A Novel Multimodal Digital Service (Moderated Online Social Therapy+) for Help-Seeking Young People Experiencing Mental Ill-Health: Pilot Evaluation Within a National Youth E-Mental Health Service
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Abstract
Background: Mental ill-health is the leading cause of disability worldwide. Moreover, 75% of mental health conditions emerge between the ages of 12 and 25 years. Unfortunately, due to lack of resources and limited engagement with services, a majority of young people affected by mental ill-health do not access evidence-based support. To address this gap, our team has developed a multimodal, scalable digital mental health service (Enhanced Moderated Online Social Therapy [MOST+]) merging real-time, clinician-delivered web chat counseling; interactive user-directed online therapy; expert and peer moderation; and peer-to-peer social networking. Objective: The primary aim of this study is to ascertain the feasibility, acceptability, and safety of MOST+. The secondary aims are to assess pre-post changes in clinical, psychosocial, and well-being outcomes and to explore the correlations between system use, perceived helpfulness, and secondary outcome variables. Methods: Overall, 157 young people seeking help from a national youth e-mental health service were recruited over 5 weeks. MOST+ was active for 9 weeks. All participants had access to interactive online therapy and integrated web chat counseling. Additional access to peer-to-peer social networking was granted to 73 participants (46.5%) for whom it was deemed safe. The intervention was evaluated via an uncontrolled single-group study. Results: Overall, 93 participants completed the follow-up assessment. Most participants had moderate (52/157, 33%) to severe (96/157, 61%) mental health conditions. All a priori feasibility, acceptability, and safety criteria were met. Participants provided mean scores of ≥3.5 (out of 5) on ease of use (mean 3.7, SD 1.1), relevancy (mean 3.9, SD 1.0), helpfulness (mean 3.5, SD 0.9), and overall experience (mean 3.9, SD 0.8). Moreover, 98% (91/93) of participants reported a positive experience using MOST+, 82% (70/93) reported that using MOST+ helped them feel better, 86% (76/93) felt more socially connected using it, and 92% (86/93) said they would recommend it to others. No serious adverse events or inappropriate use were detected, and 97% (90/93) of participants reported feeling safe. There were statistically significant improvements in 8 of the 11 secondary outcomes assessed: psychological distress (d=−0.39; P<.001), perceived stress (d=−0.44; P<.001), psychological well-being (d=0.51; P<.001), depression (d=−0.29; P<.001), loneliness (d=−0.23; P=.04), social support (d=0.30; P<.001), autonomy (d=0.36; P=.001), and self-competence (d=0.30; P<.001). There were significant correlations between system use, perceived helpfulness, and a number of secondary outcome variables. Conclusions: MOST+ is a feasible, acceptable, and safe online clinical service for young people with mental ill-health. The high level of perceived helpfulness, the significant improvements in secondary outcomes, and the correlations between indicators of system use and secondary outcome variables provide initial support for the therapeutic potential of MOST+. MOST+ is a promising and scalable platform to deliver standalone e-mental health services as well as enhance the growing international network of face-to-face youth mental health services.
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Therapeutic platforms of care are now becoming available and can be integrated within face-to-face care systems.
“Therapeutic platforms of care are now becoming available and can be integrated within face-to-face care systems.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [255]
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Seeking Help From Everyone and No-One
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Self-citationWhat happens to depressed adolescents? A follow-up study into early adulthood
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Self-citation(2018) · The statesman's yearbook online/Statesman's year-book · doi:10.1007/978-1-349-70154-4_163 · Cited by 44 · see citing works
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Self-citationSocial networks and support in early psychosis: potential mechanisms
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Development of a Moderated Online Intervention to Treat Social Anxiety in First-Episode Psychosis
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Development of a graphic medicine‐enabled social media‐based intervention for youth social anxiety
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Torous, J., Bucci, S., Bell, I. H., Kessing, L. V., Faurholt‐Jepsen, M., Whelan, P., Carvalho, A. F., Keshavan, M., Linardon, J., & Firth, J. (2021) · World Psychiatry · doi:10.1002/wps.20883 · Cited by 1,199 · see citing works
The Lancet Psychiatry Commission on youth mental health
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Self-citationDesigning and scaling up integrated youth mental health care
McGorry, P. D., Mei, C., Chanen, A., Hodges, C., Alvarez‐Jimenez, M., & Killackey, E. (2022) · World Psychiatry · doi:10.1002/wps.20938 · Cited by 546 · see citing works
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Self-citationHuman-Computer Interaction in Digital Mental Health
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Evaluation of the Use of Digital Mental Health Platforms and Interventions: Scoping Review
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Self-citationLoneliness in Emerging Adulthood: A Scoping Review
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Digital Mental Health Interventions for Young People Aged 16-25 Years: Scoping Review
Potts, C., Kealy, C., McNulty, J. M., Madrid‐Cagigal, A., Wilson, T., Mulvenna, M. D., O’Neill, S. M., Donohoe, G. J., & Barry, M. M. (2025) · Journal of Medical Internet Research · doi:10.2196/72892 · Cited by 57 · see citing works
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Online Indicated Preventive Mental Health Interventions for Youth: A Scoping Review
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Self-citationCoaching to Support Mental Health Apps: Exploratory Narrative Review
