Research

Journal of Telemedicine and Telecare

2021, Vol. 27(10) 638–666
Are online mental health interventions © The Author(s) 2021
Article reuse guidelines:
for youth effective? A systematic review sagepub.com/journals-permissions
DOI: 10.1177/1357633X211047285
journals.sagepub.com/home/jtt

Xiaoyun Zhou1,2 , Sisira Edirippulige1,2 , Xuejun Bai3,

and Matthew Bambling1,4,5,6

Abstract
Objectives: This systematic review aims to examine the effectiveness of online mental health interventions for youth.
Methods: We searched seven electronic databases (PubMed, PsycINFO, Medline, Embase, CINAHL, Web of Science and
SCOPUS) for the past 10 years to identify randomized controlled trials which have evaluated the use of telehealth inter-
ventions for young people with mental health problems. The included studies were assessed for quality and risk of bias.
Results: Forty-five randomized controlled trials (n = 13,291 participants) were eligible for this review. Most studies (35
trials) evaluated the use of web-based self-help platforms to deliver cognitive behavioural therapy (14 trials), mindfulness
(four trials), acceptance commitment therapy (five trials) and positive psychology (two trials). Mobile/computer applica-
tions were used to deliver cognitive behavioural therapy (four trials) and coping strategies training (two trials). Web-based
synchronous chat (one trial) was used to assist communication between counsellors and participants. Three studies used
artificial intelligence-based conversational agents to deliver cognitive behavioural therapy (two trials) and problem-solving-
strategy training (one trial). Eighty-two percent (n = 37) identified the participants as student population (i.e. university
students, high school students). Sixty-four percent (n = 29) of the telehealth interventions were found to be effective
in managing depression, anxiety, stress, insomnia and improving quality of life when compared with control conditions.
Conclusions: Online mental health interventions were found to be effective in managing diverse mental health condi-
tions among youth. Online self-help platforms were the most frequently used modality and artificial intelligence-based
chatbots are merging as potential solutions. Future research is warranted to investigate the solutions to improve the
retention rate and satisfaction of telehealth interventions among this population.

Keywords
Telehealth, telemedicine, adolescent, youth, mental health, effectiveness, systematic review
Date received: 19 July 2021; Date accepted: 1 September 2021

