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.
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People Like AI Mental Health Chatbots. Whether They Help Is Another Question
Key Takeaways:
- Across 21 studies in 11 countries, people using generative AI mental health chatbots reported high satisfaction and found them convenient and accessible.
- Personalisation and empathy did not reliably translate into better clinical outcomes, and engagement often faded over time.
- The evidence base remains early-stage, leaving safety, equity and crisis response unresolved.
A treatment gap that digital tools are being asked to fill
Generative artificial intelligence (GenAI) chatbots designed to support mental health are winning people over on experience, but the research needed to establish whether they are safe and clinically effective has not kept pace. That is the central finding of a review, currently in press in the journal npj Digital Medicine, which examined the user experience (UX) and intervention design of GenAI mental health chatbots.
The context for this work is a substantial and persistent shortfall in care. Around 25% of people worldwide experience a mental health problem, yet approximately 85% do not receive adequate treatment. The reasons are varied and overlapping: stigma, cost, shortages of trained professionals, geographic distance from services and structural inequities, among others. As the prevalence of mental health conditions has grown while treatment gaps have remained, attention has turned towards innovative models of delivery – and digital tools, with their scalability and convenience, have become a focus of that search.
Digital mental health interventions deliver treatment or support through a range of channels, including chatbots, websites, mobile applications and wearables. Conversational agents, more commonly known as chatbots, are applications that simulate human dialogue using machine learning and natural language processing algorithms.
From scripted responses to open-ended conversation
Traditional mental health chatbots deliver pre-scripted therapeutic content through rules-based or retrieval-based systems. Their strength is predictability, but that same design limits their capacity to personalise support or to recognise what an individual actually needs in the moment.
Chatbots built on large language models (LLMs) work differently. They can simulate core aspects of a therapeutic encounter, including personalised suggestions and empathetic reflections. That flexibility comes with a trade-off. GenAI systems may produce responses that are incorrect or inappropriate, and their open-ended conversational capacity makes intervention design both more consequential and more complex than it is for rules-based systems. When a system can say almost anything, design decisions carry considerably more weight.
How the review was carried out
The researchers set out to map the design characteristics and UX outcomes of interventions involving GenAI mental health chatbots. They began with a systematic literature search to identify studies covering the design and deployment of such tools. Reviews, editorials, media articles and commentaries were excluded.
In total, 21 studies were selected, conducted across 11 countries between 2023 and 2025. The largest numbers came from China and the United Kingdom, followed by the United States. The included work spanned a wide range of maturity, from early-stage prototype evaluations through to clinical trials, with one real-world implementation study.
Most studies recruited general or clinical adult populations, including older people living with dementia. Others involved simulated users or university students. Sample sizes ranged from as few as five participants to as many as 527. Across the body of evidence, there was substantial heterogeneity in outcome measures, and most interventions remained at an early stage of development – two features that shape how much can reasonably be concluded from the literature as it stands.
What the interventions were designed to do
Chatbot interventions most often targeted depression and anxiety, and tended to adopt shared therapeutic mechanisms, including mindfulness, emotion regulation and cognitive restructuring. Some systems were oriented towards mental well-being, stress and loneliness, emphasising general support and preventive care rather than treatment for a specific condition. Others addressed eating disorders, post-traumatic stress disorder and dementia.
The dementia-focused interventions are worth distinguishing. Rather than attempting to address the central neurological features of the condition, they targeted its related psychological dimensions – carer burnout, psychological distress and loneliness among them.
Most interventions were grounded in cognitive-behavioural therapy principles. The specific techniques drawn upon included behavioural activation, psychoeducation, Socratic dialogue, acceptance and commitment therapy, cognitive restructuring and mindfulness.
How the tools were delivered
Interventions varied in frequency, delivery modality and duration. The majority were short-term, running from two to eight weeks. Most were deployed through web-based interfaces and mobile applications, while some were delivered via messaging or social media platforms – meeting people on services they already used rather than asking them to adopt something new.
About 67% of interventions were non-embodied, text-based chatbots. The remainder used voice, avatar-based, augmented reality or other multimodal forms of interaction, with the intention of improving engagement and realism.
