scholarly journals Digital Mental Health Intervention Uptake Among Distressed New Zealand High School Students in a Comprehensive Survey: Implications for Digital Help Provision

2021 ◽  
Author(s):  
Jessica Shaw
Keyword(s):  
Mental Health ◽  
High School Students ◽  
Mental Distress ◽  
Digital Health ◽  
Health Resources ◽  
Health Interventions ◽  
School Students ◽  
Comprehensive Survey ◽  
Mental Health Interventions ◽  
To Receive

<p><b>Background: High rates of mental distress are reported among adolescents. Emerging evidence suggests that digital mental health interventions, such as computerised psychotherapy, informative websites, and non-clinical helplines, may help. However, it is unclear whether these resources are reaching those who experience distress in real-world settings. </b></p><p>Aim: The aim of this research is to explore adolescent uptake of digital mental health interventions offered via a comprehensive youth health survey, with a particular focus on adolescents experiencing probable mental distress. </p><p>Methods: Data were drawn from the Youth19 Rangatahi Smart Survey. At the end of the survey participants were provided the opportunity to opt-in to receive digital health resources. Participants’ opt-in and access to these digital health resources, as well as if they accessed the specific mental health resources, was remotely monitored. We compare opt-in and access among participants with and without probable mental distress. </p><p>Results: Of those who completed the Youth19 survey (n = 7721), a substantial minority of participants opted-in to receive the digital health resources (n = 1720). However, of those who opted-in, access was low (n = 187). Participants with probable mental distress were more likely than their non-distressed counterparts to opt-in and access the digital health resources, although these differences were small. Importantly, only seven participants went on to access digital </p><p>mental health interventions. </p><p>Discussion: The moderate number of participants to opt-in to receive Youth19 digital health resources suggests that digital resources may be a valuable component of supporting diverse groups of adolescents. The high attrition, however, indicates that adolescents may be experiencing barriers to accessing these interventions. Smart design to increase appeal, addressing barriers that limit access, and providing multiple options for different groups could </p><p>increase adolescents’ engagement with digital mental health interventions.</p>

scholarly journals Digital Mental Health Intervention Uptake Among Distressed New Zealand High School Students in a Comprehensive Survey: Implications for Digital Help Provision

2021 ◽  
Author(s):  
Jessica Shaw
Keyword(s):  
Mental Health ◽  
High School Students ◽  
Mental Distress ◽  
Digital Health ◽  
Health Resources ◽  
Health Interventions ◽  
School Students ◽  
Comprehensive Survey ◽  
Mental Health Interventions ◽  
To Receive

<p><b>Background: High rates of mental distress are reported among adolescents. Emerging evidence suggests that digital mental health interventions, such as computerised psychotherapy, informative websites, and non-clinical helplines, may help. However, it is unclear whether these resources are reaching those who experience distress in real-world settings. </b></p><p>Aim: The aim of this research is to explore adolescent uptake of digital mental health interventions offered via a comprehensive youth health survey, with a particular focus on adolescents experiencing probable mental distress. </p><p>Methods: Data were drawn from the Youth19 Rangatahi Smart Survey. At the end of the survey participants were provided the opportunity to opt-in to receive digital health resources. Participants’ opt-in and access to these digital health resources, as well as if they accessed the specific mental health resources, was remotely monitored. We compare opt-in and access among participants with and without probable mental distress. </p><p>Results: Of those who completed the Youth19 survey (n = 7721), a substantial minority of participants opted-in to receive the digital health resources (n = 1720). However, of those who opted-in, access was low (n = 187). Participants with probable mental distress were more likely than their non-distressed counterparts to opt-in and access the digital health resources, although these differences were small. Importantly, only seven participants went on to access digital </p><p>mental health interventions. </p><p>Discussion: The moderate number of participants to opt-in to receive Youth19 digital health resources suggests that digital resources may be a valuable component of supporting diverse groups of adolescents. The high attrition, however, indicates that adolescents may be experiencing barriers to accessing these interventions. Smart design to increase appeal, addressing barriers that limit access, and providing multiple options for different groups could </p><p>increase adolescents’ engagement with digital mental health interventions.</p>

scholarly journals Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review (Preprint)

2019 ◽  
Author(s):  
Brian Lo ◽  
Jenny Shi ◽  
Elisa Hollenberg ◽  
Alexxa Abi-Jaoudé ◽  
Andrew Johnson ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Care Delivery ◽  
Digital Health ◽  
Controlled Trial ◽  
Health Interventions ◽  
Health Apps ◽  
Mental Health Interventions ◽  
Usage Data

BACKGROUND Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. OBJECTIVE This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). METHODS A scoping review was conducted using the Arksey and O’Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. RESULTS Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. CONCLUSIONS This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.

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

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.

scholarly journals Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review

10.2196/15942 ◽  
2020 ◽  
Vol 7 (6) ◽  
pp. e15942
Author(s):  
Brian Lo ◽  
Jenny Shi ◽  
Elisa Hollenberg ◽  
Alexxa Abi-Jaoudé ◽  
Andrew Johnson ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Care Delivery ◽  
Digital Health ◽  
Controlled Trial ◽  
Health Interventions ◽  
Health Apps ◽  
Mental Health Interventions ◽  
Usage Data

Background Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. Objective This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). Methods A scoping review was conducted using the Arksey and O’Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. Results Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. Conclusions This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.

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

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.

