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BACKGROUND As the coronavirus 2019 disease pandemic has emerged as a threat to mental health, demand is increasing for online interventions that can replace face-to-face programs to prevent mental health problems. Adolescents not only have willingness to use an online mental health intervention, but also have generally positive perceptions of online intervention. However, there is still no general agreement regarding the effects of online interventions on adolescent mental health. OBJECTIVE This study aimed to evaluate the effectiveness of online interventions for reducing anxiety, depression, and stress among adolescents through a systematic review and meta-analysis. METHODS A systematic search of studies was performed using PubMed, EMBASE, and Cochrane Library CENTRAL. The Cochrane Collaboration’s tool was used for assessing risk of bias in randomized controlled trials (RCT). We performed meta-analyses to synthesize effect sizes of the included studies, which were calculated as standardized mean differences (SMD) with 95% confidence intervals (CI). RESULTS A total of 19 studies met the inclusion criteria, and 16 studies that reported sufficient numerical data were used for quantitative data synthesis. Regarding prevention level in the included interventions, universal prevention for general adolescents and selective prevention for vulnerable adolescents were conducted by 12 and seven studies, respectively. Among the interventions in this review, cognitive behavior therapy (CBT) and family-based interventions were most often used. In the result of a meta-analysis, online interventions have shown beneficial effect on reducing depression (SMD, -0.096; 95% CI. -0.175 to -0.017). Subgroup meta-analyses by preventive level found a significant effect of universal prevention on reducing depression (SMD, -0.102; 95% CI, -0.197 to -0.008) but no statistically significant effect of selective prevention on reducing depression (SMD, -0.082; 95% CI, -0.224 to 0.061). The effects of online interventions in reducing anxiety (SMD, -0.107; 95% CI, -0.231 to 0.018) and stress (SMD, -0.071; 95% CI, -0.157 to 0.016) among adolescents were not statistically significant in meta-analyses. CONCLUSIONS The findings of meta-analyses showed that online interventions significantly reduced depression among adolescents, and especially that universal prevention interventions significantly reduced depression. However, there is limited evidence for the effectiveness of online interventions for reducing anxiety and stress among adolescents. We suggest further RCTs regarding effectiveness of online intervention for adolescent anxiety and stress. |
