Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: The onset of mental health problems peaks between adolescence and young adulthood, however young people face barriers to treatment and are often reluctant to seek professional help. Many are instead seeking support and information regarding their mental health online, especially via social networking sites (SNSs), so there is a promising opportunity to use SNSs to deliver or integrate with youth-focused online mental health interventions. Previous reviews have evaluated the effectiveness of SNSs for specific disorders in young people, however none to have covered the breadth of SNS-based youth mental health interventions available across all mental health issues. Objective: The aim of this review was to systematically identify available evidence regarding the use of SNS-based interventions to support the mental health of young people up to 25 years, in order to evaluate their effectiveness, suitability and safety, and identify gaps and opportunities for future research. Methods: The PubMed and PsycInfo databases were searched using Medical Subject Headings (MeSH) terms and exploded keywords and phrases. Retrieved abstracts (n=974) were double screened, yielding 235 articles for screening at the full-text level. Of these, nine articles met the review inclusion criteria. Given the small number of studies, their exploratory nature and the variety of outcome measures used, a quantitative meta-analysis was not possible. Results: The nine articles (quantitative studies, qualitative studies and descriptions of the iterative design process) covered five separate interventions. Two interventions used purpose-built platforms based on the Moderated Online Social Therapy (MOST) model, two used Facebook, and one evaluated a purpose-built mobile app. The two MOST interventions targeted specific mental health issues (depression and psychosis), while the others focused on improving mental health literacy, social support and general wellbeing. Only three quantitative studies were identified, and all used a pre-post design (without a control group) to establish ‘proof of concept’. Of the outcome variables assessed, there were significant improvements in mental health knowledge and number of depressive symptoms, but no improvement in anxiety or psychosis symptoms. Acceptability of and engagement with the SNS platforms was generally high, as were perceptions of usefulness and safety, with no adverse incidents reported. Moderation by clinical experts was identified as a key component of the more successful interventions. When offered a choice, users showed a preference for mobile apps over web-based interfaces. Conclusions: The evidence reviewed suggests young people find SNS-based interventions highly usable, engaging and supportive. However, future studies need to address the current lack of high-quality evidence for their efficacy in reducing mental health symptoms. Given that young people are already turning to SNSs to engage in knowledge-seeking and peer-to-peer support, SNS-based youth mental health interventions provide an opportunity to address some of the barriers young people face in accessing qualified mental health support and information.