Table 1.

Characteristics and main findings of the included studies.

Reference and study country	Study design	Sample characteristics	Digital aspecta	Religion/spirituality measuresb	Mental health measuresb	Main findings
Mindu et al [25], 2023 (South Africa)	Mixed-methods study	93 youth and young adults aged 16-24 years; 44% female	Assessed participants’ knowledge and preferences for a digital mental health app	Where do youth seek treatment or assistance when they have mental health problems (Response options: Visit a spiritual healer; Go to a church for prayers; Traditional medicine; Clinic/hospital; Visit a health care worker)	Mental health awareness (eg, taught about mental health and no prior education on mental health) Mental health conditions affecting youth in the community (eg, substance abuse or misuse, posttraumatic stress disorder, depression, and anger)	No participants had experience using a mental health app, but 99% indicated mental apps are important and can benefit youth. Religious and cultural beliefs were a barrier to using digital platforms (eg, social media).
Gao et al [26], 2021 (China)	Cross-sectional study	1017 first-year college students (mean age 19 years); 77.8% female	Participants were recruited through an eHealth application to complete a survey	Religion (Response options: No religion; Buddhism; Christian; Others)	Generalized Anxiety Disorder-7 (GAD-7) and depression; Patient Health Questionnaire-9 (PHQ-9) [27,28]	95.3% indicated having no religion. Belief in Christianity and in Buddhism were associated with greater anxiety.
Craig Rushing et al [29], 2021 (United States)	Randomized controlled trial	833 American Indian or Alaska Native teenagers and young adults aged 15-24 years; 66.3% female	The 2 intervention arms included 3 SMS text messages per week for 8 weeks with information, role model videos, images, and engagement opportunities (eg, reply for more information, resource links, etc)	Rate your spiritual health (Response options: Excellent; Very good; Good; Fair) [30]	Rate your mental health (Response options: Excellent; Very good; Good; Fair) [30]	No significant differences between the 2 intervention arms within subjects. Mean scores of perceived health (physical, mental, and spiritual) significantly increased over time for both intervention arms. Those who reported better health also reported greater cultural resilience, identity, and cultural pride.
Reed et al [23], 2022 (United States)	Cross-sectional study	349 American Indian or Alaska Native youth aged 15-24 years; 71.1% female	Assessed participants’ use of media technologies (ie, media types, frequency, and duration) and how they use media technologies (ie, online behaviors and activities)	Select the top 3 health topics from a list of 15, including spiritual health	Self-reported mental health (How good is your mental health? Response options: 4-point Likert-type scale; 4=Excellent and 1=Poor) Select the top 3 health topics from a list of 15, including mental health	53.5% of participants relied heavily on the internet to access health information. Nonsexual and gender minority participants reported better mental health than sexual and gender minority participants. The top 3 most important health topics were Native identity, mental health, and social justice and equality. Spiritual health was selected as the most important health topic 14% of the time.
Au-Yeung et al [24], 2023 (Canada)	Mixed-methods study	5 Indigenous youth aged 11-16 years; 60.0% female	Assessed participants’ opinions on the JoyPop app, and the accessibility and feasibility of the app	Qualitative question: “What does a ‘Good Mind’ (Haudenosaunee concept) mean to you?” “The Good Mind is a physical, psychological, and spiritual journey that includes a reflective awareness of thoughts and intentions, and a way of being that is expressed through self-compassion and compassion for other beings.”	Perceived mental wellness (5-point Likert scale) Qualitative question: “Would you please describe what mental wellness means to you?”	Participants had mixed ratings for their mental health from “fair” to “very good.” Participants reported nature to be important for a “Good Mind.” Participants reported enjoying the app’s features (eg, games and breathing techniques) and made suggestions to make it relevant to their culture.

^aRefers to the digital component of the study, which may include the mode through which an intervention was given (eg, mobile text messages) or the constructs measured (eg, social media use and preferences for a mobile app).

^bMeasures refer to assessments, tools, or specific survey items that were used in the study to assess the construct of interest (eg, religion or spirituality, and mental health).