Digital Tools Can Support Young People’s Mental Well-Being – but Human Contact Still Matters
Key Takeaways:
- A York University-led review of 57 studies and more than 40,000 participants finds digital tools can improve young people’s emotional, behavioural, social and cognitive well-being.
- Hybrid models, pairing digital delivery with in-person contact, were the most consistently effective, with benefits sustained at follow-up.
- The evidence base has serious gaps: children from marginalised communities and those aged 0 to 4 are strikingly underrepresented.
Why this review matters
Children and young people are growing up with rising mental health challenges in an increasingly digital world, and those from marginalised communities carry a disproportionate share of that burden. Digital mental health tools have been promoted for years as a way to close the gap, on the assumption that anything delivered through a screen can reach further, faster and more cheaply than traditional services. Until now, the evidence for universal digital and hybrid interventions had never been pulled together and appraised as a whole.
A new landmark systematic review and meta-analysis led by researchers at York University changes that. Examining the effectiveness of universal digital mental health interventions, the study finds that digital tools can positively influence young people’s emotional, behavioural, social and cognitive well-being. The study is currently available online.
What the review examined
The review synthesised 57 peer-reviewed research articles and included data from more than 40,000 participants worldwide. Rather than focusing on interventions aimed at children and young people already identified as needing clinical support, it looked specifically at universal interventions, that is, those offered to whole populations regardless of individual risk. That distinction matters for anyone planning services at scale, because universal provision is where digital delivery is most often proposed as a solution.
The research was led by York University Faculty of Health Professor Rebecca Pillai Riddell, a nationally recognised expert in clinical psychology, alongside York postdoctoral fellow Kaitlin Di Pierdomenico.
“This study is the first of its kind to synthesize universal digital and hybrid interventions for child and youth mental health,” says Pillai Riddell. “It’s clear that digital tools must be embraced but only if we implement them thoughtfully, equitably, and with real-world contexts in mind. We need to invest in research that includes the children most often left behind.”
Hybrid delivery outperformed fully digital approaches
The clearest signal in the analysis was that hybrid models, those that combine digital delivery with some in-person engagement, emerged as the most consistently effective approach. Moderate-certainty evidence supported sustained benefits across multiple psychological domains at follow-up, meaning the gains did not simply disappear once the intervention ended.
This finding pushes back against the assumption that a fully virtual programme is a straightforward substitute for one delivered face to face. The technology appears to work best when it is wrapped around human contact rather than used to replace it.
“This work looked at whether digital mental health tools help, under what conditions, and whose data we actually have,” says Di Pierdomenico. “Hybrid approaches, pairing digital tools with in-person structure, held up better over time than fully virtual ones. We also found real gaps, including underreporting of participant demographics and limited inclusion of younger children and marginalized populations, that matter so universal tools are developed to actually reach all children and youth.”
Benefits across four psychological domains
The analysis revealed significant improvements across emotional, behavioural, social and cognitive psychological domains. Effects were most consistent and most sustainable when digital tools were embedded in supportive, structured settings such as schools.
The implication for commissioners and practitioners is that the delivery context is not incidental to the outcome. A well-designed app or online programme placed into an environment with adults who can prompt, reinforce and follow up appears to perform differently from the same tool handed to a young person to use alone.
That emphasis on structured human contact places renewed weight on the interpersonal skills practitioners bring to digitally supported care. It is the ground covered by CCH’s Behaviour Change Skills – Complete Package, a set of three online CPD short courses in person-centred communication, enhancing motivation and applying CBT in practice, worth six CPD hours in total.
Significant gaps in who the evidence represents
Alongside the positive findings, the study highlights a striking underrepresentation of research involving marginalised populations and younger children aged 0 to 4. This raises concerns about equity and inclusion in the current evidence base.
Two problems compound each other here. The first is straightforward absence: if the youngest children and those from marginalised communities are rarely included in trials, there is no reliable basis for claiming that universal tools work for them. The second is underreporting of participant demographics, which makes it difficult even to establish who has and has not been studied. Universal interventions are, by definition, meant to reach everyone, so evidence drawn from a narrow and poorly described sample is a weak foundation for population-wide rollout.
A national partnership behind the research
The York researchers worked with Strong Minds Strong Kids, Psychology Canada (SMSKPC) for the study, a national charity that promotes children’s mental well-being through psychological science.
