Quality Social Connection as an 'Active Ingredient' in Digital Interventions for Young People With Depression and Anxiety: A Systematic Scoping Review and Meta-Analysis

Background Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. Objective The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. Methods A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. Results Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (–25.6%, 95% CI –0.352 to –0.160; P<.001) and anxiety (–15.1%, 95% CI –0.251 to –0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. Conclusions D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.

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Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis (Preprint)

10.2196/preprints.26584 ◽

2020 ◽

Author(s):

Lindsay H Dewa ◽

Emma Lawrance ◽

Lily Roberts ◽

Ellie Brooks-Hall ◽

Hutan Ashrafian ◽

...

Keyword(s):

Mental Health ◽

Young People ◽

Conceptual Framework ◽

Scoping Review ◽

Meta Analysis ◽

Social Connections ◽

Social Connection ◽

Depression And Anxiety ◽

Digital Interventions ◽

The Impact

BACKGROUND Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. OBJECTIVE The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. METHODS A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. RESULTS Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (–25.6%, 95% CI –0.352 to –0.160; <i>P</i><.001) and anxiety (–15.1%, 95% CI –0.251 to –0.051; <i>P</i>=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. CONCLUSIONS D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.

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School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis

Clinical Psychology Review ◽

10.1016/j.cpr.2016.10.005 ◽

2017 ◽

Vol 51 ◽

pp. 30-47 ◽

Cited By ~ 202

Author(s):

Aliza Werner-Seidler ◽

Yael Perry ◽

Alison L. Calear ◽

Jill M. Newby ◽

Helen Christensen

Keyword(s):

Systematic Review ◽

Young People ◽

Meta Analysis ◽

Prevention Programs ◽

Depression And Anxiety ◽

Anxiety Prevention ◽

School Based

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Self-evaluation as an active ingredient in the experience and treatment of adolescent depression; An integrated scoping review with expert advisory input

10.31234/osf.io/8hsy9 ◽

2021 ◽

Author(s):

Faith Orchard ◽

Juliette Westbrook ◽

Brioney Gee ◽

Tim Clarke ◽

Sophie M. Allan ◽

...

Keyword(s):

Young People ◽

Scoping Review ◽

Active Ingredient ◽

Adolescent Depression ◽

Cognitive Capacity ◽

Depression Symptoms ◽

Self Evaluation ◽

Symptoms Of Depression ◽

Self Perceptions ◽

Expert Advisory

Background: Negative self-perceptions is one of the most common symptoms of depression in young people, and has been found to be strongly associated with severity of depression symptoms. Psychological treatments for adolescent depression are only moderately effective. Understanding the role and importance of these self-perceptions may help to inform and improve treatments. The aim of this review was to examine self-evaluation as a characteristic of adolescent depression, and as an active ingredient in treatment for adolescent depression. Methods: We conducted a scoping review which included quantitative and qualitative studies ofany design that reported on self-evaluation as a characteristic of, or focus of treatment for, adolescent depression. Participants were required to be 11-24 years and experiencing elevated symptoms of depression or a diagnosis. We also met with 14 expert advisory groups of young people with lived experience, clinicians, and researchers, for their input. Findings from 46 peer-reviewed research studies are presented alongside views of 64 expert advisors, to identify what is known and what is missing in the literature.Results: Three overarching topics were identified following the review and reflections from advisors: 1) What does it look like? 2) Where does it come from? and 3) How can we change it?The literature identified that young people view themselves more negatively and less positively when depressed, however expert advisors explained that view of self is complex and varies for each individual. Literature identified preliminary evidence of a bidirectional relationship between self-evaluation and depression, however, advisors raised questions regarding the influences and mechanisms involved, such as being influenced by the social environment, and by the cognitive capacity of the individual. Finally, there was a consensus from the literature and expertadvisors that self-evaluation can improve across treatment. However, research literature was limited, with only 11 identified studies covering a diverse range of interventions and self-2evaluation measures. Various barriers and facilitators to working on self-evaluation in treatment were highlighted by advisors, as well as suggestions for treatment approaches. Conclusions: Findings indicate the importance of self-evaluation in adolescent depression, but highlight the need for more research on which treatments and treatment components are most effective in changing self-evaluation.

