Understand the growing issues of anxiety and substance addiction among today’s youth. Examines the impact of these problems on young lives, it underscores the urgency of addressing them. Reviews current prevention and intervention methods to provide a clear understanding of how to support youth struggling with these issues.

Keywords

Mental Health, Adolescents, Anxiety, Depression, Addiction.

Bio

Rituu Guptaa, born and raised in the scenic valleys of Dehradun, India, is a passionate advocate for justice and empowerment. With a career spanning over 25 years as a clinical psychologist and counsellor, she has been a guiding light for many in overcoming life’s challenges. Rituu firmly believes in the inherent resilience and strength within each individual, empowering her clients to navigate through adversity with courage and determination. She epitomizes the adage “Be the change you want to see,” inspiring others to tap into their inner resources and embark on a journey of self-discovery and transformation.

Bio

Uddayvir Singh is a dedicated student with a clear ambition to pursue a career in medicine. Currently, he is rigorously studying a diverse range of subjects including Chemistry, Biology, Physics, Psychology, and Mathematics, laying a robust foundation for his future medical studies. His academic journey began with a strong performance in his I/GCSEs, where he developed a keen interest in the sciences and an understanding of the intricate workings of the human body. With a passion for learning and a commitment to excellence, Uddayvir is keen to make significant contributions to the field of medicine in the future.

Abstract

The prevalence of mental and psychological disorders among younger generations has significantly increased in recent years, raising critical public health concerns. This literature review examines the factors contributing to this rise and explores various disorders affecting today’s youth. Using a systematic search and analysis of scholarly articles from databases such as PubMed, PsycINFO, and Google Scholar, the review identifies key studies on the prevalence, correlation, and determinants of depression, anxiety, substance addiction, among adolescents and young adults, with a specific focus on anxiety and substance addiction.

A critical appraisal framework evaluates the methodological rigor and quality of included studies, ensuring reliable and valid findings. By synthesising current research, the review elucidates the complex interplay of genetic, environmental, social, and cultural factors influencing the mental health landscape of younger generations.

This understanding is essential for developing targeted interventions and promoting resilience among youth facing mental health challenges. The review also highlights the impact of technology, social media, academic pressures, family dynamics, and socio-economic disparities on mental health outcomes. By critically evaluating existing literature, the review offers insights into potential research avenues and underscores the need for comprehensive, evidence-based approaches to address the growing crisis of mental health disorders among younger populations.

Introduction

Many studies have reported an increase of anxiety related symptoms within the past decade, but the exact prevalence remains unknown. Anxiety disorders are complex and often under-diagnosed because they can manifest a variety of physical and psychological symptoms (Back, Waldrop, & Brady, 2070). Anxiety is commonly identified as a sense of dread or apprehension, which is often accompanied by physical complaints such as headache, stomach-ache, muscle tension, shortness of breath, shakiness, and dizziness. Sudden and intense anxiety for no apparent reason is referred to as a panic attack (Marks, 7987). Though not life threatening, anxiety disorders often impair functioning and quality of life. It is a main contributor to mental health diagnoses and can often be an offshoot or precursor to additional psychiatric disorders such as depression or further anxiety conditions. The social and academic pressures on today’s youth, in addition to an uncertain economic and political climate also contributing to loss of identity, have been presumed as an attributing factor to anxiety prevalence (Baumeister & Muraven, 7996) (Baumeister & Muraven, 7996). These factors are expected to increase competition in the job market and thus increase the requirements for higher education and standard of living. This, in turn, brings higher expectations upon our youth and a scarce job market for unskilled workers The recent shift towards a global community has proposed increased opportunities for travel and a wider and more competitive job market on a world scale. This has created a mindset of necessity for today’s youth to achieve and be successful on an international platform. Failure to meet those more rigid standards could contribute to a sense of inadequacy and additional pressures high in causative factors for anxiety conditions.

With the steady dominance of mental and psychological disorders among today’s youth, researchers aim to decipher the primary catalysts and aid pathways to potential solutions. A media storm of technological  advancements, social networking, and added pressures such as academic targets and financial uncertainties have all played a supportive role in the accelerated prevalence of mental disorders within the millennial and post- millennial generations. Anxiety and substance addiction are the primary focus due to noting the substantial rise of diagnoses within these specific areas and the dire negative implications they pose to a person’s mental health and future outcomes. This research study will seek to comprehensively understand the surge of mental and psychological disorders among today’s youth, specifically anxiety and substance addiction. By synthesising quantitative and qualitative data over a multi-disciplinary arena, we hope to identify the causative factors that have contributed to the escalation of these conditions, attempt to quantify the severity of these issues, and explore potential preventative and intervention measures.

Aim

This literature review aims to understand and discuss the following:

-Growing issues of anxiety and substance addiction among today’s youth.

-Examines the impact of these problems on young lives, it underscores the urgency of addressing them.

-Reviews current prevention and intervention methods to provide a clear understanding of how to support youth struggling with these issues.

Methodology

This review examined literature on the rise and causation of mental and psychological disorders among today’s youth, focusing on anxiety and substance addiction. Despite the increasing number of studies on the prevalence of these disorders, understanding why this increase is occurring remains crucial. By identifying the causes, prevention strategies can be developed to avoid a lifetime of coping. The review included literature from journals and various youth samples, ranging from clinical populations to college students. Although the severity of anxiety and some substance disorders varied, the issue is relevant to all youth, especially those facing the stresses of higher education. The review explored the various causes and issues surrounding diagnosable anxiety disorders, noting similarities to substance addiction issues.

In the National Health Interview Survey, 6.8% of Americans (about 77 million people) had at least one depressive episode in the year prior to being surveyed. Of these, 80% reported some level of functional impairment in doing work, school, or housework, or in their interpersonal relationships. In the United States, the leading cause of dropout in high schools is depression related (Rones & Hoagwood, 2007). Figures for other anxiety disorders are not easy to split from figures for behaviour disorders, but one UK study found that 3.3% of children aged 4-76 had an anxiety disorder (Ford, Goodman, & Meltzer, 2003). In an Australian survey, it was found that 74.4% of 4-77-year-olds, and 27% of 78-24-year-olds were assessed as having either a “high” or “very high” level of psychological distress (based on K-70 scores) (AIHW, 2027). In twelve months prior to the survey, 7.7% or around 300,000 young Australians had experienced an anxiety disorder, while the rate of affective disorders for the same period was 5.7%. With the growing realisation of the seriousness of anxiety disorders and their grave outcomes on life impairment, it is important that they are not ignored in research and people continue to try to understand them. Figure 7 illustrates Psychological Distress Levels Among 11-17 Year Olds, Categorised by Age Group and Gender, 2013-2014. An understanding of this is needed to persuade funding bodies to support further research into anxiety disorders. High prevalence rates and serious outcomes in younger people may potentially affect the future productivity of youths and have implications for future generations.

