. Schools, community |
Problem-solving therapy | Lessons, exercises, email support. Supported |
Adapted from PST programme for adults by authors | RCT: 45 young people. Overall improvement in depression and anxiety for both arms, but no difference (v. waiting list) | Not available outside of research projects |
| LEAP Project (Rickhi 2015; Canada) | Depression, well-being. Community, schools, clinics |
Psychotherapeutic spiritual principles (e.g. gratitude, compassion) | Interactive modules, videos, relaxation techniques, journal. Stand-alone |
Assignments/meetings/workshops/focus groups: young people, parents, practitioners, educators | Pilot RCT: 31 young people. Reduced severity of depression (v. waiting list) | Not available outside of research projects. Reformulated as BreathingRoom: breathingroom.me |
| iCBT (Topooco 2019; Sweden) | Depression. Community |
CBT | iCBT modules, assignments, reflection. Supported |
Surveys, text/oral feedback: users, practitioners | RCT: 70 young people. Improvements in depression symptoms post-treatment (v. minimal attention control), sustained at 12 months | Not available outside of research projects |
| iPDT (Lindqvist 2020; Sweden) | Depression. Schools, clinics, community |
Psychodynamic psychotherapy | Modules, exercises, therapist feedback. Supported |
Adapted from psychodynamic programme for adults by authors | RCT: 76 young people. Reduced depression and anxiety symptoms at 6 months (v. online supportive contact) | Not available outside of research projects |
| DAD Programme (Moeini 2019; Iran) | Depression. Schools |
Social cognitive theory | Modules, videos, animations, slides. Supported |
Interviews/focus group: young people | RCT: 128 female students. Improved depression symptoms at 12 weeks (v. control group). | Not available outside of research projects |
| BRAVE-ONLINE (Spence 2011; Australia) | Anxiety. Any setting |
CBT | Interactive sessions, animations, games. Stand-alone and supported versions |
Surveys/focus groups: CYP, practitioners | RCT: 115 young people. Similar improvements in anxiety diagnoses and symptoms compared with face-to-face therapy at 12 months (and greater than waiting list) | BRAVE Self-Help available free in Australia: brave4you.psy.uq.edu.au BRAVE Therapist-Assisted not available outside research projects. Information: brave-online.com |
| Cool Teens/ ChilledOut Online (Wuthrich 2012; Stjerneklar 2019; Australia) | Anxiety. Schools, community, clinics |
CBT | Multimedia information, activities, homework. Supported |
Questionnaires: young people | Cool Teens: RCT: 43 young people. Reduced number and severity of anxiety disorders post-treatment (v. waiting list), sustained at 3 months. ChilledOut: RCT: 70 young people. Outperformed waiting-list condition on diagnostic severity and anxiety symptoms post-treatment (sustained at 12 months) |
Not available outside of research projects or centres with service agreements. Information: chilledout.org.au |
| Camp Cope-A-Lot (Pryor 2021; USA) | Anxiety. Any setting |
CBT | Interactive sessions, animation, cartoon characters, homework. Supported |
Adapted from Coping Cat programme by authors | Controlled trial: 27 CYP with anxiety and ASD. Reduced anxiety compared with digital social skills programme | Information: copingcatparents.com/Camp_Cope_A_Lot |
| Gamification, serious games and avatars | ||||||
| SPARX (Merry 2012; New Zealand) | Depression. Any setting (especially primary care) |
CBT | Gamification, avatars. Stand-alone |
Workshops/focus groups: young people, families, clinicians, designers, cultural advisors | RCT: 187 young people in primary healthcare. Not inferior to TAU (primarily face-to-face counselling) on depressive symptoms at 3 months | Available online and via app stores for free in New Zealand: sparx.org.nz |
| The Journey (Stasiak 2014; New Zealand) | Depression. Schools |
CBT | Gamification, videos/animation. Stand-alone |
Workshops: young people, designers | Pilot RCT: 34 students. Feasible, acceptable and reduction in depressive symptoms (v. computerised psychoeducation) | Not available |
| SPARX-R (Perry 2017; Australia) | Depression. Schools |
CBT | Gamification. Stand-alone |
Interviews/focus groups: young people, families, practitioners | RCT: 540 students. Reduced depression symptoms at 6 months(v. online attention control) | Not available outside of research projects. Information: sparx.org.nz |
| Rainbow SPARX (Lucassen 2015; New Zealand) | Depression. Schools, primary care |
CBT | Gamification, avatars. Stand-alone |
Questionnaires/focus groups: young people | Open pilot trial: 21 sexual minority youth. Acceptable, feasible, and reduction in depressive symptoms | Not available outside of research projects. Information: sparx.org.nz |
| Pesky/Mindful gNATs (Tunney 2017; van der Meulen 2019; Ireland) | Anxiety, depression. Primary care, clinics |
CBT, mindfulness | Gamification. Supported |
Focus groups: CYP, practitioners, designers | Tunney 2017: two-armed qualitative study: 93 CYP. Six themes identified, technology can offer ‘rich experience’. van der Meulen 2019: naturalistic deployment study: 21 therapists, 95 young people. Three themes identified, supports real-world delivery |
Available for licence fee (some resources free): peskygnats.com and mindfulgnats.com |
| Moderated group, social media and messaging | ||||||
| Master Your Mood Online (van der Zanden 2012; The Netherlands) | Depression, anxiety. Community |
CBT | Mood measure, facilitated sessions, chat function. Supported |
Adapted from face-to-face intervention and Coping with Depression course by authors | RCT: 244 young people from community. Reduced depression and anxiety symptoms at 3 months (v. waiting list), sustained at 6 months. | Information: gripopjedip.nl |
| MEMO (Whittaker 2017; New Zealand) | Depression. Schools |
