Effectiveness of E-mental Health Interventions Among Adolescents and Young Adults: A

Literature Review

Jasmine Gutierrez Santillan

 Effectiveness of E-mental Health Interventions Among Adolescents and Young Adults: A

Methodological Literature Review

Introduction

Mental health plays a significant role in the health and well-being of individuals and can

impact our emotional and psychological well-being. It can profoundly impact an individual’s

personal, academic, and professional responsibilities (World Health Organization, 2022). Over

the last couple of years, the prevalence of mental health illnesses and disorders has become a

significant public health issue among adolescents and young adults. This mental health crisis and

the unfortunate situations individuals may find themselves in, like the COVID-19 pandemic, lack

of resources, and limited engagement due to stigma or lack of mental health literacy, has posed a

challenge for adolescents and young adults (Alvarez-Jimenez et al., 2020; Fitzpatrick et al.,

2017). In response to the increasing rates, e-mental health services have emerged to help treat

and reduce the mental health burden. E-mental health refers to “mental health services and

information delivered or enhanced through the internet and related technologies such as video

conferencing, web-based interventions, or social media” (Rickhi et al., 2015, 450). In this

methodological literature review, I review studies examining the impact, if any, of e-mental

health interventions on the mental health and well-being of adolescents and young adults. In this

case, the independent variable is the use of e-mental health interventions, for example, online

youth peer support and online therapy. The dependent variable is mental health and well-being

outcomes, like improved well-being and symptom reduction.

Methods

For this literature review, five articles were gathered and analyzed by filtering and

specifying key terms and words, the research question, and effectively employing measures to
search databases for relevant studies that align with the health intervention. The literature for this

review was conducted from May 2, 2023, to May 10, 2023, where the first step was identifying

databases. I began my search by going to the John Spoor Broome Library and using the research

guide for the Health Science Department, as it provides databases covering the health and

health-related field. The following databases were searched: PubMed, Academic Search Premier,

PsycInfo, Cinahl, and Google Scholar. After identifying the databases, a systematic search

strategy was performed. I was as specific as possible in generating, narrowing, and finding

relevant articles to reduce unwanted studies.

In each database, I included a combination of keywords and phrases related to my

research on e-mental health interventions and mental health outcomes in adolescents and young

adults. The search terms used were: [e-mental health], [intervention or treatment or therapy],

[mental health or mental illness or mental disorder], [young adults or adolescents or teenagers or

children], [effects or impacts or consequences], and [study]. I refined my search to these terms

and adapted them according to each database. Using these terms was important as excluding one

term could leave out important information regarding e-mental health interventions. The search

was limited to January 1, 2013, to May 2023 to ensure that the studies were less than ten years

old. The search was further modified to original studies to exclude any literature reviews. After

the initial search, articles and abstracts were analyzed to ensure the studies met the criteria and

were relevant. The total number of articles identified was five. After identifying the five articles,

I looked to find information on the study design, the methods, the e-mental health intervention

used, the outcomes, and the researchers’ overall findings.

Sampling Methods
 Moving from the methods I employed, it's essential to see the sampling methods used by

all five studies where various sampling methods, probability, and non-probability, were used to

gather the sample population and investigate the use of e-mental health interventions. Two

articles (Alvarez-Jimenez et al., 2020; Stevens et al., 2022) used non-probability sampling, and

three articles (Fitzpatrick et al., 2017; Gericke et al., 2020; Rickhi et al., 2015) used a mixed

sampling design, combining probability and non-probability sampling. Non-probability was used

in all five studies (Alvarez-Jimenez et al., 2020; Fitzpatrick et al., 2017; Gericke et al., 2020;

Rickhi et al., 2015; Stevens et al., 2022) as convenience sampling and voluntary response

sampling were used to recruit participants via surveys, social media, flyers, and email.

Probability sampling methods were used (Fitzpatrick et al., 2017; Gericke et al., 2020; Rickhi et

al., 2015) as random sampling was done to place individuals in either the control or intervention

groups.

In terms of similarities, all five studies used non-probability sampling. The most common

sampling method observed among these articles was convenience sampling, as individuals were

reached through social media and online platforms (Alvarez-Jimenez et al., 2020; Fitzpatrick et

al.; Rickhi et al., 2015, Stevens et al., 2022). Individuals interested in participating would

volunteer and reach out via these platforms instead of the researcher choosing them. The

difference between the studies was that some articles also used probability sampling. Given the

study's design, probability sampling was used to randomize participants into different groups.

This is important as each participant is equally likely to be placed into the e-mental health

intervention group or the control. The strengths of non-probability sampling are that it is a fast,

cost-effective, and flexible way to obtain data. The weakness of non-probability is that due to the

lack of randomization, you may not generalize the findings as they might not represent the
population, and bias may arise. As for probability sampling, the strengths are generalizing the

results to an extent as the sample is representative and decreasing some bias. Non-response bias

may be a weakness as participants may respond slowly or drop out. Despite the weaknesses,

researchers must decide which method works best and account for limitations.

Research design

Following sampling methods, research designs were investigated, and all five studies

were experimental but differed from pilot studies to randomized controlled (RCTs) and

uncontrolled trials. The experimental design employed quantitative, qualitative, and mixed

methods components, which allowed researchers to evaluate the feasibility, acceptability, and/or

effectiveness of different e-mental health interventions used in the pilot studies and randomized

controlled/uncontrolled trials (Alvarez-Jimenez et al., 2020; Fitzpatrick et al.; Gericke et al.,

2020; Rickhi et al., 2015, Stevens et al., 2022) on mental health outcomes. The experimental

designs are similar in that they uniquely serve a purpose in research by providing evidence of the

design's effectiveness, allowing researchers to make changes before launching the complete

design or analysis. The research designs differ because some have a controlled component, and

others don't. In a controlled study, participants are divided into two groups: one receiving the

treatment (i.e., e-mental health tool or intervention) and the control group receiving no

intervention or a placebo. In an uncontrolled study, the sample population receives the

intervention, but no control group exists to compare. The strengths of pilot studies, RCTs, and

RCTs without control are that it allows researchers to assess the feasibility and accessibility of

interventions, the effectiveness of interventions, and the validity of the research, respectively.