3.1 The Interplay Between Anxiety and Substance Addiction

The enhanced predisposition of those with anxiety toward consuming addictive substances is well documented. Anxiety was positively associated with a wide range of lifetime substance use:

ten of the eleven substances studied (cannabis, inhalants, cocaine, hallucinogens, heroin, ecstasy, prescription medications, alcohol, and nicotine) showed positive associations with anxiety (Conrod, Castellanos-Ryan, & Mackie, 2077) Though among specific anxiety disorders, only social anxiety has been consistently associated with substance use and abuse, the data is more robust for alcohol abuse, especially among male subjects. A possible explanation is that those with social anxiety utilise alcohol to ameliorate the negative emotions associated with the disorder (Vasey, 7995).

There are functional ramifications of the relationship between anxiety disorders and substance abuse. Following exposure to anxiogenic stress, individuals with anxiety disorders have been shown to be more vulnerable to developing an addiction to an abused substance. The seeking of intoxication and subsequent chronic abuse of a substance can be seen as a method of self-medication to reduce the negative affect and emotional suffering associated with the anxiety disorder (Cisler, Olatunji, Feldner, & Forsyth, 2009).

Figure 1. (AIHW, 2021)

The acute intake of an abused substance has an immediate effect on the brain and neurotransmissions, potentially causing a rapid psychological shift from negative affect to relief. This shift can serve as positive reinforcement for continued substance use and in the gradual formation of an addiction. High comorbidity rates are seen in the more severe anxiety disorders, with ten of the eleven substances studied (cannabis, inhalants, cocaine, hallucinogens, heroin, ecstasy, prescription medications, alcohol, and nicotine) showed positive associations with anxiety (Conrod, Castellanos-Ryan, & Mackie, 2011) Though among specific anxiety disorders, only social anxiety has been consistently associated with substance use and abuse, the data is more robust for alcohol abuse, especially among male subjects. A possible explanation is that those with social anxiety utilise alcohol to ameliorate the negative emotions associated with the disorder (Vasey, 1995).

There are functional ramifications of the relationship between anxiety disorders and substance abuse. Following exposure to anxiogenic stress, individuals with anxiety disorders have been shown to be more vulnerable to developing an addiction to an abused substance. The seeking of intoxication and subsequent chronic abuse of a substance can be seen as a method of self-medication to reduce the negative affect and emotional suffering associated with the anxiety disorder (Cisler, Olatunji, Feldner, & Forsyth, 2009). The acute intake of an abused substance has an immediate effect on the brain and neurotransmissions, potentially causing a rapid psychological shift from negative affect to relief. This shift can serve as positive reinforcement for continued substance use and in the gradual formation of an addiction. High comorbidity rates are seen in the more severe anxiety disorders, with addicts making up as much as 20% of those with social anxiety disorder and panic disorder. This represents a near doubling in the odds of being addicted to alcohol and a 4- 5-fold increase in the odds of addiction to another drug. Time constraints and participants means having the presented literature has been focused on adults, and it is important to consider further the link between anxiety disorders and substance abuse in adolescents. Numerous studies have found strong associations between psychiatric conditions, both treated and untreated, and subsequent academic achievement (Rones & Hoagwood, 2001).

A British birth cohort study found that parental report of ’emotional disturbance’ at age 16 was associated with reduced occupational attainment at age 26. Those who met criteria for depression at ages 15 and 16 in another study were found to have lower grade point averages, educational attainment, and occupational functioning ten years later, as compared with their non-depressed counterparts. Although it is difficult to dissociate the effects of comorbidity, substance abuse, medication, and the underlying disorder itself, the clear impact on educational functioning is compelling (Fergusson & Lynskey, 1998).

3.2 Treatment Approaches and Modalities

Treatment types in general practice the recommended approach for choosing the right treatment for each specific problem should involve considering recent advancements. While primary care is typically sufficient for managing mental health issues in young individuals, it may not always be the ideal option. Psychological therapies can be administered in primary care, but specialists may be required to provide more specialised assistance or guidance. When selecting the most suitable form of treatment, factors such as the problem’s severity, persistence, associated functional impairment, and the specific preferences of the child or young individual and their family should be taken into account. It is crucial to recognise that early intervention at the least severe level is often the most effective approach in addressing most mental health problems.

3.3 Cognitive- Behavioural Therapy (CBT)

The focus in CBT is to redefine irrational beliefs that may lead to emotionally distressing events, by a series of teaching a client to monitor and identify their thoughts and attitudes. With CBT, the patient is thought to be equipped to alter those thoughts and this, in turn, will change their reaction to those events (Jones & Pulos, 1993). Once the patient has mastered the reconstruction of events to outcomes that can relieve emotional distress, a clear plan of gradual exposure to the distressing events can now be tackled with a defined cognitive and behavioural formula that will not cause distress (David & Szentagotai, 2006). This is a process that can be seen in the treatment of anxiety disorders where people will often avoid certain situations and events and thereby deny themselves the opportunity to alter an outcome to less distressing or treat a fear which in reality is not threatening. The end of treatment with CBT is always termination with a conscious use of the coping methods learned by the patient and with a reinforcement of the new methods as a way of life. Szasz, 1960 and Scheff, 1966, and many other sociologists of the labelling theory within mental illness, have had a pivotal view in the criticism of psychological treatments (Krohn, Lizotte, & Hall, 2009). They have researchable evidence that shows the process of how a patient of a mental illness being subjected to a certain therapy or medical treatment is, in fact, conforming to the label of their illness and in many cases getting worse or prolonging the illness. This is due to the social construction of the label; the patient is stigmatised to being who has a mental illness and the only way they can escape the label is to consider themselves as cured and that the treatment failed to remove the irrational belief that led to the distressing events. This view of CBT can be seen as somewhat positive, in the case that there is the variability for individual or group therapy and that the treatment is a focused attempt at changing specific symptoms. The different techniques and methods used in CBT show that it is a viable treatment option for many common mental disorders and its direct and problem-based approach make it favourable in the medical community in today’s age.

