Abstract
Digital mental health interventions show promise for populations with barriers to mental healthcare access, including youth and immigrant and refugee communities. These interventions can provide early screening for mental disorders, symptom monitoring, and connections to further care. This study pilot tests a transdiagnostic digital mental health intervention for immigrant and refugee youth in the United States for preliminary clinical effectiveness and implementation outcomes such as barriers and facilitators to integrating the intervention with the focal population. The pre-post pilot study design took place from May to September 2021. STARS (Sustainable Technology for Adolescents to Reduce Stress) is a transdiagnostic digital mental health intervention that delivers evidence-based psychological content designed to reduce symptoms of common mental disorders like anxiety and depression. Content is delivered via a chatbot that provides daily interactive 10–20-min sessions for 10 days. Participants were immigrant and refugee youth ages 14–25. Baseline assessments were performed followed by a 10-day intervention usage period and follow-up assessment. Measures included symptom severity of common mental disorders, intervention usage statistics, and a usability survey. A subset of participants took part in semi-structured interviews to assess barriers and facilitators to implementation, which was structured according to the CFIR framework. A total of 129 participants ages 14–25 from immigrant and refugee communities enrolled in the study. The majority (62.8%, n = 81) of participants were female, 31.8% were male (n = 41), and 5.4% (n = 7) were non-binary or another gender identity. Participants had been living in the United States for an average of 17.9 years (SD = 11.4), had a mean age of 19.5 (SD = 2.9), and reported 53 countries of origin. Baseline mental health scores were generally high using all measures. Participants completed an average of 7 sessions out of 10 (SD = 3.9). Regression results showed each additional intervention session completed was associated with reductions in mental health severity scores, but these associations were non-significant. Barriers and facilitators to uptake and engagement with the intervention fell into three CFIR categories: characteristics of the intervention, inner setting, and characteristics of individuals. The short, module-based delivery of the intervention was well received, as was personalized content, use of mixed media (text, video, audio), and user control of the intervention (i.e., responses to the chatbot). Barriers included time constraints, technological problems, and perceptions that the content was suitable for younger teenagers. The STARS transdiagnostic digital mental health intervention was well-received by participants and showed initial evidence of suitability for immigrant and refugee youth in the United States. More research is needed to maximize clinical effectiveness and bridge the gap between publicly available online mental health resources and evidence-based digital mental health interventions tailored to specific populations.