The DID-guide: A guide to developing digital mental health interventions

Adolescents with type 1 diabetes (T1D) experience higher rates of psychological disorders compared with their healthy peers. As poor psychological health has been associated with suboptimal glycaemic control and more frequent complications, there is an urgent need to develop more 'clinically usable' interventions. Digital mental health interventions offer unique advantages compared with in-person interventions; however, what adolescents with T1D want in terms of content and functionality is poorly understood. Accordingly, the current study conducted focus groups to examine the views of adolescents with T1D regarding digital mental health interventions. Four focus groups were conducted, including 16 adolescents with T1D, ranging from 13 to 17years in age (69% female). Transcripts were analysed using directed content analysis to examine (1) 'what adolescents dislike about existing digital mental health interventions?' and (2) 'what adolescents want in future digital mental health interventions?'. Findings provide a preliminary understanding of what adolescents dislike and also the type of content and functional features, which may be important to include in digital mental health programs for this population, such as a peer support feature (reported by 16 of 16), emotion and diabetes check-in feature (11 of 16) and diabetes-relevant content (12 of 16). Early data suggest that digital mental health interventions should include a significant peer support element, diabetes-relevant content and examples, and check-in on their mental health and diabetes self-management regularly, while avoiding fixed responses or modules and non-age-appropriate content. Based on these findings, a digital intervention is currently being developed.

BACKGROUND Racialized immigrant youth face a multitude of challenges that heighten their vulnerability to mental illness. Digital mental health has increasingly been recognized as an effective method to improve accessibility to mental health services for communities with limited access to inclusive care, particularly among youth. However, despite the growing emphasis on cultural inclusivity in interventions targeting racialized and marginalized populations, there remains a gap in empirical evidence regarding how culturally inclusive elements are integrated into digital mental health practices and their impact on the effectiveness of these interventions. OBJECTIVE Focusing on Asian immigrant youth in Canada, this protocol outlines our community-engaged project, which aims to assess whether current digital mental health interventions provide effective and culturally accessible support, and how we can collaboratively develop a framework for creating innovative, inclusive, and effective digital interventions to promote youth mental health. METHODS A two-phase community-engaged approach will be used to involve Asian immigrant youth facing mental health challenges, youth leaders, service providers, and stakeholders from East, Southeast, and South Asian communities. Phase one includes scoping reviews on the technology, access, and cultural inclusivity of digital mental health interventions for Asian and racialized newcomer youth in Canada. In phase two, 15 diverse Asian youth leaders and 15 service providers will participate in a 3.5-hour online session to discuss the need for effective digital mental health interventions, share results from the reviews, co-identify key elements of an inclusive and innovative intervention, and outline next steps for forming a community-campus research partnership focused on mental health promotion for Asian immigrant youth. RESULTS This project is expected to yield a co-developed framework outlining key elements of culturally inclusive and effective digital mental health interventions for Asian immigrant youth in Canada. Anticipated outcomes include enhanced understanding of cultural accessibility gaps in existing digital interventions and strengthened community-campus partnerships to support youth mental health. CONCLUSIONS This research aims to improve access to culturally safe and effective digital mental health interventions for Asian immigrant youth. Benefits include enhanced mental health support for this population, increased awareness of mental health issues among stakeholders, and the development of a framework for culturally inclusive mental health services