3.4 Medication Management

In particular, anxiety medications play a role in the self-medication of anxiety conditions. A recent study with over 1000 college students showed that 9 out of 10 of these individuals sought out various medications, both legal and illegal, to get them through their anxiety problems. Hence, the opportunity for a student to abuse anxiety medications is very high. Tolerance can develop for anxiety medications, causing an individual to need more and more of this drug to calm down.There are various types of medications used to treat anxiety. Acute treatment for anxiety is usually a prescription for a type of benzodiazepine. Benzodiazepines are a class of compounds that are widely used for the treatment of anxiety and insomnia. These types of medications are known to be effective and fast-acting for relief of anxiety symptoms; however, the long-term use of these medications is not recommended and can be habit-forming. Long-term maintenance medications include certain SSRIs and buspirone, which are safer compared to benzodiazepines and do not induce a dependency. Beta- blockers are also used on an as-needed basis for control of performance anxiety. Any of these medications should be utilised while combined with psychotherapy for the best effectiveness and long- term results.

3.5 Holistic and Alternative Therapies

Holistic treatment looks at the situation as a whole and tries to decide what elements of life are causing the individual distress. Alternative treatments may include activities such as yoga, Tai Chi, or meditation. It is possible that alternative treatment may be mixed with herbal medicine, for example taking herbal supplements to relieve anxiety symptoms. Yoga and meditation have been scientifically proven to decrease anxiety and stress levels. Tai Chi has the same effect, although it is not as well researched; recent studies have proven that herbal supplements are just as effective as prescription medication, and patients view them more positively. Many patients never return to herbal medicine once they have been prescribed psychiatric drugs, and it is likely that there are differences in people seeking herbal treatments and prescription drugs. Mixing the two treatments is ill-advised and it can be dangerous, patients should seek advice from an herbal practitioner or homeopathic doctor, who is likely to be critical about mixing alternative and prescription remedies. Engaging in physical exercise increases the serotonin in the brain, which leads to improved mood and decreased anxiety. This may be anything from going for a run, to taking a dog for a walk in the park. There are a vast number of activities which people can undertake to increase their fitness, and it is up to the individual to find something that they will enjoy and will maintain. The exercise recommended to combat anxiety would be that which gets the heart pumping, as this is what is required to increase serotonin. Nutrition is also important, and maintaining a healthy diet will improve an individual’s general health and resistance to illness. Step one is avoiding junk food, which is high in sugar and fat. High levels of sugar cause hyperactivity and elation due to increased blood sugar, however this is followed by fatigue and depression when it drops. A good diet does not simply mean not eating bad food, and it is important that people eat sufficient amounts of good, nutritious food. It may involve some research and many people are unaware of the nutrients that they are supposed to be taking. It may be necessary to see a professional nutritionist who can advise on meal plans and diets; this is a long-term investment which will lead to improved mood, self-esteem, and confidence. The overall effect of alternative therapies is a positive one, and successfully removing an anxiety sufferer from their problem. At this stage a person would no longer be classified as mentally ill and would have achieved a high level of mental health. This is different to the aim of removing a person from severe depression to a state of nothingness, and it is difficult to weigh up the cost efficiency of the two as the effect of removing depression is an increased suicide risk.

3.6 Support Groups and Peer Counselling

An effective intervention for youth mental health is support groups that focus on social skill building and self-esteem activities. These groups help normalise experiences, as shown in an anxiety study where clients felt relief discovering others shared similar issues (Durlak & Wells, 1997).

The social context of groups can harness peer pressure positively. According to Bandura’s social learning theory, youth learn coping behaviours by modelling others (Koutroubas & Galanakis, 2022). Support groups provide a setting that teaches healthy coping habits, especially beneficial for socially anxious youth. They offer exposure therapy and help generalise coping skills through homework tasks. While group CBT can treat adolescent depression, research favours individual therapy for severe cases, self- harm, and complex depression, as recommended by NICE guidelines (NICE, 2022). Despite their accessibility and cost-effectiveness, research on support groups for youth anxiety and depression is limited, even though they are effective for adults (Gibbons, et al., 2010). Prioritising the development and research of group-based interventions is essential for improving youth mental health.

3.7 Future Directions and Research Implications

Results have highlighted an increase in youth mental health problems and drug use as a temporary escape. Explanations focused on adolescent experiences, and while predictions were not tested within problem behaviour theory, future research could validate these hypotheses. Reassessing future generations’ mental health will be crucial. Today’s youth benefit from technological  advancements, with new media and computers standard in developed countries. Technology has educational benefits, but its impact on mental health is mixed, potentially leading to issues like internet addiction. Conversely, technology can aid in prevention through educational resources.

Longitudinal studies following current youth to evaluate these theories would be valuable. The overlap between mental health and drug abuse, such as self-medication in depressed adolescents using prescribed antidepressants, suggests these fields may merge. It’s not a question of whether youth face problems but what will come next. Anxiety disorders often lead to other issues, including depression.

Understanding these sequences in adolescence requires ongoing research and integration with existing explanations.

3.8 Identifying Protective Factors and Resilience

Other than targeting the risk factors, identifying, and building on the protective factors and resilience of the youth is also an important means of preventing youth mental disorders. Protective factors are influences that reduce the impact of early stressful life events and act as a shield against the progression from stress to mental disorder. It was found in a cross-sectional study in Victoria, Australia that the common protective factors amongst young people with high levels of mental wellbeing were the possession of good life skills (including social, personal, and study skills, and skills related to future employability) and participation in structured and prosocial (including voluntary) activities. These factors were associated with mental wellbeing in youth across the range of socio-emotional problems and levels of functioning. On the other hand, poor mental wellbeing was strongly linked with the young person not being in education and employment. Although the presence of good life skills and the engagement in structured and prosocial activities are considered protective, a recent study found that the intrinsic belief in the value of the future of these young people was the most important factor in determining whether the skills and activities act protectively. This profound finding presents a potential intervention point for enhancing mental wellbeing amongst Australian youth.

Risky behaviors and poor physical health are common in young people with mental disorders and have been described as markers of an underlying continuum of social and emotional problems (Salkovskis, 1991). There is a bidirectional relationship between poor physical health and mental disorders, and it is likely that a strong focus on improving the physical health of individuals with mental disorders will reap its own benefits in terms of improved mental wellbeing. Development of interventions targeting health behaviours and early medical treatment of youth mental disorders may be a further investment in the mental health continuum of future generations (Côté, 2009). . A recent study has shown that for those individuals at the severe end of the continuum, premature death or decreased life expectancy is likely and represents a major public health issue. Suicide is the leading cause of death in people aged 24 years or younger in Australia and New Zealand, and for these reasons, it is important to enhance the continuum of care for young people with mental disorders until their general health and life expectancy more closely resembles that of people without mental disorders. This might also be considered for at-risk populations of youth showing socio-emotional problems before the point of diagnostic  mental  disorder in order to reduce the prevalence and burden of these problems.

