Transdiagnostic digital mental health interventions for youth and young adults: approaches to effectiveness and implementation

Abstract

This dissertation is composed of three studies that broadly examine transdiagnostic digital mental health interventions designed to improve symptoms of common mental disorders among youth and young adults. The first study (Aim 1) systematically reviews the existing published literature to comprehensively catalogue and characterize transdiagnostic digital mental health interventions (DMHIs) for youth and young adults ages 13-25 in the United States. it examines the core components, delivery modality, clinical tools, and focal outcomes of the identified DMHIs, as well as the characteristics of the studies used to evaluate the interventions and any included implementation components. The second study (Aim 2) uses Human Centered Design methods to adapt a WHO-developed DMHI called STARS (Sustainable Technology for Adolescents to Reduce Stress) for use among youth and young adults from immigrant and refugee families in Seattle. The third study (Aim 3) conducts a mixed method pilot test of the adapted STARS intervention among immigrant and refugee youth across the United States.In Aim 1 we evaluated nine studies: the most common intervention components were modular or session-based delivery formats, elements of cognitive behavioral therapy as clinical tools, and symptoms of depression and anxiety as focal outcomes. Seven of the nine included studies contained an implementation component, most commonly to assess feasibility and/or acceptability of the intervention. The limited studies identified in the review shows the dearth of research about DMHIs for youth and young adults, despite the wide availability of mental health related apps and online programs. In Aim 2 we used Human Centered Design methods to engage the intended end user in the adaptation process for the intervention. We modified the STARS intervention in three iterative cycles with 3-5 participants each. Major modifications included updating language to increase salience and familiarity to participants and reduce the resemblance to digital scams; adding non-text media including emojis, GIFs, and audio; and adding elements of choice so the user can select content that they believe is most relevant. In Aim 3 we conducted a pre-post study among immigrant and refugee youth ages 14-25 in the US to evaluate the usability and preliminary clinical effectiveness of the adapted STARS intervention. Participants were evaluated for measures of intervention use and symptom severity of common mental disorders; a subset of participants also took part in qualitative interviews that assessed barriers and facilitators to uptake and engagement with the intervention. Results included 129 participants from 53 countries of origin with a mean age of 17.9 (SD = 11.4) and generally high mental distress symptom scores at baseline. Participants completed an average of 7 out of ten sessions (SD = 3.9). Facilitators included the length of the intervention, personalized content, and mixed media. Barriers included time constraints, technical problems, and personal preference. This dissertation informs the rapidly growing field of digital mental health, which can be especially relevant for underserved and hard to reach populations like youth and immigrant/refugee communities.