Youth experiencing early psychosis in West Africa often face delays in accessing evidence-based treatment. Digital mental health interventions may offer an acceptable and scalable approach to improve access to early psychosis care in West Africa; however, few data exist on the experiences and perspectives of patients with early psychosis and their caregivers to inform digital intervention development. This study aims to explore current experiences of early psychosis care, identify barriers and facilitators to in-person early psychosis care within health facilities, and identify opportunities for digital interventions to support patients with early psychosis and caregivers in Ghana. We conducted qualitative focus group discussions among patients with early psychosis, their caregivers, and their mental health care providers recruited at Accra Psychiatric Hospital in Accra, Ghana. Trained qualitative researchers facilitated discussions using a structured qualitative interview guide, exploring current care practices for early psychosis in Ghana, barriers and facilitators to facility-based care, and perceptions of digital mental health interventions. Transcripts were translated, transcribed, and analyzed thematically using a hybrid inductive and deductive approach grounded in the theoretical framework of acceptability. Overall, we conducted 4 focus group discussions (N=31) among 7 patients with early psychosis (median age 28, IQR 21-41 years), 6 caregivers (median age 58, IQR 29-34 years), and 18 clinicians (median age 30, IQR 29-34 years). Participants described current early psychosis care practices in Ghana, including seeking spiritual and traditional healing, the dearth of information and resources about psychosis, and the integral role of caregivers in facilitating treatment engagement and continuation (often at the cost of caregiver mental distress and burnout). Common barriers to facility-based mental health care included stigma associated with mental illness, lack of prior knowledge about early psychosis and treatment options, and practical constraints (eg, financial, logistical, and health care system limitations). Motivating factors for facility-based care included success stories from community members and strong rapport and trust in mental health clinicians. Technology (eg, mobile phones, laptops, radio, and television) was commonly used among participants in typical daily tasks, health information seeking, and stress reduction. Participants expressed support for digital tools that could deliver psychoeducation about early psychosis, support treatment adherence, and extend patient-provider communication between clinic visits. Digital mental health interventions have the potential to complement facility-based early psychosis services in Ghana by addressing misinformation, reducing access barriers, and supporting caregiver roles. These qualitative findings inform potential integration points, content, attributes, and strengths of digital modalities that could be leveraged to support patients with early psychosis and their caregivers in Ghana.

School teachers face the paradox of being in a privileged position to act in youth mental health prevention, but in a vulnerable position for not receiving adequate training and personal support. Digital interventions can provide unexpensive tools and narrow this gap in a large scale without major structural changes. We aimed to synthesize the evidence for digital mental health interventions for school teachers. Studies published from any date until August 2022 were identified through a literature search of the MEDLINE, Embase, ScIELO, and Cochrane Central databases. The studies included evaluated digital interventions targeting school teachers to deal with their own mental health or to assist them in the management of students' mental health. Studies that addressed school-based digital mental health interventions, but directly targeted students, parents, or specifically other professionals were not included. The literature search retrieved 5626 hits and several interventions were described, but only 11 studies fulfilled the inclusion criteria, none of which focused on teachers' mental health. There was some evidence that these interventions improved knowledge about general or specific topics in mental health, and most studies also reported gains in preparedness, confidence, and attitudes towards mental health. The studies identified in this review provide initial support for teacher-focused mental health digital interventions. However, we discuss limitations regarding study designs and data quality. We also discuss barriers, challenges, and the need for effective evidence-based interventions.