“Our history has always been about promoting mental health. This research reinforces the urgency to get promotion right – and get it to the children who need it most,” says Anne Lovegrove, President and Executive Director of SMSKPC and a co-author on the study. “We undertook this study not only to inform our own work but to guide the entire sector toward what actually works in a rapidly changing digital landscape.”
The project was also generously supported by philanthropy from the Jackman Foundation, a longtime champion of youth mental health and of SMSKPC and York University.
What this means for practice
For practitioners and service planners, the review offers a more nuanced brief than either uncritical enthusiasm or blanket scepticism about digital mental health. Digital tools have a demonstrable place in supporting young people’s well-being. They appear to work best when paired with in-person structure, embedded in settings that already provide routine and relationships, and supported by adults who can hold the human side of the intervention.
Equally, the gaps identified in the evidence are a caution against assuming that a tool shown to help one group will help another. Extending reach is only meaningful if the children and young people who are currently least well served are actually included, both in the interventions themselves and in the research that evaluates them.
The full study, Universal Digital Mental Health Interventions for Children and Youth: A Systematic Review and Meta-Analysis, is available open access via npj Digital Medicine.
CCH insight
The strongest finding in this review is that digital tools worked best when paired with human contact and structure. That places the quality of practitioner conversations at the centre of digitally supported care.
CCH’s Behaviour Change Skills – Complete Package brings together three online CPD short courses – Person-Centred Communication, Enhancing Motivation, and Applying CBT in Practice – for six CPD UK hours. It is 100% online, self-paced, and accredited by The CPD Certification Service.
Explore Behaviour Change Skills – Complete Package
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How Losing Around 80 Minutes of Sleep a Night Could Drive Weight Gain and Inactivity
Key Takeaways:
- Adults who cut their nightly sleep by about 80 minutes over six weeks gained roughly one pound (around 0.45 kg) on average and became more sedentary, Columbia University researchers found.
- Modest over six weeks, but the team estimates that sustaining this mild sleep loss for a year could cause clinically meaningful weight gain – a pattern affecting around 30% of adults.
- Related work in the same participants linked mild sleep restriction to greater insulin resistance and heart inflammation, pointing to a wider risk of type 2 diabetes and heart disease.
Why modest sleep loss deserves attention
Trimming a little sleep each night may carry more weight for your health than you might realise. Researchers at Columbia University Vagelos College of Physicians and Surgeons found that adults who shortened their nightly sleep by about 80 minutes over a six-week period gained an average of one pound and spent more of their waking hours being inactive.
The findings add to a growing body of evidence suggesting that consistently getting enough sleep may play an important role in preventing weight gain and in lowering the risk of obesity-related disease. Rather than pointing solely to diet and exercise, the results place sleep alongside them as a factor worth taking seriously.
“Our study shows that getting adequate sleep may help reduce the risk of weight gain and obesity-related conditions like heart disease and diabetes,” says Marie-Pierre St-Onge, a professor of nutritional medicine in Columbia’s Department of Medicine and Institute for Human Nutrition and the study leader. “People tend to gain weight over the course of their adulthood, and obesity is a major risk factor for heart disease. But focusing on eating a healthier diet and getting more physical activity to offset weight gain is simplistic and can be difficult to maintain.”
Looking beyond extreme sleep deprivation
Much of the earlier research connecting poor sleep with obesity has centred on severe sleep deprivation, frequently restricting people to as little as four hours of sleep a night. Those studies indicated that extreme sleep loss can heighten appetite and encourage overeating – behaviours that in turn contribute to weight gain.
The difficulty is that such severe restriction is hard for most people to sustain for more than a few days, which limits how far the results can be applied to everyday life. Very few people live with four hours of sleep for weeks at a time, so the relevance of those findings to the wider population has remained uncertain.
“These studies only show us what happens under the most extreme conditions and don’t tell us if mildly sleep-deprived people, like a lot of Americans who get 5 or 6 hours of sleep a night, will gain weight,” St-Onge says.
To reflect real-world habits more closely, the researchers set out to examine the effects of chronic, mild sleep loss – a pattern estimated to affect around 30% of adults.
