Depressive disorders frequently onset in adolescence, and although effective treatments for these disorders are known, many youth have difficulty accessing care when needed. Electronic interventions and mobile applications have been posited as a possible solution for increasing access to affordable care. This narrative review explores the state of the evidence for their effectiveness, safety, and acceptability with teenagers. Although many electronic interventions and mobile applications have received widespread attention, minimal rigorous independent research has been conducted, and their use with teenagers who have depression cannot be recommended at this time.
ArayaR.FritschR.SpearsM.RojasG.MartinezV.BarroilhetS.. . . MontegomeryA. A. (2013). School intervention to improve mental health of students in Santiago, Chile: A randomized clinical trial. JAMA Pediatrics, 167, 1004–1010.
2.
BarakA.HenL.Boniel-NissimM.ShapiraN. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26, 109–160. doi:10.1080/15228830802094429
3.
BhatiaS. K.BhatiaS. C. (2007). Childhood and adolescent depression. American Family Physician, 75, 73–80.
4.
BobierC.StasiakK.MountfordH.MerryS.MoorS. (2013). When “e” therapy enters the hospital: Examination of the feasibility and acceptability of SPARX (a cCBT programme) in an adolescent inpatient unit. Advances in Mental Health, 11, 286–292.
5.
BradfordS.RickwoodD. (2014). Adolescent’s preferred modes of delivery for mental health services. Child and Adolescent Mental Health, 19, 39–45.
6.
CalearA. L.ChristensenH.MackinnonA.GriffithsK. M. (2013). Adherence to the MoodGYM program: Outcomes and predictors for an adolescent school-based population. Journal of Affective Disorders, 147, 338–344. doi:10.1016/j.jad.2012.11.036
7.
ChildressC. A. (2000). Ethical issues in providing online psychotherapeutic interventions. Journal of Medical Internet Research, 2(1), e5.
8.
ChristensenH.GriffithsK.GrovesC. (2004). MoodGYM Training Programme: Clinician’s manual. Canberra, Australian Capital Territory, Australia: Centre for Mental Health Research.
9.
Clinical Standards Advisory Group for Depression. (1999). Services for patients with depression. London, England: Department of Health.
10.
CoxG. R.CallahanP.ChurchillR.HunotV.MerryS. N.ParkerA. G.HetrickS. E. (2012). Psychological therapies versus antidepressant medication, alone and in combination for depression in children and adolescents. Cochrane Database of Systematic Reviews, 11, CD008324. doi:10.1002/14651858.CD008324.pub2
11.
DrakeG.CsipkeE.WykesT. (2013). Assessing your mood online: Acceptability and use of Moodscope. Psychological Medicine, 43, 1455–1464. doi:10.1017/S0033291712002280
12.
FlemingT.DixonR.FramptonC.MerryS. (2012). A pragmatic randomized controlled trial of computerized CBT (SPARX) for symptoms of depression among adolescents excluded from mainstream education. Behavioural and Cognitive Psychotherapy, 40, 529–541. doi:10.1017/S1352465811000695
13.
GerhardsS. A. H.de GraafL. E.JacobsL. E.SeverensJ. L.HuibersM. J. H.ArntzA.. . . EversS. M. A. A. (2010). Economic evaluation of online computerized cognitive-behavioural therapy without support for depression in primary care: Randomised trial. The British Journal of Psychiatry, 196, 310–318. doi:10.1192/bjp.bp.109.065748
14.
GilbodyS.LittlewoodE.HewittC.BrierleyG.TharmanathanP.ArayaR.. . . REEACT Team. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): Large scale pragmatic randomised controlled trial. British Medical Journal, 351, h5627.
15.
GladstoneT.Marko-HolguinM.HenryJ.FogelJ.DiehlA.Van VoorheesB. W. (2014). Understanding adolescent response to a technology-based depression prevention program. Journal of Clinical Child & Adolescent Psychology, 43, 102–114. doi:10.1080/15374416.2013.850697
16.
GouldM. S.KingR.GreenwaldS.FisherP.Schwab-StoneM.KramerR.. . . ShafferD. (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 915–923.
HilgartM.ThorndikeF. O.PardoJ.RitterbandL. M. (2012). Ethical issues of web-based interventions and online therapy. In FerreroA.KorkutY.LeachM. M.LindsayG.StevensM. J. (Eds.), The Oxford handbook of international psychological ethics (pp. 161–175). Oxford, UK: Oxford University Press.
19.