CBT | Text messages, videos/ animations. Stand-alone |
Focus groups: young people, practitioners, mHealth experts | RCT: 855 students. More from MEMO CBT group felt it helped them to be more positive and to get rid of negative thoughts (v. MEMO control). No effect on depressive symptoms | Not available |
| Rebound/ MOST (Rice 2018; Australia) | Depression. Clinics |
CBT, mindfulness, positive psychology, social support | Social media-enabled platform. Supported |
Workshops/focus groups/ consultations: young people, families, professionals, writers/artists, designers | Pilot study: 42 young people. Acceptable, feasible and safe | Not available outside of research projects. Information: orygen.org.au/Clinical-Care/Clinical-services/Moderated-Online-Social-Therapy |
| SOVA (Radovic 2018; USA) | Depression, anxiety. Clinics, community |
Social support, psycho-education | Moderated social media. Supported |
Interviews/focus groups: young people, parents, advocates, professionals | Feasibility study: 96 young people, established feasibility and usability | Available for free at: sova.pitt.edu wisesova.pitt.edu |
| School-based technologies | ||||||
| Climate Schools (Teesson 2020; Australia) | Depression, anxiety, substance misuse. Schools |
Psycho-education, CBT, harm minimisation | Interactive modules, illustrated storylines. Stand-alone (with teacher component) |
Focus groups: young people, practitioners, designers | Cluster RCT: 6386 students. Combined intervention led to increased knowledge and decreased anxiety symptoms at 30 months (v. health education, active control) | Available to schools for free in Australia: rebranded as OurFutures ourfutures.education Adapted materials available in UK (climateschools.co.uk) and USA (climateschools.com) |
| Smooth Sailing (O'Dea 2021; Australia) | Depression, anxiety. Schools |
Step-wise approach: psycho-education, CBT, school counselling |
Stepped-care, interactive modules. Supported |
Surveys/interviews/focus groups: young people, counsellors, GPs, parents | Cluster RCT: 1841 students. Marginal difference in help-seeking intentions at 12 weeks (v. school-as-usual control). | Not widely available outside research projects. Information: blackdoginstitute.org.au/research-projects/smooth-sailing |
| e-couch Anxiety and Worry programme (Calear 2016; Australia) | Anxiety. Schools |
Psycho-education, CBT | Interactive modules. Stand-alone |
Developed from existing programmes by researchers and practitioners, input/feedback from consumers | Cluster RCT: 1767 students. Externally supported v. teacher-supported v. waiting list. No differences on mental health or well-being | Available for free in Australia; with subscription fee elsewhere: ecouch.com.au |
| Emerging interactive and personalised technologies | ||||||
| Shamiri-Digital (Osborn 2020; Kenya) |
Depression, anxiety. Schools |
Growth mindset, gratitude, value affirmation | Interactive exercises (single session). Stand-alone |
Feedback from recent high school graduates, authors | RCT: 103 students. Reduced depressive symptoms at 2 weeks (v. study-skills control) | Available for free: outside research projects. thrive-online.shamiri.institute |
| Depis.Net (Anttila 2021, Finland) | Depression. Clinics, schools |
Self-determination theory | Sessions, exercises, mood/sleep diary, support system. Supported |
Interviews: young people, practitioners | Quasi-experimental study: 151 students. No difference in health outcomes (v. control group). Encouraging results on adherence and acceptance | Not available outside research projects |
| Quest-Te Whitianga (Christie 2019; Fleming 2019; Bevan Jones 2020a; New Zealand) | Anxiety, depression. Any setting |
CBT, positive psychology, mindfulness, interpersonal skills | Modular activities, gamification. Stand-alone |
Interviews/focus groups/ workshops: young people, designers, practitioners | Acceptability testing: support from young people, Māori and Pasifika people and clinicians | Not available outside of research projects |
| HABITs (Thabrew 2018; Merry 2020; New Zealand) | Emotional health, substance use. Schools, community |
CBT, positive psychology, harm minimisation | Different user groups: games, chatbots, intrinsic motivators; digital ecosystem. Stand-alone |
Surveys/focus groups: young people, practitioners, cultural advisors | Acceptability/usability testing: young people with similar mental health needs and backgrounds had diverse preferences, including gamified and serious/simple interface | Not available outside of research projects |
| MoodHwb (Bevan Jones 2020b; Wales) | Depression. Clinics, schools, community |
Psycho-education, CBT, social support | Illustrations/animations, profile builder, mood diary, goal-setting. Stand-alone |
Interviews/workshops/focus groups: young people, parents/carers, practitioners, designers | Feasibility evaluation; 44 young people, 31 parents/carers. Acceptable and feasible | Not available outside of research projects |
| Smartteen (Srivastava 2020; India) | Depression. Clinics |
CBT | Interactive presentation, quizzes, vignettes, diary. Supported |
Focus groups: young people, practitioners | Pilot RCT: 21 young people. Feasible, acceptable and reduced depressive symptoms | Not available outside research projects |
| Anxiety Coach (Whiteside 2019; USA) | Anxiety. Clinics |
Exposure therapy | Interactive activities, parent-coached. Supported |
Developed by authors | Feasibility study: 4 therapists, 8 CYP. Feasible and acceptable | Information: anxietycoach.mayoclinic.org/anxiety |
ASD, autism spectrum disorder; CBT, cognitive–behavioural therapy; CYP, children and young people; GP, general practitioner; iCBT, internet-based cognitive–behavioural therapy; iPDT, internet-based psychodynamic psychotherapy; IPT, interpersonal psychotherapy; RCT, randomised controlled trial; TAU, treatment as usual; v., versus (compared with).