Internet-Delivered Interventions for Depression and Anxiety Symptoms in Children and Young People: Systematic Review and Meta-analysis
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Abstract
BACKGROUND: Mental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP). OBJECTIVE: In this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP. METHODS: Systematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol. RESULTS: A total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=-0.25, 95% CI -0.38 to -0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=-0.27, 95% CI -0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=-0.01, 95% CI -0.23 to 0.21; P=.94). CONCLUSIONS: The results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP. TRIAL REGISTRATION: PROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171.
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Recent reviews and meta-analyses on adolescents report small but significant pooled effect sizes in favor of Internet interventions compared to predominantly non-active control groups.
“Most of them report small but significant pooled effect sizes in favor of Internet interventions compared to predominantly non-active control groups (i.e., waitlist or placebo) [47, 59, 60].”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [59]
The Abstract’s Results report a small, significant pooled benefit for anxiety, but the small pooled effect for depression was not significant (P=.06). The Results’ Description of Included Studies says 13 of 21 comparisons used wait-list controls, while eight used active controls, including two placebo programs. Thus, the control-group description is broadly supported, but the claim overstates the significance of the pooled effects. (LLM, conf=0.90)
Experimental — accuracy not yet measuredW-MHIs have potential effectiveness in reducing anxiety and depression symptoms among young people.
“W-MHIs have been increasingly utilised among young people due to their feasibility, acceptability, and potential effectiveness in reducing anxiety and depression symptoms [8].”
From Young People’s Barriers and Facilitators of Engagement with Web-Based Mental Health Interventions for Anxiety and Depression: A Qualitative Study (2024) · cites this paper as [8]
A recent meta-analysis focusing on young people ≤18 years and Internet-delivered interventions found a significant reduction in anxiety and functioning but not in depressive symptoms.
“However, evidence is still mixed as a recent meta-analysis focusing on young people (≤ 18 years) and Internet-delivered (vs. technology-delivered) interventions only found a significant reduction in anxiety and functioning but not in depressive symptoms [59].”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [59]
Evidence based on previous empirical studies is still inconclusive whether Internet interventions can reduce subclinical symptoms beyond depression and anxiety and whether they can actually prevent the onset of a mental disorder.
“Nevertheless, evidence based on previous empirical studies is still inconclusive whether such Internet interventions can reduce subclinical symptoms beyond depression and anxiety and whether they can actually prevent the onset of a mental disorder [59].”
From Efficacy of a transdiagnostic Internet prevention approach in adolescents (EMPATIA study): study protocol of a randomized controlled trial (2024) · cites this paper as [59]
The Objectives and Discussion examine treatment of depression and anxiety symptoms in children and young people. The Discussion explicitly excludes population-level preventive interventions, and no passage assesses symptoms beyond depression and anxiety or prevention of disorder onset. Searches for prevention and other subclinical symptoms found no passage establishing the claimed uncertainty. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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References 66 · Cited by 43
Research works printed but not linked: 2
- [12]Wolpert M Jacob J Napoleone E Whale A Calderon A Edbrooke-Childs J Child- and Parent-reported Outcomes and Experience from Child and Young People’s Mental Health Services 2011–2015 2016 London CAMHS Press
- [35]Eilert N Leen A Richards D Systematic review of internet-delivered interventions for childhood and adolescence anxiety and depression symptoms Internet PROSPERO 2020 10 10 123 127
- Authors
- Eilert, N., Wogan, R., Leen, A., & Richards, D.
- Affiliations
- Trinity College Dublin (IE)
- SilverCloud (Ireland) (IE)
- Corresponding author
- Eilert, Nora
- Venue
- JMIR Pediatrics and Parenting
- Publisher
- JMIR Publications Inc.
- Published
- 2022-05-12
- Volume
- 5
- Issue
- 2
- Pages
- e33551
- ISSN
- 2561-6722 (ISSN-L)
- PMC
- PMC9136650
- OpenAlex
- W4210551455
- Cited by
- 43
- References
- 66
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 11 · 2023: 4 · 2022: 3
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Pediatrics and Parenting (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Trinity's Access to Research Output (TARA) (Trinity College Dublin) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- online intervention, depression, anxiety, children and young people, adolescents, parent-mediated intervention, treatment effectiveness, impaired functioning, quality of life, access to mental health care, digital mental health
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