The drawbacks would be not getting conclusive evidence between the observed relationship,

bias, and lack of generalizability.

Data Collection

Regarding data collection, all five articles used either quantitative or qualitative

components or mixed methods to gather numerical data on the use of the e-mental health

intervention, the outcomes (i.e., increase in well-being, reduction in symptoms), and responses

relating to participant's experience with the e-mental health intervention. One article used

qualitative components (Gericke et al., 2020), and four articles (Alvarez-Jimenez et al., 2020;

Fitzpatrick et al., 2017; Rickhi et al., 2015; Stevens et al., 2022) used both a quantitative and

qualitative approach. Those using quantitative components comprised a self-reported feedback

questionnaire, self-reported measures, and surveys. The components were quantitative because

close-ended questions were asked, and individuals were asked to rate their experiences via

5-point scales answering questions like, "How would you rate your experience?" And "Rate the

helpfulness of the e-mental health intervention" (Alvarez-Jimenez et al., 2020; Fitzpatrick et al.,

2017). Depression questionnaires like the PHQ-9 and CDRS-R and anxiety questionnaires like

GAD-7 and YP-CORE were used to assess mental health at baseline and after intervention

(Alvarez-Jimenez et al., 2020; Fitzpatrick et al., 2017; Gericke et al., 2020; Stevens et al., 2022).

Although many studies used quantitative data, qualitative data was also used in some studies.

In-depth, semi-structured interviews and focus groups were conducted in some studies to get a

deeper understanding and for participants to further explain their perspectives and experience

using e-interventions (Gericke et al., 2020; Rickhi et al., 2015; Stevens et al., 2022). Interviews

were open-ended, allowing individuals to provide researchers with as much detail as they'd like

and an opportunity for researchers to ask for clarification.

Like any other component, there are strengths and weaknesses when choosing specific

data collection methods. The strengths of quantitative methods are accuracy in measuring
numerical data and providing statistical evidence to help support the relationship, which in this

case would be the impact of an e-mental health intervention on health outcomes. The weakness

of quantitative research is not getting a deep understanding of people's thoughts. Since the

questions are close-ended, we don't truly see an individual's feelings. Although quantitative

research lacks this component, this is one of the qualitative research's greatest strengths as

researchers get in-depth details on people's experiences and perspectives. The weakness would

be that the nature of qualitative research requires extensive time and resources. The data

collection methods differed among the five articles, but each serves a unique purpose.

Analytical Techniques

Once data was collected, the articles used various analytical techniques to help analyze

and present their findings on the impact of e-mental health interventions on mental health

outcomes. Four articles (Alvarez-Jimenez et al., 2020; Fitzpatrick et al., 2017; Rickhi et al.,

2015; Stevens et al., 2022) conducted statistical analyses to evaluate the effectiveness of their

e-interventions. Linear models, t-tests, confidence intervals, p-values, f-tests, chi-square

analyses, parametric and nonparametric correlations, and descriptive statistics were used in these

studies to help highlight the impact of the e-intervention group and its difference from the control

group, if present. To help readers understand their findings, the researchers also presented their

data in tables showing the measured variables and the differences between both groups. In

addition to quantitative analyses, some researchers conducted qualitative analyses. Qualitative

analyses were done to examine participants' experiences in detail. In some studies, interviews

were transcribed, and researchers applied the thematic analyses by Braun & Clarke

(Alvarez-Jimenez et al., 2020; Gericke et al., 2020; Fitzpatrick et al., 2017; Stevens et al., 2022).

Researchers identify common themes or topics through thematic analysis, develop data codes,
and generate thematic maps. The strengths of these analyses were having quantifiable data to

analyze the intervention's effectiveness and providing insight into participants' experiences. The

weaknesses are not getting a complete picture of participants in quantitative analysis and

potential bias.

Conclusion

The literature in this review provided valuable information and data on the effectiveness

of various e-interventions for mental health among adolescents and young adults. The studies

presented in this review helped improve the individual's mental health and well-being, as

positive relationships were observed between e-mental health services and mental health

(Alvarez-Jimenez et al., 2020; Gericke et al., 2020; Fitzpatrick et al., 2017; Rickhi et al., 2015;

Stevens et al., 2022). In four articles (Alvarez-Jimenez et al., 2020; Gericke et al., 2020;

Fitzpatrick et al., 2017; Rickhi et al., 2015), depression and depressive symptoms decreased after

the e-intervention compared to baseline data. There were also improvements in psychological

distress and psychological well-being across the studies. While the studies provided valuable

data, the methods had some limitations. Many of the studies employed self-reported measures,

which could have either under- or over-represented the participant's well-being and thus

impacted the studies' validity. The sampling methods were mostly non-probability, producing

bias and being unrepresentative. Lastly, the findings from the research design of pilot studies and

RCTs without controls could have been a limitation, as small sample size or no control group

would limit generalizability. To address these limitations, future studies should increase sample

size, incorporate probability sampling, and long-term follow-ups to assess the effectiveness of

e-interventions. Overall, these studies contributed significantly to research on e-interventions in

improving mental health outcomes.

 References

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https://www.who.int/news-room/fact-sheets/detail/mental-health