Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review

Abstract

Background Digital 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. Objective This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods A 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). Results A 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. Conclusions The 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.

Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): a randomized controlled pilot trial

“…Furthermore, they could continually ask the AYA about completing the modules to reinforce a certain commitment of AYA. Another important aspect in regard to adherence might be parental involvement [ 77 , 78 ]. In our focus groups study, AYA pointed out that they would prefer not to involve their parents [ 27 ].…”

Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis

“…However, a comparison of the results of the 1-stage IPD-MA with the results of an optional 2-stage IPD-MA comprising all relevant studies might lessen this possible limitation. Second, the harmonization and standardization of mediation studies might be especially challenging, given the heterogeneity of this research field ( 35 , 44 , 50 , 51 , 85 ) and the large number of data points and variables that have to be synthesized. Third, only a minority of mediation studies have implemented a longitudinal design with at least three assessments points of mediators and outcomes ( 44 ), principally enabling the examination of the temporal ordering and patterns of changes in mediators and outcomes; in consequence, the scope of causal conclusions might be constrained—beyond the inherent limitations of statistical mediation itself ( 86 ).…”

“…In order to evaluate the appropriateness of research designs of included studies to detect mechanisms of change and to approach causality, a rating system based on the criteria proposed by Kazdin ( 31 ) and adapted to psychotherapy research for common mental disorders by Lemmens et al ( 39 ), Domhardt et al ( 34 , 35 , 44 , 50 ), and Steubl et al ( 51 , 52 ) will be applied. Studies will be rated in regard to the following nine criteria as either fulfilled or not fulfilled independently by two reviewers: (a) utilization of an appropriate RCT design, (b) inclusion of a control group, (c) report of a theoretical foundation for mediators, (d) minimum sample size of 40 participants per group, (e) examination of multiple mediators within one study, (f) assessment of temporality (three or more assessments of the mediator variables and outcomes), (g) experimental manipulation of the mediator, (h) significant statistical association between treatment, mediator and outcome ( p < 0.05) and (i) consideration and control of confounding variables in a methodologically appropriate manner ( 35 , 53 ).…”

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“…Com o aumento de pacientes incluídos, além de beneficiar a saúde pública em geral, gerará números para aproximar os resultados desta pesquisa com os estudos já publicados. (43)(44)(45) Com a análise de todos os dados apresentados e da literatura, infere-se que a aplicação da videomediastinoscopia para o estadiamento e o diagnóstico do câncer de pulmão é eficaz. Neste estudo, observou-se um elevado número de biópsias realizadas por ocasião de maior visibilidade do mediastino durante o ato cirúrgico, inclusive de cadeias linfonodais paratraqueais à esquerda, com taxas de mortalidade nulas.…”

“…Um artigo de referência sobre a presença de exossomos em parasitas foi publicado por Silverman et al (42) que mostraram que apenas 14% das proteínas detectadas no secretoma de Leishmania donovani continham o peptídeo sinal N-terminal característico de uma secreção clássica (43). A análise proteômica do secretoma mostrou que todas as proteínas para as quais existe um ortólogo de Leishmania se assemelham àquelas previamente identificadas em exossomos se-cretados por linfócitos B (43). Usando centrifugação diferencial, foi isolada uma fração contendo exossomos com diâmetro de 30-70 nm, contendo marcadores exossomais como HSP70, HSP90 e fator de alongamento-1α.…”