What people made of them
All but two of the studies evaluated at least one UX domain. The majority relied on quantitative measures, typically Likert scales, while some gathered qualitative feedback through open-ended questions and semi-structured interviews.
User satisfaction and acceptability were the most commonly reported outcomes. Across studies, participants described the interventions as convenient and accessible, with acceptability generally rated moderate-to-high and reported satisfaction high.
Half of the studies examined usability, using qualitative feedback, the System Usability Scale or Likert scales. Interface design, interaction mode and deployment platform were all observed, alongside differences in usability between studies. A clear preference emerged for free-flowing chat interfaces and customisable features over predefined options. At the same time, some interventions had an unclear scope or limited functionality, leaving people uncertain about what the chatbot could actually do for them.
Usability, engagement and the drop-off problem
Only some studies reported objective utilisation and engagement metrics, such as session frequency, interaction duration, retention over time and task completion. Where these were captured, attrition patterns frequently emerged over time in repeated-measures designs. Uptake in multi-week interventions was often high at the outset before declining – a pattern familiar across digital health more broadly, and one that matters a great deal for interventions whose therapeutic logic depends on sustained practice.
Personalisation and perceived benefit
Most chatbots featured some form of personalisation, reflecting their capacity to adapt conversations and interfaces in response to previous interactions and a person’s emotional state. The most common approach was emotion detection paired with adaptive interaction, allowing people to receive tailored responses and empathetic reflections.
Perceived impact was not consistently measured as a standalone metric. It was more usually folded into qualitative feedback or broader UX evaluations. In the intervention that produced the most granular data, the most frequently reported benefit was improved clarity and awareness.
Where empathy stops being enough
The review’s more cautionary finding is that personalisation and empathy did not consistently translate into stronger clinical outcomes or sustained use. Feeling supported and being helped are not the same thing, and the studies reviewed do not yet demonstrate a reliable link between the two.
Some people reported responses that were repetitive, generic or contextually misaligned. Others raised concerns about over-reliance on chatbots, reduced human contact, data privacy and whether these systems can respond appropriately when someone is in crisis. Inaccurate or clinically misaligned outputs were also linked to an erosion of trust and to disengagement in several studies.
For healthcare professionals, the practical question is less whether these tools have promise than how to appraise them – knowing what a given system is grounded in, where its limits sit and when a conversation needs to move to a human. That judgement is increasingly treated as a core clinical competency, and it sits at the centre of CPD training on the everyday, ethical use of AI in practice.
Design features linked to a better experience
The authors identified several design features associated with better UX outcomes, while being careful to note that these were associations rather than demonstrated causes. They included:
- Deployment on platforms people already knew and used
- Richer interaction modalities beyond plain text
- Integration into existing care pathways
- Personalisation
- Grounding in domain knowledge
- Structured delivery
- Proactive outreach
- Co-design with both experts and end users
The predominance of early-stage studies, combined with limited direct comparative analyses, prevented firm conclusions about which of these features genuinely improved user experience.
What needs to happen next
Taken together, the review suggests that GenAI chatbots have meaningful potential to deliver tailored, empathetic mental health support, and that their acceptability among the people who use them is promising. That is a real finding, and not a small one given the scale of unmet need.
Significant challenges remain, however. Standardising how UX is assessed, grounding intervention design in the needs and preferences of the people who will use these tools, and sustaining engagement beyond the first few weeks all stand out as unresolved. Addressing them, the authors argue, will require co-design with experts and users, validated UX metrics applied in long-term studies, transparent reporting standards, independent evaluation, clearer reporting of model design and training data, and stronger attention to safety, equity and the limits of crisis response.
CCH insight
Generative AI tools are arriving in patient-facing care faster than the evidence base supporting them, which puts the burden of appraisal on clinicians. CCH’s CPD-accredited short course AI Essentials for Primary Care: Tools, Ethics and Everyday Applications covers the practical and ethical judgement this requires – what these tools can and cannot do, where the risks sit, and how to use them safely in day-to-day practice.