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Problem solving as an active ingredient in indicated prevention and treatment of youth depression and anxiety: A critical review and synthesis of trial outcomes, qualitative evidence and lived experience insights

10.31234/osf.io/gnhym ◽

2021 ◽

Author(s):

Daniel Michelson

Keyword(s):

Problem Solving ◽

Young People ◽

Active Ingredient ◽

Therapeutic Approach ◽

Population Characteristics ◽

Advisory Group ◽

Depression And Anxiety ◽

Indicated Prevention ◽

Qualitative Evidence ◽

Prevention And Treatment

Background: Problem solving is a key developmental capacity and a common focus of psychological interventions for young people. Despite widespread use of problem solving in practice, existing evidence syntheses of this therapeutic approach are relatively limited in their scope and conclusions. Method: We examined the role of problem solving as an active ingredient for the indicated prevention and treatment of depression and anxiety in 14-24-year-olds. Three information sources were integrated: (i) a systematic review of randomised controlled trials of problem solving; (ii) a meta-synthesis of qualitative evidence on the therapeutic experience of problem solving; and (iii) consultation with a youth advisory group. Results: Problem solving appeared to be effective as a sole intervention for depression but not anxiety. Multi-component interventions with a problem-solving element achieved moderate effect sizes for both conditions. There was no clear evidence that effectiveness varied by population characteristics, intervention formats or contextual factors. Evidence about why problem solving works was generally consistent with Lazarus & Folkman’s “stress-coping” theory.Discussion: Problem solving is a widely applicable therapeutic approach that can help young people with emotional problems to resolve specific stressors and lead to a more hopeful mindset about managing future challenges. Implications for practice are discussed.

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Preventing depression and anxiety in young people: a review of the joint efficacy of universal, selective and indicated prevention

Psychological Medicine ◽

10.1017/s0033291715001725 ◽

2015 ◽

Vol 46 (1) ◽

pp. 11-26 ◽

Cited By ~ 109

Author(s):

E. A. Stockings ◽

L. Degenhardt ◽

T. Dobbins ◽

Y. Y. Lee ◽

H. E. Erskine ◽

...

Keyword(s):

Young People ◽

Meta Analysis ◽

Internalizing Disorders ◽

Cochrane Library ◽

Depression And Anxiety ◽

Preventive Interventions ◽

Post Intervention ◽

Indicated Prevention ◽

Shared Risk ◽

Internalizing Disorder

Depression and anxiety (internalizing disorders) are the largest contributors to the non-fatal health burden among young people. This is the first meta-analysis to examine the joint efficacy of universal, selective, and indicated preventive interventions upon both depression and anxiety among children and adolescents (5–18 years) while accounting for their co-morbidity. We conducted a systematic review of reviews in Medline, PsycINFO and the Cochrane Library of Systematic Reviews, from 1980 to August 2014. Multivariate meta-analysis examined the efficacy of preventive interventions on depression and anxiety outcomes separately, and the joint efficacy on both disorders combined. Meta-regressions examined heterogeneity of effect according to a range of study variables. Outcomes were relative risks (RR) for disorder, and standardized mean differences (Cohen's d) for symptoms. One hundred and forty-six randomized controlled trials (46 072 participants) evaluated universal (children with no identified risk, n = 54) selective (population subgroups of children who have an increased risk of developing internalizing disorders due to shared risk factors, n = 45) and indicated prevention (children with minimal but detectable symptoms of an internalizing disorder, n = 47), mostly using psychological-only strategies (n = 105). Reductions in internalizing disorder onset occurred up to 9 months post-intervention, whether universal [RR 0.47, 95% confidence interval (CI) 0.37–0.60], selective (RR 0.61, 95% CI 0.43–0.85) or indicated (RR 0.48, 95% CI 0.29–0.78). Reductions in internalizing symptoms occurred up to 12 months post-intervention for universal prevention; however, reductions only occurred in the shorter term for selective and indicated prevention. Universal, selective and indicated prevention interventions are efficacious in reducing internalizing disorders and symptoms in the short term. They might be considered as repeated exposures in school settings across childhood and adolescence. (PROSPERO registration: CRD42014013990.)

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Parental factors associated with depression and anxiety in young people: A systematic review and meta-analysis

Journal of Affective Disorders ◽

10.1016/j.jad.2013.11.007 ◽

2014 ◽

Vol 156 ◽

pp. 8-23 ◽

Cited By ~ 188

Author(s):

Marie Bee Hui Yap ◽

Pamela Doreen Pilkington ◽

Siobhan Mary Ryan ◽

Anthony Francis Jorm

Keyword(s):

Systematic Review ◽

Young People ◽

Meta Analysis ◽

Depression And Anxiety ◽

Parental Factors ◽

Factors Associated

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The effectiveness of gaming interventions for depression and anxiety in young people: systematic review and meta-analysis

BJPsych Open ◽

10.1192/bjo.2021.1078 ◽

2022 ◽

Vol 8 (1) ◽

Author(s):

Christopher Townsend ◽

Clara Humpston ◽

Jack Rogers ◽

Victoria Goodyear ◽

Anna Lavis ◽

...

