The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis.

BACKGROUND: Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. OBJECTIVE: This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. METHODS: We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. RESULTS: Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI -0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. CONCLUSIONS: For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995.

How do aspects of selfhood relate to depression and anxiety among youth? A meta-analysis.

Adolescents' sense of self has important implications for their mental health. Despite more than two decades of work, scholars have yet to amass evidence across studies to elucidate the role of selfhood in the mental health of adolescents. Underpinned by the conceptual model of selfhood, this meta-analytic review investigated the strength of associations of different facets of selfhood and their associated traits with depression and anxiety, moderating factors that attenuate or exacerbate these associations, and their causal influences. Using mixed-effects modeling, which included 558 effect sizes from 298 studies and 274 370 adolescents from 39 countries, our findings revealed that adolescents' self-esteem/self-concept [r = -0.518, p < 0.0001; (95% CI -0.49 to -0.547)] and self-compassion [r = -0.455, p < 0.0001; (95% CI -0.568 to -0.343)] demonstrating largest effect sizes in their associations with depression. Self-esteem/self-concept, self-compassion, self-awareness, self-efficacy, and self-regulation had similar moderate negative associations with anxiety. Meta-regressions revealed that adolescent age and type of informants (parents v. adolescents) were important moderators. Findings on causal influences indicated bidirectional causations, particularly low self-esteem/self-concept, self-awareness and self-efficacy drive higher depression and vice-versa. In contrast, the different self traits did not demonstrate specific causal direction with anxiety. These results pinpoint self traits that are pivotal in relating to adolescent mental health functioning. We discussed the theoretical implications of our findings in terms of how they advance theory of selfhood for adolescent mental health, and the practical implications of building selfhood as cultivating psychological skills for mental health.

Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores.

BACKGROUND: Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. OBJECTIVE: The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both. METHODS: A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores-Google Play Store and Apple App Store-to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information. RESULTS: The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially. CONCLUSIONS: A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality-utility, safety, and effectiveness-of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms.

Trajectories of emotional disclosure with parents during the college transition among Asian first-year students.

The college transition is a time of great emotional lability, and sharing emotional experiences with parents can be beneficial for first-year students. Guided by the social sharing of emotions framework and the cultural theory on self-construal, this study investigated the developmental course of freshmen's emotional disclosure with parents during the first semester and the mediating role of independence-orientation in two Asian contexts-Beijing (China) and Singapore. Using experience sampling method (online diary), 205 Chinese freshmen (Mage = 19.43) and 291 Singapore freshmen (Mage = 19.44) reported on four facets of emotional disclosure with parents (frequency, intimacy, negativity, and positivity) across four timepoints and their independence-interdependence orientation (Time 1). Latent growth curve modeling comparing the two Asian samples revealed that frequency increased for Chinese students and decreased for Singapore students. Intimacy indicated upward trajectories for both Asian samples, whereas negativity and positivity showed downward trajectories but were less pronounced for Chinese students. Mediated latent growth curve modeling revealed that the cultures predicted independence-orientation, which in turn negatively predicted increase in frequency for the Singapore sample and positively predicted decrease for the Chinese sample. Independence-orientation negatively predicted increase in intimacy, positively predicted decline in negativity, and negatively predicted decline in positivity. In sum, we found complex and differentiated trajectories for the four facets of emotional disclosure in two Asian samples and the mediating role of independence-orientation in explaining cultural differences in the trajectories, which have implications for understanding emotional disclosure to parents during the developmental phase of the college transition in Asian contexts. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations of childhood adversity with emotional well-being and educational achievement: A review and meta-analysis.