Introduction Telehealth has been increasingly used to manage youth

The age-of-onset for mood and anxiety disorders was
reported as 15–24 years.1,2 The prevalence rate for signifi-
cant symptoms for depression or anxiety among youth was
up to 28% in 2018.3,4 The global prevalence of subthres-
hold social anxiety disorders among youth was estimated
to be 36% in 2020.5 Youth-onset mental health problems
are associated with chronic and severe mental disorders in
adulthood.6 Early interventions in youth are effective in
preventing the progression to chronic mental health pro-
blems, however, it is estimated that the cost for mental
health services was estimated to be $6460 per youth in
2019.7 The perceived need for mental health service
among youth is increasing, however, the accessibility,
affordability and stigma associated with mental health ser-
vices prevented youth from seeking professional help.
mental health; for instance, E-CYMHS, a video-based
mental health program, was developed to provide
1
Centre for Online Health, The University of Queensland, Australia
2
Centre for Health Services Research, The University of Queensland,
Australia
3
Academy of Psychology and Behavior, Tianjin Normal University, China
4
Navitas ACAP School of Psychology, Australia
5
School of Psychology, Queensland University of Technology, Australia
6
Brisbane Central Medical School, The University of Queensland,
Australia
Corresponding author:
Xiaoyun Zhou, Centre for Online Health, The University of Queensland,
Ground Floor Building 33, Princess Alexandra Hospital, 199 Ipswich Road,
Woolloongabba QLD 4102, Australia.
Email: xiaoyun.zhou1@uqconnect.edu.au
Zhou et al.
Australian rural adolescents with mental health care.8,9 In
addition to videoconferencing, various technologies (e.g.
email, text, e-consult) have been integrated into youth
mental health care shown to be accessible, effective and
cost-effective.10 Despite of efforts made by health care pro-
viders, young people may also prefer to access mental
health services through websites and applications.11,12
Increasing number of studies have evaluated the effect of
online interventions to manage youth mental health con-
cerns. However, some studies showed that online interven-
tions were effective in reducing depression,13,14
anxiety,15,16 conduct disorders17 and substance abuse18
among youth. Whilst others suggested that online interven-
tions were not effective in managing mental health
issues.19–21 To date there has not been a systematic evalu-
ation of the evidence for online mental health interventions
among youth. The purpose of this study is to systematically
review the literature to determine the effects of online
mental health interventions for youth.
Methods
Search procedures
This review was conducted between November 2020 and July
2021. The preferred reporting items for systematic reviews
and meta-analysis (PRISMA) guidelines were followed to iden-
tify and analyse relevant studies.22 Search terms were adoles-
cent, mental health, telehealth, and intervention and databases
were PubMed, PsycINFO, Medline, Embase, CINAHL, web
of science and SCOPUS (see Appendix 1). The inclusion and
exclusion criteria were formulated following PICO. We included
studies that (i) included youth (15–24 years); (ii) were rando-
mised controlled trials (RCTs); (iii) were underpinned by
stand-alone or combined psychological therapies; (iv) were
delivered via online format (e.g. mobile applications, web-based
programs etc.); and (v) targeted mental health outcomes. We
excluded studies that (i) only recruited parents or teachers of
youth; (ii) were quasi-experimental studies, single-arm trials,
cross-sectional studies or qualitative studies; (iv) used online
interventions which were not based on psychological therapies
(e.g. solely based on physical activities); (v) solely used tele-
phone consulting; email or face-to-face counselling as delivery
format; (vi) did not include mental health outcomes or primarily
targeted conduct disorders (e.g. drug abuse). Two authors (XZ
and SE) independently performed the screening process, and dis-
agreement was resolved by the third author (MB).
Data extraction
In addition to basic demographic details of the included
studies, we collected and tabulated the following informa-
tion: study design, sample characteristics, modalities of
online interventions, psychological interventions, mental
health outcomes, effect sizes and retention rates.
639
Quality assessment
Two independent reviewers (XZ and SE) used JBI’s
Critical Appraisal Checklist for Randomised Controlled
Trials23 to assess the quality of the studies. Any discrepan-
cies were revolved around the involvement of a third
reviewer (MB). The total score ranged from 1 to 13
points. For this review, studies meeting at least 10 out of
13 criteria were categorised into ‘good’ quality, seven to
nine were categorised into ‘moderate’ quality, less than
seven were deemed ‘poor’ quality. The studies that scored
less than seven were excluded from this review.
Results
The initial search identified 2184 articles from PubMed,
PsycINFO, Medline, Embase, CINAHL, Web of Science
and SCOPUS. After duplicates were removed, 1426 articles
were screened for title and abstract. Screening for titles and
abstracts excluded 971 articles. A total of 455 full texts
were screened against inclusion and exclusion criteria.
Three hundred and eighty-two ineligible articles were
removed (see Figure 1). Seventy-three articles were
assessed for methodological quality using the JBI tool
and 28 were deemed to be of poor quality and excluded.
Forty-five studies were included in this review.
Study characteristics
Forty-five randomized controlled trials (RCTs) (n = 13,291
participants) were included in this review (see Appendix 2
for characteristics of each study). The year of publication
ranged from 2012 to 2021. The majority of the studies
were conducted in developed countries (e.g. the USA,
Australia, the UK etc.). Thirty-seven studies identified their
sample as the student population. The mean age of partici-
pants ranged from 14.8 to 26.7 years. Twenty-three studies
recruited a universal sample, the other 22 studies recruited
selected samples with elevated symptoms. The sample sizes
ranged widely from 61 to 1767. The intervention duration
ranged from one session to 12 months. Thirty-five studies
used web-based self-help platforms as formats to deliver psy-
chological interventions. Six studies used applications, one
study used web-based synchronous chat, and three studies
used artificial intelligence (AI)-based conversational agents.
Quality appraisal
An overview of the quality appraisal of the included studies
is illustrated in Appendix 3. Due to the nature of online
interventions, no studies concealed participants or research-
ers from the interventions. The risk of selection bias was
reported in six studies15,20,24–27 and four studies16,28–30
did not report baseline differences. In addition, 10
studies14,15,20,21,27,31–35 did not report concealing outcomes
640
Figure 1. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart.
assessors from the intervention allocations. Three
studies25,36,37 reported that extra contacts were provided
to intervention groups (e.g. extra email, text messages for
encouraging engagement with the interventions).
Furthermore, there was insufficient description and analysis
of lost participants.15,19,21,27,28,30,32,38–42 Five studies did
not perform intent-to-treat analysis.28,33,36,42,43
Efficacy outcomes
The most frequently assessed mental health outcomes were
depression or depressive symptoms (n = 38; 84%),
anxiety-related symptoms (n = 33; 73%), psychological
Journal of Telemedicine and Telecare 27(10)
stress level (n = 14, 40%). Several studies also investigated
mental health outcomes relating to mental health well-
being,13,20,25,32,44,45 quality of life,32,36,37,46 life satisfac-
tion,21,44 psychological distress,16,25,37,45 insomnia47 and
sleep quality.43
Modalities of online mental health interventions
Thirty-five studies (78%) used web-based self-help plat-
forms as formats to deliver psychological interventions.
Six studies used applications (13%), one study (2%) used
web-based synchronous chat and three studies (7%) used
AI-based conversational agents.
Zhou et al.
The efficacy of web-based self-help platforms. Web-based
self-help platforms were the most frequently used online
format (n = 35).14,20,25–27,29,30,33,34,36,37,39,40,42–44,46–55 A
total of 24 studies were effective in managing
mental health issues whilst other 11 were found to be not
effective.
Cognitive behavioural therapy. Fourteen self-help plat-
forms were underpinned by cognitive behavioural
therapy.15,16,27,33,35,39,42,48,50,52,53,55–57 Eleven studies
found that the web-based platforms underpinned by cogni-
tive behavioural therapies were effective in reducing out-
comes scores relating to depression,15,27,35,39,48,50,52,55,57
anxiety,15,33,39,50,55–57 psychological stress level15,39 as
compared with the control condition. In contrast, the
other three studies showed that their interventions were
not effective in reducing anxiety,16,42 depression16,42,53
and psychological stress level.16
Acceptance commitment therapy. Five trials were
underpinned by acceptance commitment
therapy.21,25,36,40,51 Three interventions were effective in
reducing depression,36 psychological stress level,36,51 psy-
chological distress25 and improving quality of life36 and
mental health wellbeing.25 In contrast, two interventions
did not affect outcomes relating to depressive symp-
toms,40,51 life satisfaction,51 anxiety40 and psychological
stress level.40
Mindfulness. Four studies14,31,43,46 tested the effective-
ness of web-based programs among young people. One
study did not report the efficacy due to the low retention
rate.43 The other three mindfulness web-based interven-
tions14,31,46 showed efficacies in reducing perceived
stress, anxiety, depression14,31,46 and improving quality of
life.46
Positive psychology. Two self-help platforms were
based on positive psychology.30,44 Burckhardt et al.44
found that the intervention was not effective in managing
anxiety, depression, stress, life satisfaction or mental
health wellbeing. In contrast, the other intervention30 was
effective.
Other stand-alone interventions. Four online platforms
were based on present control theory,49 psychodynamic
therapy,41 social cognitive theory26 and religious beliefs
spiritual practices.34 All of these interventions were found
to be effective in reducing psychological stress level,
anxiety and depression.
Combined psychological interventions. Six studies used
web-based self-help interventions combined with several
psychological interventions.20,29,37,38,47,54 Calear et al.20
used a web-based self-help platform to deliver a combin-
ation of psychoeducation, cognitive behavioural therapy
(CBT), relaxation skills and physical activity among
641
school students. Findings were that the intervention had
no impact on anxiety, depressive symptoms or mental
health wellbeing. One intervention was based on CBT
and mindfulness,38 the intervention was effective in redu-
cing depression, and anxiety but not effective in reducing
psychological stress levels. Farrer et al.37 used a web-based
self-help platform to deliver psychoeducation and train stu-
dents with coping strategies. They found that the interven-
tion was not effective in reducing anxiety, depression,
psychological distress or improving quality of life.
Gladstone et al.29 delivered a combination of behavioural
activation strategies and interpersonal psychotherapy tech-
niques via a web-based self-help platform. They found
the intervention was not effective in reducing anxiety or
depressive symptoms. Schleider et al.54 delivered psychoe-
ducation on growth mindsets of personality, self-regulation
and intelligence via a web-based platform. They found that
the intervention was effective in reducing depressive symp-
toms, but not effective in reducing social anxiety symp-
toms. Short et al.47 delivered web-based self-help
intervention which combined motivational interviewing
(MI) and CBT. They found that the intervention was not
effective in reducing anxiety or insomnia.
Efficacy of web-based applications. Six studies13,24,32,45,58,59