Six weeks of less sleep led to measurable changes
The study involved 95 adults who typically slept between seven and eight hours each night. During one six-week phase, participants delayed their usual bedtime by 90 minutes, which shortened their nightly sleep. During a separate six-week phase, they kept to their normal sleep schedule, allowing each participant to serve as their own comparison.
Across both phases, participants wore wrist monitors that tracked sleep and physical activity. The researchers also measured body weight, waist circumference, body composition, and fasting levels of several hormones involved in regulating appetite, building a detailed picture of how the body responded to the change.
“While the one-pound weight gain observed with modest sleep curtailment is not overwhelming, it is important to remember this is occurring over just six weeks,” says Faris Zuraikat, assistant professor of nutritional medicine in Columbia’s Department of Medicine and Institute for Human Nutrition and first author of the study. “Our study was designed to mimic sleep patterns that most adults experience chronically. When extrapolated to a full year, we would expect that losing less than an hour and a half of sleep per night could result in clinically meaningful weight gain.”
Less sleep also meant more sitting
Alongside the change in weight, the researchers found that participants became less active during the sleep-restriction phase. On average, sedentary time rose by 17 minutes per day. Among men and postmenopausal women, inactivity climbed by nearly 30 minutes each day.
Notably, this increase in sitting held up even after accounting for the extra waking hours that come with shorter sleep – so the added inactivity was not simply a matter of being awake for longer.
“Even when we accounted for the fact that they were awake longer when sleep was shortened, participants spent more time being inactive than when they got adequate sleep,” Zuraikat says. “This is notable, as people who are more sedentary have elevated risk for chronic diseases.”
Earlier research suggests broader health effects
The same group of participants has featured in several related studies, which together suggest that the consequences of mild sleep loss may extend well beyond weight. In one earlier investigation, women with increased cardiometabolic risk who reduced their sleep by about 80 minutes each night for six weeks developed greater insulin resistance – an important risk factor for type 2 diabetes. The effect was particularly pronounced in postmenopausal women.
A separate study found that men and women with an elevated risk of heart disease developed an influx of inflammatory cells in the heart after undergoing mild sleep restriction, hinting at a possible mechanism linking short sleep to cardiovascular harm.
“Though more research is needed to further understand how sleep restriction leads to weight gain, all of our findings suggest that insufficient sleep increases the risk of obesity-related conditions like type 2 diabetes and heart disease,” St-Onge says.
“Now we need to understand the health effects of improving sleep in those who fail to get adequate sleep on a regular basis.”
About the study
The study, titled “Skimping on Sleep and Its Impact on Body Weight and Composition: A Pooled Analysis of Randomized Trials,” was published on 6 July in Annals of Internal Medicine.
The authors are Faris Zuraikat, Samantha Scaccia, Justin Cochran, Bin Cheng, Keith Diaz, Seth Creasy (University of Colorado), Brooke Aggarwal, Sanja Jelic, and Marie-Pierre St-Onge. The authors report no conflicts of interest.
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Digital Therapy Outperforms Campus Clinic Referrals Among College Students
Key Takeaways:
- College students who received a digitally delivered therapy programme were significantly more likely to engage with treatment than those referred to campus counselling services.
- Students using the digital intervention were more likely to be symptom free at six weeks, six months and two years after the intervention.
- Researchers found the app-based approach not only treated existing mental health disorders but also appeared to help prevent new disorders from developing in students considered at high risk.
A digital alternative to traditional campus counselling
A large U.S. study led by researchers at Penn State has found that college students living with anxiety, depression and eating disorders may benefit more from a digitally delivered therapy programme than from referrals to traditional campus counselling clinics.
Published in Nature Human Behaviour, the study examined whether a proactive digital mental health intervention could improve treatment uptake and mental health outcomes among university students at a time when demand for psychological support services continues to rise sharply.
Researchers noted that between 40% and 60% of college students globally experience a mental health disorder at some stage during their academic life. At the same time, many universities have struggled to expand counselling services quickly enough to meet growing demand.
The research team therefore investigated whether a digitally delivered therapy app based on cognitive behavioural therapy (CBT) principles could provide a scalable and effective alternative to standard referrals for in-person support.
How the digital therapy programme worked
The commercially available app used in the study incorporated CBT-based techniques designed to help individuals identify unhelpful thinking patterns and develop behavioural strategies to manage them.
