key: cord-0760270-6scugy1r
authors: Dewa, Lindsay H; Lawrance, Emma; Roberts, Lily; Brooks-Hall, Ellie; Ashrafian, Hutan; Fontana, Gianluca; Aylin, Paul
title: Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis
date: 2021-12-17
journal: J Med Internet Res
DOI: 10.2196/26584
sha: 4b821026126890c114891137debecade873fe678
doc_id: 760270
cord_uid: 6scugy1r

BACKGROUND: Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. OBJECTIVE: The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. METHODS: A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. RESULTS: Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (–25.6%, 95% CI –0.352 to –0.160; P<.001) and anxiety (–15.1%, 95% CI –0.251 to –0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. CONCLUSIONS: D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.

Of six main themes identified that were important features of the apps, one was social connection, another personalisation. Some valued anonymity, while others worried that some users would use anonymity to be hurtful on forums. Some concerns that forums would need to be highly moderated to avoid harm. Benefits of peer support included knowing others are sharing the same issues as you. Some expressed concern that apps could be used as a crutch, and people use them to avoid face-to-face contact with people. Horgan 6/8 in SAD group felt satisfied that the intervention helped them feel closer to others, and in the non-SAD group 9/11 felt this way. For the non-SAD group,S-SIAS and CES-D scores decreased from baseline (M(SD) 29.18(7.85) and 11.55(7.10) respectively) to postintervention (21.64(14) and 8.45(7.37) respectively) and 3 months post intervention (22(11.96) and 8.45(6.93) respectively). For the SAD group. S-SIAS scores decreased in a linear trend from baseline (43.22(7.56)) to 3 months postintervention (34.89(13.8)), however, CES-D scores decreased from baseline (21.89(7.75)) to posttreatment (14(5.51)), but scores regressed toward baseline at 3months post-intervention (15.56(8.88)). 

Mechanism(s): Conjunct face-to-face support Measure(s): SSS, VSSS

BDI-II Beck's Depression Inventory II, BFNE Brief Fear of Negative Evaluation

Perceptions of a mobile home-based Peer Support, MSPSS Multidimensional Scale of Perceived Social Support, NMMSP Networked Minds Measure of Social Presence, NRI Network of Relationships Inventory, OSSS Online Social Support Scale, PANAS Positive And Negative Affect Scale, PHQ-9 Patient Health Questionnaire Depression Scale, PSEI Peer Support Evaluation Inventory, PSSS Perceived Social Support Scale, RCMAS Revised Children's Manifest Anxiety Scale, RCT Randomised Controlled Trial, SAM Self-Assessment Manikin, SASC-R Social Anxiety Scale for Children-Revised, SCAS Spence Children's Anxiety Scale SCS Self-Compassion Scales