One of the most potentially modifiable factors of mental disorders in youth is a family history of mental and substance use disorders. It is well known that there is both a strong genetic and environmental risk from parental mental illness, and a recent study has estimated that 15-20% of children are at risk of developing a mental disorder due to a parental history. This has been linked to poor parent mental health and disturbances in parenting practices, which can result in the exposure of these children to a range of socio-emotional problems. The negative effects of parental disorders are particularly concerning given the potential to prevent disorders in both the parents and children and in terms of the high human and economic burden from disorders across the lifespan. As such, there is great potential to prevent the development of mental disorders in these children through the improvement of parent mental health and parenting practices, and this may also serve to protect against disorders developing in subsequent generations.

3.9 Addressing Cultural and Socioeconomic Disparities

There are particularly important issues to consider in the context of anxiety and substance addictions in the young, and that is of culture and socioeconomic status. Studies have shown that members of ethnic and racial minority groups in the United States are less likely to receive diagnosis and treatment for their mental illness, have fewer positive attitudes toward mental health, and are more likely to use emergency mental health care or general medical services rather than mental health specialists (Stephens, Bohanna, & Graham, 2017).

Research also indicates that even when minorities are diagnosed with mood, anxiety, or substance abuse disorders, they are still less likely than the white majority population to receive any treatment (McHugh, Hearon, & Otto, 2010). It is believed that the disparities occur because ethnic and racial minorities have less access to mental health services, are less likely to seek help, and are more likely to receive poor quality care. This is especially problematic as rates of anxiety, depression, and substance misuse are often the same or sometimes higher for minority groups than the white majority population. This section aims to discuss some potential reasons for these disparities and how they can be addressed to provide better quality care for those affected by anxiety and substance addictions.

The surge of mental and psychological disorders among today’s youth has become a growing area of interest for researchers, clinicians, educators, and parents. Given that mental disorders usually have their onset in childhood and adolescence, it is of vital importance to understand why this disturbing trend is occurring, what are the consequences in terms of youths’ well-being, and what can be done to prevent it. In this paper, we have reviewed the evidence of the past 50 years and have seen a dramatic increase in rates of a variety of mental disorders among children and adolescents. This has been shown for different types of disorders, in different countries, and by many measures of mental disorder. The review covered the prevalence of youth mental disorders and their impact; the changing rates of disorders; the significant link between mental disorders and mental health services use; and clinical severity/detection of disorders.

The evidence points to a complex and as yet not fully understood mix of contributing factors to the increase in youth mental disorders that is almost certainly multi-determined. Pressing areas for further research exist. This includes the reasons for the wide variation in rates of disorder across developed countries, and why youth today appear to be so much more distressed than those of the past. For the sake of today’s youth and of future generations, it is hoped that research that seeks to understand the origins of this trend will continue to be prioritised. . In particular, a greater focus on prevention rather than cure is needed. Given the clear evidence of the potential for adverse impacts of mental disorders of youth well into adult life, every effort should be made to reduce the prevalence of these disorders among young people today.

The increase in mental and psychological disorders is now alarmingly high and this research study has shown they are often more prevalent than other health issues. This is now the time for psychological health to stand on its pedestal and receive the recognition it deserves. High rates of anxiety and substance addiction in youth may serve as a wake-up call-in mental health recognition. It can be hoped that mental health will now start to receive more funding and research tipping towards the provided better care and options for adolescents in the future.

References

AIHW. (2021, 06 25). Mental illness. Retrieved from Australian Institute of Health and Welfare: https://www.aihw.gov.au/reports/children-youth/mental- illness

Back, S. E., Waldrop, A. E., & Brady, K. T. (2010). Anxiety in the context of substance abuse. In D. J. Stein, E. Hollander, & B. O. Rothbaum, Textbook of anxiety disorders (pp. 665–679).

American Psychiatric Publishing, Inc. Baumeister, R. F., & Muraven, M.(1996). Identity as adaptation to social, cultural, and historical context. Journal of Adolescence, 405– 416.

Cisler, J. M., Olatunji, B., Feldner, M., & Forsyth, J. P. (2009). Emotion Regulation and the Anxiety Disorders: An Integrative Review. Journal of psychopathology and behavioural assessment, 68–82.

Conrod, P. J., Castellanos- Ryan, N., & Mackie, C. (2011). Long-term effects of a personality-targeted intervention to reduce alcohol use in adolescents. Journal of consulting and clinical psychology, 296–306.

Côté, E. J. (2009). 9 Identity Formation and Self- Development in Adolescence. John Wiley & Sons, Inc. .

David, D., & Szentagotai, A. (2006). Cognitions in cognitive-behavioral psychotherapies; toward an Integrative Model. Clinical Psychology Review, 284–298.

Durlak, J. A., & Wells, A. M. (1997). Primary Prevention Mental Health Programs: The Future is Exciting. American journal of community psychology, 233–243.

Fergusson, D. M., & Lynskey, M. T.(1998). Conduct Problems in Childhood and Psychosocial Outcomes in Young Adulthood: A Prospective Study. Journal of Emotional and Behavioral Disorders, 2-18.

Ford, T., Goodman, R., & Meltzer, H. (2003). The British Child and Adolescent Mental Health Survey 1999: the Prevalence of DSM-IV Disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 1203–1211.

Gibbons, C. .., Fournier, J. C., Stirman, S. W., DeRubeis, R. J., Crits-Christoph, P., & Beck, A. (2010). The clinical effectiveness of cognitive therapy for depression in an outpatient clinic. Journal of affective disorders, 1-3.

Jones, E. E., & Pulos, S. M. (1993). Comparing the process in psychodynamic and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 306–316.

Koutroubas,  V.,  &  Galanakis, M. (2022). Bandura’s AIHW. (2021, 06 25).

Mental illness. Retrieved from Australian Institute of Health and Welfare: https://www.aihw.gov.au/rep orts/children-youth/mental- illness.

Back, S. E., Waldrop, A. E., & Brady, K. T. (2010). Anxiety in the context of substance abuse. In D. J. Stein, E. Hollander, & B. O. Rothbaum, Textbook of anxiety disorders (pp. 665–679).

American Psychiatric Publishing, Inc. Baumeister, R. F., & Muraven, M. (1996). Identity as adaptation to social, cultural, and historical context. Journal of Adolescence, 405– 416.

Cisler, J. M., Olatunji, B., Feldner, M., & Forsyth, J. P. (2009). Emotion Regulation and the Anxiety Disorders: An Integrative Review. Journal of psychopathology and behavioural assessment, 68–82.