used web-based mobile applications as vehicle to deliver
psychological interventions. CBT,32,45,58,59 mindfulness,32
attention bias modification training,32 coping strategies24,58
and social learning theory45 were used as psychological
interventions which underpinned these web-based applica-
tions. Three studies13,58,59 demonstrated the effectiveness
of app-based intervention in improving mental health well-
being13 and reducing anxiety, depression13,58,59 and per-
ceived stress.58 The effect sizes ranged from d = 0.30 to d
= 0.76. In contrast, two studies24,32 did not find significant
differences between intervention groups and control groups
in the changes of mental health outcomes at post-
intervention. Interestingly, O’Dea et al.45 found that the
intervention was not effective in reducing depression or
anxiety. However, it demonstrated effectiveness in improv-
ing mental health wellbeing. The retention rates ranged
from 28% to 92.7%.
Efficacy of web-based synchronous chat between
psychotherapists and participants. Kramer et al.60 tested the
effectiveness of web-based synchronous chat between
mental health professionals and participants. The interven-
tion consisted of individual real-time chat sessions with a
psychotherapist Solution-Focused Brief Therapy (SFBT)
techniques were used by the psychotherapist The result
showed that compared with the waiting list condition, the
intervention group showed significantly greater reductions
in symptoms of depression. The retention rate was 51%.
642
Efficacy of AI-based conversational agents (chatbots). Three
studies19,28,61 tested the effectiveness of AI-based chatbot
in reducing anxiety and depression among university stu-
dents. Bird et al.19 used a computerised AI-based chatbot
(MYLO) to train participants with problem-solving strate-
gies. They used another mental health chatbot (ELIZA) as
a control condition. ELIZA is a text-based chatbot designed
to encourage users to discuss their problems. They found
that both intervention and control groups demonstrated sig-
nificant reductions in depression and anxiety. However,
MYLO was not found to be more effective than ELIZA.
Fitzpatrick and Darcy61 and Fulmer et al.28 used chatbots
(Weobot and Tess) to deliver CBT. Both studies provided
control groups with only online mental health-related infor-
mation. Fitzpatrick et al. found that the intervention was
effective in reducing depressive symptoms but not in redu-
cing anxiety. Fulmer et al. found that the chatbot (Tess) was
effective in reducing depression and anxiety. The retention
rate of AI-based chatbot interventions ranged from 83% to
100%, with one study reporting 83% and two studies
reporting 100%.
Discussion
Telehealth is a clinically effective approach for managing
diverse health conditions62,63 and it is well-accepted and
widely used in the management of mental health con-
cerns.64 This systematic review summarised the modalities
and effectiveness of online mental health interventions for
youth in the recent literature. Four modalities were used
to manage youth mental health problems: web-based self-
help platforms, web-based applications, web-based syn-
chronous chat and AI-based chatbots. Sixty-four percent
(n = 29) of the online interventions were effective in mana-
ging depression, anxiety, psychological stress level, insom-
nia and psychological distress and improving mental health
well-being, life satisfaction, sleep quality, and quality of life
among youth.
Web-based self-help platforms were the most frequent
method used in the reviewed studies (n = 35). In line with
previous studies,65,66 majority of self-help platforms (n =
25) were effective in managing anxiety, depression and
psychological stress level when compared with the
control conditions, with those underpinned by cognitive
behavioural therapies demonstrating most evidence. These
included self-help platforms comprised of different
modules with each module achieving certain aims such as
psychoeducation and skills training. Participants could
access the platform at their convenience. Previous studies
have suggested that internet self-help platforms were con-
venient67 and helpful in reducing stigma.68 It is worth
noting that the retention rate ranged widely from 1% to
100%. This confirmed previous findings relating to online
self-help platforms,69 which indicated that the uptake and
Journal of Telemedicine and Telecare 27(10)
engagement varied widely for self-help programs. Some
studies, therefore, sent participants reminders to increase
the engagement.25,37 This nevertheless may produce mod-
erators and contaminate the intervention.65 Therefore,
future studies investigating the effect of self-help platforms
should take into account co-design to increase the
engagement.
Our study suggested mixed evidence relating to the
effectiveness of web-based applications in managing
mental health issues among youth. Previous reviews inves-
tigating the effectiveness of app-based mental health inter-
ventions found a similar trend.70 This potentially reflects
the fact that app-based interventions are still in the
nascent stages. More rigorous designs of apps for youth
mental health are needed. Unlike the previous study
which indicate a mean effect size of d = 0.42 for anxiety
and d = 0.16 for depression for app-based interventions,
our study found that the effect sizes of app-based interven-
tions ranged from d = 0.32 to 0.76 for anxiety and d = 0.30
to 0.63 for depression. This is likely because included
studies in our review are all underpinned by standardized
psychotherapy approaches. Our study also found slightly
higher retention rates for mental health applications which
ranged from 58% to 92%. This may be because compared
to self-help platforms, applications could be accessed via
various devices (e.g. tablets, smartphones and laptops),
and are therefore easy to use. A review conducted by
Chan and Honey71 suggested that consumers held positive
attitudes toward mental health apps and rated them ‘easy to
use’.
In line with the previous review,72 our studies only
found a limited number of synchronous text-based chats,
indicating that there is potentially a research gap in investi-
gating the efficacy of this modality. The only study in this
review suggested that web-based synchronous chat was
effective in reducing depression as compared with the
control condition. As this modality relied largely on the
characteristics of the psychotherapist, this modality served
mostly as a communication tool.
Three trials were identified that investigated the effect-
iveness of AI-based chatbots. The evidence was mixed
with two studies showing reduced anxiety28 and depres-
sion28,61 whilst one study did not.19 Abd-Alrazaq et al.73
also found conflicting results relating to the effectiveness
of the chatbots in managing anxiety and depression.
These altogether suggested that confirmatory studies asses-
sing the effectiveness of chatbots are needed. Moreover, the
AI-based chatbots had the highest retention rates: 83% (n =
1) to 100% (n = 2). This finding is in line with previous
studies74 which suggested that chatbots were rated as
acceptable, satisfying and enjoyable.
The majority (33/45) of the included studies were of
‘good’ quality, however, the included studies are heteroge-
neous. For instance, some studies recruited a universal
sample whilst some studies recruited a targeted sample
Zhou et al.
(i.e. those with elevated symptoms), previous studies sug-
gested that mental health interventions which recruited a
targeted sample are likely to produce larger effect sizes.75
Furthermore, the use of different control conditions (i.e.
active control and passive control) is likely to have an
impact on the effect.75 Therefore, these factors should be
considered when interpreting the results of this review.
Conclusion
The findings of this review indicate that online mental
health interventions have the potential as an effective treat-
ment for a variety of common youth mental health presen-
tations. However, a low retention rate (especially among
web-based platforms) remains a problem in implementing
such interventions, therefore, future studies are warranted
to investigate approaches to engage the youth population.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for
the research, authorship, and/or publication of this article: This
work was supported by the Major Projects of the National
Social Science Foundation (grant no. 20ZDA079).
ORCID iD
Xiaoyun Zhou https://orcid.org/0000-0002-3903-4166
Sisira Edirippulige https://orcid.org/0000-0001-6196-5437
References
1. The United States. Definition of youth, https://www.un.org/
esa/socdev/documents/youth/fact-sheets/youth-definition.pdf
(2013, accessed 28 September 2021).
2. Kessler RC, Amminger GP, Aguilar-Gaxiola S, et al. Age of
onset of mental disorders: a review of recent literature. Curr
Opin Psychiatry 2007; 20: 359.
3. Yatham S, Sivathasan S, Yoon R, et al. Depression, anxiety,
and post-traumatic stress disorder among youth in low and
middle income countries: a review of prevalence and treat-
ment interventions. Asian J Psychiatr 2018; 38: 78–91.
4. Leathers C, Kroenke K, Flanagan M, et al. Somatic, anxiety,
and depressive (SAD) symptoms in young adult Latinx immi-
grants: prevalence and predictors. J Immigr Minor Health
2021; 23: 956–964.
5. Jefferies P and Ungar M. Social anxiety in young people: a
prevalence study in seven countries. PloS One 2020; 15:
e0239133.
6. Goldstein BI and Levitt AJ. Prevalence and correlates of
bipolar I disorder among adults with primary youth-onset
anxiety disorders. J Affect Disord 2007; 103: 187–195.
7. Jacobs P and Lesage A. The public cost of mental health- and
addiction-related services for youth (ages 12–17) in Alberta.
643
Canadian J Psychiatr Revue Canadienne de Psychiatr
2019; 64: 323–328.
8. Wood J, Stathis S, Smith A, et al. E-CYMHS: an expansion of
a child and youth telepsychiatry model in Queensland.
Australas Psychiatr 2012; 20: 333–337.
9. Ryan VN, Stathis S, Smith AC, et al. Telemedicine for rural
and remote child and youth mental health services.
J Telemed Telecare 2005; 11: S76–S78.
10. Hilty DM, Sunderji N, Suo S, et al. Telepsychiatry and other
technologies for integrated care: evidence base, best practice
models and competencies. Int Rev Psychiatr 2018; 30: 292–
309.
11. Becker MPE, Christensen BK, Cunningham CE, et al.
Preferences for early intervention mental health services: a
discrete-choice conjoint experiment. Psychiatr Serv 2016;
67: 184–191.
12. Cunningham CE, Walker JR, Eastwood JD, et al. Modeling
mental health information preferences during the early adult
years: a discrete choice conjoint experiment. J Health
Commun 2014; 19: 413–440.
13. Bendtsen M, Mussener U, Linderoth C, et al. A mobile health
intervention for mental health promotion among university
students: randomized controlled trial. JMIR Mhealth
Uhealth 2020; 8: e17208.
14. Cavanagh K, Churchard A, O’Hanlon P, et al. A randomised
controlled trial of a brief online mindfulness-based interven-
tion in a non-clinical population: replication and extension.
Mindfulness 2018; 9: 1191–1205.
15. Day V, McGrath PJ and Wojtowicz M. Internet-based guided
self-help for university students with anxiety, depression and
stress: a randomized controlled clinical trial. Behav Res Ther
2013; 51: 344–351.
16. Dear BF, Fogliati VJ, Fogliati R, et al. Treating anxiety and
depression in young adults: a randomised controlled trial
comparing clinician-guided versus self-guided internet-
delivered cognitive behavioural therapy. Aust N Z J
Psychiatry 2018; 52: 668–679.
17. Su W, Fang X, Miller JK, et al. Internet-based intervention for
the treatment of online addiction for college students in China:
a pilot study of the healthy online self-helping center.
Cyberpsychol Behav Soc Netw 2011; 14: 497–503.
18. Das JK, Salam RA, Arshad A, et al. Interventions for adoles-
cent substance abuse: an overview of systematic reviews.
J Adolesc Health 2016; 59: S61–S75.
19. Bird T, Mansell W, Wright J, et al. Manage your life online: a
web-based randomized controlled trial evaluating the effect-
iveness of a problem-solving intervention in a student
sample. Behav Cogn Psychother 2018; 46: 570–582.
20. Calear AL, Batterham PJ, Poyser CT, et al. Cluster rando-
mised controlled trial of the e-couch anxiety and worry