Find out more about AI Essentials for Primary Care →
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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GLP-1 Receptor Agonists Show Potential to Reduce Mental Health Risks in People with Diabetes and Obesity
Key Takeaways:
- GLP-1 receptor agonists were associated with a reduced risk of worsening mental illness in people living with diabetes and co-existing anxiety or depression
- Semaglutide and liraglutide showed the most notable effects, including reductions in depression, anxiety, and self-harm risk
- Findings from a large Swedish cohort study highlight potential dual benefits, though randomised trials are still needed
Growing interest in the mental health effects of GLP-1 therapies
A large national cohort study from Sweden, published in The Lancet Psychiatry, suggests that glucagon-like peptide-1 receptor agonists may offer benefits beyond metabolic control. The findings indicate that medications such as semaglutide and liraglutide could help reduce the risk of worsening mental illness in people living with diabetes and co-existing obesity, anxiety, or depression.
GLP-1 receptor agonists are widely used in the management of type 2 diabetes and obesity. However, their impact on mental health outcomes has remained uncertain, with previous research producing mixed results. This study contributes new large-scale evidence suggesting a potentially protective effect.
Mental illness and diabetes – a high-risk overlap
People living with diabetes are known to have a higher risk of mental health conditions, including depression, anxiety, and suicide. This overlap creates a complex clinical picture, where both metabolic and psychological factors influence outcomes.
The researchers emphasised that understanding how commonly prescribed antidiabetic medications affect mental health is essential, particularly in populations already at elevated psychiatric risk.
Study design and population
The study analysed data from Swedish national electronic health registers, covering the period from 2009 to 2022. Researchers identified individuals with diagnosed depression or anxiety who were also receiving antidiabetic treatment.
Participants who used GLP-1 receptor agonists were compared with those who did not use these medications, as well as with individuals taking other second-line antidiabetic therapies.
In total, nearly 95,500 people were included in the analysis. Approximately 60% of participants were female and 40% male, with a mean age of around 50 years. Data on ethnicity were not available.
During the follow-up period, almost 22,500 individuals used GLP-1 receptor agonists.
Outcomes measured
The study assessed several primary and secondary outcomes related to mental health.
Primary outcomes included:
- Psychiatric hospitalisation
- Sick leave exceeding 14 days due to psychiatric reasons
- Hospitalisation due to self-harm
- Death by suicide
Secondary outcomes included:
- Worsening symptoms of depression or anxiety
- Substance use disorder
- Self-harm
Reduced risk of worsening mental illness
The findings indicated that some GLP-1 receptor agonists were associated with a lower risk of worsening mental health outcomes.
Semaglutide and liraglutide were linked to a 42% and 18% lower risk of worsening mental illness, respectively, compared with people who did not use GLP-1 therapies.
When examining specific outcomes:
- Semaglutide was associated with a 44% lower risk of worsening depression
- A 38% reduced risk of worsening anxiety
- A 47% lower likelihood of worsening substance use disorder
Liraglutide showed a more limited effect, with a 26% reduction in the risk of worsening depression, but no significant impact on other mental health outcomes.
Other GLP-1 receptor agonists, including exenatide and dulaglutide, did not demonstrate meaningful changes in risk.
Impact on self-harm risk
One of the most notable findings was the association between GLP-1 receptor agonist use and a reduced risk of self-harm.
Overall, these medications were linked to a 44% lower risk of self-harm compared with non-use, suggesting a potentially important role in mitigating severe psychiatric outcomes in this population.
Implications for clinical practice
The results suggest that certain GLP-1 receptor agonists may provide dual therapeutic benefits for people living with diabetes and obesity, addressing both metabolic and mental health outcomes.
However, the authors cautioned that observational findings cannot establish causality. They highlighted the need for randomised controlled trials to confirm these associations and better understand the mechanisms involved.
Conclusion
This large Swedish cohort study provides evidence that some GLP-1 receptor agonists, particularly semaglutide and liraglutide, may be associated with reduced risks of worsening mental illness and self-harm in people living with diabetes and co-existing psychiatric conditions.
