Mechanisms of change in digital health interventions for mental disorders in youth: Systematic review

Matthias Domhardt, Sophie Engler, Hannah Nowak, Arne Lutsch, Amit Baumel, Harald Baumeister

Research output: Contribution to journalReview articlepeer-review


Background: Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. Objective: This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods: A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). Results: A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. Conclusions: The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future.

Original languageEnglish
Article numbere29742
Pages (from-to)e29742
JournalJournal of Medical Internet Research
Issue number11
StatePublished - 26 Nov 2021

Bibliographical note

Funding Information:
This work was supported by the German Federal Ministry of Education and Research (grant identification FKZ01KG1802). The funding source, the Federal Ministry of Education and Research, had no role in the study design, collection, analysis, or interpretation of the data, writing of the manuscript, or the decision to submit this paper for publication.

Publisher Copyright:
© Matthias Domhardt, Sophie Engler, Hannah Nowak, Arne Lutsch, Amit Baumel, Harald Baumeister. Originally published in the Journal of Medical Internet Research (, 26.11.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.


  • Children and adolescents
  • Digital health intervention
  • Mechanisms of change
  • Mediator
  • Mental disorders
  • Mobile phone
  • Psychotherapy

ASJC Scopus subject areas

  • Health Informatics


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