Meyer, A., Wisniewski, H., & Torous, J. (2022) · JMIR Human Factors · doi:10.2196/28301 · Cited by 34 · see citing works
Clinical Staging for Youth Mental Disorders: Progress in Reforming Diagnosis and Clinical Care
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Self-citationThe psychological effects of COVID-19 spread in young Canadian adults
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Self-citationThe Urgent Need for an Evidence-Based Digital Mental Health Practice Model of Care for Youth
Ridout, B., Forsyth, R., Amon, K. L., Navarro, P., & Campbell, A. (2024) · JMIR Mental Health · doi:10.2196/48441 · Cited by 23 · see citing works
Moderated Online Social Therapy for Young People With Active Suicidal Ideation: Qualitative Study
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Self-citationO’Sullivan, S., Schmaal, L., D’Alfonso, S., Toenders, Y. J., Valentine, L., McEnery, C., Bendall, S., Nelson, B., Gleeson, J., & Álvarez‐Jiménez, M. (2022) · JMIR Mental Health · doi:10.2196/29211 · Cited by 22 · see citing works
Self-citationGamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review
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Phone-Based Text Therapy for Youth Mental Health: Rapid Review
Karnik, V. A., Henderson, H., Khan, U. R., & Boyd, J. (2023) · Interactive Journal of Medical Research · doi:10.2196/47250 · Cited by 21 · see citing works
Young people's experience of online therapy for first-episode psychosis: a qualitative study
Valentine, L., McEnery, C., O’Sullivan, S., D’Alfonso, S., Gleeson, J., Bendall, S., & Alvarez‐Jimenez, M. (2022) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/papt.12356 · Cited by 19 · see citing works
Self-citationLozoya, D. C., Conway, M., Duro, E. S. D., & D’Alfonso, S. (2025) · JMIR Medical Education · doi:10.2196/68056 · Cited by 22 · see citing works
Self-citationBeneria, A., Santesteban‐Echarri, O., Daigre, C., Tremain, H., Ramos‐Quiroga, J. A., McGorry, P. D., & Álvarez‐Jiménez, M. (2021) · Early Intervention in Psychiatry · doi:10.1111/eip.13226 · Cited by 20 · see citing works
Self-citationO’Sullivan, S., van Berkel, N., Kostakos, V., Schmaal, L., D’Alfonso, S., Valentine, L., Bendall, S., Nelson, B., Gleeson, J., & Álvarez‐Jiménez, M. (2023) · JMIR Mental Health · doi:10.2196/44812 · Cited by 19 · see citing works
Self-citationGleeson, J., Koval, P., Zyphur, M. J., Lederman, R., Herrman, H., Eleftheriadis, D., Bendall, S., Cotton, S., Gorelik, A., & Álvarez‐Jiménez, M. (2023) · Schizophrenia Research · doi:10.1016/j.schres.2023.03.019 · Cited by 19 · see citing works
Self-citationCOVID-19 and the Future with Digital Mental Health: Need for Attention to Complexities
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Integrating digital interventions with clinical practice in youth mental health services
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van Doorn, M., Nijhuis, L. A., Monsanto, A., van Amelsvoort, T., Popma, A., Jaspers, M., Noordzij, M. L., Öry, F. G., Álvarez‐Jiménez, M., & Nieman, D. H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.871813 · Cited by 13 · see citing works
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Self-citationO’Sullivan, S., McEnery, C., Cagliarini, D., Hinton, J. D. X., Valentine, L., Nicholas, J., Chen, N. A., Castagnini, E., Lester, J., Kanellopoulos, E., et al. (2024) · JMIR Mental Health · doi:10.2196/49217 · Cited by 13 · see citing works
Self-citationvan Doorn, M., Popma, A., van Amelsvoort, T., McEnery, C., Gleeson, J., Öry, F. G., Jaspers, M., Alvarez-Jimenez, M., & Nieman, D. H. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03315-x · Cited by 13 · see citing works
Self-citationLal, S., Gleeson, J., D’Alfonso, S., Lee, H., Etienne, G., Joober, R., Lepage, M., & Álvarez‐Jiménez, M. (2023) · Schizophrenia · doi:10.1038/s41537-023-00352-1 · Cited by 13 · see citing works
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Self-citationButorac, I., McNaney, R., Seguin, J. P., Olivier, P. L., Northam, J. C., Tully, L. A., Carl, T., & Carter, A. (2025) · JMIR Pediatrics and Parenting · doi:10.2196/65163 · Cited by 9 · see citing works
Transdiagnostic prevention in youth mental health, Part II: interventions
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Sustained engagement with a digital youth mental health platform: A mixed-methods study
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Self-citationA scoping review of effective health practices for the treatment of birth trauma
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“14 15 24–26 The design of Rebound considers SDT principles to best support intrinsic motivation 36 (see table 1).”
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Digital Mental Health Interventions: A Comprehensive Systematic Review
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The Role of Digital Technology in Youth Suicide Prevention
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- Authors
- Alvarez-Jimenez, M., Rice, S., D'Alfonso, S., Leicester, S., Bendall, S., Pryor, I., Russon, P., McEnery, C., Santesteban-Echarri, O., Da Costa, G., Gilbertson, T., Valentine, L., Solves, L., Ratheesh, A., McGorry, P. D., & Gleeson, J.
- Affiliations
- The University of Melbourne (AU)
- Orygen (AU)
- Maresme Health Consortium (ES)
- Australian Catholic University (AU)
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-08-13
- Volume
- 22
- Issue
- 8
- Pages
- e17155
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7453330
- OpenAlex
- W3035464488
- Cited by
- 106
- References
- 108
- Citations by year
- 2026: 17 · 2025: 27 · 2024: 15 · 2023: 17 · 2022: 14 · 2021: 14 · 2020: 2
- FWCI
- 10.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council (1177235, 1082934)
- Young and Well Cooperative Research Centre
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- youth mental health, help-seeking, feasibility and acceptability, access to mental health care, social connectedness, digital mental health interventions, adolescents and young adults, pilot evaluation, help-seeking facilitators
- MeSH terms
- Adolescent, Adult, Mental Disorders, Child, Counseling, Female, Humans, Male, Mental Health Services, Pilot Projects, Social Support, Telemedicine, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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