Students assigned to the digital intervention received access to structured therapeutic modules together with support from trained therapy coaches. The programme offered six to eight modules for each mental health condition, with each module lasting approximately 20 minutes.
Participants in the digital therapy group completed an average of 2.4 modules and received roughly 15 supportive messages from a trained coach during the intervention period.
According to the researchers, students initially focused on modules related to their primary mental health concern before progressing to additional modules targeting co-occurring conditions.
Lead author Michelle Newman, professor of psychology and psychiatry at Penn State, said the team was particularly interested in whether students would meaningfully engage with the digital intervention.
“One of the challenges with any digital intervention is that people sometimes download an app but then do not use it,” said Newman.
“We were also interested in learning the extent to which people actually received services after being randomized to the app or on-campus counseling center. We found that uptake was significantly better in the digital intervention than referral to the counseling center.”
Digital intervention achieved much higher service uptake
One of the clearest findings from the study was the substantial difference in treatment engagement between the two groups.
Researchers found that service uptake was seven times higher among students assigned to the digital intervention compared with those referred to campus counselling centres.
Approximately 74% of participants who received access to the app began the programme. By comparison, only 30% of those referred to university counselling services received at least one therapy session or obtained a new prescription for medication.
The researchers said this suggested that digital interventions may lower some of the practical or psychological barriers that prevent students from accessing conventional mental health support.
Large population-level screening across 26 universities
To conduct the study, researchers partnered with 26 colleges and universities across the United States and used what they described as a population-level recruitment strategy.
Emails inviting participation in a mental health screening were sent to entire student bodies across participating institutions.
A total of 39,194 individuals completed the initial screening. Of these, 6,205 students either had clinical levels of mental health disorders or were identified as being at high risk of developing them.
The disorders assessed included:
- Generalized anxiety disorder
- Panic disorder
- Social anxiety disorder
- Depression
- Eating disorders
Eligible participants then completed a baseline survey before being randomly assigned to one of two groups. One group received six months of access to the coached digital intervention, while the second group received referrals to their campus counselling centres.
Improvements were observed across multiple timepoints
The researchers reported that students using the digital intervention were more likely to be symptom free than students in the campus referral group at every follow-up stage assessed in the study.
Compared with students referred to campus services, participants using the app showed:
- A 4.3% lower prevalence of any mental health disorder at six weeks
- A 4.9% lower prevalence at six months
- A 3.8% lower prevalence at the two-year follow-up
The findings suggested that the digital intervention both treated existing disorders and reduced the likelihood of new disorders emerging over time.
Newman said one distinctive feature of the study was its focus on multiple mental health conditions simultaneously.
“A unique aspect of the work was that we screened for five disorders—generalized anxiety disorder, social anxiety disorder, panic disorder, depression and eating disorders—and measured all disorders at every point in the treatment, because we know that disorders like depression and anxiety often co-occur, but that co-occurrence doesn’t necessarily happen simultaneously,” Newman said.
“The digital intervention overall had a significantly larger number of individuals who had no disorders at every timepoint in the study. We did not just treat individuals with clinical levels of these disorders, but we also prevented the onset in more of those in the digital intervention who screened to be at risk.”
Study conducted during the COVID-19 pandemic
The research took place during the COVID-19 pandemic, with recruitment occurring between October 2019 and November 2021. Data collection was completed by October 2023.
The researchers said the timing highlighted the potential value of digital mental health interventions during periods when access to face-to-face services may be disrupted or limited.
However, Newman suggested the approach could remain valuable well beyond the pandemic and may have applications outside university settings.
“This approach could potentially be used anywhere where you have access to a full population in terms of email addresses, like at a company, to help disseminate mental health services that people might not think about seeking,” she said.
She added that proactive screening could help identify individuals who are both living with mental health disorders and those at high risk of developing them before conditions worsen.
Future research will explore personalised digital mental health support
The next phase of the research will focus on identifying which individuals are most likely to benefit from digital mental health interventions.
Newman said future work, led alongside Penn State graduate student Adam Calderon, will analyse data from the current study and earlier projects conducted by Newman’s laboratory to better understand the personal characteristics that predict successful outcomes with digital therapy approaches.