BACKGROUND: Profound negative implications of adverse childhood experiences (ACEs) have raised public health concern worldwide. METHOD: This systematic review and meta-analysis examined associations of three types of ACEs (abuse, neglect, and household dysfunctions) with experiential (emotional quality of momentary and everyday experiences) and reflective (judgments about life satisfaction, sense of meaning, and ability to pursue goals that can include and extend beyond the self) facets of emotional well-being (EWB) and educational achievement. The systematic review yielded 100 studies with 176 effect sizes that met criteria for inclusion in the meta-analysis. RESULTS: ACEs were related particularly strongly to lower EWB, r = -0.32, p < .001; [95 % CI: -0.44 to 0.01], but also to lower educational achievement, r = -0.18, p < .001; [95 % CI: -0.21 to -0.05]. Associations were stronger for abuse and composite indicators of ACEs than for household dysfunctions. Associations of ACEs with EWB and educational achievement were stronger in childhood and adolescence than in emerging or later adulthood. Associations did not differ for males and females or for Eastern versus Western cultural groups. Analyses provided evidence for the causal role of ACEs in the development of lower EWB and academic achievement as well as their reciprocal associations. LIMITATIONS: There is no standard conceptualization of well-being and studies are not always clear about the types of ACEs examined, with limited research on educational achievement. CONCLUSION: Findings have important implications for mental health professionals, policy makers and social service agencies in developing resources and intervention services that target ACEs to protect individuals and promote well-being and academic achievement.

Commonality and Specificity in Chinese Parental Emotion Socialization and Adolescents' Psychological Functioning: A Bifactor Approach.

Understanding of the conceptual relations among different parental emotion socialization processes (i.e., whether and how they are distinct or share common components) and their developmental implications for adolescents is limited, especially within Asian cultural contexts. Guided by the parental emotion socialization framework, this study aimed to: (1) investigate a conceptual model that delineates general and specific components in parental emotion socialization with both adolescents and parents within a contemporary Asian cultural context-Beijing, China, and (2) examine whether the common and specific processes predicted adolescents' psychological functioning six months later for both informants. Participants included 1486 Chinese adolescents (Mage = 15.11 years; 52.6% males) and their primary caregivers (Mage = 44.93 years; 44.9% males). Both adolescents and parents self-reported on parental emotion socialization and adolescents completed a measure of their psychological functioning at two time-points. We evaluated the fit of one-factor, first-order factor, and bifactor models for both informants separately. Results indicated a good fit of the bifactor model with a proposed general factor of parent meta-emotion philosophy and specific factors of parental reaction and emotional expressivity, with partial factorial invariance of the parental reaction factor across informants. The common and specific factors uniquely predicted adolescents' psychological functioning. Findings inform the parental emotion socialization framework, particularly our conceptual understanding of the different processes with Asian samples, and have practical implications for the design and implementation of comprehensive and culturally relevant parenting interventions in support of adolescent psychological functioning.

Negotiating Emerging Adulthood at the Onset of COVID-19 in Singapore.

Historical events and cultural contexts have major implications for emerging adults' developmental experiences. Underpinned by the theory of emerging adulthood, this study examined how COVID-19 interacted with Singapore youths' negotiation of emerging adulthood. We employed a mixed-methods design and drew on Telegram text messaging among 757 Singapore youths (Mage = 19.60, SD = .63) at the onset of the pandemic. Using qualitative analysis, we examined whether the five features of emerging adulthood were salient in the context of the pandemic among Singapore youths. Using the quantitative methodology of topic modelling, we identified five culturally salient domains that emerged in Singapore youths' negotiation of the developmental features of emerging adulthood at the onset of the COVID-19 pandemic, with work and studies being the most salient domain. Finally, quantitative analysis using a person-centered approach revealed four classes of youths with varying patterns of how experiences of the COVID-19 pandemic interacted with their negotiation of developmental features and domains of emerging adulthood: the Struggling youths, Relationship-Oriented youths, Me generation, and Go-Getters. Results from this study revealed how the pandemic and socio-cultural conditions of the Singapore society presented a unique developmental context for emerging adults. Practical implications for supporting each group of emerging adults are discussed.

A Digital Peer Support Platform to Translate Online Peer Support for Emerging Adult Mental Well-being: Randomized Controlled Trial.