Conrod, P. J., Castellanos- Ryan, N., & Mackie, C. (2011). Long-term effects of a personality-targeted intervention to reduce alcohol use in adolescents. Journal of consulting and clinical psychology, 296–306.

Côté, E. J. (2009). 9 Identity Formation and Self- Development in Adolescence. John Wiley & Sons, Inc. .

David, D., & Szentagotai, A. (2006). Cognitions in cognitive-behavioral psychotherapies; toward an Integrative Model. Clinical Psychology Review, 284–298. Durlak, J. A., & Wells, A. M. (1997). Primary Prevention Mental Health Programs: The Future is Exciting. American journal of community psychology, 233– 243.

Fergusson, D. M., & Lynskey, M. T. (1998). Conduct Problems in Childhood and Psychosocial Outcomes in Young Adulthood: A Prospective Study. Journal of Emotional and Behavioral Disorders, 2-18.

Ford, T., Goodman, R., & Meltzer, H. (2003). The British Child and Adolescent Mental Health Survey 1999: the Prevalence of DSM-IV Disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 1203–1211.

Gibbons, C. .., Fournier, J. C., Stirman, S. W., DeRubeis, R. J., Crits-Christoph, P., & Beck, A. (2010). The clinical effectiveness of cognitive therapy for depression in an outpatient clinic. Journal of affective disorders, 1-3.

Jones, E. E., & Pulos, S. M. (1993). Comparing the process in psychodynamic and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 306–316.

Koutroubas,  V.,  &  Galanakis, M. (2022). Bandura’s Social Learning Theory and Its Importance in the Organization al Psychology Context . Psychology Research, 315-322 .

Krohn, M., Lizotte, A., & Hall, G. (2009). Handbook on Crime and Deviance. Springer.

Marks, I. M. (1987). Fears, phobias, and rituals: Panic, anxiety, and their disorders. . Oxford: Oxford University Press.

McHugh, R. K., Hearon, B. A., &   Otto,   M.   W.   (2010). Cognitive behavioural therapy for substance use disorders. Psychiatric Clinics of North America.

NICE. (2022). Depression in adults: treatment and management. National Institute for Health and Care Excellence.

Rones, M., & Hoagwood, K. (2001). School-Based Mental Health Services: A Research Review. Clinical child and family psychology review, 223-41.

Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 6–19.

Stephens, A., Bohanna, I., & Graham, D. (2017). Expert Consensus to Examine the Cross-Cultural Utility of Substance Use and Mental Health Assessment Instruments for Use with Indigenous Clients. Evaluation Journal of Australasia, 14-22.

Vasey, M. W. (1995). Social anxiety disorders. In A. R. Eisen, C. A. Kearney, & C. E. Schaefer, Clinical handbook of anxiety disorders in children and adolescents (pp. 131-168). Jason Aronson.

To provide an insight into conditions for implementing synchronous digital mental health interventions) in ‘real-world’ settings, thus contributing to the feld of implementation science.

Keywords:

Mental Health, Anxiety, Technology, Wellbeing

Bio

Prof. Dr. Parin Somani, Director of LOSD, is a distinguished Academic Scholar, TEDx Speaker, and Author, honoured the title of Mrs. Universe 2022 and crowned by Bollywood Actress Mahek Chahal. With 2 Academic and 6 Honorary Doctorates, she’s a multi-award-winner and humanitarian. She is a prolific author of 19 books, and a record-breaker recognised in Guinness World Records and multiple prestigious record books. She was invited to deliver a Keynote Speech at Harvard University, Cambridge University and many more. In her global travels to 127 countries, Prof. Dr. Parin Somani tirelessly contributes to education, women empowerment, and youth development.

Roxanne Boodhoo is an accomplished professional with a diverse and versatile background. Her extensive academic training has equipped her with a wide range of skills and knowledge, enabling her to excel in various roles. Roxanne is known for her strong work ethic, diligence, and commitment to undertaking any responsibilities assigned to her. She is deeply passionate about helping and supporting others, making her a compassionate and empathetic individual. Throughout her career, Roxanne has consistently demonstrated a dedication to making a positive impact, whether through her professional work or community involvement, striving to uplift those around her.

Abstract

Effective mental health promotion and prevention of mental disorders is an important social and economic goal. Anxiety disorders, depression, bipolar affective disorder, and schizophrenia are among the most common and burdensome mental disorders globally. One in four adults and one in ten young people suffer from one or more mental health disorders in Europe in any given year, and at least one in two will develop psychological distress during their lifetime. Even if mental health care capacities were to be dramatically increased, it would still be a challenge to reduce these figures. Given this context, efforts to promote good mental health and self-relaxation are gaining increasing importance. Policy-makers and health care provider alike see the potential of digital interventions to address these increasing needs and demands for mental well-being. Social isolation in the wake of COVID-19 has had adverse effects on mental health. Many people have turned to digital interventions to help them cope, often without much evidence on how effective these interventions are among different user groups and under different conditions. Social isolation due to the COVID-19 pandemic has had adverse effects on mental health. In response, many have turned to digital interventions with enthusiasm. Yet, enthusiasm alone is not enough: the individual and contextual factors that infuence the effectiveness of digital mental health interventions need to be better understood.

Introduction

Mental illnesses, including depression, anxiety, and post-traumatic stress disorder (PTSD), are a leading cause of global burden of diseases and economic loss, overshadowing other chronic medical illnesses (Saad et al., 2021). Within any given year, an estimated 26% of US adults, or about 1 in 4 individuals, are suffering from a mental illness. Only half of the people with a mental illness will seek help, and even if they are able to access care for behavioral health conditions, their treatment may not be evidence-based or guideline-concordant.

Therefore, there is growing pressure to find and implement evidence-based ways to combat the mental health crisis. One possible path to such evidence-based and scalable solutions might be through digital interventions, the use of technology to provide therapeutic support for mental illnesses. To provide affordable and accessible mental health interventions, there are several critical steps that stakeholders need to develop (Liu & Zhang, 2024). These solutions should be easy to use, scalable, and built using a bottom-up approach, with insights from the target users. Investigators working in collaboration with young mental health care users to develop user-centered digital tools allows for the expedited development of scalable options.

However, digital systems require incentive-based engagement and often function within complex systems characterised by public and digital architectures with competing goals. Whereas passive interventions, like educational websites, are appealing and non-invasive, but ignorable, while active, non-invasive digital interventions, like a mobile app installed on a user’s personal device, are disruptive and require high user participation. However, this also results in a demand on the user, a barrier to help-seeking, as users often need time to trust the system and assess the potential benefits.