While further research is required, the findings point towards a potentially valuable role for these medications in addressing the interconnected challenges of metabolic and mental health.
CCH insight:
Yet more positive news about GLP-1 medications. This is very encouraging, particularly as there are so many drugs that have negative side-effects regarding mental health. However, this study only shows an association, and not causation, and did not adjust for the possible effects of losing weight – those on GLP-1 therapy may have experienced improved mood and mental health due to the fact they were losing weight, rather than as a direct effect of the drug. More research is needed to elucidate the complex interactions of obesity and mental health and the effects of GLP-1 medications.
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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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Tirzepatide Not Linked to Increased Depression or Suicidal Ideation in Obesity Trials
Key Takeaways:
- A post hoc analysis of three SURMOUNT trials found no evidence that tirzepatide increases the risk of depression compared with placebo over 72 weeks.
- Rates of suicidal ideation and behaviour were low and similar between tirzepatide and placebo groups, with most reports assessed as low risk.
- Experts emphasise the need for routine mental health assessment in people living with obesity, alongside further research in populations with established psychiatric conditions.
Overview of the analysis
Once-weekly subcutaneous tirzepatide was not associated with an increased risk of depression compared with placebo, according to a post hoc analysis of the SURMOUNT clinical trial programme. The findings were published in Obesity and add to the growing body of evidence examining the psychiatric safety of incretin-based therapies used for weight management.
As previously reported by Healio, in January the Food and Drug Administration requested the removal of warnings related to suicidal ideation and behaviours from the labels of several obesity medications, including liraglutide 3 mg (Saxenda), semaglutide 2.4 mg (Wegovy) and tirzepatide (Zepbound).
In the newly published analysis, researchers reported that adults receiving tirzepatide across three SURMOUNT trials did not experience worsening of depression over the course of the studies.
“The low occurrence of these events with tirzepatide is similar to that observed in pooled analyses of semaglutide 2.4 mg and liraglutide 3 mg, both GLP-1 receptor agonists approved for weight management,” said Thomas A. Wadden, PhD, professor of psychology in psychiatry at the Perelman School of Medicine, University of Pennsylvania, in comments to Healio. “The present report provides the first detailed analysis of the risk of these psychiatric events with tirzepatide.”
Study design and assessment methods
The analysis included data from the SURMOUNT-1, SURMOUNT-2 and SURMOUNT-3 studies. Across all three trials, adults living with obesity or with overweight and at least one weight-related comorbidity were randomly assigned to receive once-weekly subcutaneous tirzepatide or placebo for 72 weeks.
Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Suicidal ideation and behaviour were assessed using the Columbia-Suicide Severity Rating Scale. In addition, investigators recorded neuropsychiatric adverse events during scheduled study visits.
Depression symptoms over time
A total of 4,056 adults were included in the pooled analysis, of whom 63 percent were women and 74 percent were White. Overall, 2,806 participants received tirzepatide and 1,250 received placebo. At baseline, mean PHQ-9 scores were 2.7 in the tirzepatide group and 2.6 in the placebo group, indicating minimal or no depressive symptoms.
By week 72, participants receiving tirzepatide experienced a 0.6-point greater reduction in PHQ-9 score compared with those receiving placebo.
Among participants who had no or minimal depression symptoms at baseline and received tirzepatide, 79.4 percent remained in that category through the end of safety follow-up. During follow-up, 17 percent reported mild symptoms, 2.9 percent reported moderate symptoms, 0.7 percent reported moderately severe symptoms and 0.1 percent reported severe symptoms.
A smaller proportion of participants in the tirzepatide group moved to a more severe depression category compared with the placebo group, 18.2 percent versus 24.3 percent respectively, with this difference reaching statistical significance (P < .001). Conversely, a higher proportion of those receiving tirzepatide moved to a less severe depression category compared with placebo, 52.4 percent versus 41.8 percent (P < .001).
Suicidal ideation and behaviour
At baseline, a history of suicidal ideation or behaviour was reported by 70 participants receiving tirzepatide and 38 participants receiving placebo. Through the end of safety follow-up, 0.6 percent of participants in both the tirzepatide and placebo groups reported suicidal ideation. Most of these events were classified as low risk.