BACKGROUND: Emerging adulthood (ages 19 to 25 years) is a developmental phase that is marked by increased mental health conditions, especially depression and anxiety. A growing body of work indicates that digital peer emotional support has positive implications for the psychological functioning of emerging adults. There is burgeoning interest among health care professionals, educational stakeholders, and policy makers in understanding the implementation and clinical effectiveness, as well as the associated mechanism of change, of digital peer support as an intervention. OBJECTIVE: This randomized controlled trial (RCT) examined the effectiveness of a digital peer support intervention over a digital platform-Acceset-for emerging adult psychological well-being with 3 primary aims. First, we evaluated the implementation effectiveness of digital peer support training for individuals providing support (befrienders) and of the digital platform for peer support. Second, we assessed the clinical outcomes of digital peer support in terms of the intervening effect on emerging adult psychological well-being. Third, we investigated the mechanism of change linking the digital peer support intervention to emerging adult psychological well-being. METHODS: This RCT involving 100 emerging adults from the National University of Singapore follows the published protocol for this trial. RESULTS: This RCT found effectiveness in digital peer support training-specifically, befrienders' peer support responses demonstrating significantly higher post- than pretraining scores in selfhood (posttraining score: mean 62.83, SD 10.18, and SE 1.72; pretraining score: mean 54.86, SD 7.32, and SE 1.24; t34=3.88; P<.001). The digital peer support intervention demonstrated clinical effectiveness in enhancing selfhood, compassion, and mindfulness and lowering depressive and anxiety symptoms among seekers in the intervention group after the intervention (mean 7.15, SD 5.14; SE 0.88) than among seekers in the waitlist control group before the intervention (mean 11.75, SD 6.72; SE 0.89; t89=3.44; P<.001). The effect of the intervention on seekers' psychological well-being was sustained beyond the period of the intervention. The mechanism of change revealed that seekers' engagement with the intervention had both immediate and prospective implications for their psychological well-being. CONCLUSIONS: This RCT of a digital peer support intervention for emerging adult psychological well-being harnesses the interventional potential of 4 components of psychological well-being and elucidated a mechanism of change. By incorporating and validating the digital features and process of a peer support platform, our RCT provides the parameters and conditions for deploying an effective and novel digital peer support intervention for emerging adult psychological well-being in real-world settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676.

A Digital Peer Support Platform to Translate Web-Based Peer Support for Emerging Adult Mental Well-being: Protocol for a Randomized Controlled Trial.

BACKGROUND: Mental health issues among emerging adults (aged 19-25 years) on a global scale have underscored the need to address their widespread experiences of depression and anxiety. As a result of the COVID-19 pandemic, emerging studies are being directed toward the development and deployment of digital peer emotional disclosure and support for the psychological well-being of emerging adults. However, it is important to explore the implementation and clinical effectiveness, as well as associated mechanisms of change, for optimal approaches in conducting digital peer support interventions for emerging adults' psychological well-being. OBJECTIVE: We describe a randomized controlled trial to evaluate the implementation and clinical effectiveness of Acceset, a digital peer support intervention to address emerging adult mental well-being. The intervention has 2 components. First, the digital peer support training equips befrienders (ie, peers who provide support) to harness 4 components of psychological well-being-mattering, selfhood, compassion, and mindfulness-to provide effective peer support for seekers (ie, peers who seek support). Second, Acceset incorporates psychological well-being digital markers and harnesses community engagement to drive emotional disclosure among peers. METHODS: A total of 100 participants (aged 19-25 years) from the National University of Singapore will be recruited and randomized into 2 arms. In arm 1 (n=50), the seekers will use Acceset with befrienders (n=30) as well as moderators (n=30) for 3 weeks. Arm 2 comprises a wait-listed control group (n=50). A questionnaire battery will be used to monitor seekers and befrienders at 4 time points. These include baseline (before the intervention), 3 weeks (end of the intervention), and 6 and 9 weeks (carryover effect measurement). Implementation outcomes of the intervention will involve evaluation of the training curriculum with respect to adoption and fidelity as well as user acceptability of the Acceset platform and its feasibility for broader deployment. Clinical outcomes will include mattering, selfhood, compassion, mindfulness, perceived social support, and psychological well-being scores. RESULTS: This protocol received National University of Singapore Institutional Ethics Review Board approval in October 2021. Recruitment will commence in January 2022. We expect data collection and analyses to be completed in June 2022. Preliminary findings are expected to be published in December 2022. The Cohen d index will be used for effect size estimation with a .05 (95% reliability) significance level and 80% power. CONCLUSIONS: This protocol considers a novel digital peer support intervention-Acceset-that incorporates components and digital markers of emerging adult mental well-being. Through the validation of the Acceset intervention, this study defines the parameters and conditions for digital peer support interventions for emerging adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/34602.