BackgroundLow- and middle-income countries (LMICs), which bear a larger proportion of the global mental illness burden, have been disproportionately impacted by the COVID-19 pandemic due to preexisting mental health care system deficiencies. The pandemic has also led to a considerable increase in care delivered through digital mental health interventions (DMHIs), many of which have been adapted from in-person formats. Thus, there is a need to examine their fidelity to the original format along with issues regarding usability and other challenges to and facilitators of their uptake in LMICs. As most DMHIs have been developed in high-income countries, examining their cultural adaptation to LMIC settings is also critical.ObjectiveThe purpose of this research was to conduct a rapid scoping review of the available evidence on DMHIs for depression and anxiety, two of the most common mental disorders, in LMICs.MethodsA rapid scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and processes for rapid reviews by Tricco et al. The PubMed and PsycINFO databases were searched for records published between January 2020 (when COVID-19 was declared a public health emergency) and January 2025 using a search strategy developed in consultation with a liaison librarian. The pandemic accelerated the development and application of DMHIs, and this time frame was used to capture the recent literature that may have incorporated new methods of application. The search strategy was developed across three domains: (1) digital health interventions, (2) depression or anxiety, and (3) LMICs. Data were charted from the final records according to (1) intervention type; (2) discussions on fidelity, usability, and cultural adaptation; and (3) challenges to and facilitators of their uptake in LMICs.ResultsA total of 80 records were included in the final analysis, with reasons for exclusion (eg, focused on mental health in general, not being a DMHI, or not focused on LMICs) reported. Six DMHI platforms were identified: (1) mobile app, (2) the web, (3) virtual reality, (4) videoconferencing, (5) telemedicine, and (6) social media. Less than half of the records referenced fidelity (16/80, 20%), usability (29/80, 36%), and cultural adaptation (31/80, 39%). Challenges pertained to the technological system, engagement issues, structural barriers, and concerns regarding privacy and confidentiality. Facilitators included widespread mobile phone use, built-in supervision and training features, and convenience.ConclusionsDespite the opportunities that DMHIs offer for reducing the mental health treatment gap, further work examining and improving their fidelity, usability, and cultural adaptation is required. In addition, various challenges to the uptake of DMHIs in LMICs, including contextual issues, structural barriers, and privacy concerns, must be mitigated to avoid contributing further to the digital divide.

BackgroundCollege students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment.ObjectiveThis study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs.MethodsWe conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias.ResultsA total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies.ConclusionsResults suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.

The rapid advancement of digital health technologies is transforming psychiatric nursing, with telepsychiatry and digital mental health interventions emerging as essential tools for improving mental healthcare accessibility, efficiency, and patient outcomes. Telepsychiatry, a subset of telemedicine, enables remote psychiatric consultations via video conferencing, while digital interventions such as artificial intelligence (AI)-powered chatbots, mobile mental health apps, and wearable monitoring devices provide real-time support and symptom tracking. These innovations allow psychiatric nurses to deliver high-quality care to underserved populations, reduce wait times, and enhance continuous patient engagement through digital platforms. One of the most significant benefits of telepsychiatry is its ability to bridge the mental health gap, particularly in rural and low-resource settings where psychiatric services are scarce. Additionally, digital mental health tools facilitate early intervention, allowing nurses to monitor patients remotely and intervene before crises escalate. The integration of AI and machine learning in mental health diagnostics further enhances personalized care by predicting symptom progression and recommending targeted therapeutic strategies. However, despite these advancements, challenges such as data security, ethical concerns, and the digital divide remain critical barriers to widespread adoption. Ensuring compliance with privacy regulations and addressing disparities in technology access are essential for the equitable implementation of digital psychiatric nursing. Looking ahead, emerging innovations such as virtual reality (VR)-assisted therapy, augmented reality (AR)-based nursing education, and AI-driven predictive analytics will further revolutionize psychiatric care. As telepsychiatry and digital interventions become integral to mental health services, psychiatric nurses must adapt by acquiring new competencies in digital healthcare technologies. Strengthening policies, funding research, and enhancing digital literacy among psychiatric nurses will be crucial for ensuring the effectiveness and sustainability of telepsychiatry in the future of mental health care.