Moderate-risk suicidal ideation was reported by 0.3 percent of participants receiving tirzepatide and 0.1 percent of those receiving placebo. High-risk suicidal ideation occurred in three participants receiving tirzepatide and one participant receiving placebo.
Suicidal behaviour was reported by two participants in the tirzepatide group and by none in the placebo group.
Treatment-emergent nervous system disorder adverse events occurred in 15.8 percent of participants receiving tirzepatide and 13 percent of those receiving placebo. The investigators reported no difference between groups in the occurrence of treatment-emergent psychiatric disorders overall.
Implications for mental health care in obesity
Wadden noted that he and his colleagues supported the FDA decision to remove warnings related to suicidal ideation and behaviour from the labels of incretin-based obesity medications. However, he stressed that mental health assessment remains essential in the care of people living with obesity.
“Persons with obesity, particularly with a BMI of more than 40 kg/m2, are at substantially increased risk of major depression and anxiety disorders,” Wadden said. “It’s critical that they receive the same mental health care that persons of average weight would when presenting with these conditions.”
He also highlighted the need for further research to better understand the effects of incretin-based therapies in people with established psychiatric conditions.
“Randomized trials of the GLP-1 obesity medications largely excluded persons who, in the past 2 years, had experienced major depression, schizophrenia or bipolar disorder, or who had a lifetime history of suicide attempt,” Wadden said. “GLP-1 medications potentially could be beneficial to individuals who suffer from these conditions. Small, carefully controlled studies would appear warranted, as would a close examination of the FDA’s recent retrospective cohort study of more than 2 million individuals. The FDA’s dataset likely included a far greater range of psychiatric status than found in the randomized controlled trials that evaluated tirzepatide and semaglutide for chronic weight management.”
Disclosures
Wadden reports advising for Novo Nordisk and WW and receiving grants on behalf of the University of Pennsylvania from Eli Lilly, Epitomee Medical and Novo Nordisk. All other relevant financial disclosures are reported in the study.
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New Evidence Suggests GLP-1 Drugs May Improve Survival in Severe Psychiatric Disorders
Key Takeaways:
- People living with serious mental illnesses experience substantial excess cardiometabolic risk and premature mortality, driven largely by cardiovascular disease rather than psychiatric symptoms alone.
- GLP-1 receptor agonists may help narrow this mortality gap by targeting obesity, diabetes, cardiovascular disease, and renal disease rather than replacing established psychiatric treatments.
- While promising, the use of GLP-1 receptor agonists in people with serious mental illness requires careful attention to safety, access, cost, and equitable allocation.
A recent editorial published in Expert Opinion on Pharmacotherapy explored the emerging role of glucagon-like peptide-1 receptor agonists in improving survival and long-term health outcomes for people living with serious mental illnesses. The authors emphasised that these medicines are unlikely to replace established psychiatric therapies. Instead, their greatest potential lies in addressing the cardiometabolic drivers of excess morbidity and mortality that disproportionately affect this population.
The editorial situates GLP-1 receptor agonists within a broader public health context, arguing that interventions capable of extending healthspan and reducing cardiovascular mortality are urgently needed for people with serious mental illness.
Development and expanding indications of GLP-1 receptor agonists
The first GLP-1 receptor agonist, exenatide, received approval from the United States Food and Drug Administration in 2005 for the treatment of type 2 diabetes. Since that time, multiple GLP-1 mono-agonists have been approved, alongside tirzepatide, the first dual agonist targeting both the GLP-1 and glucose-dependent insulinotropic polypeptide receptors. Additional dual and triple agonists acting on GLP-1, GIP, and glucagon receptors are now in late-stage clinical development.
While initially developed for glycaemic control in type 2 diabetes, GLP-1 receptor agonists now have indications that extend well beyond glucose lowering and weight management in people living with overweight or obesity. Approved uses include treatment of metabolic dysfunction-associated steatohepatitis in people with moderate or advanced fibrosis, management of obstructive sleep apnoea in adults with obesity, reduction of major adverse cardiovascular events in adults with type 2 diabetes and established cardiovascular disease, and slowing the progression of chronic kidney disease while reducing cardiovascular mortality in people living with both chronic kidney disease and type 2 diabetes.