program in schools. J Affect Disord 2016; 196: 210–217.
21. Lappalainen R, Lappalainen P, Puolakanaho A, et al. The
youth compass-the effectiveness of an online acceptance
and commitment therapy program to promote adolescent
mental health: a randomized controlled trial. J Contextual
Behav Sci 2021; 20: 1–12.
22. Page MJ, McKenzie JE, Bossuyt PM, et al. Updating guid-
ance for reporting systematic reviews: development of the
PRISMA 2020 statement. J Clin Epidemiol 2021; 134: 103–
112.
644
23. The Joanna Briggs Institute. The Joanna Briggs Institute crit-
ical appraisal tools for use in JBI systematic reviews: check-
list for randomized controlled trials 2017, Adelaide: Joanna
Briggs Institute. Available from: https://jbi.global/sites/default/
files/2019-05/JBI_RCTs_Appraisal_tool2017_0.pdf
24. Kenny R, Fitzgerald A, Segurado R, et al. Is there an app for
that? A cluster randomised controlled trial of a mobile app-
based mental health intervention. Health Informatics J
2020; 26: 1538–1559.
25. Levin ME, Krafft J, Hicks ET, et al. A randomized dismant-
ling trial of the open and engaged components of acceptance
and commitment therapy in an online intervention for dis-
tressed college students. Behav Res Ther 2020; 126: 103557.
26. Moeini B, Bashirian S, Soltanian AR, et al. Examining the
effectiveness of a web-based intervention for depressive
symptoms in female adolescents: applying social cognitive
theory. J Res Health Sci 2019; 19: e00454.
27. Perry Y, Werner-Seidler A, Calear A, et al. Preventing depres-
sion in final year secondary students: school-based rando-
mized controlled trial. J Med Internet Res 2017; 19: e369.
28. Fulmer R, Joerin A, Gentile B, et al. Using psychological arti-
ficial intelligence (Tess) to relieve symptoms of depression
and anxiety: randomized controlled trial. JMIR Ment. Health
2018; 5: e64.
29. Gladstone T, Buchholz KR, Fitzgibbon M, et al. Randomized
clinical trial of an internet-based adolescent depression pre-
vention intervention in primary care: internalizing symptom
outcomes. Int J Environ Res Public Health 2020; 17: 1–17.
30. Osborn TL, Rodriguez M, Wasil AR, et al. Single-session
digital intervention for adolescent depression, anxiety, and well-
being: outcomes of a randomized controlled trial with Kenyan
adolescents. J Consult Clin Psychol 2020; 88: 657–668.
31. Ahmad F, El Morr C, Ritvo P, et al. An eight-week, web-
based mindfulness virtual community intervention for stu-
dents’ mental health: randomized controlled trial. JMIR
Ment Health 2020; 7: e15520.
32. Edridge C, Wolpert M, Deighton J, et al. An mHealth inter-
vention (ReZone) to help young people self-manage over-
whelming feelings: cluster-randomized controlled trial. J
Med Internet Res 2020; 22: e14223.
33. McCall HC, Richardson CG, Helgadottir FD, et al. Evaluating a
web-based social anxiety intervention among university students:
randomized controlled trial. J Med Internet Res 2018; 20: e91.
34. Rickhi B, Kania-Richmond A, Moritz S, et al. Evaluation of a
spirituality informed e-mental health tool as an intervention
for major depressive disorder in adolescents and young
adults – a randomized controlled pilot trial. BMC
Complement Altern Med 2015; 15: 1–14.
35. Topooco N, Byléhn S, Dahlström Nysäter E, et al. Evaluating
the efficacy of internet-delivered cognitive behavioral therapy
blended with synchronous chat sessions to treat adolescent
depression: randomized controlled trial. J Med Internet Res
2019; 21: e13393.
36. Eustis EH, Hayes-Skelton SA, Orsillo SM, et al. Surviving
and thriving during stress: a randomized clinical trial compar-
ing a brief web-based therapist-assisted acceptance-based
behavioral intervention versus waitlist control for college stu-
dents. Behav Ther 2018; 49: 889–903.
37. Farrer LM, Gulliver A, Katruss N, et al. A novel multi-
component online intervention to improve the mental health
Journal of Telemedicine and Telecare 27(10)
of university students: randomised controlled trial of the uni
virtual clinic. Internet Interv 2019; 18: 100276.
38. El Morr C, Ritvo P, Ahmad F, et al. Effectiveness of an
8-week web-based mindfulness virtual community interven-
tion for university students on symptoms of stress, anxiety,
and depression: randomized controlled trial. JMIR Ment
Health 2020; 7: e18595.
39. Ip P, Chim D, Chan KL, et al. Effectiveness of a culturally
attuned internet-based depression prevention program for
Chinese adolescents: a randomized controlled trial. Depress
Anxiety 2016; 33: 1123–1131.
40. Levin ME, Pistorello J, Seeley JR, et al. Feasibility of a pro-
totype web-based acceptance and commitment therapy pre-
vention program for college students. J Am Coll Health
2014; 62: 20–30.
41. Lindqvist K, Mechler J, Carlbring P, et al. Affect-focused psy-
chodynamic internet-based therapy for adolescent depression:
randomized controlled trial. J Med Internet Res 2020; 22:
e18047.
42. Melnyk BM, Amaya M, Szalacha LA, et al. Feasibility, accept-
ability, and preliminary effects of the COPE online cognitive-
behavioral skill-building program on mental health outcomes
and academic performance in freshmen college students: a ran-
domized controlled pilot study. J Child Adolesce Psychiatr
Nurs: Official Publication of the Association of Child and
Adolesce Psychiat Nurs, Inc 2015; 28: 147–154.
43. Antonson C, Thorsén F, Sundquist J, et al. Upper secondary
school students’ compliance with two internet-based self-help
programmes: a randomised controlled trial. Eur Child Adolesc
Psychiatr 2018; 27: 191–200.
44. Burckhardt R, Manicavasagar V, Batterham PJ, et al. A web-
based adolescent positive psychology program in schools: ran-
domized controlled trial. J Med Internet Res 2015; 17: e4329.
45. O’Dea B, Han J, Batterham PJ, et al. A randomised controlled
trial of a relationship-focussed mobile phone application for
improving adolescents’ mental health. J Child Psychol
Psychiatry 2020; 61: 899–913.
46. Lahtinen O and Salmivalli C. An effectiveness study of a
digital mindfulness-based program for upper secondary edu-
cation students. Mindfulness (NY) 2020; 11: 2494–2505.
47. Short NA, Developing SN and Novel Ta. Computerized
insomnia and anxiety intervention to reduce safety aids
among an at-risk student sample: a randomized controlled
trial. Behav Ther 2020; 51: 149–161.
48. Cook L, Mostazir M and Watkins E. Reducing stress and pre-
venting depression (RESPOND): randomized controlled trial
of web-based rumination-focused cognitive behavioral
therapy for high-Ruminating University students. J. Med.
Internet Res 2019; 21: e11349.
49. Frazier P, Meredith L, Greer C, et al. Randomized controlled
trial evaluating the effectiveness of a web-based stress man-
agement program among community college students.
Anxiety Stress Coping 2015; 28: 576–586.
50. Kählke F, Berger T, Schulz A, et al. Efficacy of an unguided
internet-based self-help intervention for social anxiety dis-
order in university students: a randomized controlled trial.
Int J Methods Psychiatr Res 2019; 28: e1766.
51. Puolakanaho A, Lappalainen R, Lappalainen P, et al.
Reducing stress and enhancing academic buoyancy among
adolescents using a brief web-based program based on
Zhou et al.
acceptance and commitment therapy: a randomized controlled
trial. J Youth Adolesc 2019; 48: 287–305.
52. Ren Z, Li X, Zhao L, et al. Effectiveness and mechanism of
internet-based self-help intervention for depression: the
Chinese version of MoodGYM. Acta Psychol Sin 2016.
53. Richards D, Timulak L and Hevey D. A comparison of two
online cognitive-behavioural interventions for symptoms of
depression in a student population: the role of therapist
responsiveness. Couns Psychother Res 2013; 13: 184–193.
54. Schleider JL, Burnette JL, Widman L, et al. Randomized trial
of a single-session growth mind-set intervention for rural ado-
lescents’ internalizing and externalizing problems. J Clin
Child Adolesc Psychol 2020; 49: 660–672.
55. Merry SN, Stasiak K, Shepherd M, et al. The effectiveness of
SPARX, a computerised self-help intervention for adolescents
seeking help for depression: randomised controlled non-
inferiority trial. BMJ 2012; 344: e2598.
56. Stjerneklar S, Hougaard E, McLellan LF, et al. A randomized
controlled trial examining the efficacy of an internet-based
cognitive behavioral therapy program for adolescents with
anxiety disorders. PloS One 2019; 14: e0222485.
57. Wong N, Kady L, Mewton L, et al. Preventing anxiety and
depression in adolescents: a randomised controlled trial of
two school based internet-delivered cognitive behavioural
therapy programmes. Internet Interv 2014; 1: 90–94.
58. Harrer M, Adam SH, Fleischmann RJ, et al. Effectiveness of
an internet- and app-based intervention for college students
with elevated stress: randomized controlled trial. J Med
Internet Res 2018; 20: e9293.
59. McCloud T, Jones R, Lewis G, et al. Effectiveness of a mobile
app intervention for anxiety and depression symptoms in uni-
versity students: randomized controlled trial. JMIR Mhealth
Uhealth 2020; 8: e15418.
60. Kramer J, Conijn B, Oijevaar P, et al. Effectiveness of a
web-based solution-focused brief chat treatment for depressed
adolescents and young adults: randomized controlled trial.
J Med Internet Res 2014; 16: e141.
61. Fitzpatrick KK and Darcy A. and MJJmh Vierhile. Delivering
cognitive behavior therapy to young adults with symptoms of
depression and anxiety using a fully automated conversational
agent (Woebot): a randomized controlled trial 2017; 4: e19.
62. Snoswell CL, Chelberg G, De Guzman KR, et al. The clinical
effectiveness of telehealth: a systematic review of
meta-analyses from 2010 to 2019. J Telemed Telecare 2021.
63. Snoswell CL, Stringer H, Taylor ML, et al. An overview of the
effect of telehealth on mortality: a systematic review of
meta-analyses. J Telemed Telecare 2021. 1357633X211023700.
645
64. Gajaria A, Conn DK and Madan R. Telepsychiatry: effective-
ness and feasibility. Smart Homecare Technol Telehealth
2015; 3: 59–67.
65. Bennett SD, Cuijpers P, Ebert DD, et al. Practitioner review:
unguided and guided self-help interventions for common
mental health disorders in children and adolescents: a sys-
tematic review and meta-analysis. J Child Psychol Psychiatr
2019; 60: 828–847.
66. Lewis C, Pearce J and Bisson JI. Efficacy, cost-effectiveness
and acceptability of self-help interventions for anxiety disor-
ders: systematic review. Br J Psychiatr 2012; 200: 15–21.
67. Musiat P, Goldstone P and Tarrier N. Understanding the
acceptability of e-mental health-attitudes and expectations
towards computerised self-help treatments for mental health
problems. BMC Psychiatry 2014; 14: 1–8.
68. Mills H, Mulfinger N, Raeder S, et al. Self-help interventions
to reduce self-stigma in people with mental health problems: a
systematic literature review. Psychiatr Res 2020; 284:
112702.
69. Fleming T, Bavin L, Lucassen M, et al. Beyond the trial: sys-
tematic review of real-world uptake and engagement with
digital self-help interventions for depression, low mood, or
anxiety. J Med Internet Res 2018; 20: e9275.
70. Buttazzoni A, Brar K and Minaker L. Smartphone-based
interventions and internalizing disorders in youth: systematic
review and meta-analysis. J Med Internet Res 2021; 23:
e16490.
71. Chan AHY and Honey MLL. User perceptions of mobile
digital apps for mental health: acceptability and usability–
An integrative review. J Psychiatr Ment Health Nurs 2021:
1–22.
72. Varker T, Brand RM, Ward J, et al. Efficacy of synchronous
telepsychology interventions for people with anxiety, depres-
sion, posttraumatic stress disorder, and adjustment disorder: a
rapid evidence assessment. Psychol Serv 2019; 16: 621.
73. Abd-Alrazaq AA, Rababeh A, Alajlani M, et al. Effectiveness
and safety of using chatbots to improve mental health: sys-
tematic review and meta-analysis. J Med Internet Res 2020;
22: e16021.
74. Vaidyam AN, Wisniewski H, Halamka JD, et al. Chatbots
and conversational agents in mental health: a review of
the psychiatric landscape. Can J Psychiatry 2019; 64:
456–464.
75. van Loon AWG, Creemers HE, Beumer WY, et al. Can
schools reduce adolescent psychological stress? A multilevel
meta-analysis of the effectiveness of school-based interven-
tion programs. J Youth Adolesc 2020; 49: 1127–1145.
646 Journal of Telemedicine and Telecare 27(10)

