Cited by 141Digital Mental Health InterventionsChild and Adolescent Psychosocial and Emotional DevelopmentAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions

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Thabrew, Hiran, Stasiak, Karolina, Hetrick, Sarah E, Wong, Stephen, Huss, Jessica H, Merry, Sally N·2018·Cochrane Database of Systematic Reviews

Abstract

BACKGROUND: Long-term physical conditions affect 10% to 12% of children and adolescents worldwide; these individuals are at greater risk of developing psychological problems, particularly anxiety and depression. Access to face-to-face treatment for such problems is often limited, and available interventions usually have not been tested with this population. As technology improves, e-health interventions (delivered via digital means, such as computers and smart phones and ranging from simple text-based programmes through to multimedia and interactive programmes, serious games, virtual reality and biofeedback programmes) offer a potential solution to address the psychological needs of this group of young people. OBJECTIVES: To assess the effectiveness of e-health interventions in comparison with attention placebos, psychological placebos, treatment as usual, waiting-list controls, or non-psychological treatments for treating anxiety and depression in children and adolescents with long-term physical conditions. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Group's Controlled Trials Register (CCMDTR to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 8, 2017), Web of Science (1900 - 18 August 2016, updated 31 August 2017) and Ovid MEDLINE, Embase, PsycINFO (cross-search 2016 to 18 Aug 2017). We hand-searched relevant conference proceedings, reference lists of included articles, and the grey literature to May 2016. We also searched international trial registries to identify unpublished or ongoing trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-randomised trials, and cross-over trials of e-health interventions for treating any type of long-term physical condition in children and adolescents (aged 0 to 18 years), and that measured changes in symptoms or diagnoses of anxiety, depression, or subthreshold depression. We defined long-term physical conditions as those that were more than three-months' duration. We assessed symptoms of anxiety and depression using patient- or clinician-administered validated rating scales based on DSM III, IV or 5 (American Psychological Association 2013), or ICD 9 or 10 criteria (World Health Organization 1992). Formal depressive and anxiety disorders were diagnosed using structured clinical interviews. Attention placebo, treatment as usual, waiting list, psychological placebo, and other non-psychological therapies were eligible comparators. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed titles, abstracts, and full-text articles; discrepancies were resolved through discussion or addressed by a third author. When available, we used odds ratio (OR) to compare dichotomous data and standardised mean differences (SMD) to analyse continuous data, both with 95% confidence intervals (CI). We undertook meta-analysis when treatments, participants, and the underlying clinical question were adequately similar. Otherwise, we undertook a narrative analysis. MAIN RESULTS: We included five trials of three interventions (Breathe Easier Online, Web-MAP, and multimodal cognitive behavioural therapy (CBT)), which included 463 participants aged 10 to 18 years. Each trial contributed to at least one meta-analysis. Trials involved children and adolescents with long-term physical conditions, such as chronic headache (migraine, tension headache, and others), chronic pain conditions (abdominal, musculoskeletal, and others), chronic respiratory illness (asthma, cystic fibrosis, and others), and symptoms of anxiety or depression. Participants were recruited from community settings and hospital clinics in high income countries.For the primary outcome of change in depression symptoms versus any control, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.06, 95% CI -0.35 to 0.23; five RCTs, 441 participants). For the primary outcome of change in anxiety symptoms versus any comparator, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.07, 95% CI -0.29 to 0.14; two RCTs, 324 participants). For the primary outcome of treatment acceptability, there was very low-quality evidence that e-health interventions were less acceptable than any comparator (SMD 0.46, 95% CI 0.23 to 0.69; two RCTs, 304 participants).For the secondary outcome of quality of life, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.83, 95% CI -1.53 to -0.12; one RCT, 34 participants). For the secondary outcome of functioning, there was very low-quality evidence meaning that it could not be determined whether e-health interventions were clearly better than any comparator (SMD -0.08, 95% CI -0.33 to 0.18; three RCTs, 368 participants). Fo

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  1. Blackwell 2012 {published data only} Blackwell LS, Romero SL, Romero CV, McLean KA, Dawkins K, Hoag J, Schoumacher R, Stokes DC. CFfone: A social networking site for adolescents and young adults with cf. Pediatric Pulmonology 2012;47:430.
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  5. Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313(7066):1200.
  6. Bennett K, Manassis K, Walter SD, Cheung A, Wilansky-Traynor P, Diaz-Granados N, et al. Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data meta-analysis. Depression and Anxiety 2013;30(9):829-41.
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  8. Fleming T, Cheek C, Merry S, Thabrew H, Briedgeman H, Stasiak K, et al. Serious games for the treatment or prevention of depression: a systematic review. Revista de Psicopatología y Psicología Clínica 2015;19(3):227.
  9. Gilbert PJ. Compassion: Conceptualisations, Research and Use in Psychotherapy. New York (NY): Brunner-Routledge, 2005.
  10. cardiomyopath,,kw,ky,emt,mh,mc #12 ("Brave for Teen*" or "Brave for Child*" or "Camp Cope-A-Lot" or "Cool Teens" or Interapy or Memo or Minded or Mindcheck* or "Mood Gym" or Moodgym or Moodhelper or "Mood Helper" or Sparx or "The Journey" or "Think Feel Do") #13 (Bebo or "Club Penguin" or Facebook or Franktown or Friendster or Habbo or Jabbersmack or hi5 or iTwixie or MySpace or Orkut
  11. Bebo or "Club Penguin" or Facebook or Franktown or Friendster or Habbo or Jabbersmack or
  12. Bebo or Club Penguin or Facebook or Franktown or Friendster or Habbo or Jabbersmack

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Authors
Thabrew, H., Stasiak, K., Hetrick, S. E., Wong, S., Huss, J. H., & Merry, S. N.
Affiliations
  • University of Auckland (NZ)
  • University of Kassel (DE)
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2018-08-15
Volume
2018
Issue
8
Pages
CD012489-CD012489
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
OpenAlex
W2780529262
Cited by
141
References
218
Citations by year
2026: 9 · 2025: 19 · 2024: 22 · 2023: 16 · 2022: 17 · 2021: 28 · 2020: 22 · 2019: 4 · 2018: 2 · 2017: 1 · 2013: 1
FWCI
1.90
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
digital health interventions, anxiety, depression, children and adolescents, chronic disease, digital mental health interventions, serious games, virtual reality, biofeedback, subthreshold depression, treatment effectiveness, access to mental health care, waitlist control
MeSH terms
Adolescent, Anxiety, Breathing Exercises, Child, Chronic Disease, Depression, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Telemedicine

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