Insights from fifteen years of real-world development, testing and implementation of youth digital mental health interventions

IF 3.6 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Shane Cross , Shaminka Mangelsdorf , Lee Valentine , Shaunagh O'Sullivan , Carla McEnery , Isabelle Scott , Tamsyn Gilbertson , Shona Louis , Jon Myer , Ping Liu , Niel Mac Dhonnagáin , Tom Wren , Eleanor Carey , Daniela Cagliarini , Ross Jacobs , Roos Pot-Kolder , Imogen Bell , Jennifer Nicholas , Lucia Valmaggia , John Gleeson , Mario Alvarez-Jimenez
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引用次数: 0

Abstract

This paper reviews the current evidence and synthesizes fifteen years of real-world development, testing, and implementation of digital mental health interventions (DMHIs) for young people. Drawing on the work of Orygen Digital, we outline the evolution of interventions including the Moderated Online Social Therapy (MOST) platform, the Mello app, and a suite of virtual reality-based therapies; all developed to meet the complex clinical, developmental, and service needs of youth aged 12 to 25.
We identify ten key challenges and opportunities encountered in designing, developing and implementing these DMHIs: (1) meaningful co-design; (2) sustained user engagement; (3) personalization and transdiagnostic targeting; (4) optimizing intensities of human support; (5) leveraging peer support and social networking; (6) embedding DMHIs in clinical services; (7) blending digital and face-to-face care; (8) building data infrastructure and learning health systems; (9) developing sustainable and scalable business models; and (10) preparing DMHIs for large language models. Each theme reflects both achievements and persistent challenges, and is illustrated through a synthesis of the current evidence and real-world insights from our clinical trials and national-scale service implementations.
Our approach is grounded in various frameworks including clinical staging, self-determination theory, supportive accountability, and minimally disruptive medicine. Emerging innovations such as just-in-time adaptive interventions, extended reality (XR) therapies, stratified treatment models, and large language models offer promising future pathways for greater personalization, engagement, effectiveness, and scalability.
Our findings highlight the potential value of context-sensitive, co-designed, and system-integrated DMHIs, while also emphasising enduring limitations such as variable engagement, implementation barriers, and population-specific adaptation. Moving beyond controlled efficacy trials toward agile, real-world learning health systems will be essential to realising the full potential of DMHIs in transforming youth mental health care.
15年来对青少年数字心理健康干预措施的实际开发、测试和实施的见解
本文回顾了目前的证据,并综合了15年来现实世界中针对年轻人的数字心理健康干预(DMHIs)的开发、测试和实施。根据Orygen Digital的工作,我们概述了干预措施的发展,包括适度在线社会治疗(MOST)平台,Mello应用程序和一套基于虚拟现实的治疗;所有这些都是为了满足12至25岁青少年复杂的临床、发展和服务需求而开发的。我们确定了在设计、开发和实施这些DMHIs时遇到的十大关键挑战和机遇:(1)有意义的协同设计;(2)持续的用户粘性;(3)个性化和跨诊断靶向;(4)优化人力支持强度;(5)利用同伴支持和社会网络;(6)在临床服务中嵌入DMHIs;(7)数字化与面对面护理相结合;(8)建立数据基础设施和学习型卫生系统;(9)发展可持续和可扩展的商业模式;(10)为大型语言模型准备DMHIs。每个主题都反映了成就和持续的挑战,并通过综合当前证据和我们临床试验和国家规模服务实施的现实世界见解来说明。我们的方法基于各种框架,包括临床分期、自我决定理论、支持性问责制和最小破坏性医学。诸如即时自适应干预、扩展现实(XR)疗法、分层治疗模型和大型语言模型等新兴创新为实现更大的个性化、参与度、有效性和可扩展性提供了有希望的未来途径。我们的研究结果强调了上下文敏感、共同设计和系统集成的DMHIs的潜在价值,同时也强调了持久的局限性,如可变参与、实施障碍和针对特定人群的适应。从受控疗效试验转向敏捷、现实世界的学习卫生系统,对于充分发挥DMHIs在改变青少年精神卫生保健方面的潜力至关重要。
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来源期刊
CiteScore
6.50
自引率
9.30%
发文量
94
审稿时长
6 weeks
期刊介绍: Official Journal of the European Society for Research on Internet Interventions (ESRII) and the International Society for Research on Internet Interventions (ISRII). The aim of Internet Interventions is to publish scientific, peer-reviewed, high-impact research on Internet interventions and related areas. Internet Interventions welcomes papers on the following subjects: • Intervention studies targeting the promotion of mental health and featuring the Internet and/or technologies using the Internet as an underlying technology, e.g. computers, smartphone devices, tablets, sensors • Implementation and dissemination of Internet interventions • Integration of Internet interventions into existing systems of care • Descriptions of development and deployment infrastructures • Internet intervention methodology and theory papers • Internet-based epidemiology • Descriptions of new Internet-based technologies and experiments with clinical applications • Economics of internet interventions (cost-effectiveness) • Health care policy and Internet interventions • The role of culture in Internet intervention • Internet psychometrics • Ethical issues pertaining to Internet interventions and measurements • Human-computer interaction and usability research with clinical implications • Systematic reviews and meta-analysis on Internet interventions
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