Peer-to-Peer Mental Health Support: Validating Scores on the Mental Distress Response Scale With High School Students

2021 ◽  
Vol 25 (1) ◽  
pp. 2156759X2110066
Author(s):  
Michael T. Kalkbrenner ◽  
Emily Goodman-Scott
Keyword(s):  
Mental Health ◽  
High School Students ◽  
School Counselors ◽  
Mental Distress ◽  
National Sample ◽  
Peer To Peer ◽  
Response Scale ◽  
School Students ◽  
Mental Health Support ◽  
Health Support

This investigation tested the internal structure of scores on the Mental Distress Response Scale (MDRS), a peer-to-peer mental health support screening tool, with a national sample of 237 adolescents from 111 high schools in 30 states. Results revealed psychometric support for the scores on the MDRS and demographic differences in students’ responses. We discuss implications for how school counselors can use the MDRS to enhance peer-to-peer mental health support as part of a comprehensive school counseling program.

scholarly journals Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire (Preprint)

2017 ◽  
Author(s):  
Katherine Berry ◽  
Amy Salter ◽  
Rohan Morris ◽  
Susannah James ◽  
Sandra Bucci
Keyword(s):  
Mental Health ◽  
Therapeutic Alliance ◽  
Digital Health ◽  
Health Intervention ◽  
Health Interventions ◽  
Health Staff ◽  
Service Users ◽  
Face To Face ◽  
Mental Health Interventions ◽  
Stage 1

BACKGROUND Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. OBJECTIVE This study presented the first attempt to (1) explore service users’ views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. METHODS In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word “therapist” with the word “app.” In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. RESULTS Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person’s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (“The app is like having a member of my care team in my pocket”). CONCLUSIONS This study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif)

Development of a framework for the implementation of synchronous digital mental health: a realist synthesis of systematic reviews (Preprint)

2021 ◽  
Author(s):  
David Villarreal-Zegarra ◽  
Christoper A. Alarcon-Ruiz ◽  
GJ Melendez-Torres ◽  
Roberto Torres-Puente ◽  
Alba Navarro-Flores ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Digital Health ◽  
Health Problems ◽  
Realist Synthesis ◽  
Health Interventions ◽  
Theory Approach ◽  
Access To Treatment ◽  
Mental Health Interventions

BACKGROUND The use of technologies has served to reduce gaps in access to treatment and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it's imperative to document the aspects related to their challenging implementation. OBJECTIVE To determine what evidence is available for synchronous digital mental health implementation and develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS The SPIDER framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020 were searched with no language restriction. AMSTAR-2 was used to assess the risk of bias, and CERQual was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded theory approach with an emergent approach. RESULTS 21 systematic reviews were included in the study. Ninety percent of the studies presented a critically low confidence level assessed with the AMSTAR-2. The realist synthesis allowed the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: Hypothesis 1: These interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy. Hypothesis 2: These interventions reach populations otherwise unable to have access because they can be successfully delivered by non-specialists, which makes them more cost-effective to implement in health services. Hypothesis 3: These interventions are acceptable and show good results in satisfaction, because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represented essential outcomes in the implementation process. CLINICALTRIAL PROSPERO (CRD420203811). INTERNATIONAL REGISTERED REPORT RR2-10.12688/f1000research.27150.2

scholarly journals Development of a Framework for the Implementation of Synchronous Digital Mental Health: A Realist Synthesis of Systematic Reviews

2021 ◽  
Author(s):  
David Villarreal-Zegarra ◽  
Christoper A. Alarcon-Ruiz ◽  
GJ Melendez-Torres ◽  
Roberto Torres-Puente ◽  
Alba Navarro-Flores ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Digital Health ◽  
Health Problems ◽  
Realist Synthesis ◽  
Health Interventions ◽  
Theory Approach ◽  
Access To Treatment ◽  
Mental Health Interventions

Abstract Background: The use of technologies has served to reduce gaps in access to treatment and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it's imperative to document the aspects related to their challenging implementation. Methods: The SPIDER framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020 were searched with no language restriction. AMSTAR-2 was used to assess the risk of bias, and CERQual was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded theory approach with an emergent approach.Results: 21 systematic reviews were included in the study. Ninety percent of the studies presented a critically low confidence level assessed with the AMSTAR-2. The realist synthesis allowed the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: Hypothesis 1: These interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy. Hypothesis 2: These interventions reach populations otherwise unable to have access because they can be successfully delivered by non-specialists, which makes them more cost-effective to implement in health services. Hypothesis 3: These interventions are acceptable and show good results in satisfaction, because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist.Conclusion: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represented essential outcomes in the implementation process.Registration: PROSPERO (CRD420203811).

scholarly journals Development of a Framework for the Implementation of Synchronous Digital Mental Health: A Realist Synthesis of Systematic Reviews

2021 ◽  
Author(s):  
David Villarreal-Zegarra ◽  
Christoper A. Alarcon-Ruiz ◽  
GJ Melendez-Torres ◽  
Roberto Torres-Puente ◽  
Alba Navarro-Flores ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Digital Health ◽  
Health Problems ◽  
Realist Synthesis ◽  
Health Interventions ◽  
Theory Approach ◽  
Access To Treatment ◽  
Mental Health Interventions

Abstract Background: The use of technologies has served to reduce gaps in access to treatment and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it's imperative to document the aspects related to their challenging implementation. Objective: To determine what evidence is available for synchronous digital mental health implementation and develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems.Methods: The SPIDER framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020 were searched. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded theory approach with an emergent approach.Results: 21 systematic reviews were included in the study. The realist synthesis allowed the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: Hypothesis 1: These interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy. Hypothesis 2: These interventions reach populations otherwise unable to have access because they can be successfully delivered by non-specialists, which makes them more cost-effective to implement in health services. Hypothesis 3: These interventions are acceptable and show good results in satisfaction, because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist.Conclusion: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represented essential outcomes in the implementation process.Systematic review registration: PROSPERO (CRD420203811).

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