Appendix 1

Table A1. Searching strategy for each database.

Database Number Searching strategy

PubMed 202 (((Adolescent[Ti/Ab] OR Adolescence[Ti/Ab] OR Teen[Ti/Ab] OR Teenager[Ti/Ab] OR Youth[Ti/Ab] OR

student[Ti/Ab] OR ‘young adult’ [Ti/Ab] OR ‘young people’ [Ti/Ab]) AND (‘mental health’ [Ti/Ab] OR
‘mental disorder’ [Ti/Ab] OR depressive[Ti/Ab] OR depression [Ti/Ab] OR anxiety [Ti/Ab] OR stress [Ti/
Ab] OR ‘psychological wellbeing’ [Ti/Ab])) AND (Web-based [Ti/Ab] OR computerized[Ti/Ab] OR
‘mobile health’ [Ti/Ab] OR mHealth[Ti/Ab] OR eHealth [Ti/Ab] OR telehealth [Ti/Ab] OR VR [Ti/Ab] OR
‘virtual reality’ [Ti/Ab] OR text-messaging [Ti/Ab] OR ‘text messaging’ [Ti/Ab] OR ‘text message’ [Ti/Ab]
OR ‘text based’ [Ti/Ab] OR texting [Ti/Ab] OR text-based [Ti/Ab] OR SMS [Ti/Ab] OR app [Ti/Ab] OR
application [Ti/Ab] OR digital [Ti/Ab] OR internet-based [Ti/Ab] OR online [Ti/Ab] OR chatbot[Ti/Ab]
OR ‘conversational agent’ [Ti/Ab] OR chatterbot[Ti/Ab] OR ‘conversational bot’ [Ti/Ab] OR ‘dialog agent’
[Ti/Ab] OR ‘virtual agent’ [Ti/Ab] OR ‘artificial intelligent’ [Ti/Ab] OR AI[Ti/Ab] OR ‘artificial intelligence’
[Ti/Ab] OR NLP[Ti/Ab] OR ‘natural language processing’ [Ti/Ab] OR cyber[Ti/Ab])) AND
(Intervention[Ti/Ab] OR program[Ti/Ab]).
Filters: Filters applied: Books and Documents, Clinical Trial, Randomized Controlled Trial, in the last 10 years,
Child: birth-18 years, Adolescent: 13–18 years, Young Adult: 19–24 years.
PsycINFO 678 Abstract: Adolescent OR Adolescence OR Teen OR Teenager OR Youth OR student OR ‘young adult’ OR
‘young people’ AND Abstract: ‘mental health’ OR ‘mental disorder’ OR depressive OR depression OR
anxiety OR stress OR ‘psychological wellbeing’ AND Abstract: Web-based OR computerized OR ‘mobile
health’ OR mHealth OR eHealth OR telehealth OR VR OR ‘virtual reality’ OR text-messaging OR ‘text
messaging’ OR ‘text message’ OR ‘text based’ OR texting OR text-based OR SMS OR app OR application
OR digital OR internet-based OR online OR chatbot OR ‘conversational agent’ OR chatterbot OR
‘conversational bot’ OR ‘dialog agent’ OR ‘virtual agent’ OR ‘artificial intelligent’ OR AI OR ‘artificial
intelligence’ OR NLP OR ‘natural language processing’ OR cyber AND Abstract: Intervention OR
Abstract: program AND NOT Methodology: Literature Review OR Systematic Review OR Meta-Analysis
AND Peer-Reviewed Journals only AND Year: 2010 To 9999.
Medline 296 TI (Adolescent OR Adolescence OR Teen OR Teenager OR Youth OR student OR ‘young adult’ OR ‘young
people’) AND AB (‘mental health’ OR ‘mental disorder’ OR depressive OR depression OR anxiety OR
stress OR ‘psychological wellbeing’) AND TI (Web-based OR computerized OR ‘mobile health’ OR
mHealth OR eHealth OR telehealth OR VR OR ‘virtual reality’ OR text-messaging OR ‘text messaging’ OR
‘text message’ OR ‘text based’ OR texting OR text-based OR SMS OR app OR application OR digital OR
internet-based OR online OR chatbot OR ‘conversational agent’ OR chatterbot OR ‘conversational bot’
OR ‘dialog agent’ OR ‘virtual agent’ OR ‘artificial intelligent’ OR AI OR ‘artificial intelligence’ OR NLP OR
‘natural language processing’ OR cyber) AND TI (Intervention OR program OR cost-effectiveness OR
perspective OR perception).
Limiters – Scholarly (Peer Reviewed) Journals; Date of Publication: 20100101 –; Language: English.
Expanders – Apply equivalent subjects.
Search modes – Find all my search terms.
Embase 354 (adolescent:ab,ti OR adolescence:ab,ti OR teen:ab,ti OR teenager:ab,ti OR youth:ab,ti OR student:ab,ti OR
’young adult’:ab,ti OR ’young people’:ab,ti) AND (’mental health’:ab,ti OR ’mental disorder’:ab,ti OR
depressive:ab,ti OR depression:ab,ti OR anxiety:ab,ti OR stress:ab,ti OR ’psychological wellbeing’:ab,ti)
AND (’web based’:ab,ti OR computerized:ab,ti OR ’mobile health’:ab,ti OR mhealth:ab,ti OR ehealth:ab,ti
OR telehealth:ab,ti OR vr:ab,ti OR ’virtual reality’:ab,ti OR ’text messaging’:ab,ti OR ’text message’:ab,ti
OR texting:ab,ti OR ’text based’:ab,ti OR sms:ab,ti OR app:ab,ti OR application:ab,ti OR digital:ab,ti OR
’internet based’:ab,ti OR online:ab,ti OR chatbot:ab,ti OR ’conversational agent’:ab,ti OR chatterbot:ab,ti
OR ’conversational bot’:ab,ti OR ’dialog agent’:ab,ti OR ’virtual agent’:ab,ti OR ’artificial intelligent’:ab,ti
OR ai:ab,ti OR ’artificial intelligence’:ab,ti OR nlp:ab,ti OR ’natural language processing’:ab,ti OR cyber:ab,
ti) AND (intervention:ab,ti OR program:ab,ti) AND ([controlled clinical trial]/lim OR [randomized
controlled trial]/lim) AND [2010–2021]/py.
CINAHL 184 TI (Adolescent OR Adolescence OR Teen OR Teenager OR Youth OR student OR ‘young adult’ OR ‘young
people’) AND AB (‘mental health’ OR ‘mental disorder’ OR depressive OR depression OR anxiety OR
stress OR ‘psychological wellbeing’) AND AB (Web-based OR computerized OR ‘mobile health’ OR
(continued)
Zhou et al. 647

Table A1. Continued

Database Number Searching strategy

mHealth OR eHealth OR telehealth OR VR OR ‘virtual reality’ OR text-messaging OR ‘text messaging’ OR

‘text message’ OR ‘text based’ OR texting OR text-based OR SMS OR app OR application OR digital OR
internet-based OR online OR chatbot OR ‘conversational agent’ OR chatterbot OR ‘conversational bot’
OR ‘dialog agent’ OR ‘virtual agent’ OR ‘artificial intelligent’ OR AI OR ‘artificial intelligence’ OR NLP OR
‘natural language processing’ OR cyber) AND TI (Intervention OR program) Limiters – Published Date:
20100101–; English Language; Peer Reviewed.
Expanders – Apply equivalent subjects.
Narrow by SubjectAge: – adult: 19–44 years.
Narrow by SubjectAge: – adolescent: 13–18 years.
Search modes – Boolean/Phrase.
Narrow by SubjectAge: – adolescent: 13–18 years.
Search modes – Boolean/Phrase.
Web of 208 TITLE: (Adolescent OR Adolescence OR Teen OR Teenager OR Youth OR student OR ‘young adult’ OR
Science ‘young people’) AND TITLE: (‘mental health’ OR ‘mental disorder’ OR depressive OR depression OR
anxiety OR stress OR ‘psychological wellbeing’) AND TITLE: (Web-based OR computerized OR ‘mobile
health’ OR mHealth OR eHealth OR telehealth OR VR OR ‘virtual reality’ OR text-messaging OR ‘text
messaging’ OR ‘text message’ OR ‘text based’ OR texting OR text-based OR SMS OR app OR application
OR digital OR internet-based OR online OR chatbot OR ‘conversational agent’ OR chatterbot OR
‘conversational bot’ OR ‘dialog agent’ OR ‘virtual agent’ OR ‘artificial intelligent’ OR AI OR ‘artificial
intelligence’ OR NLP OR ‘natural language processing’ OR cyber) AND TITLE: (Intervention OR
program).
Timespan: 2010–2021. Indexes: SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, BKCI-S, BKCI-SSH,
ESCI, CCR-EXPANDED, IC.
SCOPUS 262 (TITLE (adolescent OR adolescence OR teen OR teenager OR youth OR student OR ‘young adult’ OR
‘young people’) AND TITLE-ABS-KEY (‘mental health’ OR ‘mental disorder’ OR depressive OR
depression OR anxiety OR stress OR ‘psychological wellbeing’) AND TITLE (web-based OR
computerized OR ‘mobile health’ OR mhealth OR ehealth OR telehealth OR vr OR ‘virtual reality’ OR
text-messaging OR ‘text messaging’ OR ‘text message’ OR ‘text based’ OR texting OR text-based OR sms
OR app OR application OR digital OR internet) AND TITLE (intervention OR program OR
cost-effectiveness OR perspective OR perception)) AND DOCTYPE (ar) AND PUBYEAR > 2009.
Appendix 2
648

Table A2. Characteristics of each study.

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

Ahmad 2020, Design: 4-arm RCT Sample description: Web-based platform: Mindfulness Depression, At 8-week time point, Did not report Post-intervention:
Canada Intervention groups: university students Video-based anxiety, stress compared with the 92%
web-based Condition: modules, symptoms control condition,
interventions universal peer-to-peer there was significant
Control group: WLC Age: M = 24.8 discussion forums, reductions in
Duration: 8 weeks Number:113 brief guided symptoms of
videoconferences depression (p <
0.001), anxiety (p =
0.01) and stress (p <
0.01).
Antonson Design: 3-arm RCT Sample description: Web-based self-help Mindfulness Sleep quality; Did not report the Did not report Post-intervention:
2018, Intervention group 1: upper secondary program: video and perceived effectiveness due to 1%
Sweden internet based school students audio material, stress low compliance
mindfulness Condition: Any device
Intervention group 2: universal Age: 15– No human
internet music 19 interference
therapy intervention Number:283
Control group: WLC
Duration: 8 weeks
Bendtsen Design: 2-arm RCT Sample description: Fully automated mobile Positive psychology Mental health Compared with Wellbeing: IRR = Post-intervention:
2020, Intervention group: university students phone application wellbeing; control group, there 1.052 58%
Sweden mHealth Condition: and daily text anxiety; was significant Depression: IRR =
intervention universal messages depression improvement in 0.878; anxiety: IRR
Control group: TAU Age: Mean = 25 mental health = 0.936
Duration: 10 weeks Number: 654 wellbeing (p = 0.02)
and significant
reduction in anxiety
(p = 0.02) and
depression (p =
0.05)
Bird 2018, UK Design: two-arm RCT Sample description: AI-based computerized Problem-solving skills Depression, Both programs N/A Post-intervention:
Intervention group: university students conversational agent building anxiety, stress (MYLO and ELIZA) 100%
AI-based Condition: were associated with
computerized universal improvements in
Journal of Telemedicine and Telecare 27(10)

(continued)
Table A2. Continued

Retention rate (i.e.

Percentage of
Zhou et al.

Sample [sample participants who

description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

intervention (MYLO) Age: M = 22.8 problem distress (p

Control group: Number:213 < 0.01, η2 = 0.23,)
ELIZA which anxiety and
emulates a Rogerian depression (η2=
psychotherapist 0.24), but MYLO
Duration: 2 weeks was not found to be
more effective than
ELIZA.
Burckhardt Design: two-arm RCT Sample description: Web-based self-help Positive psychology Depression, Both Bite Back and Did not report Post-intervention:
2015, Intervention group: high school program anxiety, stress, control conditions 33%
Australia web-based students life satisfaction, demonstrated
intervention (Bite Condition: mental health significant
Back) universal wellbeing improvements in life
Control group: Age: 12.6–15.6 satisfaction scores
non-psychology Number: 572 post-intervention,
entertainment however only
websites control condition
Duration:6 weeks demonstrated
significant increases
in flourishing scores
(mental health
wellbeing)
post-intervention.
Calear 2016, Design: three-arm Sample description: Web-based self-help Psychoeducation, Generalized There was no N/A Post-intervention:
Australia cluster RCT school students program CBT, relaxation anxiety, social significant 47.5%
Intervention group: Condition: and physical anxiety, anxiety improvement
online self-help universal activity. sensitivity, (compared with
program (e-GAD Age: M = 14.83 depressive control group) for
school method; Number: 1767 symptoms, generalized anxiety,
e-GAD service mental health social anxiety,
method) wellbeing anxiety sensitivity,
Control group: WLC depressive
Duration: 6 weeks symptoms, mental
health wellbeing.
Cavanagh Design: two-arm RCT Sample description: Web-based self-help Mindfulness Perceived There were significant Mindfulness skills: d Post-intervention:
2013, UK Intervention group: university students program stress, improvement in = 0.27; perceived 52.3%
online self-help Condition: perceived stress, stress: d = 0.37;
(continued)
649
Table A2. Continued
650