HirschfeldR. M. A.KellerM. B.PanicoS.AronsB. S.BarlowD.DavidoffF.. . . WyattR. J. (1997). The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. Journal of the American Medical Association, 277, 333–340.
20.
HollinghurstS.PetersT. J.KaurS.WilesN.LewisG.KesslerD. (2010). Cost-effectiveness of therapist-delivered online cognitive-behavioural therapy for depression: Randomised controlled trial. The British Journal of Psychiatry, 197, 297–304.
21.
HorwathE.JohnsonJ.KlermanG. L.WeissmanM. M. (1992). Depressive symptoms as relative and attributable risk factors for first-onset major depression. Archives of General Psychiatry, 49, 817–823. doi:10.1001/archpsyc.1992.01820100061011
22.
KataokaS. H.ZhangL.WellsK. B. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.
23.
KatzJ. E.RiceR. E. (2002). Social consequences of internet use. Cambridge, MA: The MIT Press.
24.
KauerS. D.ReidS. C.CrookeA. H. D.KhorA.HearpsS. J. C.JormA. F.. . . PattonG. (2012). Self-monitoring using mobile phones in the early stages of adolescent depression: Randomized controlled trial. Journal of Medical Internet Research, 14, e67. doi:10.2196/jmir.1858
25.
KaufmanJ.BirmaherB.BrentD.RaoU.RyanN. (1996). The schedule for affective disorders and schizophrenia for school-age children and lifetime version (version 1.0). Pittsburgh, PA: Department of Psychiatry, University of Pittsburgh School of Medicine.
26.
KesslerR. C.AvenevoliS.Ries MerikangasK. (2001). Mood disorders in children and adolescents: An epidemiologic perspective. Biological Psychiatry, 49, 1002–1014.
27.
KesslerR. C.BerglundP.DemlerO.JinR.MerikangasK. R.WaltersE. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. doi:10.1001/archpsyc.62.6.593
28.
KesslerR. C.FosterC. L.SaundersW. B.StangP. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. American Journal of Psychiatry, 152, 1026–1032.
29.
KutcherS. (2011). Facing the challenge of care for child and youth mental health in Canada: A critical commentary, five suggestions for change and a call to action (Special Issue). Healthcare Quarterly, 14, 14–21.
30.
Lancet Global Mental Health Group. (2007). Scale up services for mental disorders: A call for action. The Lancet, 370, 1241–1252.
31.
LillevollK. R.VangbergH. C.GriffithsK. M.WaterlooK.EisemannM. R. (2014). Uptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway. BMC Psychiatry, 14, 14. doi:10.1186/1471-244X-14-14
32.
MaiQ.HolmanC. D. J.SanfilippoF. M.EmeryJ. D.PreenD. B. (2011). Mental illness related disparities in diabetes prevalence, quality of care and outcomes: A population-based longitudinal study. BMC Medicine, 9, 118. doi:10.1186/1741-7015-9-118
33.
MarchJ. S.SilvaS.PetryckiS.CurryJ.WellsK.FairbankJ.. . . SevereJ. (2007). The Treatment for Adolescents With Depression Study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 64, 1132–1143.
34.
MartinezV.MartinezP.VohringerP. A.ArayaR.RojasG. (2014). Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): Study protocol for a randomized controlled trial. Trials, 15, 309.
35.
MerryS. N.StasiakK.ShepherdM.FramptonC.FlemingT.LucassenM. F. G. (2012). The effectiveness of SPARX, a computerized self help intervention for adolescents seeking help for depression: Randomized controlled non-inferiority trial. British Medical Journal, 344, e2598. doi:10.1136/bmj.e2598
36.
MoncrieffJ.KirschI. (2005). Efficacy of antidepressants in adults. British Medical Journal, 331, 155. doi:10.1136/bmj.331.7509.155
37.
MoncrieffJ.KirschI. (2015). Empirically derived criteria cast doubt on the clinical significance of antidepressant-placebo differences. Contemporary Clinical Trials, 43, 60–62. doi:10.1016/j.cct.2015.05.005
38.
OffordD. R.BoyleM. J.FlemingJ. E.Munroe BlumH.Rae-GrantN. I. (1989). Ontario Child Health Study: Implications for clinical services, research and training. Canadian Journal of Psychiatry, 34, 483–491.
39.
O’KearneyR.KangK.ChristensenH.GriffithsK. (2009). A controlled trial of a school-based internet program for reducing depressive symptoms in adolescent girls. Depression and Anxiety, 26, 65–72.
