Internet- and mobile-based anxiety and depression interventions for children and adolescents: efficacy and negative effects - a systematic review and meta-analysis

Mental disorders, most commonly anxiety disorders and fourth most commondepression, are prevalent in children and adolescents. Internet- and mobile-basedinterventions might represent a scalable approach to improve mental health care,however, evidence so far is inconclusive and systematic reports on negative effectsare missing. Four data-bases were searched for randomized controlled trialsevaluating internet- and mobile-based interventions (IMIs) targeting anxietydisorders or depression in children and adolescents up to 18 years exhibitingclinically relevant symptoms. Meta-analytic evaluations were conducted in comparisonto active and passive control groups, furthermore, pre-defined sub-groups wereexplored and reported negative effects examined. Pooled estimates showed a moderatepositive effect for IMIs targeting anxiety disorders compared to passive controlgroups (g = -0.69; CI -0.94 to -0.45; k = 8; n = 559; p ≤ 0,001), but not for depression. Pooledestimates compared to active control groups remained non-significant. Subgroupanalyses were largely omitted due to an insufficient number of trials or werenon-significant. Negative effects were mainly reported as drop-out rates and(non)-response rates, while additional negative effects, such as deterioration ratesor the development of additional symptoms, were reported by only one third ofincluded studies. The focus on children and adolescents with clinically relevantsymptoms allowed the present findings to complement previous work, however, thelimited amount of trials hindered many planned comparisons. The overview of reportednegative effects highlighted that negative effects are being neglected in themajority of RCTs. Hence, in the future RCTs should include more information aboutpotential negative effects, at best a combination of quantitative and qualitativeinformation. Open Science Framework (osf.io/ch5nj).