According to the National Health Service almost 1 in 6 people in the last week encounter a common mental health issue like stress, decay, anxiety, or mental ill-health at the workplace. A daily stressor is the major symptom of difficulty in focusing and improving the patient’s well-being. If issues of well-being are not properly dealt early, they could lead to more serious mental health issues. If significant well-being treatment is offered, individuals with common mental health disorders gain from enhanced productivity and improved working and caring performance. Depression, anxiety, and insomnia are essential components of a major depressive disorder (Woodward et al., 2019). Therefore, well-being is not only an optimistic way to measure our life quality but deficiencies in well-being and illness may be a significant problem that creates factors that contribute to significant depressive and anxious problems and is also associated with numerous physical diseases. Nonetheless, it was revealed that training in mindfulness targeting anxiety showed significant changes of satisfaction with life.

The unprecedented challenges of a growing mental health crisis, exemplifed by the COVID-19 pandemic and its association with increases in mental health disorders, propelled the expansion of electronic interventions. These electronic interventions range from web-based and smartphone-based schedules to fully automated digital characters (avatars). Although there are proven efficient interventions and useful therapy delivery modes, these technological interventions have not been broadly implemented due to the demanding technological infrastructure and regular post-development research to guarantee effectiveness, as well as adherence to local mental health care regulations (Mohammed, 2023).

E-mental health interventions may implement methodologies dependent on digital components to identify and monitor mental illness tendencies, to avoid and detoxify emotional distress, to care of present mild psychiatric conditions, to support mental health disorders as a complementary approach to a weaker central therapy, or to avoid decompensating the chronic and acute psychiatric disorders with routine maintenance treatment by the acceptable mix of both digital and face-to-face therapy techniques. Therefore, it is important in this modern era to advance communications with mental health care centers to make modifications in the present psychotherapeutic interventions to develop additional ethnic treatment packages, and also to develop innovative e-therapy systems, with particular emphasis on how to envelop and monitor them in regular health practices and all that efficiently, appropriately, and ethically through the integration of tested, proof based treatment methodologies, in addition to the flexible contribution of new clinical knowledge from every current delivery form, thereby increasing the overall impact (Robinson et al., 2023).

Increasingly, agencies are looking beyond face-to-face singular treatments towards digital solutions. National Health Service (NHS) England have established the ‘Digital First’ initiative, aiming to expand digital services as a cost-effective and inherently patient-centred option for service users to access support (Easton et al., 2021). Since 2016, NHS England has aimed to increase digital services to England, with over 58 services now available. If digital solutions to reduce the demand for face-to-face services are provided centrally, the service may see need fewer appointments. Such interventions may also improve patient-clinician communication, with attractive proposals of eHealth records (EHRs).

Writing Health applications are helping to reshape the way we think about mental health treatment (Woodward et al., 2019). A change in patient expectation and the promotion of self-management in health services is tangible evidence of the effect of not only interventions in mental healthcare, but also digital and mobile technologies that have a major part to play in promoting mental well-being and accessing interventions (A. J. De Witte et al., 2021). Mobile technologies have been identified as superior for delivering such treatment or interventions for many reasons. The results from this review will be able to help users choose an effective smartphone application to improve their psychological health according to the systematic evaluation of free and fee-based smartphone applications (Santhanam et al., 2023). The issues of needing external development funding and content updating were evaluated as suboptimal. Even multiform interventions to create less professional dependence on one of the counter participants in the user-interview process were indicated. For an advanced updating of counteractive smartphone applications in an ethical and moral manner, researchers should collaborate closely with development and production units. Mobile mental health apps have seen rapid and robust development, shaping the epidemiology of mental health services (Koh et al., 2022). The increasing prevalence of mental health produces a challenging and diversified usage of such mobile applications, which need to be continuously reviewed. This study aimed to systematically review and rate smartphone applications to reduce alcohol consumption and depressive symptoms among youth (Magwood et al., 2022). The umbrella review was conducted using several databases, such as PubMed, ScienceDirect, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar. Keywords in the umbrella review were: (1) mobile apps, (2) youth, (3) depression, (4) alcohol addiction, (5) randomized controlled trials or quasi-experimental trials, and (6) pre-post comparison studies.

The quality of the included studies in the umbrella review was assessed using relevant tools for systematic reviews and meta-analyses of randomized controlled studies, and the results were presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Literature Review

Third Generation Cognitive Behavioral Therapy (CBT) has garnered empirical support in treating various mental health concerns with good effect sizes. Thus, third generation CBT is regarded as the state-of the-art psychological therapy. When applying third wave CBT models, very few researchers or therapists use manualized third wave CBT treatments, in contrast to manualized CBT.

This suggests that a more adaptive, flexible, and holistic approach to understanding what specific persons want a change in is needed. Third wave CBT focuses on understanding mental challenges with a more functional perspective, emphasizing factors such as personal values, and targets experiential avoidance and psychological inflexibility in addition to matching selected strategies to actual functions of the specific mental challenge. Hence, the future of personalized third wave CBT can potentially be digital and machine learning can be used to achieve psychological personalized treatments, according to the user’s profile (Zhao et al., 2024).

Most people experience mental health challenges at some point in their lives. Modern challenges, including COVID-19, have made the demand for effective and scalable digital mental health interventions ever more salient (Somani, P., 2020). The shift to remote mental health care has accelerated the development of innovative digital mental health interventions, including those that harness machine learning techniques.

However, for these interventions to be effective, they must be grounded in a deep understanding of psychological processes and evidence-based therapies. The tension between the potential flexibility of digital interventions and the need for clear and standardized interventions from a clinical perspective will be discussed (Sage Chen et al., 2022). Digital mental health interventions have the potential to transformatively improve mental health care in ways that are likely to be unprecedented. This new and emerging field of mental health interventions primarily involves providing mental health services or self-help services via web portals, online counselling, secure e-mailing, video calls, chat rooms, health-related apps, or automated text messages. Sometimes, monitoring or interventions can be integrated in mobile interventions. Other intervention forms can contain augmented or virtual reality. Advanced interventions include decision and prediction functionalities. Digital mental health interventions can be preventive or therapeutic. They can range from education and promotion to destinations such as crisis intervention and assessment and therapy services. These therapies can represent different schools of psychotherapy, including cognitive-behavioral therapy, dialectic behavior therapy and mindfulness-based interventions. Moreover, therapies can be provided by different stakeholders such as health care professionals and clinicians to digital agents based on different machine-learning approaches. Virtually any mental disorder or symptom can be the target and any form of digitally mediated interaction between people or digital artifacts related to mental health are eligible. Topos of digital mental health interventions can span mental health literacy, wellbeing and self-help, psychoeducation, preventing, diagnosis, therapy and monitoring or assessment (Jadhakhan et al., 2022).

