Digital Mental Health Interventions For Disadvantaged Families

Cobb, C. L. (2023). Mental health and disadvantaged youth: Empowering parents as interventionists through technology. American Psychologist, 78(8), 927–940. https://doi.org/10.1037/amp0001156

Key Points

1. Mental health issues among youth, especially disadvantaged youth, are increasing. Factors like discrimination, socioeconomic status, adverse childhood experiences, and structural barriers contribute to mental health disparities.
2. Parents play a critical role in youth mental health as interventionists, but many barriers impede access to parent training for disadvantaged families. These barriers occur at the individual (e.g., mental illness), family (e.g., attitudes), and structural levels (e.g., cost, location).
3. Digital mental health interventions (DMHIs) like apps and online training show promise for reaching disadvantaged families, but more culturally sensitive DMHIs are needed that focus specifically on training parents as interventionists.
4. To advance this work, scholars should prioritize health equity, strengthen the evidence base, increase cultural sensitivity, and engage communities in co-designing interventions.

Rationale

Youth mental health is worsening, especially among disadvantaged populations, but these groups underutilize services (United States Surgeon General, 2021).

Health disparities will likely widen without improving access to evidence-based treatments (Cobb, 2022).

Parents are well-positioned to intervene in youth mental health, but disadvantaged families experience barriers to parent training (Reardon et al., 2017).

DMHIs reduce common barriers to care and show potential for disadvantaged groups, but more research is needed (Ellis et al., 2022; Schueller et al., 2019).

Training parents from disadvantaged backgrounds through DMHIs may help curb persistent mental health disparities.

Method

This narrative review synthesizes recent epidemiological, meta-analytic, experimental, and longitudinal studies on youth mental health disparities and the potential for DMHIs to train disadvantaged parents as interventionists.

Sample

The review encompassed empirical studies and national surveys focused primarily on disadvantaged youth mental health and parent training interventions.

Statistical analysis

The author synthesized descriptive statistics from epidemiological studies and effect sizes from meta-analyses.

Results

• Prevalence of internalizing disorders among U.S. youth doubled from 2005-2015, with faster increases among adolescent girls (Weinberger et al., 2018).
• Suicide rates increased 57% among adolescents from 2007-2018 (Curtin, 2020).
• Disadvantaged youth show greater prevalence and poorer outcomes for multiple mental health issues compared to advantaged groups (CDC, 2022; Merikangas et al., 2010).
• Barriers like discrimination, adverse childhood experiences, neighborhood conditions, and restrictive policies contribute to disparities (Alegría et al., 2015).
• Disadvantaged youth underutilize treatments despite high need (Cook et al., 2017). Barriers include stigma, attitudes, cost, and location (Moore, 2018; Reardon et al., 2017).
• Parents are well-positioned as interventionists (Reardon et al., 2017), but disadvantaged parents lack access to training (Moore, 2018).
• DMHIs show efficacy for reducing youth problem behaviors and internalizing symptoms (Bausback & Bunge, 2021; Khanna et al., 2017).
• Preliminary studies support DMHIs for disadvantaged families (Armaou et al., 2020), but more research is needed (Schueller et al., 2019).

Insight

This review offers valuable perspectives on worsening youth mental health disparities and how parent-focused DMHIs could provide disadvantaged families with vital intervention skills.

The author makes a compelling case that training parents through DMHIs is a promising approach if done thoughtfully.

The synthesis of epidemiological, experimental, and demographic data paints a sobering picture of the youth mental health crisis and underscores the urgent need for progress in this area.

Strengths

• Synthesized broad literature to highlight a critical gap at the intersection of parent training and digital interventions for the disadvantaged.
• Reviewed multiple types of studies (e.g. surveys, meta-analyses, trials) for a comprehensive perspective.
• Discussed specific factors contributing to disparities across levels of the social ecology.
• Outlined clear rationale linking poor outcomes among disadvantaged youth to parent intervention potential.