Oral formulations are also expanding. Oral semaglutide is already available, and synthetic small-molecule oral GLP-1 receptor agonists are expected to receive approval in 2026. These formulations may help address barriers related to injectable delivery, manufacturing complexity, supply chains, and access. There is now broad consensus that GLP-1 receptor agonists have transformed the management of metabolic disease and are associated with reductions in renal disease progression, cardiovascular events, and mortality among people with metabolic disorders.
Cardiometabolic burden in serious mental illness
Conditions such as schizophrenia, major depressive disorder, bipolar disorder, and related serious mental illnesses are severe, prevalent, and often lifelong. They are major contributors to disability, reduced healthspan, and diminished social and economic participation, particularly among younger adults.
People living with serious mental illness experience markedly premature and excess mortality. Estimates of years of life lost typically range from five to twenty-five years, with cardiovascular disease accounting for the majority of this gap. Earlier onset of cardiometabolic conditions, higher prevalence of obesity and diabetes, and cumulative exposure to cardiometabolic risk factors all contribute to this disparity.
Each condition currently treated with GLP-1 receptor agonists contributes differently to cardiometabolic risk in this population. In parallel, several agents in mid- and late-stage development target chronic diseases such as peripheral artery disease and atherosclerotic heart disease, conditions that disproportionately affect people living with serious mental illness.
Limitations of current psychiatric treatments on mortality
Although antipsychotics, antidepressants, mood stabilisers, and anticonvulsants are clinically effective for managing psychiatric symptoms, their impact on healthspan and cardiovascular mortality has been limited. Demonstrated reductions in mortality have been confined to selected classes and agents, including second-generation long-acting antipsychotics, lithium, and clozapine.
Lithium, despite strong evidence of efficacy in bipolar disorder and potential mortality benefits, remains under-prescribed. This limits its overall public health impact and underscores the need for complementary strategies that directly address physical health outcomes alongside psychiatric symptom control.
Current and emerging clinical applications in psychiatric populations
GLP-1 receptor agonists are already recommended for managing weight gain associated with psychotropic medications when discontinuation or switching of psychiatric treatment is not feasible. This indication is particularly relevant given the high prevalence of medication-associated weight gain in people living with serious mental illness.
Preliminary evidence also suggests a potential protective effect against lithium-induced nephrotoxicity, a complication for which no approved therapy currently exists. In addition, several GLP-1 receptor agonists are being developed or repurposed for the treatment of alcohol, tobacco, and opioid use disorders.
Beyond metabolic outcomes, preclinical studies, small controlled trials, and observational research suggest that GLP-1 receptor agonists may exert beneficial effects on mood disorders and on specific psychopathology domains that significantly impair quality of life, including cognitive dysfunction and anhedonia. While these findings remain early, they point to possible neuropsychiatric benefits that warrant further investigation.
Safety considerations in people living with serious mental illness
Several safety considerations are particularly relevant in this population. Gastrointestinal side effects, including constipation, may interact with pre-existing gastrointestinal motility disturbances caused by psychotropic medications.
Clinicians should also consider the elevated risks of pancreatitis and sarcopenia, both of which disproportionately affect people living with serious mental illness. Renal function requires particular attention, as GLP-1 receptor agonists that are primarily renally eliminated, such as lixisenatide and exenatide, are contraindicated in severe renal disease, which is more prevalent in this group.
Early pharmacovigilance reports raised concerns about a possible association between GLP-1 receptor agonists and suicidality. However, larger subsequent studies have not demonstrated a causal relationship. Continued monitoring remains advisable, particularly in populations already at increased risk of suicidal ideation and behaviour.
Navigating these considerations well – patient selection, contraindications, side-effect management and monitoring – is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Practice: Prescribing, a CPD-accredited online short course.
Implications for healthspan and mortality reduction
People living with serious mental illness account for a disproportionate share of years of life lost and disability-adjusted life years worldwide. Despite decades of progress in psychopharmacology, the mortality gap between this population and the general population has not meaningfully narrowed.
