E-Health interventions for anxiety and depression in children and adolescents with long-term physical conditions
Open accessAbstract
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 We also searched international trial registries to identify unpublished or ongoing trials.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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Only a few studies focus on the efficacy of internet- and mobile-based interventions targeting adolescents and young adults with a chronic condition and comorbid mental health disorders.
“However, only a few studies focus on the efficacy of IMI targeting AYA with a chronic condition and comorbid mental health disorders.”
From Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): a randomized controlled pilot trial (2022) · cites this paper as [22]
The Included studies section reports only five eligible trials, supporting the claim that research is limited. But the Settings section says none of their participants had a formal anxiety or depressive disorder, and the review focuses on children and adolescents rather than young adults. It therefore does not establish that the few trials specifically targeted AYA with comorbid mental health disorders. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMeta-analyses of studies focusing exclusively on internalizing symptoms showed limited methodological quality and indicate limited efficacy.
“These studies showed limited methodological quality and indicate limited efficacy [21, 22].”
From Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): a randomized controlled pilot trial (2022) · cites this paper as [22]
The Quality of the evidence section (page unavailable) rates the evidence low or very low quality and identifies substantial risks of bias. Treatment efficacy §1.1 (page unavailable) says it is unclear whether e-health interventions reduce anxiety or depression, rather than establishing limited efficacy. The review also states that none of the included trials was designed to investigate effects on anxiety or depression, so describing them as studies focusing exclusively on internalizing symptoms is unsupported. (LLM, conf=0.87)
Experimental — accuracy not yet measuredEvidence regarding the effectiveness of iCBT in targeting psychological comorbidity in AYA with chronic medical conditions is limited.
“However, evidence regarding the effectiveness of iCBT in targeting psychological comorbidity in AYA with chronic medical conditions is limited (Thabrew et al., 2018).”
From Involving patients' perspective in the development of an internet- and mobile-based CBT intervention for adolescents with chronic medical conditions: Findings from a qualitative study (2021) · cites this paper as Thabrew et al., 2018
The Quality of the evidence section reports low or very low-quality evidence and says none of the included trials was designed to test effects on anxiety or depression. This supports the claim that evidence for effectiveness is limited. However, the Age section specifies children and adolescents aged 0–18, so the review does not directly support extending that assessment to young adults in the claimed AYA population. (LLM, conf=0.82)
Experimental — accuracy not yet measured
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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2 of the 218 references couldn’t be matched to a known paper.
Research works printed but not linked: 12
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- Gilbert PJ. Compassion: Conceptualisations, Research and Use in Psychotherapy. New York (NY): Brunner-Routledge, 2005.
- 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
- Bebo or "Club Penguin" or Facebook or Franktown or Friendster or Habbo or Jabbersmack or
- Bebo or Club Penguin or Facebook or Franktown or Friendster or Habbo or Jabbersmack
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Bringing health care to the patient
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Gonzalez, V. J., Kimbro, R. T., Cutitta, K. E., Shabosky, J. C., Bilal, M. F., Penny, D. J., & Lopez, K. N. (2021) · PEDIATRICS · doi:10.1542/peds.2020-1693 · Cited by 168 · see citing works
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Lau, N., Waldbaum, S., Parigoris, R., O'Daffer, A., Walsh, C., Colt, S. F., Yi-Frazier, J. P., Palermo, T. M., McCauley, E., & Rosenberg, A. R. (2020) · JMIR Pediatrics and Parenting · doi:10.2196/22329 · Cited by 68 · see citing works
“The literature has addressed the benefits of eHealth interventions for anxiety and depression [31], technological tools for disease self-management [32], and technology-based family interventions for improving family functioning [33].”
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Brigden, A., Anderson, E., Linney, C., Morris, R., Parslow, R., Serafimova, T., Smith, L., Briggs, E., Loades, M., & Crawley, E. (2020) · Journal of Medical Internet Research · doi:10.2196/16924 · Cited by 63 · see citing works
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Geirhos, A., Domhardt, M., Lunkenheimer, F., Temming, S., Holl, R. W., Minden, K., Warschburger, P., Meissner, T., Mueller-Stierlin, A. S., & Baumeister, H. (2022) · BMC Pediatrics · doi:10.1186/s12887-022-03134-3 · Cited by 37 · see citing works
“These studies showed limited methodological quality and indicate limited efficacy [21, 22].”
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Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention
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“It has been reported that online games bring happiness to players, reduce anxiety, depression (12) and improve cognitive function (13).”
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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
- PMC
- PMC6513202
- 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
- bronze
- doi.org
- 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
About these checks
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