Adolescent Mental Health Service: Is E-Health the Answer?
Adolescent Mental Health Service: Is E-Health the Answer?
There is growing evidence for the effectiveness of online CBT interventions for reducing the level of anxiety and depressive symptoms in adolescents aged between 12 and 18 years, when delivered in school and clinical settings, with some level of supervision. However, a number of gaps in knowledge remain. The heterogeneity in sample sizes, randomization procedures, and outcome measures made it difficult to compare trial results and the study designs did not attempt to identify the specific aspects of the internet interventions responsible for success. These factors, alongside the lack of cost effectiveness data, mean that the likelihood of internet interventions being adopted by governments and healthcare providers in their current form remains limited. If internet interventions are to adequately address the shortfalls in the current healthcare systems, future research needs to include larger RCTs, more diverse samples, longer follow-up periods, assessments of clinically significant change and user satisfaction, comparisons of internet-based programs with face-to-face interventions and other online programs, and examination of the role of clinical and nonclinical support and supervision in maintaining adherence and increasing effectiveness. Despite these issues, the evidence is clear that some internet interventions, mainly online CBT, are effective for lowering symptoms of depression and anxiety in youth and have the potential to fill the gap for some mental health service providers. However, for this potential to be realized, rigorous implementation trials need to be conducted which attempt to integrate e-health interventions into existing and future healthcare services for adolescents, as well as school settings. To date, this has been a largely neglected field of research and represents a significant opportunity for the future.
Conclusion
There is growing evidence for the effectiveness of online CBT interventions for reducing the level of anxiety and depressive symptoms in adolescents aged between 12 and 18 years, when delivered in school and clinical settings, with some level of supervision. However, a number of gaps in knowledge remain. The heterogeneity in sample sizes, randomization procedures, and outcome measures made it difficult to compare trial results and the study designs did not attempt to identify the specific aspects of the internet interventions responsible for success. These factors, alongside the lack of cost effectiveness data, mean that the likelihood of internet interventions being adopted by governments and healthcare providers in their current form remains limited. If internet interventions are to adequately address the shortfalls in the current healthcare systems, future research needs to include larger RCTs, more diverse samples, longer follow-up periods, assessments of clinically significant change and user satisfaction, comparisons of internet-based programs with face-to-face interventions and other online programs, and examination of the role of clinical and nonclinical support and supervision in maintaining adherence and increasing effectiveness. Despite these issues, the evidence is clear that some internet interventions, mainly online CBT, are effective for lowering symptoms of depression and anxiety in youth and have the potential to fill the gap for some mental health service providers. However, for this potential to be realized, rigorous implementation trials need to be conducted which attempt to integrate e-health interventions into existing and future healthcare services for adolescents, as well as school settings. To date, this has been a largely neglected field of research and represents a significant opportunity for the future.
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