Mental health applications or apps are a promising approach to reduce the pervasive unmet mental health need observed among marginalized groups. However, these groups face unique challenges to engage in and benefit from these interventions, and apps that consider issues of diversity, equity, and inclusion (DEI) may be better positioned to reach them. App evaluation frameworks emerge as crucial tools for researchers, clinicians, and users to select evidence-based apps. Nevertheless, it is unclear the extent to which existing assessment tools capture DEI factors. The present scoping review identified 68 studies that employed one or more assessment tools to evaluate a mental health app, leading to 44 unique app evaluation frameworks. Results showed that most frameworks were developed after 2015, and only 58% of them considered at least one DEI criterion. Frameworks that performed exceptionally well were those that combined multiple standardized and validated measures. This lack of consideration for DEI variables may limit the ability of app-based interventions to serve marginalized communities, or even worse, create new disparities. Therefore, we provide recommendations to improve current app evaluation frameworks' cultural robustness and clinical utility, maximizing their effectiveness when working with individuals from marginalized communities.

Background: Many youth rely on direct-to-consumer generative artificial intelligence (GenAI) chatbots for mental health support, yet the quality of the psychotherapeutic capabilities of these chatbots is understudied. Objective: This study aimed to comprehensively evaluate and compare the quality of widely used GenAI chatbots with psychotherapeutic capabilities using the Conversational Agent for Psychotherapy Evaluation II (CAPE-II) framework. Methods: In this cross-sectional study, trained raters used the CAPE-II framework to rate the quality of 5 chatbots from GenAI platforms widely used by youth. Trained raters role-played as youth using personas of youth with mental health challenges to prompt chatbots, facilitating conversations. Chatbot responses were generated from August to October 2024. The primary outcomes were rated scores in 9 sections. The proportion of high-quality ratings (binary rating of 1) across each section was compared between chatbots using Bonferroni-corrected chi-square tests. Results: While GenAI chatbots were found to be accessible (104/120 high-quality ratings, 86.7%) and avoid harmful statements and misinformation (71/80, 89%), they performed poorly in their therapeutic approach (14/45, 31%) and their ability to monitor and assess risk (31/80, 39%). Privacy policies were difficult to understand, and information on chatbot model training and knowledge was unavailable, resulting in low scores. Bonferroni-corrected chi-square tests showed statistically significant differences in chatbot quality in the background, therapeutic approach, and monitoring and risk evaluation sections. Qualitatively, raters perceived most chatbots as having strong conversational abilities but found them plagued by various issues, including fabricated content and poor handling of crisis situations. Conclusions: Direct-to-consumer GenAI chatbots are unsafe for the millions of youth who use them. While they demonstrate strengths in accessibility and conversational capabilities, they pose unacceptable risks through improper crisis handling and a lack of transparency regarding privacy and model training. Immediate reforms, including the use of standardized audits of quality, such as the CAPE-II framework, are needed. These findings provide actionable targets for platforms, regulators, and policymakers to protect youth seeking mental health support.

Background: There is a dearth of information on the compatibility of Western-developed, internet-based interventions that prevent onset and precipitation of depression in global settings. Recently, Project CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic and Interpersonal Training), an information technology-based intervention, was adapted to prevent depression in Hong Kong Chinese adolescents. This paper evaluates qualitative data from consultations to develop a revised intervention of CATCH-IT for Hong Kong youth. Methods: A theoretical thematic analysis approach was used to analyze data. Materials from three consultation trips which included focus groups (2007), an expert panel (2007), a public health campaign (2009), and a joint primary care physician-social worker review group (2010) were compiled. Authors (KS and AZ) independently reviewed the data and applied the theoretical framework of behavioral vaccines to code the data. These data were subsequently consolidated to provide a coherent narrative analysis. Results: The cognitive behavioral therapy (CBT), behavioral activation (BA), and resiliency modules were maintained, while the interpersonal therapy (IPT) modules of CATCH-IT were excluded in the Hong Kong adaptation. Concurrent self-reports of drinking, smoking, illicit drug use and gambling behavior were added. Rather than primary care consultations, social worker consultations may be the best point of entry for intervention. Conclusion: Socio-cultural relevance of psychotherapeutics and delivery context of internet-based interventions will require significant adaptation for the Hong Kong setting. However, because of community engagement throughout the process of adaptation, we believe the CATCH-IT intervention can be adapted for Chinese adolescents in Hong Kong with retained fidelity. The revised intervention is called “Grasp the Opportunity”.

Background. Despite high levels of mental illness, Vietnamese youth have limited access to mental health care. Internet interventions, evidence-based psychotherapy treatments delivered through the internet, have the potential to increase access to mental health for youth in Vietnam. This study explored the perceptions of youths and parents toward internet interventions for youth mental health. Methods. Four focus groups were conducted with youths (n = 20) and parents (n = 20) in Danang, Vietnam. The Technology Acceptance Model was used a framework for focus group questions. The data were analyzed using direct content analysis. Results. Most youths and parents agreed that the internet serves well as a care delivery model. Participants expressed that the web would be useful for psychoeducation and sharing and receiving information with others. Both groups reported lack of awareness of web-based interventions and logistical concerns regarding access as main barriers. In addition, many parents were concerned about internet addiction. Specific adaptations in Vietnam such as standalone internet service centers and partnering with local organizations may benefit uptake of internet interventions. Conclusion. This study suggests that internet-based programs for youth mental health, particularly interventions incorporating psychoeducation and social networking components, will be well received in Vietnam. Barriers need to be addressed to successfully implement internet-based treatment. Future initiatives should incorporate acceptance models to improve development of internet interventions for youth.

The COVID-19 pandemic and related public health efforts limiting in-person social interactions present unique challenges to adolescents. Social media, which is widely used by adolescents, presents an opportunity to counteract these challenges and promote adolescent health and public health activism. However, public health organizations and officials underuse social media to communicate with adolescents. Using well-established risk communication strategies and insights from adolescent development and human-computer interaction literature, we identify current efforts and gaps, and propose recommendations to advance the use of social media risk communication for adolescents during the COVID-19 pandemic and future disasters.