Mental health conditions are among the most common and widespread morbidities worldwide (Mohammed, 2023). Digital mental health services, provided through the use of mobile technologies or media, have gained increased attention and momentum in mental health care contexts, leading to significant changes in the therapeutic landscape. Mental health conditions have been long associated with social and economic costs. Further, these morbidities are associated with a higher risk of comorbidities or chronic health conditions. Moreover, with the COVID-19 pandemic, rates of mental health illness and psychological distress might have increased exponentially. It is therefore critical for societies to invest in strategies that prevent mental health conditions or reduce their effects. Researchers studying the mental health of people with chronic diseases have reported that people with a chronic disease have twice the risk of depression compared with the general population. Given that mental conditions might have a bidirectional association with physical conditions, preventing or managing mental health conditions early-on could support the prevention, amelioration or management of chronic health conditions as well. This prevention and early intervention might help in reducing wider societal implications throughout the lifespan of individuals.

Results and Discussion

Digital health care interventions such as smart phone -based apps aimed at mental health promotion are widely used, few systematic reviews have been published providing an overview of what is available. However, recently published work, primarily focused on low-cost mobile apps and web-based platforms, has nonetheless identified advancements in this area. Smartphone applications (apps) have been developed, for example, to monitor and treat mood disorders such as depression. These apps have been shown to significantly reduce self-reported depression symptoms. Limitations include the relatively small number of mental health disorders targeted by available apps and approaches mainly anchored in the principles of cognitive-behavioral therapy.

In another systematic review, Firth et al (2017) identified a substantial gap in apps tailored to address mental well-being proactively as opposed to providing treatment for existing symptoms. Notwithstanding these limitations, digital selfhelp interventions are recognized as having great potential for scalability and cost-effectiveness for population-level public mental health. Such adaptive digital health inter3. Results and Discussion venations suitable for broad mental well-being promotion are essential in the current scenario. Rooted in optimal human-computer interaction, they can provide real-time objective measures and timely, personalized support to the user for different contexts. There is ongoing scaling-up of the development of digital apps from a passive monitoring role primarily in the mental health/illness places to also include those that aim at addressing mental well-being and relaxation through reminders and live sessions in nonclinical and nonstandard settings (Saleem et al., 2021).

A number of digital interventions including smartphone applications (apps), wearable devices, and web-based platforms have been developed to address mental health challenges. Substantial progress has been made in the development and evaluation of digital interventions to provide real-time support, monitor symptoms, promote relaxation and enhance mindfulness (Woodward et al., 2019). The use of digital technologies for psychological interventions has been discussed extensively. In a systematic review by Firth et al (2017), apps targeting depression and/or anxiety showed greater effect sizes at postintervention than those targeting mental well-being. In a 2017 meta-analysis of 18 studies involving university students, Carey et al found a significant effect size (g=.25) for psychological intervention with mobile apps relative to waiting list control. Digital interventions for mental health include a wide range of technologies—mobile devices and wearable devices—and methods for monitoring and enhancing mental well-being such as gaming and 3D visualisation. Technologies are available for real-time monitoring of well-being with multiple indices (eg, psychophysiological, movement, and movement patterns), positive feedback, and automated (‘smart’) guidance. Smartphone and wearable devices make the collection of physiological data cost-effective and convenient. Figure 1 highlights a summary of the most popular mental health apps on the Google Play Store compared to Wellmind, an app developed by the NHS.

A growing area of research called “digital health” is aimed at understanding how technology and digital tools can be used to improve health outcomes in patients with a variety of diseases. For example, a recent review identified a reliance on stand-alone products rather than ecosystem integration (i.e., how an app contributes to the broader collection of mental health tools), proprietary systems (i.e., apps and digital health products created by one company rather than supporting interoperability with other tools), and an underrepresentation of apps focused on anxiety (Romael Haque & Rubya, 2022). If users do not continue to engage with interventions (i.e., repeated use or longer usage periods), it is unlikely that outcomes will be achieved. Several psychological theories have been developed to explain the process of why individuals continue to engage with systems and how to influence them. Digital interventions for mental health promotion continue to increase in prevalence as a way to overcome several of the barriers to mental health care (e.g., lack of resources, physical and social accessibility; (Fonseca Zuccolo et al., 2021)). Moreover, digital interventions offer completions in an innovative way that can include more tailored and real-time support. However, user engagement with digital interventions for mental health continues to be a challenge. Engaging and retaining users alternate digital interventions can promote the utilization of services, and potentially improve health outcomes and well-being ( (Saleem et al., 2021)).

Supportive strategies like reminders, gamification, and push notifications have been successful in increasing engagement with digital interventions. A digital mental health intervention that enhanced their implementation of key engagement components was able to increase the number of completed activities by over 20% compared to their standard implementation.

Proposed strategies will need to be assessed further in empirical studies in order to evaluate the benefits and risks associated with different engagement strategies.

Conclusion

Capturing the voices of service beneficiaries is crucial to developing and improving mental health services. Many service users have now experienced the recent digital turn in mental health; less is known about their experiences and needs. This study aimed to understand service users’ attitudes and experiences of accessing and engaging with digital mental health interventions, comparing these with their experiences of traditional face-to-face services. A meta-ethnographic synthesis was conducted of qualitative research comparing service users’ experiences of accessing digital interventions and traditional face-to-face mental healthcare. Included studies were those published in English about digital mental health interventions and their effectiveness on common mental disorders (CMD) in primary care. Outcomes were changes in mental health symptom severity and experts’ perspectives on implementation of digital mental health interventions. Metadata and a quality assessment of the quantitative studies were conducted. 14 quantitative studies were included with data (n > 1000). Interventions were seen as acceptable. Effects were suggested to be dependent on course and symptom severity. Digital mental health interventions require tailored, ethical and evidence-based implementation. Utilization of digital health should be naïve and encouraged to benefit people.

The COVID-19 pandemic has been particularly threatening for the mental health of many people, with increased levels of mental distress and spiking mental health problems in certain populations (Mohammed, 2023) (Hanf et al., 2021). This situation has given a push for the development and implementation of (digital) (preventive) mental health care. Although digital interventions can bring many benefits in facilitating timely, personalized and remote support, we must be aware of potential negative side effects of digital mental health solutions.