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

mindfulness program universal depression, anxiety/depression anxiety and

Control group: WLC Age: M = 24.7 anxiety symptoms depression: d =
Duration: two-week Number: 104 0.24
Cook 2019, Design: three-arm Sample description: Therapist-guided Rumination-focused Depression, No formal significance Did not report Post-intervention:
UK RCT university students web-based self-help CBT anxiety analyses were 77.7%
Intervention group1: Condition: platform undertaken relative
guided web-based targeted (those to an unguided
intervention with elevated web-based
Intervention group1: rumination) intervention.
unguided web-based Age: M = 20 For guided
intervention Number: 235 web-based
Control group: TAU intervention:
Duration: 6 modules compared with
(3 months) control condition,
depression (p <
0.05) score
significantly lower
for guided
web-based
intervention at
post-intervention.
Day 2013, Design: two-arm RCT Setting: university Web-based guided CBT Anxiety, There were significant Depression: ηp2 = 80% participants
Canada Intervention group: students self-help program depression, reductions in 0.07; Anxiety: ηp2 completed
Online CBT Condition: stress depression, anxiety = 0.08; stress: ηp2 post-intervention
intervention distressed and stress compared = 0.12 assessment
Control group: WLC Age: M = 23.55 with control
Dose: 6 weeks Number: 66 condition
Dear 2018, Design: two-arm RCT Setting: young adults Web-based (self-help CBT Depression, There was no At 3 month At post-intervention:
Australia Intervention group 1: Condition: those or clinician guided) Anxiety, significant difference follow-up, effect 88.5%
clinician guided with anxiety and platform general between the two size for difference
web-based depressive psychological groups at post-test was 0.31
intervention (CG) symptoms distress in outcomes relating
Intervention group 2: Age: M = 21.47 to anxiety,
self-guided Number: 192 depression and
web-based psychological stress.
intervention (SG) At 3-month
follow-up, SG group
(continued)
Journal of Telemedicine and Telecare 27(10)
Table A2. Continued

Retention rate (i.e.

Percentage of
Zhou et al.

Sample [sample participants who

description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

Dose: 4 sessions (5 reported

weeks) significantly more
anxiety symptoms
than the CG group
(p = 0.002).
Edridge 2020, Design: two-arm RCT Setting: primary and Web-based CBT, mindfulness, mental health There were no N/A Did not report
UK Intervention group: secondary school smartphone or tablet and attention bias wellbeing, significant
mHealth students application modification health-related differences between
intervention Condition: training (ABMT) quality of life the ReZone
(ReZone) universal condition and
Control group: TAU Age: 10–15 management as usual
Dose: 12 classes Number: 409 in the self-reported
outcome measures.
ElMorr 2020, Design: two-arm RCT Sample description: Web-based platform CBT and mindfulness Depression, Compared with Depression: d = 92.5% of participants
Canada Intervention group: university students (online videos, anxiety, control group, 0.69; completed
web-based guided Condition: peer-to-peer perceived intervention group Anxiety: d = 0.74; post-intervention
mindfulness-CBT universal discussion forums, stress achieved significant assessment
condition Age: M = 22.6 live reductions in
Control group: WLC Number: 160 videoconferences) depression (P = .01),
Duration: 8 weeks anxiety (P = .006).
There were no
statistically
significant
differences in
perceived stress P =
.48).
Eustis 2018, Design: two-arm RCT Sample description: Web-based self-help ACT Depression, Compared with Stress: d = 0.44; 50% of participants
USA Intervention group: university students platform; anxiety, stress, control group, Depression: d = completed
web-based Condition: quality of life intervention group 0.80; post-intervention
intervention universal achieved significantly Quality of life: d = assessment. 41%
(SATDS) Age: M = 25.4 more reductions in 0.52 completed
Control group: WLC Number: 156 stress (p = 0.04) and 1-month follow-up
Duration: 3 sessions depression (p < assessment.
(4 weeks) 0.001) and achieved
a significant more
increase in quality of
life (p = 0.02), but
(continued)
651
 652
Table A2. Continued

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

not in anxiety (p =
0.46)
Farrer 2019, Design: two-arm RCT Sample description: Web-based self-help Psychoeducation, Depression, There was no N/A 72% of participants
Australia Intervention group: university students platform coping strategies anxiety, quality significant difference completed
online intervention Condition: training of life, between post-intervention
(UVC) targeted (those psychological intervention and assessment. 47.5%
Control group: WLC with elevated distress control group in completed
Duration: 6 weeks psychological outcomes relating to 3-month follow-up
distress (K10 > anxiety (p = 0.32), assessment.
15)) depression (p =
Age: M = 22 0.45), psychological
Number:200 distress (p = 0.09) or
quality of life (p =
0.74).
Frazier 2015, Design: two-arm RCT Sample description: Web-based self-help Present control Perceived Compared with Between-group 56.8% of participants
USA Intervention group: university students platform theory stress, stress control condition, effect size range completed
web-based stress Condition: symptoms, intervention group from: d = 0.30 to d post-intervention
management universal depression, achieved significantly = 0.36 at assessment. 52.5%
program (PCI) Age: 18–21 anxiety bigger reductions in post-intervention completed a
Control group: Number: 257 perceived stress (p = but d = 0.12 at 3-week follow-up
stress-information 0.007), DASS stress follow-up. assessment.
only (p = 0.006), anxiety
Duration: two weeks (p = 0.05),
depression (p =
0.02).
Gladstone Design: two-arm RCT Sample description: Web-based self-help Behavioral activation Depression, There were no N/A Did not report
2020, USA Intervention group: adolescents platform strategies training, anxiety significant
web-based self-help Condition: interpersonal differences between
intervention targeted (those psychotherapy groups in change in
(CATCH-IT) with elevated techniques training depressive
Control group: depression) symptoms (p = 0.80)
online health Age: 15.4 or anxiety (p =
education (HE) Number: 369 0.79).
Duration: 14 Improvement in
modules (24 months) depressive
(continued)
Journal of Telemedicine and Telecare 27(10)
Table A2. Continued

Retention rate (i.e.

Percentage of
Zhou et al.

Sample [sample participants who

description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

symptoms was
statistically
significant (p < 0.05)
for both groups.
Improvement in
anxiety was
significant for
CATCH-IT (p =
0.04) but not HE (p
= 0.07).
Harrer 2018, Design: two-arm RCT Sample description: Internet- and CBT, Perceived Compared to control Stress: d = 0.69; 92.7% of participants
Germany Intervention group: university students app-based program problem-focused stress, group, intervention Anxiety: d = 0.76; completed
internet- and Condition: coping and depression, group achieved a Depression: d = post-intervention
app-based targeted (those emotion-focused state anxiety bigger reduction in 0.63 assessment. 70% of
intervention with elevated coping perceived stress, participants
(CATCH-IT) levels of perceived depression, anxiety. completed
Control group: WLC stress (PSS-4 > = follow-up
Duration: 7 weeks 8)) assessment (3
Age: M = 24 months after
Number: 150 randomization).
Lappalainen Design: three-arm Sample description: Online self-help ACT Depressive The change in the two N/A 96.0% of the
2021, RCT secondary school platform and symptoms; life intervention groups participant finished
Finland Intervention group1: students WhatsApp messages satisfaction was not significantly post-assessment.
online intervention Condition: sent by coaches different compared
with two face-to-face universal with the control
sessions Age:15–16 (M = group in regard to
Intervention group2: 15.27) depressive
online intervention Number: 243 symptoms (p =
with no face-to-face 0.153); life
sessions satisfaction (p =
Control group: no 0.195).
treatment
Duration: 5 weeks
Ip 2016, China Design: two-arm RCT Sample description: Web-based self-help CBT Depression, At post-intervention, Post-intervention: post-intervention:
Intervention group: secondary school program anxiety, stress intervention group Depression: d = 97%
online intervention students achieved statistically −0.28;
Control group: Condition: significant Anxiety: d =
(continued)
653
 654

Table A2. Continued

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

attention control targeted (those reductions in DASS −0.35;

Duration: 8 months with anxiety (p = 0.01), Stress: d = −0.27
mild-to-moderate depression (p = 4-month
depressive 0.03) and stress (p = follow-up: d =
symptoms) 0.03). −0.36
Age: M = 14.63 At 4-month
Number: 257 follow-up,
intervention group
improved
significantly in
depression (p =
0.01)
Kählke 2019, Design: two-arm RCT Sample description: Web-based self-help CBT for social Social anxiety Results indicated Social anxiety Post-intervention:
Germany, Intervention group: university students platform phobia disorder, moderate to large disorder: 92.5%
Australia, internet-based Condition: depression effect sizes in favor
Switzerland self-help intervention targeted (those of intervention
Control group: WLC with social anxiety group compared
Duration: 10 weeks disorder) with WLC for SAD
Age: M = 26.7 at posttest for the
Number: 200 primary outcomes
(SPS:d = 0.76; SIAS:d
= 0.55, p < 0.001).
Effects on all
secondary outcomes
were significant and
in favour of the
intervention group
Kenny 2020, Design: cluster Sample description: Smartphone app Emotional Depression, No significant changes N/A Post-intervention:
Ireland two-arm RCT school students self-monitoring and anxiety, stress, in the intervention 67.7%
Intervention group: Condition: the use of positive mental health group from pre-test
mental health mobile universal coping strategies well-being to post-test, when
app (CopeSmart) Age: 15–18 compared to the
Control group: Number:560 control group, in
Duration: 4 weeks terms of emotional
(continued)
Journal of Telemedicine and Telecare 27(10)
Table A2. Continued
Zhou et al.