ReidS. C.KauerS. D.HearpsS. J. C.CrookeA. H. D.KhorA. S.SanciL. A.PattonG. C. (2011). A mobile phone application for the assessment and management of youth mental health problems in primary care: A randomized controlled trial. BMC Family Practice, 12, 131.
43.
ReidS. C.KauerS. D.HearpsS. J. C.CrookeA. H. D.KhorA. S.SanciL. A.PattonG. C. (2013). A mobile phone application for the assessment and management of youth mental health problems in primary care: Health service outcomes from a randomized controlled trial of mobiletype. BMC Family Practice, 14, 84. doi:10.1186/1471-2296-14-84
44.
RichardsD.RichardsonT. (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32, 329–342.
45.
RobinsL. N.RegierD. A. (1991). Psychiatric disorders in America: The epidemiologic catchment area study. New York, NY: Free Press.
46.
RosenG. M. (1987). Self help treatment books and the commercialization of psychotherapy. American Psychologist, 42, 46–51.
47.
RubyA.Marko-HolguinM.FogelJ.Van VoorheesB. W. (2013). Economic analysis of an internet-based depression prevention intervention. The Journal of Mental Health Policy and Economics, 16, 121–130.
48.
SaulsberryA.Marko-HolguinM.BlomekeK.HinkleC.FogelJ.GladstoneT.. . . Van VoorheesB. W. (2013). Randomized clinical trial of a primary care internet-based intervention to prevent adolescent depression: One-year outcomes. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 22, 106–117.
49.
SethiS. (2013). Treating youth depression and anxiety: A randomized controlled trial examining the efficacy of computerized versus face-to-face cognitive behaviour therapy. Australian Psychologist, 48, 249–257. doi:10.1111/ap.12006
50.
ShafferD.GouldM. S.FisherP.TrautmanP.MoreauD.KleinmanM.FloryM. (1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 339–348.
51.
StallardP.PhillipsR.MontgomeryA. A.SpearsM.AndersonR.TaylorJ.. . . SayalK. (2013). A cluster randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of classroom-based cognitive-behavioural therapy (CBT) in reducing symptoms of depression in high-risk adolescents. Health Technology Assessment, 17(47), 1–109.
TwomeyC.O’ReillyG.ByrneM.BuryM.WhiteA.KissaneS.. . . ClancyN. (2014). A randomized controlled trial of the computerized CBT programme, MoodGYM, for public mental health service users waiting for interventions. British Journal of Clinical Psychology, 53, 433–450. doi:10.1111/bjc.12055
54.
Van VoorheesB. W.EllisJ. M.GollanJ. K.BellC. C.StuartS. S.FogelJ.FordD. E. (2007). Development and process evaluation of a primary care internet-based intervention to prevent depression in emerging adults. Journal of Clinical Psychiatry, 9, 346–355.
55.
Van VoorheesB. W.FogelJ.ReineckeM. A.GladstoneT.StuartS.GollanJ.. . . BellC. (2009). Randomized clinical trial of an internet-based depression prevention program for adolescents (Project CATCH-IT) in primary care: 12-week outcomes. Journal of Developmental & Behavioural Pediatrics, 30, 23–37.
56.
WaddellC.OffordD. R.ShepherdC. A.HuaJ. M.McEwanK. (2002). Child psychiatric epidemiology and Canadian public policy-making: The state of the science and the art of the possible. Canadian Journal of Psychiatry, 47, 825–832.
57.
WalshB. T.SeidmanS. N.SyskoR.GouldM. (2002). Placebo response in studies of major depression: Variable, substantial, and growing. Journal of the American Medical Association, 287, 1840–1847.
58.
WalshS. P.WhiteK. M.YoungR. M. (2008). Over-connected? A qualitative exploration of the relationship between Australian youth and their mobile phones. Journal of Adolescence, 31, 77–92.
59.
WarmerdamL.SmitF.van StratenA.RiperH.CuijpersP. (2010). Cost-utility and cost-effectiveness of internet-based treatment for adults with depressive symptoms: Randomized trial. Journal of Medical Internet Research, 12(5), e53.
60.
WatsonD.ClarkL. A.TellegenA. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.
61.
World Health Organization. (2001). The world health report 2001—Mental health: New understanding, new hope. Retrieved from http://www.who.int/whr/2001/en/
ZhaoS.GrasmuckS.MartinJ. (2008). Identity construction on Facebook: Digital empowerment in anchored relationships. Computers in Human Behavior, 24, 1816–1836. doi:10.1016/j.chb.2008.02.012