Therapeutic strategies that directly reduce mortality and extend healthspan are therefore urgently required. In this context, GLP-1 receptor agonists represent one of the most promising pharmacological classes currently available. Their potential impact will depend on addressing persistent challenges related to cost, reimbursement policy, equitable access, and ongoing supply constraints.
Prioritising people living with serious mental illness within fair allocation frameworks could help reduce excess and premature mortality in this vulnerable population in the near term, while longer-term evidence continues to emerge.
CCH insight
This emerging evidence points to real promise for a group facing a stark mortality gap – but realising it safely depends on clinicians who are confident using GLP-1 medications well, particularly in patients with complex comorbidities. CCH’s GLP-1RAs in Practice: Prescribing CPD short course (2 CPD hours, fully online, CPD-accredited) equips prescribers to get every part of the consultation right, from patient selection and contraindications through to titration, side-effect management and monitoring.
Explore GLP-1RAs in Practice: Prescribing →
Genetic Study Establishes Causal Link Between Obesity and Dementia
Key Takeaways:
- New genetic evidence suggests that higher body weight and elevated blood pressure play a direct causal role in the development of dementia.
- The findings indicate that addressing obesity and high blood pressure earlier in life may offer an important opportunity for dementia prevention.
- Much of the increased dementia risk associated with higher body weight appears to be driven by high blood pressure, highlighting a potentially modifiable pathway.
Obesity, blood pressure and dementia risk
People living with obesity and high blood pressure may face a higher risk of developing dementia, according to a new study published in The Journal of Clinical Endocrinology & Metabolism. The research adds to a growing body of evidence linking cardiovascular and metabolic health to long-term brain health.
Dementia represents a major and escalating global public health challenge. There is currently no cure, and people living with dementia experience a progressive decline in mental abilities, including memory, thinking and reasoning. Over time, this decline can significantly impair daily functioning and independence.
The most common forms of dementia include Alzheimer’s disease, vascular dementia and mixed dementia. Although these conditions vary in their underlying pathology, all involve progressive damage to nerve cells in the brain, leading to worsening problems with memory, language, problem-solving and behaviour.
Study identifies a causal relationship
The study was led by Ruth Frikke-Schmidt, M.D., Ph.D., Professor and Chief Physician at Copenhagen University Hospital – Rigshospitalet and the University of Copenhagen.
“In this study, we found high body mass index (BMI) and high blood pressure are direct causes of dementia,” said Frikke-Schmidt. “The treatment and prevention of elevated BMI and high blood pressure represent an unexploited opportunity for dementia prevention.”
Researchers analysed genetic and health data from participants in Copenhagen and the UK. Their analysis revealed a clear causal link between higher body weight and an increased risk of dementia.
How Mendelian randomisation strengthened the findings
The researchers were able to establish a direct causal relationship by using a Mendelian randomisation study design, which closely mimics the structure of a randomised controlled trial.
In Mendelian randomisation, naturally occurring genetic variants associated with higher BMI are used as proxies for lifelong exposure to higher body weight. Because these genetic variants are randomly inherited from parents to offspring, their distribution is not influenced by lifestyle, socioeconomic status or other confounding factors.
This process mirrors the random assignment of participants to treatment or placebo groups in drug trials. As a result, any differences in dementia outcomes between individuals with BMI-increasing genetic variants and those without can be more confidently attributed to body weight itself, rather than to external influences.
Using this approach, the researchers were able to demonstrate that higher BMI plays a direct causal role in increasing the risk of dementia.
Blood pressure emerges as a key driver
Further analysis suggested that much of the increased dementia risk associated with higher body weight was driven by elevated blood pressure. This finding points to a potential pathway through which obesity may contribute to cognitive decline.
By implication, preventing or effectively treating obesity and high blood pressure could help reduce the risk of dementia, particularly forms linked to vascular damage in the brain.
“This study shows that high body weight and high blood pressure are not just warning signs, but direct causes of dementia. That makes them highly actionable targets for prevention,” said Frikke-Schmidt.