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

distress, mental
health well-being,
emotional
self-awareness or
coping strategies.
Kramer 2014, Design: two-arm RCT Sample description: Brief web-based Solution-Focused Depression Compared with D = 0.79 Post-intervention:
the Intervention group: young people (12– synchronous chat Brief Therapy control condition, 51%
Netherlands web-based chat 22 years) (PratenOnline/ (SFBT) intervention group
treatment Condition: Talking online) showed significantly
Control group: WLC targeted (those greater
Duration: 4.5 months with depressive improvement at
symptoms) post-intervention.
Age: M = 19.5
Number: 263
Lahtinen, Design: two-arm RCT Sample description: Web-based self-help mindfulness Anxiety, Completing the MBP Anxiety: d = 0.26; Post-intervention:
2020, Intervention group: upper secondary platform depression, resulted in a Depression: d = 70.3%;
Finland digital school students qualify of life small-to-moderate 0.15; At 3-month
mindfulness-based Condition: reduction in anxiety Quality of life: d = follow-up: 53.7%
intervention universal (p < 0.01), a small 0.16
Control group: WLC Age: M = 17 reduction in
Duration: 8 weeks Number: 1349 depression (p <
0.01), and a small
increase in quality of
life (p = 0.05).
Levin 2020, Design: four-arm RCT Sample description: Web-based self-help ACT Psychological All three ACT Psychological Post-intervention:
USA Intervention group: university students program distress, conditions distress: d = 0.71– 89%
online intervention Condition: mental health significantly 0.86 mental health At follow-up:
Control group: WLC targeted (those wellbeing improved over time wellbeing: d = 84.6%
Duration: 12 sessions were relative to the 0.14–0.69
psychologically waitlist condition on
distressed) the primary
Age: M = 22 outcome of mental
Number: 181 health symptoms
(psychological
(continued)
655
 656

Table A2. Continued

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

distress: p < 0.001;

mental health
wellbeing: p < 0.05).
Levin 2014, Design: two-arm RCT Sample description: Web-based self-help ACT Depression, For distressed Anxiety: d = 0.81; Did not report
USA Intervention group: university students program anxiety, stress students, Depression: d =
web-based ACT Condition: intervention group 0.91.
program universal showed significant
Control group: WLC Age: 18 reductions in anxiety
Duration: 3 weeks Number: 76 (p = 0.03),
depression (p =
0.02). No significant
between-group
differences were
observed on
depression or
anxiety among
non-distressed
students.
Lindqvist Design: two-arm RCT Sample description: Web-based Affect-focused Depression, Compared with Depression: d = Post-intervention:
2020, Intervention group: adolescents therapist-supported psychodynamic anxiety control condition, 0.80–0.82; 92.0%
Sweden internet-based Condition: self-help platform therapy intervention group Anxiety: d = 0.78;
psychodynamic targeted (those significantly reduced emotion
therapy intervention with unipolar depression (p = regulation: d =
(IPDT) depressive 0.01) anxiety (p < 0.97;
Control group: disorder) 0.001). self-compassion: d
internet-based Age: 16.6 = 0.65
supportive group Number: 76
Duration: 8 weeks
McCall 2018, Design: two-arm RCT Sample description: Web-based self-help CBT Social anxiety Compared control d = 0.56 64.4%
Canada Intervention group: university students platform condition,
web-based social Condition: intervention group
anxiety intervention targeted (those showed significant
self-reported to improvement in
(continued)
Journal of Telemedicine and Telecare 27(10)
Table A2. Continued

Retention rate (i.e.

Zhou et al.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

Control group: WLC experience social social anxiety

Duration: 4 months anxiety) symptoms (p =
Age: 22 0.001).
Number: 65
McCloud Design: two-arm RCT Sample description: Smartphone app CBT Depression, Compared with At week 6: anxiety: d Post-intervention:
2020, UK Intervention group: university students anxiety control condition, at = 0.32 58.3%
smartphone app Condition: week 6, intervention At week4:
intervention targeted (those group significantly Anxiety: d = 0.58;
Control group: ELC self-identified as reduced depression depression: d =
Duration: 6 weeks experiencing (p = 0.006); at week 0.30
anxiety or 4, intervention
depression) group significantly
Age: M = 24.3 reduced anxiety (p =
Number: 168 0.001) and
depression (p =
0.04).
Melnyk 2015, Design: cluster Sample description: Web-based self-help CBT Anxiety, There were no N/A 99% of participants
two-arm RCT university students platform depression significant finished all sessions
Intervention group: Condition: differences in anxiety
online universal and depressive
cognitive-behavioral Age: M = 18 symptoms between
skill-building Number: 121 the groups
intervention
Control group: TAU
Duration: 7 sessions
Merry 2012, Design: two-arm Sample description: Computerized CBT Depression, SPARX was not N/A Post-intervention:
New randomized adolescents gamified self-help anxiety inferior to treatment 90.9%
Zealand controlled (primary care program as usual. 3-month follow-up:
non-inferiority trial health sites) Post-intervention, 89.8%
Intervention group: Condition: there was a mean
computerized targeted (those reduction of 10.32 in
self-help intervention who seek help for SPARX and 7.59 in
(SPARX) depressive treatment as usual in
Control group: TAU symptoms) raw scores on the
(face-to-face children’s depression
(continued)
657
 658
Table A2. Continued

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

counselling) Age: M = 15.6 rating scale-revised

Duration: 7 modules Number: 187 (P = 0.079).
(4–7 weeks)
Moeini 2019, Design: two-arm RCT Sample description: Web-based self-help Social cognitive Depression The intervention Did not report At post-intervention
Iran Intervention group: high school platform theory group achieved (24 weeks): 35.2%
web-based students significantly more
intervention Condition: reduction in
Control group: targeted (female, depressive
Duration: 6 months with symptoms,
mild-to-moderate compared with
depressive control group (p <
symptoms) 0.05).
Age: M = 16.7
Number: 128
O’Dea 2020, Design: two-arm RCT Sample description: Smartphone CBT and Social Depression, At post-intervention, Well-being: d = 0.37; At post-intervention:
Australia Intervention group: adolescents application Learning Theory anxiety, there was no help-seeking 83.9%;
mobile intervention Condition: (WeClick) psychological significant difference intention: d = 0.36 At 12-week
Control group: WLC universal distress, in depression or follow-up: 59.6%
Duration: 4 weeks Age: 14.82 mental health anxiety between
Number: 193 wellbeing intervention and
control groups.
However, there was
a significant
difference in health
wellbeing (p = 0.02)
and help-seeking
intention (p =
0.016–0.008)
Osborn 2020, Design: two-arm RCT Sample description: Web-based self-help Positive psychology Depression, Compared to the Depression: Post-intervention:
Kenya Intervention group: high school platform anxiety control, intervention Full sample: d = 100%
digital intervention students group produced a 0.50
Control group: study Condition: greater reduction in Subsample of
skill control universal depressive youths with
Duration: single Age: M = 15.54 symptoms in both moderate to
session, two weeks Number: 103 the full sample (p =
(continued)
Journal of Telemedicine and Telecare 27(10)
Table A2. Continued
Zhou et al.

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

0.028) and a severe depression:

subsample of youths d = 0.83
with moderate to
severe depression
symptoms (p =
0.010). There were
no significant effects
on anxiety
symptoms.
Perry 2017, Design: cluster Sample description: Web-based gamified CBT Depression Compared to Post-intervention: d Post-intervention:
Australia two-arm RCT secondary school self-help platform controls, = 0.29 75.2%
Intervention group: students participants in the 6 months 6-month follow-up:
online intervention Condition: intervention group post-baseline: d = 63.1%
(SPARX-R) universal showed significantly 0.21
Control group: Age: M = 16.7 reduced depression
online active control Number: 540 symptoms relative to
program (lifeSTYLE) the control at
Duration: 7 modules; post-intervention (p
7 weeks < 0.001) and 6
months
post-baseline (p =
0.01) but not at 18
months
post-baseline.
Puolakanaho Design: 3-arm RCT Sample description: Web-based self-help ACT Stress The intervention Stress: d = 0.22 Post-intervention:
2019, Intervention groups: secondary school platform group showed a Academic 96.0%
Finland (i) iACTface group students small but significant buoyancy: d = 0.27
(web-based Condition: decrease in overall
interventions plus a universal stress (p = 0.037).
face-to-face meeting Age: M = 15
(ii) iACT group (only Number: 249
web-based
intervention)
(continued)
659
Table A2. Continued
660

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

Control group: TAU

Duration: 5 weeks
Ren 2016， Design: two-arm RCT Sample description: Web-based self-help CBT Depression Compared with Depression: d = Post-intervention:
China Intervention group: university students platform control condition, 0.79-0.93 72.5
Chinese version of Condition: intervention group
MoodGYM targeted (those achieved a
Control group: WLC with elevated significantly larger
Duration: 3 weeks depression reduction in
symptoms) depression (p <
Age: M = 20.82 0.05)
Number: 62
Richards Design: two-arm RCT Sample description: Web-based self-help CBT Depression There was a significant N/A Post-intervention:
2013, Irish Intervention group: university students platform overall improvement 45.5%
online self-help Condition: over time for both 16-week follow-up:
intervention (cCBT) targeted (those groups on 42.6%
Control group: with symptoms of depression (p < 32-week follow-up:
therapist-assist email depression) 0.001). 32.7%
therapy (eCBT) Age: 26.45 There were no
Duration: 8 weeks Number: 101 significant difference
between
intervention and
control groups.
Rickhi 2015, Design: two-arm RCT Sample description: Web-based self-help Spiritual practices Depression At week 8, N/A Post-intervention:
Canada Intervention group: adolescents and platform and religious beliefs intervention group 93.5%
web-based program young adults achieved a greater
Control group: WLC Condition: reduction in
Duration: 8 weeks targeted (those depression (p <
with major 0.05).
depressive
disorder)
Age: M = 17.74
Number: 62
Schleider Design: two-arm RCT Sample description: Web-based self-help Psychoeducation on Depression, Compared with Depression: d = 0.23 Post-intervention:
2019, USA Intervention group: high school platform growth mind-sets social anxiety control group, 99.5%
online self-help students of personality, intervention group 4-month follow-up:
intervention Condition: self-regulation, and achieved significant 95.0%
Control group: targeted (female) intelligence reductions in
(continued)
Journal of Telemedicine and Telecare 27(10)
Table A2. Continued
Zhou et al.