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Virtual Care Could Reduce Hospital Admissions in Severe Eating Disorders, Study Finds
Key Takeaways:
- A fully virtual, multidisciplinary treatment programme demonstrated strong engagement and positive clinical outcomes for adults living with severe eating disorders
- Structured online support during high-risk transition periods may help reduce hospital admissions and sustain recovery following discharge
- The model highlights the potential for digitally delivered, evidence-based care to bridge gaps between inpatient and community services
Evaluating a new approach to severe eating disorder care
An evaluation conducted by Oxford Health NHS Foundation Trust has examined whether intensive, fully virtual treatment can effectively support people living with severe eating disorders. The study, published in the Journal of Eating Disorders, focused on a service known as Step Care, developed through the HOPE Provider Collaborative.
Researchers describe this as the first prospective study to investigate a completely virtual, intensive treatment model using multidisciplinary enhanced cognitive behavioural therapy (CBT-E). The programme is designed to support individuals as they transition between inpatient treatment and community-based care.
This period of transition is widely recognised as a critical phase in recovery. People living with severe eating disorders face a particularly high risk of relapse shortly after discharge from hospital, especially within the first two months. The study therefore explored whether structured virtual support during this vulnerable period could help maintain recovery and reduce the likelihood of readmission.
Addressing gaps in existing services
Step Care was developed in response to well-documented challenges within eating disorder services. These include fragmented transitions between inpatient and community care, repeated hospital admissions, and limited access to intensive day treatment.
The service is delivered entirely online and brings together a multidisciplinary team, including professionals from psychology, nursing, dietetics, and art therapy. This integrated approach aims to provide consistent and coordinated care across different stages of recovery.
Step Care operates through three distinct pathways:
- Starting Well – for individuals at risk of requiring hospital admission, with a focus on prevention
- Staying Well – for those recently discharged from inpatient care, supporting early recovery
- Working towards Recovery – for individuals who have begun restoring weight and are focusing on longer-term recovery
Lucy Gardner, professional lead dietitian within the Step Care service, highlighted the importance of integrating nutritional support within a broader therapeutic framework:
“Nutrition plays a crucial role in mental health, yet access to the right level of dietetic support is often inconsistent,” she said. “Our model offers a clear, evidence-informed way to tailor dietetic input to individual need, delivering CBT-E virtually as part of a multidisciplinary team.”
Positive outcomes across key measures
The evaluation reported high levels of engagement and programme completion, including among individuals who had been living with eating disorders for an extended period.
Participants within the Starting Well pathway experienced significant improvements across several clinical and psychological measures, including:
- Body mass index (BMI)
- Eating disorder symptoms
- Psychosocial impairment
- Mood
Importantly, most individuals in this group were able to avoid hospital admission during the course of the programme.
For those in the Staying Well pathway, outcomes were also encouraging. Participants maintained their weight and experienced a reduction in the overall impact of their illness during a period typically associated with high relapse risk. Unplanned hospital admissions were reported to be rare, and many individuals were successfully supported in transitioning to community-based care.
Sharon Ryan, nurse lead within the Step Care service, emphasised the importance of this post-discharge phase:
“The weeks after leaving hospital are often the most fragile,” she said. “Step Care provides consistent multi-disciplinary support at that point, helping people maintain their recovery with support to feel safe and confident out of hospital.”
Implications for future care models
The findings suggest that intensive, evidence-based treatment for severe eating disorders can be delivered effectively in a virtual format. This approach may offer a valuable additional option for supporting individuals at home, particularly during critical transition periods.
Agnes Ayton, clinical lead for the HOPE Provider Collaborative, explained the underlying aim of the service:
“Step Care was designed to bridge the gap between inpatient and community services,” she said. “The findings show that intensive, evidence-based treatment can be delivered safely online, providing continuity of care at a time when people are most vulnerable.”
She also noted that both engagement and clinical outcomes were encouraging, including among individuals who had experienced long-term illness.
A complement to existing services
The authors conclude that virtual programmes such as Step Care may serve as an important complement to traditional inpatient and community services. By providing structured, multidisciplinary support during high-risk periods, these models have the potential to enhance continuity of care and support sustained recovery for people living with severe eating disorders.
As healthcare systems continue to explore digital and hybrid models of care, this study adds to a growing body of evidence suggesting that virtual interventions can play a meaningful role in complex, long-term conditions.
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