Blended digital mental health interventions combining technology with human support are more effective than stand-alone treatments. However, limited research has examined how to train and supervise personnel delivering human support components. The Kuamsha app, a gamified digital intervention for adolescent depression based on behavioral activation, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was codeveloped through workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in low- and middle-income countries. This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters delivering a digital mental health intervention in South Africa and Uganda. We conducted a mixed methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (n=13, South Africa; n=4, Uganda), as well as training acceptability. Fidelity, adherence, and competence were scored at the session level and converted to percentages of the maximum possible score. Linear mixed-effects regression models with a random intercept for provider and site estimated adjusted marginal means (95% CI). In-depth interviews and focus group discussions explored program acceptability and implementation factors. The peer mentor training and supervision program was feasible and acceptable in both settings, with high recruitment (South Africa: n=13/19, 68%; Uganda: 4/4, 100%), retention (South Africa: 9/13, 69%; Uganda: 4/4, 100%), and training attendance rates (89%-92% in South Africa and 100% in Uganda), alongside qualitative reports of high satisfaction. All peer mentors met a minimum posttraining competency threshold (≥50%), with median competency scores of 70.7% (IQR 45.8%-78.2%) in South Africa and 75.4% (IQR 73.8%-77.3%) in Uganda. Independent ratings of recorded calls indicated high overall fidelity in South Africa (84.7%, 95% CI 80.3%-89.0%) and Uganda (87.7%, 95% CI 83.4%-92.1%). Adherence was higher in Uganda than South Africa (adjusted mean difference [AMD] 13.30 percentage points, 95% CI 8.99-17.61; P<.001), as was competence (AMD 4.88 percentage points, 95% CI 1.23-8.53; P=.009). The AMD in overall fidelity (3.06 percentage points, 95% CI -0.98 to 7.10) was not statistically significant (P=.14). The qualitative findings emphasized the value of ongoing supervision and capacity development, interactive training approaches, and blended delivery models. Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Adequate supervisory capacity and incentive structures are critical to sustain engagement, retention, and fidelity. In settings with frequent network disruptions, periodic in-person contact between peer mentors and supervisors may enhance fidelity. Future research should examine how peer mentor fidelity influences user engagement and mental health outcomes.

Purpose: This review aimed to investigate the effectiveness of digital school-based mental health interventions for adolescents in Sub-Saharan Africa. Method: The authors conducted a comprehensive search of digital school-based mental health interventions to identify studies conducted in Sub-Saharan Africa targeting adolescents between the ages of (10–19) years. Peer-reviewed studies published in English between 2009 and May 2023 were obtained through electronic bibliographic databases. Result: Only one study met the full inclusion criteria for this review. The included study tested a digital mental health intervention (“Shamiri Digital”) for treating depression, anxiety, and well-being in adolescents. The “Shamiri Digital” intervention demonstrated positive outcomes on depressive symptoms within the full sample. Discussion: The dearth of studies investigating digital mental health solutions for adolescents in low-income countries demonstrates a critical gap in intervention and research for adolescent mental health in resource constrictive settings

Digital mental health: a potential opportunity to improve health equity in China

Background: A major challenge in providing mental health interventions for young people is making such interventions accessible and appealing to those most in need. Online and app-based forms of therapy for mental health are burgeoning. It is therefore crucial to identify features that are most effective and engaging for young users.Objectives: This study reports a systematic review and meta-analysis of digital mental health interventions and their effectiveness in addressing anxiety and depression in young people to determine factors that relate to outcomes, adherence, and engagement with such interventions.Methods: A mixed methods approach was taken, including a meta-analysis of 9 randomized controlled trials that compared use of a digital intervention for depression in young people to a no-intervention control group, and 6 comparing the intervention to an active control condition. A thematic analysis and narrative synthesis of 41 studies was also performed.Results: The pooled effect size of digital mental health interventions on depression in comparison to a no-intervention control was small (Cohen’s d = 0.33, 95% CI 0.11 to 0.55), while the pooled effect size of studies comparing an intervention group to an active control showed no significant differences (Cohen’s d = 0.14, 95% CI -.04 to 0.31). Pooled effect sizes were higher when supervision was involved (studies with no-intervention controls: Cohen’s d = 0.52, 95% CI 0.23 to 0.80; studies with active control: Cohen’s d = 0.49, 95% CI -0.11, 1.01). Engagement and adherence rates were low. Qualitative analysis revealed that users liked interventions with a game-like feel and relatable, interactive content. Educational materials were perceived as boring, and users were put off by non-appealing interfaces and technical glitches.Conclusions: Digital interventions work better than no intervention to improve depression in young people when results of different studies are pooled together. However, these interventions may only be of clinical significance when use is highly supervised. Digital interventions do not work better than active alternatives regardless of the level of support. Future interventions need to move beyond the use of digital educational materials, considering other ways to attract and engage young people and to ensure relevance and appeal.