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

Duration: one Age: M = 15.2 depressive

session Number: 222 symptoms (p =
0.04). There were
no significant
differences between
intervention and
control groups for
reduction in social
anxiety symptoms.
Short 2020, Design: two-arm RCT Sample description: Web-based self-help MI, CBT Anxiety, There was no N/A Post-intervention:
USA Intervention group: university students platform insomnia significant difference 73.8%
web-based Condition: between the two
intervention targeted (those groups in outcomes
Control group: with elevated relating to anxiety (p
web-based education subclinical anxiety = 0.40) or insomnia
about physical health and insomnia) (p = 0.09).
Duration: one Age: M = 19.43
session (1 month) Number: 61
Stjerneklar Design: two-arm RCT Sample description: Web-based CBT Anxiety Compared with those Clinician-rated Post-intervention:
2019， Intervention group: adolescents therapist-guided in control condition, severity of anxiety: 75.7%
Denmark web-based Condition: platform significantly more d = 0.83 3-month follow-up:
intervention targeted (those adolescents in the 61.4%
(ChilledOut) with anxiety intervention group
Control group: WLC disorders) were free of anxiety
Duration: 8 modules Age: M = 15 diagnosis (p = 0.027)
(14 weeks) Number: 70
Topooco Design: two-arm RCT Sample description: Web-based self-help CBT Depression Compared with D = 0.86 Post-intervention:
2019, Intervention group: adolescents platform and control condition, 94.3%
Sweden web-based Condition: real-time therapist intervention group 12-month
intervention targeted (those sessions via chat demonstrated a follow-up:
Control group: with depressive significant decrease
minimal attention symptoms) in depression
control
(continued)
661
 662
Table A2. Continued

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

Duration: 8 weeks (8 Age: M = 17.5 symptoms (P <

modules) Number: 70 0.001)
Wong 2014, Design: three-arm Sample description: Web-based self-help CBT Anxiety, Compared to the Depression Post-intervention:
Australia cluster RCT school students platform plus depression control group, intervention: 27.15%
Intervention group 1: Condition: teachers stimulating students in the (anxiety: d = 0.29;
anxiety universal discussion depression depression: d =
internet-based Age: 14–16 intervention group 0.14).
intervention Number: 976 showed a significant Anxiety
Intervention group 2: improvement in intervention:
depression anxiety (p < 0.01) anxiety: d = 0.18
internet-based and depressive
intervention symptoms (p < 0.05)
Control group: TAU at the end of the
Duration: depression course, whilst
intervention (7 students in the
lessons); anxiety anxiety intervention
intervention (6 demonstrated a
lessons) reduction in
symptoms of anxiety
(p < 0.05).
Fitzpatrick Design: two-arm RCT Sample description: Fully automated CBT Anxiety, Compared to control Depression: d = 0.44 Post-intervention:
2017, USA Intervention group: university students text-based depression condition, 83%
chatbot intervention Condition: conversational agent intervention group
(Weobot) targeted (those (Weobot) significantly reduced
Control group: with symptoms of depression (p =
information-only anxiety and 0.017).
control group depression) There was no
Duration: two weeks Age: M = 22.2 significant difference
(up to 20 sessions) Number: 70 between
intervention group
and control group
on anxiety. However,
both groups
improved
significantly on
(continued)
Journal of Telemedicine and Telecare 27(10)
 Zhou et al.

Table A2. Continued

Retention rate (i.e.

Percentage of
Sample [sample participants who
description; finished
Study design condition (universal/ Assessed Results (statistical post-intervention/
Author, year, （intervention/control targeted); age; Online intervention Psychological mental health significance compared Effect size of follow-up
country group; duration） number] modalities intervention outcomes with control group) intervention assessment)

anxiety symptoms (p
= 0.004).
Fulmer 2018, Design: three-arm Sample description: AI-based chatbot (Tess) CBT Depression, Compare with control Did not report Post-intervention:
USA RCT university students anxiety group, intervention 100%
Intervention group 1: Condition: group 1
2-week chatbot universal demonstrated a
intervention Age: M = 22.9 significant reduction
Intervention group 2: Number: 75 in depression (p =
4-week chatbot 0.02); both
intervention intervention groups
Control group: 1 and 2
information only demonstrated a
control significant reduction
Duration: 2–4 weeks in anxiety (group 1: p
= 0.045; group 2: p =
0.02).
663
Appendix 3
664

Table A3. Assessment of methodological quality of the included studies.

8. Was 13. Was the trial

follow-up design
complete and appropriate, and
if not, were any deviations
7. Were differences from the standard
treatment between RCT design
1. Was true 5. Were groups groups in 9. Were 10. Were (individual
randomization 2. Was 3. Were those 6. Were treated terms of participants outcomes randomization,
used for allocation treatment 4. Were delivering outcomes identically their analysed in measured 11. Were 12. Was parallel groups)
assignment of to groups participants treatment assessors other than follow-up the groups to in the same outcomes appropriate accounted for in
participants to treatment similar at blind to blind to blind to the adequately which they way for measured statistical the conduct and
treatment groups the treatment treatment treatment intervention described were treatment in a reliable analysis analysis of the
groups? concealed? baseline? assignment? assignment? assignment? of interest? and analysed? randomized? groups? way? used? trial? Score

Ahmad et al., Yes Yes Yes No No NA Yes Yes Yes Yes Yes Yes Yes 11
2020
Antonson et al., Yes Yes Yes No No Yes Yes Yes No Yes Yes Yes Yes 10
2018
Bendtsen et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2020
Bird et al., 2018 Yes Yes Yes No No Yes Yes No Yes Yes Yes Yes Yes 10
Burckhardt Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
et al., 2015
Calear et al., Yes Yes No No No NA Yes Yes Yes Yes Yes Yes Yes 9
2016
Cavanagh et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2013
Cook et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2019
Day et al., 2013 Yes Yes No No No NA Yes No Yes Yes Yes Yes Yes 8
Dear et al., 2018 Yes Yes NA No No Yes Yes Yes Yes Yes Yes Yes Yes 10
Edridge et al., Yes Yes Yes No No NA Yes No Yes Yes Yes Yes Yes 8
2020
El Morr et al., Yes Yes Yes No No Yes Yes No Yes Yes Yes Yes Yes 10
2020
Eustis et al., 2018 Yes Yes Yes No No Yes No Yes No Yes Yes Yes Yes 8
Farrer et al., Yes Yes Yes No No Yes No Yes Yes Yes Yes Yes Yes 10
2019
Frazier et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2015
Gladstone et al., Yes Yes NA No No Yes Yes Yes Yes Yes Yes Yes Yes 10
2020
Journal of Telemedicine and Telecare 27(10)

(continued)
Table A3. Continued

8. Was 13. Was the trial

Zhou et al.

follow-up design
complete and appropriate, and
if not, were any deviations
7. Were differences from the standard
treatment between RCT design
1. Was true 5. Were groups groups in 9. Were 10. Were (individual
randomization 2. Was 3. Were those 6. Were treated terms of participants outcomes randomization,
used for allocation treatment 4. Were delivering outcomes identically their analysed in measured 11. Were 12. Was parallel groups)
assignment of to groups participants treatment assessors other than follow-up the groups to in the same outcomes appropriate accounted for in
participants to treatment similar at blind to blind to blind to the adequately which they way for measured statistical the conduct and
treatment groups the treatment treatment treatment intervention described were treatment in a reliable analysis analysis of the
groups? concealed? baseline? assignment? assignment? assignment? of interest? and analysed? randomized? groups? way? used? trial? Score

Harrer et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2018
Lappalainen Yes Yes Yes No No NA Yes No Yes Yes Yes Yes Yes 9
et al., 2021
Ip et al., 2016 Yes Yes Yes No No Yes Yes No Yes Yes Yes Yes Yes 10
Kählke et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2019
Kenny et al., Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes 10
2020
Kramer et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2014
Lahtinen & Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
Salmivalli,
2020
Levin et al., 2020 Yes Yes No No No Yes No Yes Yes Yes Yes Yes Yes 9
Levin et al., 2014 Yes Yes Yes No No Yes Yes No Yes Yes Yes Yes Yes 10
Lindqvist et al., Yes Yes Yes No No Yes Yes No Yes Yes Yes Yes Yes 10
2020
McCall et al., Yes Yes Yes No No NA Yes Yes No Yes Yes Yes Yes 9
2018
McCloud et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2020
Melnyk et al., Yes Yes Yes No No Yes Yes No NA Yes Yes Yes Yes 9
2015
Merry et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2012
Moeini et al., Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes 10
2019
O’Dea et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2020
(continued)
665
 666

Table A3. Continued

8. Was 13. Was the trial

follow-up design
complete and appropriate, and
if not, were any deviations
7. Were differences from the standard
treatment between RCT design
1. Was true 5. Were groups groups in 9. Were 10. Were (individual
randomization 2. Was 3. Were those 6. Were treated terms of participants outcomes randomization,
used for allocation treatment 4. Were delivering outcomes identically their analysed in measured 11. Were 12. Was parallel groups)
assignment of to groups participants treatment assessors other than follow-up the groups to in the same outcomes appropriate accounted for in
participants to treatment similar at blind to blind to blind to the adequately which they way for measured statistical the conduct and
treatment groups the treatment treatment treatment intervention described were treatment in a reliable analysis analysis of the
groups? concealed? baseline? assignment? assignment? assignment? of interest? and analysed? randomized? groups? way? used? trial? Score

Osborn et al., Yes Yes NA No No Yes Yes No Yes Yes Yes Yes Yes 9
2020
Perry et al., 2017 Yes Yes No No No NA Yes No Yes Yes Yes Yes Yes 8
Puolakanaho Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes 10
et al., 2019
Ren et al., 2016 Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
Richards et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2013
Rickhi et al., Yes Yes Yes No No NA Yes Yes Yes Yes Yes Yes Yes 10
2015
Schleider et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2019
Short & Yes Yes Yes No No Yes Yes NA Yes Yes Yes Yes Yes 10
Schmidt, 2020
Stjerneklar et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2019
Topooco et al., Yes Yes Yes No No NA Yes Yes Yes Yes Yes Yes Yes 10
2019
Wong et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 11
2014
Fitzpatrick et al., Yes Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes 12
2017
Fulmer et al., Yes Yes NA No No Yes Yes No No Yes Yes Yes Yes 9
2018

NA: not available.

Journal of Telemedicine and Telecare 27(10)