JMIR Publications

ABSTRACT

Background:

Adolescence is a critical period for stress vulnerability, with high levels of stress linked to anxiety, depression, ADHD, and sleep problems. While digital mental health interventions (DMHIs) are increasingly used to support adolescent mental health, little is known about their effectiveness in managing stress. Measurement-based collaborative care models (CoCM) in DMHIs may provide a structured approach to addressing adolescent stress, but research on their impact remains limited.

Objective:

The purpose of this study is to explore the effectiveness of a CoCM DMHI in managing stress among adolescents. We aimed to (1) quantify self-reported stress levels and identify factors associated with elevated stress, (2) assess changes in stress during care, and (3) explore key factors influencing stress reduction.

Methods:

Adolescents (ages 13-17 years) who receive coaching and therapy through a CoCM DMHI (Bend Health Inc.) completed mental health assessments at enrollment and monthly throughout care. Associations between stress levels and demographic factors, co-occurring mental health symptoms, and caregiver well-being were used to identify predictors of stress, and mixed-effects models were used to assess changes in stress during care.

Results:

At enrollment, 91.5% of adolescents reported elevated stress. Higher stress levels were associated with co-occurring mental health and sleep problems, as well as female sex (P’s<0.05). Caregiver stress (t2152=3.90, P<.001) and sleep problems (t2152=3.82, P<.001) were linked to adolescent stress, but caregiver burnout was not (t2152=1.02, P=.31). During care, 80.9% of adolescents experienced stress reductions, with improvements emerging after one month. In adolescents with a caregiver reporting co-occurring stress at enrollment, non-elevated caregiver stress during care was associated with larger improvements in adolescent stress (t248.73=-2.27, P=.024). Adolescents with elevated anxiety showed larger stress reductions compared to those with non-elevated anxiety (t3369=-2.77, P=.006).

Conclusions:

Stress levels were closely linked to co-occurring mental health symptoms and caregiver stress and sleep problems. A CoCM DMHI was effective in reducing adolescent stress, with reductions in caregiver stress and co-occurring elevated anxiety associated with larger improvements, demonstrating its potential for broader stress management. These findings underscore the need for DMHIs to incorporate family-centered approaches, and future research should explore ways to optimize DMHIs for long-term stress reduction and assess their impact on broader mental health outcomes.