BackgroundBorderline personality disorder (BPD) is a mental health condition with insufficient care availability worldwide. Digital mental health interventions could reduce this treatment gap. Persuasive system design (PSD) is a conceptual framework outlining elements of digital interventions that support behavior change.ObjectiveThis systematic review aims to characterize digital interventions targeting BPD symptoms, assess treatment efficacy, and identify its association with intervention features, including PSD elements.MethodsA systematic review of automated digital interventions targeting symptoms of BPD was conducted. Eligible studies recruited participants aged ≥18 years, based on a diagnosis of BPD or one of its common comorbidities, or as healthy volunteers. OVID Embase, OVID MEDLINE, OVID PsycINFO, and the Cochrane Central Register for Controlled Trials were searched on July 19, 2022, and February 28, 2023. Intervention characteristics were tabulated. A meta-analysis of randomized controlled trials (RCTs) determined treatment effects separately for each core symptom of BPD using Hedges g. Associations between the treatment effect and intervention features, including PSD elements, were assessed by subgroup analysis (Cochran Q test). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the National Institutes of Health Quality Assessment Tool for pre-post studies.ResultsA total of 40 (0.47%) publications out of 8520 met the inclusion criteria of this review, representing 6611 participants. Studies comprised examinations of 38 unique interventions, of which 32 (84%) were RCTs. Synthesis found that included interventions had the following transdiagnostic treatment targets: severity of BPD symptoms (4/38, 11%), suicidal ideation (17/38, 45%), paranoia (5/38, 13%), nonsuicidal self-injury (5/38, 13%), emotion regulation (4/38, 11%), and anger (3/38, 8%). Common therapeutic approaches were based on dialectical behavioral therapy (8/38, 21%), cognitive behavioral therapy (6/38, 16%), or both (5/38, 13%). Meta-analysis found significant effects of digital intervention for both symptoms of paranoia (Hedges g=–0.52, 95% CI –0.86 to –0.18; P=.01) and suicidal ideation (Hedges g=–0.13, 95% CI –0.25 to –0.01; P=.03) but not overall BPD symptom severity (Hedges g=–0.17, 95% CI –0.42 to 0.10; P=.72). Subgroup analysis of suicidal ideation interventions found that evidence-based treatments such as cognitive behavioral therapy and dialectical behavior therapy were significantly more effective than alternative modalities (Cochran Q=4.87; P=.03). The degree of human support was not associated with the treatment effect. Interventions targeting suicidal ideation that used reminders, offered self-monitoring, and encouraged users to rehearse behaviors were associated with a greater reduction in ideation severity.ConclusionsEvidence suggests that digital interventions may reduce the symptoms of suicidal ideation and paranoia and that the design of digital interventions may impact the efficacy of treatments targeting suicidal ideation. These results support the use of transdiagnostic digital interventions for paranoia and suicidal ideation.Trial RegistrationPROSPERO CRD42022358270; https://tinyurl.com/3mz7uc7k