Keyword(s):

Systematic Review ◽

Young People ◽

Therapeutic Intervention ◽

Repeated Measures ◽

Mental Health Problems ◽

Meta Analysis ◽

Depression And Anxiety ◽

Post Intervention ◽

Youth Depression ◽

Repeated Measures Design

Background Recent research has investigated the use of serious games as a form of therapeutic intervention for depression and anxiety in young people. Aims To conduct a systematic review and meta-analysis into the effectiveness of gaming interventions for treating either depression or anxiety in individuals aged 12–25 years. Method An electronic search was conducted on the 30 March 2020, using PsycINFO, ISI Web of Science Core Collection, Medline and EMBASE databases. Standardised effect sizes (Hedge's g) were calculated for between-participant comparisons between experimental (therapeutic intervention) and control conditions, and within-participant comparisons between pre- and post-intervention time points for repeated measures designs. Results Twelve studies (seven randomised controlled trials (RCTs) and five non-randomised studies) were included. For RCTs, there was a statistically significant and robust effect (g = −0.54, 95% CI −1.00 to −0.08) favouring the therapeutic intervention when treating youth depression. For non-RCTs, using a repeated measures design, the overall effect was also strong (g = −0.75, 95% CI −1.64 to 0.14) favouring therapeutic intervention, but this was not statistically significant. Interestingly, we found no statistically significant effect for treating youth anxiety. Conclusions There is preliminary evidence to suggest that gaming interventions are an effective treatment for youth depression, but not anxiety. Further research is warranted to establish the utility, acceptability and effectiveness of gaming interventions in treating mental health problems in young people.

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Clinical and non-clinical depression and anxiety in young people: A scoping review on heart rate variability

Autonomic Neuroscience ◽

10.1016/j.autneu.2017.08.008 ◽

2017 ◽

Vol 208 ◽

pp. 1-14 ◽

Cited By ~ 23

Author(s):

Melissa Paniccia ◽

David Paniccia ◽

Scott Thomas ◽

Tim Taha ◽

Nick Reed

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Young People ◽

Scoping Review ◽

Clinical Depression ◽

Depression And Anxiety

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Young People’s Experience of a Long-Term Social Media–Based Intervention for First-Episode Psychosis: Qualitative Analysis (Preprint)

10.2196/preprints.17570 ◽

2019 ◽

Author(s):

Lee Valentine ◽

Carla McEnery ◽

Shaunagh O’Sullivan ◽

John Gleeson ◽

Sarah Bendall ◽

...

Keyword(s):

Mental Health ◽

Social Media ◽

Young People ◽

First Episode ◽

Social Connection ◽

Mental Health Intervention ◽

Digital Interventions ◽

Episode Psychosis ◽

Mental Health Interventions

BACKGROUND Digital mental health interventions present a unique opportunity to address the lack of social connection and loneliness experienced by young people with first-episode psychosis (FEP). The first generation of digital interventions, however, is associated with high attrition rates. Social media presents an opportunity to target this issue. A new generation of digital intervention has harnessed the popularity of social media to both promote engagement and foster social connectedness in youth mental health interventions. Despite their potential, little is known about how young people engage with, and experience, social media–based interventions as well as the optimal design, implementation, and management needed to ensure young people with psychosis receive benefit. OBJECTIVE This study aimed to explore how young people engage with, and experience, a long-term social media–based mental health intervention designed to address social functioning in individuals with FEP. METHODS This qualitative study was based on 12 interviews with young people (19 to 28 years, mean 23 years) who used Horyzons, a long-term social media–based mental health intervention, as part of a previous randomized controlled trial. A semistructured phenomenological interview guide with open-ended questions was used to explore young people’s subjective experience of the intervention. All interviews were recorded and transcribed verbatim. Data were analyzed using interpretative phenomenological analysis. RESULTS A total of 4 superordinate themes emerged during the analysis including (1) shared experience as the catalyst for a cocreated social space, (2) the power of peer support, (3) an upbeat environment, and (4) experiences that interrupt being in Horyzons. CONCLUSIONS We found that Horyzon’s therapeutic social network fostered a connection and an understanding among young people. It also aided in the creation of an embodied experience that afforded young people with FEP a sense of self-recognition and belonging over the long term. However, although we found that most young people had strong positive experiences of a social connection on Horyzons, we also found that they experienced significant barriers that could substantively interrupt their ability to use the platform. We found that social anxiety, paranoia, internalized stigma, lack of autonomy, and social protocol confusion interfered with young people’s usage of the platform. From a design perspective, digital interventions are flexible and thus equipped to begin addressing these implications by providing customizable and personalized treatment options that account for varying levels of social connection and psychological need that could otherwise interrupt young people’s usage of social media–based interventions. CLINICALTRIAL

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