Young people (YP) (between 10 and 24 years) are disproportionally vulnerable to developing and being affected by mental health conditions due to physical, social and emotional risk factors. YP in low-and middle-income countries (LMICs) have poorer access to, and quality of, mental health services compared to those in high-income countries. Digital mental health interventions (DMHIs) have been proposed as tools to address this burden of disease and reduce the global treatment gap in youth mental health outcomes. This study aimed to examine the evidence for DMHIs for treating mental disorders in YP based in LMICs. To do this, the author searched academic databases (MEDLINE, PsycINFO, Embase and Web of Science) for primary studies on DMHIs targeting YP in LMICs. Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria were followed. The quality of the studies was assessed using the Critical Appraisal Skills Programme) framework. A narrative synthesis methodology was used to summarise and explain the findings. The authors identified 287 studies of which 7 were eligible in the final review. The authors found evidence of the effectiveness of multiple forms of DMHI (especially internet-based cognitive behavioural therapy) on anxiety and depression outcomes. Studies reported a lack of long-term benefits of treatment, high dropout rates, and did not include key geographical settings or data on cost-effectiveness. No studies were judged to be of high quality. This review highlights the available evidence showing that DMHIs can improve mental health outcomes for YP in LMICs, but due to the limited number of studies and lack of high-quality data, increased adoption and scaling up of digital interventions require more rigorous studies showing clinical effectiveness and ability to provide return on investment.

Autistic children and young people (CYP) experience mental health difficulties but face many barriers to accessing and benefiting from mental health care. There is a need to explore strategies in mental health care for autistic CYP to guide clinical practice and future research and support their mental health needs. Our aim was to identify strategies used to improve mental health care for autistic CYP and examine evidence on their acceptability, feasibility, and effectiveness. A systematic review and meta-analysis were carried out. All study designs reporting acceptability/feasibility outcomes and empirical quantitative studies reporting effectiveness outcomes for strategies tested within mental health care were eligible. We conducted a narrative synthesis and separate meta-analyses by informant (self, parent, and clinician). Fifty-seven papers were included, with most investigating cognitive behavioral therapy (CBT)-based interventions for anxiety and several exploring service-level strategies, such as autism screening tools, clinician training, and adaptations regarding organization of services. Most papers described caregiver involvement in therapy and reported adaptations to communication and intervention content; a few reported environmental adjustments. In the meta-analyses, parent- and clinician-reported outcomes, but not self-reported outcomes, showed with moderate certainty that CBT for anxiety was an effective treatment compared to any comparison condition in reducing anxiety symptoms in autistic individuals. The certainty of evidence for effectiveness, synthesized narratively, ranged from low to moderate. Evidence for feasibility and acceptability tended to be positive. Many identified strategies are simple, reasonable adjustments that can be implemented in services to enhance mental health care for autistic individuals. Notable research gaps persist, however.

Humanitarian emergencies pose a significant global health challenge for children and young people’s mental and psychological health. This systematic review investigates the effectiveness of mental health and psychosocial support (MHPSS) programmes delivered to children and young people affected by humanitarian emergencies in low- and middle-income countries (LMICs). Twelve electronic databases, key websites and citation checking were undertaken. Forty-three randomised controlled trials (RCTs) published in English between January 1980 and May 2023 were included in the review. Overall, the findings suggest that cognitive behavioural therapy may improve depression symptoms in children and young people affected by humanitarian emergencies. Narrative exposure therapy may reduce feelings of guilt. However, the impact of the other MHPSS modalities across outcomes is inconsistent. In some contexts, providing psychosocial programmes involving creative activities may increase the symptoms of depression in children and young people. These findings emphasise the need for the development of MHPSS programmes that can safely and effectively address the diverse needs of children and young people living in adversarial environments.

Residential independence and incorporation into the labour market are two fundamental aspects of the transition of young people to adulthood, and gender differences have been observed in both. This study aims to determine the reasons behind the gender gap seen in young adults leaving their parental home and in finding paid employment. We analyse both the decisions of residential independence and employment jointly, for the sample of men and that of women. We separate the influence of observed factors from the influence of unobserved factors or preferences on the gender gap using decomposition techniques. The analysis is carried out for two points in time; this temporal comparison can help demonstrate whether the recent social changes experienced have modified the behaviour patterns of young people. Our findings indicate that, in accordance with the trend observed in recent decades in Europe, there is a convergence between men and women in the residential independence of young adults in Spain. However, in the labour market, there is still much to be done to reduce the gender gap. One recommendation arising from our study would be to promote policies which further improve the conciliation of family and work life, since this could reduce female labour abandonment associated with starting a family or motherhood.

Practitioners have mixed views about the value of cognitive behavioural therapy (CBT) manuals, with some preferring to work based on professional judgement. The workbook represents a compromise, providing guidance and resources without prescribing standardised procedures. Workbooks have not previously been widely addressed in the CBT literature. This exploratory study analysed how practitioners use a CBT workbook (Think Good – Feel Good, TGFG) to support therapeutic work with young people (YP). Practitioners (n=238) completed an online survey about how TGFG is used and how it supports CBT. A convergent mixed-methods design was pursued. Qualitative and quantitative data were analysed using content analysis, descriptive statistics, and chi-squared tests before themes were defined to summarise the dataset. When deciding whether to use TGFG, practitioners consider a YP’s presenting difficulty, level of understanding, motivation, and availability of systemic support. Practitioners use TGFG inside and outside the therapeutic space to plan sessions, revise CBT concepts, and complete worksheets (particularly those with a cognitive focus). Practitioners use TGFG flexibly and pragmatically (combining it with other therapeutic approaches), and they adapt resources to suit a YP’s understanding and interests. TGFG appears to be a widely used resource for practitioners across the range of experience.

Obsessive-compulsive disorder (OCD) is a common and debilitating disorder that frequently begins in childhood and adolescence. Previous work (Bolton et al., 2011) has demonstrated that brief CBT (5 sessions), supplemented by therapeutic workbooks, is as effective as more traditional length (12 sessions) therapist-delivered treatment for adolescents with OCD. However, as was typical at the time, the treatment was developed with very limited patient and public involvement (PPI) and was delivered in the context of a randomised controlled trial which might affect translation to routine child and adolescent mental health services (CAMHS). To be able to implement such treatment within routine clinical services, it is crucial that it acceptable to young people, their families and the clinicians delivering the treatment. The aim of this project was to improve the acceptability of the brief treatment through PPI and consultation with clinicians, and consider issues relating to implementation. This was done through written feedback, interviews and focus groups with five adolescents and two parents, and a focus group and a half-day workshop with 12 clinicians. This led to revisions to the workbooks and materials to improve (a) acceptability by updating the design through changes to wording, language and images, and to ensure that they were consistent with values of equality, diversity and inclusion, and (b) usability by clarifying, adding, removing content, and organising the materials in new ways. We emphasise the importance of continued PPI throughout the project to maximise the translation of findings into practice.