Digital health interventions have gained prominence in the management of chronic diseases like Type 1 Diabetes Mellitus (T1DM), helping patients adhere to their treatment plans. However, the effectiveness of these interventions in improving adherence to T1DM management varies globally. To systematically review existing digital interventions designed to improve adherence to T1DM management. To identify key features of digital tools that enhance adherence and glycaemic control in T1DM patients. Primary outcomes were improvements in patient adherence, measured by frequency of insulin administration, self-monitoring of blood glucose, and HbA1c levels. Secondary outcomes included patient satisfaction and engagement with digital interventions. A systematic review of randomized controlled trials (RCTs) was conducted using the PICO framework. The review encompassed studies from various global regions. Studies included T1DM patients across different age groups. Databases such as PubMed, Cochrane, and Ovid were searched for relevant studies. A total of 12 randomized controlled trials (RCTs) were included in this review, focusing on improving adherence in T1DM patients. The digital interventions evaluated included mobile health applications, continuous glucose monitoring, telemedicine platforms, and educational video games. Most studies demonstrated significant improvements in patient adherence behaviours, such as insulin administration and self-monitoring of blood glucose, reductions in HbA1c levels were also noted. The improvements in HbA1c as seen in this review for individuals with T1DM are in line with findings from prior studies. The evidence showed that digital health technologies could enhance glycaemic control. These findings are in line with other studies where real-time data monitoring equipment of the emergent CGM systems and mobile apps facilitated accurate and timely modification of diabetes self-management. The reviewed studies also highlighted the effectiveness of digital technology-targeted interventions in enhancing the aspect of self-management and health behaviour among T1DM patients. These results are also aligned with the behavioural change theories which highlight the significance of education, perceived self-ability and continuous feedback in adopting good health behaviour. Digital interventions have a positive impact on adherence to T1DM management and glycaemic control. Their application, particularly in low-resource settings, holds great potential for improving health outcomes. Not applicable. The aim of this review was to look at how mobile applications among other digital tools can assist people living with Type 1 Diabetes (T1DM) through continuous glucose monitoring to manage their health condition in a better way. For this purpose, we reviewed 12 different studies and found that interventions delivered through digital tools enhanced patients' adherence to their treatment by helping them lower the blood sugar levels as measured by HbA1c levels. Main findings reflected how digital tools improved health behaviours and self-management of T1DM. This was facilitated by real-time data monitoring and feedback for the diabetes care. In conclusion, Digital health interventions have the potential to positively impact the T1DM treatment leading to improved health outcomes especially in low resource settings.

Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS). We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS. A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists' feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study. The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course's sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms. The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers.

&lt;p&gt;&lt;b&gt;Background: High rates of mental distress are reported among adolescents. Emerging evidence suggests that digital mental health interventions, such as computerised psychotherapy, informative websites, and non-clinical helplines, may help. However, it is unclear whether these resources are reaching those who experience distress in real-world settings. &lt;/b&gt;&lt;/p&gt;&lt;p&gt;Aim: The aim of this research is to explore adolescent uptake of digital mental health interventions offered via a comprehensive youth health survey, with a particular focus on adolescents experiencing probable mental distress. &lt;/p&gt;&lt;p&gt;Methods: Data were drawn from the Youth19 Rangatahi Smart Survey. At the end of the survey participants were provided the opportunity to opt-in to receive digital health resources. Participants’ opt-in and access to these digital health resources, as well as if they accessed the specific mental health resources, was remotely monitored. We compare opt-in and access among participants with and without probable mental distress. &lt;/p&gt;&lt;p&gt;Results: Of those who completed the Youth19 survey (n = 7721), a substantial minority of participants opted-in to receive the digital health resources (n = 1720). However, of those who opted-in, access was low (n = 187). Participants with probable mental distress were more likely than their non-distressed counterparts to opt-in and access the digital health resources, although these differences were small. Importantly, only seven participants went on to access digital &lt;/p&gt;&lt;p&gt;mental health interventions. &lt;/p&gt;&lt;p&gt;Discussion: The moderate number of participants to opt-in to receive Youth19 digital health resources suggests that digital resources may be a valuable component of supporting diverse groups of adolescents. The high attrition, however, indicates that adolescents may be experiencing barriers to accessing these interventions. Smart design to increase appeal, addressing barriers that limit access, and providing multiple options for different groups could &lt;/p&gt;&lt;p&gt;increase adolescents’ engagement with digital mental health interventions.&lt;/p&gt;