This editorial reflects on the experiences of digital mental health interventions in the first year of the COVID-19 pandemic, mainly from ongoing research programs in Specialized Mental Health Care in Dutch treatment programs. In these digital interventions we address both people with and without current mental health problems. Furthermore, digital mental health interventions are integrated in routine mental health care programs. From these experiences, we have learned a few lessons, and make recommendations to guide future implementation and development of digital mental health interventions beyond this COVID-19 period. With these recommendations we aim at avoiding stigmatization and dismantling barriers to equitable and ethical digital mental interventions. And in this way maximizing the effectiveness and applicability of digital mental health interventions for everybody.

Artifcial Intelligence therapies have been shown to have a positive impact on depression and anxiety. Wearable devices have the potential to collect continuous cardio data in the real world, which can be integrated with momentary self-report data and ecological momentary assessments for more fine-grained tailoring of (intervention) components. Most literature addressing mental health and technology is very clinical: we question whether technological solutions have to be large-scale and institutionalized, or can there be sand-boxed (prototype) or community-based solutions next to larger platforms. We would advocate that in technological design, for every problem, about as many types of solutions can also exist. The importance of having a variety of technological solutions could be to accommodate (in)formality, but also a one-size-fts-all approach may not work for all users different populations, age groups. Technological challenges in creating digital interventions for mental well-being (Gu et al., 2019). Digital and mobile interventions have demonstrated success with respect to a range of app-based and web-based interventions, others have looked at text message interventions or other types of digital interventions like sensors and smart devices. The efficacy of such interventions is also shown to depend on different factors, and understanding which digital interventions or settings are most successful is important to disseminate successful interventions.

References

A. J. De Witte, N., Joris, S., Van Assche, E., & Van Daele, T. (2021). Technological and Digital Interventions for Mental Health and Wellbeing: An Overview of Systematic Reviews. ncbi.nlm.nih.gov

Blease, C., Locher, C., Leon-Carlyle, M., & Murali Doraiswamy, P. (2019). Artifcial Intelligence and the Future of Psychiatry: Qualitative Findings from a Global Physician Survey. [PDF]

Easton, K., Kellett, S., Cooper, M., Millings, A., Varela, J., & Parry, G. (2021). Blending Cognitive Analytic Therapy With a Digital Support Tool: Mixed Methods Study Involving a User-Centered Design of a Prototype App. ncbi.nlm.nih.gov

Fonseca Zuccolo, P., O. Xavier, M., Matijasevich, A., Polanczyk, G., & Fatori, D. (2021). A smartphone-assisted brief online cognitive-behavioral intervention for pregnant women with depression: a study protocol of a randomized controlled trial. ncbi.nlm.nih.gov

Gu, J., Du, C., & Zuo, W. (2019). Galactic Stellar Populations from Photometric Metallicity Distribution Functions. [PDF]

Hanf, M., Hirt, J., & van den Akker, M. (2021). Primary care professionals’ attitudes towards digital health interventions for common mental disorders: study protocol for a mixed methods systematic review. ncbi.nlm.nih.gov

Jadhakhan, F., Blake, H., Hett, D., & Marwaha, S. (2022). Effcacy of digital technologies aimed at enhancing emotion regulation skills: Literature review. ncbi.nlm.nih.gov

Koh, J., Y. Q. Tng, G., & Hartanto, A. (2022). Potential and Pitfalls of Mobile Mental Health Apps in Traditional Treatment: An Umbrella Review. ncbi.nlm. nih.gov

Liu, J. & Zhang, Y. (2024). Understanding and Facilitating Mental Health Help-Seeking of Young Adults: A Socio-technical Ecosystem Framework. [PDF]

Magwood, O., Saad, A., Ranger, D., Volpini, K., Rukikamirera, F., Haridas, R., Sayf, S., Alexander, J., Tan, Y., Petkovic, J., & Pottie, K. (2022). PROTOCOL: Mobile apps to reduce depressive symptoms and alcohol use in youth: A systematic review and meta‐analysis. ncbi.nlm.nih.gov

Mohammed, H. (2023). Technology in Association With Mental Health: Meta-ethnography. [PDF]

Robinson, N., Connolly, J., Suddrey, G., & J. Kavanagh, D. (2023). A Brief Wellbeing Training Session Delivered by a Humanoid Social Robot: A Pilot Randomized Controlled Trial. [PDF]

Romael Haque, M. D. & Rubya, S. (2022). For an App Supposed to Make Its Users Feel Better, It Sure is a Joke — An Analysis of User Reviews of Mobile Mental Health Applications. [PDF]

Rukn al-Din, R. (2020).Advancing psychosocial measures for COVID-19 affected populations: Perspectives on digital health interventions promoting health equity. osf.io

Saad, A., Bruno, D., Camara, B., D’Agostino, J., & Bolea-Alamanac, B. (2021). Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review. ncbi. nlm.nih.gov

Sage Chen, Z., Prathamesh, undefned, Kulkarni, undefned, R. Galatzer-Levy, I., Bigio, B., Nasca, C., & Zhang, Y. (2022). Modern Views of Machine Learning for Precision Psychiatry. [PDF]

Saleem, M., Kühne, L., Karolina De Santis, K., Christianson, L., Brand, T., & Busse, H. (2021). Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review. ncbi. nlm.nih.gov

Santhanam, S., P, K., MS, B., & Kumar Rajagopal, M. (2023). Amity — A Hybrid Mental Health Application. [PDF]

Somani, P. (2020). The Impact of COVID-19 on Human Psychology. In B. S. Lal, & N. Patel, Economics of Covid-19 Digital Health Education & Psychology (pp. 328-357). New Delhi: Adhyayan Publishers & Distributors.

Villarreal-Zegarra, D., A Alarcon-Ruiz, C., Melendez-Torres, G. J., Torres-Puente, R., Navarro-Flores, A., Cavero, V., Ambrosio-Melgarejo, J., Rojas-Vargas, J., Almeida, G.,

Albitres-Flores, L., B Romero-Cabrera, A., & Huarcaya-Victoria, J. (2022). Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews. ncbi.nlm. nih.gov

Woodward, K., Kanjo, E., & Brown, D. (2019). Challenges of Designing and Developing Tangible Interfaces for Mental Well-being. [PDF]

Woodward, K., Kanjo, E., Brown, D., M. McGinnity, T., Inkster, B., J Macintyre, D., & Tsanas, A. (2019). Beyond Mobile Apps: A Survey of Technologies for Mental Well-being. [PDF]

Zhao, Y., Li, T., & Sobolev, M. (2024). Digital Wellbeing Redefned: Toward User-Centric Approach for Positive Social Media Engagement. [PDF]