Limitations

• The scope was limited to the U.S. context. Findings may differ in other nations.
• As a narrative review, subjective bias in study selection is possible.
• Study samples were often not reported or lacked diversity. Generalizability is uncertain.
• There remains a dearth of research on culturally adapted DMHIs for disadvantaged parents.

Implications

• Tailored DMHIs for training disadvantaged parents could expand access to vital intervention skills otherwise unlikely received.
• Taking a social justice approach is critical so innovations benefit those with greatest mental health need.
• Capitalizing on parents’ untapped potential could mitigate poor trajectories linked to unresolved mental health issues.
• Success requires carefully designed DMHIs that account for unique cultural assets and barriers faced by target groups.

Conclusion

Youths’ worsening mental health demands urgent action, especially for disadvantaged groups who continue to be left behind.

This review spotlighted the promise of harnessing parents’ intervention potential through DMHIs.

Realizing this promise requires ongoing collaboration with communities to co-design appropriate, evidence-based DMHIs.

Then parents can become empowered to curb mental health disparities from inside the home. While sensitive cultural tailoring is needed, the premise of supporting disadvantaged families through DMHIs aligns with ethical imperatives for diversity, inclusion, and justice.

References

Alegría, M., Green, J. G., McLaughlin, K. A., & Loder, S. (2015). Disparities in child and adolescent mental health and mental health services in the US. William T. Grant Foundation.

Bausback, K., & Bunge, E. L. (2021). Meta-analysis of parent training programs utilizing behavior intervention technologies. Social Sciences, 10(10), 367. https://doi.org/10.3390/socsci10100367

Centers for Disease Control and Prevention. (2022). Youth risk behavior survey, 2009-2019. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-508.pdf

Cobb, C. L. (2022). Editorial perspective: Reducing mental health disparities among underserved youth: Using technology to equip parents as agents of change. Journal of Child Psychology and Psychiatry and Allied Disciplines, 64(3), 480-483. https://doi.org/10.1111/jcpp.13703

Cook, B. L., Trinh, N.-H., Li, Z., Hou, S. S., & Progovac, A. M. (2017). Trends in racial-ethnic disparities in access to mental health care, 2004-2012. Psychiatric Services, 68(1), 9–16. https://doi.org/10.1176/appi.ps.201500453

Curtin, S. C. (2020). State suicide rates among adolescents and young adults aged 10-24: United States, 2000-2018. National Vital Statistics Reports, 69(11), 1-10.

Ellis, D. M., Draheim, A. A., & Anderson, P. L. (2022). Culturally adapted digital mental health interventions for ethnic/racial minorities: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 90(10), 717–733. https://doi.org/10.1037/ccp0000759

Khanna, M. S., Carper, M. M., Harris, M. S., & Kendall, P. C. (2017). Web-based parent-training for parents of youth with impairment from anxiety. Evidence-Based Practice in Child and Adolescent Mental Health, 2(1), 43-53. https://doi.org/10.1080/23794925.2017.1283548

Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017

Moore, K. L. (2018). Mental health service engagement among underserved minority adolescents and young adults: A systematic review. Journal of Racial and Ethnic Health Disparities, 5(5), 1063-1076. https://doi.org/10.1007/s40615-017-0455-9

Reardon, T., Harvey, K., Baranowska, M., O’Brien, D., Smith, L., & Creswell, C. (2017). What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. European Child & Adolescent Psychiatry, 26(6), 623–647. https://doi.org/10.1007/s00787-016-0930-6

Schueller, S. M., Hunter, J. F., Figueroa, C., & Aguilera, A. (2019). Use of digital mental health for marginalized and underserved populations. Current Treatment Options in Psychiatry, 6(3), 243–255. https://doi.org/10.1007/s40501-019-00181-z

United States Surgeon General. (2021). Protecting youth mental health: The U.S. Surgeon General’s advisory. https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

Weinberger, A. H., Gbedemah, M., Martinez, A. M., Nash, D., Galea, S., & Goodwin, R. D. (2018). Trends in depression prevalence in the USA from 2005 to 2015: Widening disparities in vulnerable groups. Psychological Medicine, 48(8), 1308-1315. https://doi.org/10.1017/S0033291717002781

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