Implications for prevention and future research
The findings also raise important questions about the timing of weight management interventions. While weight-loss medications have recently been tested in people with early-stage Alzheimer’s disease, these trials have not shown clear benefits for halting cognitive decline once symptoms are established.
“Weight-loss medication has recently been tested for halting cognitive decline in early phases of Alzheimer’s disease, but with no beneficial effect,” Frikke-Schmidt said. “An open question that remains to be tested is if weight-loss medication initiated before the appearance of cognitive symptoms may be protective against dementia. Our present data would suggest that early weight-loss interventions would prevent dementia, and especially vascular-related dementia.”
Together, the results reinforce the importance of addressing obesity and high blood pressure not only to protect cardiovascular health, but also as part of a broader strategy to reduce the long-term risk of dementia.
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Digital Tools Show Promise in Schizophrenia Care, Large-Scale Study Finds
Key Takeaways:
- A smartphone app, FOCUS, helped people living with schizophrenia manage symptoms and recovery more effectively.
- External facilitation by digital specialists improved outcomes, including reduced psychiatric emergency visits.
- Researchers highlight that the greatest challenge for digital mental health tools remains real-world adoption.
Evidence grows for mobile mental health support
A major clinical study has found that using a smartphone app to support the treatment of schizophrenia can deliver modest but meaningful improvements in symptoms and recovery outcomes. The research, published in Psychiatric Services, is among the largest trials of its kind examining the impact of digital interventions on people with serious mental illness.
While the research took place in the United States, its findings are relevant globally as health systems, including the NHS, seek innovative ways to expand access to mental healthcare and support self-management outside the clinic.
The FOCUS app: bridging the gap between appointments
The FOCUS app was first launched in 2013 to provide digital support for people living with schizophrenia and related conditions. It offers structured prompts and tools to help users manage symptoms, take medication consistently, improve sleep routines, and practise social and coping skills.
Previous small-scale studies showed early promise, but uptake within mental health services has been limited, reflecting wider challenges in embedding digital tools into routine care.
Comparing models of implementation
The new trial enrolled 274 people receiving care for schizophrenia across 23 community clinics. It tested two models of introducing the FOCUS app into clinical practice:
- External facilitators – digital health specialists who supported multiple clinics and provided guidance to both staff and patients.
- Internal facilitators – trained in-house staff who integrated app use within their own teams and services.
Both methods proved feasible, but patients supported by external facilitators experienced better clinical outcomes, including fewer psychiatric emergency attendances.
Digital tools and the challenge of adoption
“Getting access to a mental health provider can be challenging for patients with serious mental illness,” said Dr Dror Ben-Zeev, clinical psychologist, director of UW Medicine’s BRiTE Center, and the study’s lead author. “Mobile health tools hold enormous potential because we can meet patients where they are. The biggest hurdle today for digital mental health solutions is effective implementation and real-world adoption.”
Each participant in the study was paired with a digital navigator, who had access to the individual’s app data, conducted weekly check-in calls, and communicated key updates to the person’s clinical team.
Ensuring digital solutions deliver real results
“There are so many digital solutions being offered right now,” commented Dr Charissa Fotinos, Washington State Medicaid and behavioural health medical director, who served as an advisor on the project. “It’s important for us, as a payor, to support tools that have evidence of efficacy. We need to pay for things that work.”
Her remarks echo a growing sentiment among UK health commissioners and policymakers: while digital mental health tools hold promise, investment must prioritise those that have been proven to work in practice, not just in theory.
Towards a future of evidence-based digital psychiatry
The study forms part of mHealth Washington, a multi-year programme funded by the National Institute of Mental Health, developed in collaboration with the University of Washington School of Medicine and the Washington State Health Care Authority.
Researchers emphasised the wider relevance of their findings to healthcare systems internationally. As the NHS continues to expand its use of digital therapy tools, from remote cognitive behavioural therapy to AI-assisted triage, evidence such as this may help shape best practice for integrating digital interventions into routine psychiatric care.
Conflict-of-interest statements for the study authors are available in the published paper.
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