Hybrid digital and face-to-face mental health interventions show modest benefits for children and adolescents

A recent systematic review indicates that while digital mental health programmes for children and young people produce small improvements, particularly when combined with face-to-face support, the evidence remains inconclusive due to study quality and limited diversity.

Universal digital mental health interventions aimed at children and adolescents can produce small gains in wellbeing, but the latest evidence suggests the benefits are modest and the overall certainty remains low. A systematic review and meta-analysis published in npj Digital Medicine on 27 July examined 57 studies involving 43,973 participants and found that programmes combining digital delivery with face-to-face support tended to perform better than fully virtual models. The researchers assessed emotional, behavioural, social and cognitive outcomes in children and young people aged 18 and under who did not have a diagnosed mental health condition.

The review found that hybrid interventions were the most reliable performers across the outcomes studied. According to the researchers, emotional measures improved immediately after treatment and at follow-up, while behavioural and social outcomes also showed positive effects, particularly when digital tools were embedded in schools or other real-world settings. By contrast, the evidence for cognitive gains was limited. The authors said the pattern of null results in some areas suggests not that the tools are ineffective, but that they may not yet be designed or measured well enough to capture subtler developmental changes.

The strength of the evidence was constrained by study quality. Among the randomised trials reviewed, just over half were judged to have a high risk of bias, while most non-randomised studies were rated as having serious risk of bias. The authors also noted that much of the research came from high-income Western countries, leaving younger children and marginalised communities underrepresented. That gap is especially important for the youngest age group, because interventions for children aged four and under are usually delivered through parents or carers rather than directly to the child.

Experts not involved in the work said the findings are encouraging, but incomplete. Manuela Ferrari, an associate professor of psychiatry at McGill University and a researcher at the Douglas Hospital Research Centre in Montréal, told Medscape News Canada that hybrid models appear especially promising because schools and community settings can provide the structure, support and accountability that standalone digital products often lack. Rebecca Pillai Riddell of York University, who co-led the study, said the results point to the need for tools that are designed with equity in mind and developed alongside the communities they are meant to serve.