The current status of culturally adapted mental health interventions: a practice-focused review of meta-analyses

Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (Preprint)

10.2196/preprints.11528 ◽

2018 ◽

Author(s):

Hanneke Scholten ◽

Isabela Granic

Keyword(s):

Mental Health ◽

Design Thinking ◽

Health Interventions ◽

New Wave ◽

Digital Interventions ◽

Wide Range ◽

Mental Health Interventions ◽

Principles Of Design ◽

Meta Analyses ◽

Scientific Standards

UNSTRUCTURED Numerous reviews and meta-analyses have indicated the enormous potential of technology to improve the appeal, effectiveness, cost, and reach of mental health interventions. However, the promise of digital mental health interventions for youth has not yet been realized. Significant challenges have been repeatedly identified, including engagement, fidelity, and the lack of personalization. We introduce the main tenets of design thinking and explain how they can specifically address these challenges, with an entirely new toolbox of mindsets and practices. In addition, we provide examples of a new wave of digital interventions to demonstrate the applicability of design thinking to a wide range of intervention goals. In the future, it will be critical for scientists and clinicians to implement their scientific standards, methods, and review outlets to evaluate the contribution of design thinking to the next iteration of digital mental health interventions for youth.

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Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview

JMIR Mental Health ◽

10.2196/25847 ◽

2021 ◽

Vol 8 (4) ◽

pp. e25847

Author(s):

Susanna Lehtimaki ◽

Jana Martic ◽

Brian Wahl ◽

Katherine T Foster ◽

Nina Schwalbe

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Young People ◽

Digital Health ◽

Health Interventions ◽

Middle Income ◽

Middle Income Countries ◽

Mental Health Interventions ◽

Meta Analyses ◽

Low And Middle Income

Background An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. Objective This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). Methods We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. Results In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. Conclusions Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

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Evidence on Digital Mental Health Interventions for Adolescents and Young People: Systematic Overview (Preprint)

10.2196/preprints.25847 ◽

2020 ◽

Author(s):

Susanna Lehtimaki ◽

Jana Martic ◽

Brian Wahl ◽

Katherine T Foster ◽

Nina Schwalbe

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Young People ◽

Digital Health ◽

Health Interventions ◽

Middle Income ◽

Middle Income Countries ◽

Mental Health Interventions ◽

Meta Analyses ◽

Low And Middle Income

BACKGROUND An estimated 1 in 5 adolescents experience a mental health disorder each year; yet because of barriers to accessing and seeking care, most remain undiagnosed and untreated. Furthermore, the early emergence of psychopathology contributes to a lifelong course of challenges across a broad set of functional domains, so addressing this early in the life course is essential. With increasing digital connectivity, including in low- and middle-income countries, digital health technologies are considered promising for addressing mental health among adolescents and young people. In recent years, a growing number of digital health interventions, including more than 2 million web-based mental health apps, have been developed to address a range of mental health issues. OBJECTIVE This review aims to synthesize the current evidence on digital health interventions targeting adolescents and young people with mental health conditions, aged between 10-24 years, with a focus on effectiveness, cost-effectiveness, and generalizability to low-resource settings (eg, low- and middle-income countries). METHODS We searched MEDLINE, PubMed, PsycINFO, and Cochrane databases between January 2010 and June 2020 for systematic reviews and meta-analyses on digital mental health interventions targeting adolescents and young people aged between 10-24 years. Two authors independently screened the studies, extracted data, and assessed the quality of the reviews. RESULTS In this systematic overview, we included 18 systematic reviews and meta-analyses. We found evidence on the effectiveness of computerized cognitive behavioral therapy on anxiety and depression, whereas the effectiveness of other digital mental health interventions remains inconclusive. Interventions with an in-person element with a professional, peer, or parent were associated with greater effectiveness, adherence, and lower dropout than fully automatized or self-administered interventions. Despite the proposed utility of digital interventions for increasing accessibility of treatment across settings, no study has reported sample-specific metrics of social context (eg, socioeconomic background) or focused on low-resource settings. CONCLUSIONS Although digital interventions for mental health can be effective for both supplementing and supplanting traditional mental health treatment, only a small proportion of existing digital platforms are evidence based. Furthermore, their cost-effectiveness and effectiveness, including in low- and middle-income countries, have been understudied. Widespread adoption and scale-up of digital mental health interventions, especially in settings with limited resources for health, will require more rigorous and consistent demonstrations of effectiveness and cost-effectiveness vis-à-vis the type of service provided, target population, and the current standard of care.

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Culture and psychiatric epidemiology

Practical Psychiatric Epidemiology ◽

10.1093/med/9780198735564.003.0003 ◽

2020 ◽

pp. 33-50

Author(s):

Brandon A. Kohrt ◽

Vikram Patel

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Illnesses ◽

Health Interventions ◽

Cultural Variations ◽

Cultural Frameworks ◽

Culturally Adapted ◽

Care Systems ◽

Mental Health Interventions ◽

The Relationship

Culture refers to values, beliefs, knowledge, norms, and practices and the notion that these are shared among a specific set of people. Culture shapes the meaning and social experience of mental illness; influences the types of exposures to factors that cause mental illness; and moderates the relationship between risks and mental health outcomes. Cultural differences in models of causality and labelling of mental illnesses contribute to degree of family support, use of religious and traditional healing, and engagement with biomedical care systems. Cultural variations in describing, disclosing, and categorizing suffering are also sources of potential bias in epidemiological research. Instruments developed in one culture may be used in others, but greater emphasis must be placed on their adaptation to ensure equivalence. Use of cultural frameworks is crucial to optimize utilization and outcomes of culturally adapted psychological treatments and other mental health interventions.

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