One quarter of children and young people (CYP) experience anxiety and/or depression before adulthood, but treatment is sometimes unavailable or inadequate. Self-help interventions may have a role in augmenting treatment and this work aimed to systematically review the evidence for computerised anxiety and depression interventions in CYP aged 5–25 years old. Databases were searched for randomised controlled trials and 27 studies were identified. For young people (12–25 years) with risk of diagnosed anxiety disorders or depression, computerised CBT (cCBT) had positive effects for symptoms of anxiety (SMD −0.77, 95% CI −1.45 to −0.09, k = 6, N = 220) and depression (SMD −0.62, 95% CI −1.13 to −0.11, k = 7, N = 279). In a general population study of young people, there were small positive effects for anxiety (SMD −0.15, 95% CI −0.26 to −0.03; N = 1273) and depression (SMD −0.15, 95% CI −0.26 to −0.03; N = 1280). There was uncertainty around the effectiveness of cCBT in children (5–11 years). Evidence for other computerised interventions was sparse and inconclusive. Computerised CBT has potential for treating and preventing anxiety and depression in clinical and general populations of young people. Further program development and research is required to extend its use and establish its benefit in children.
One quarter of children and young people suffer anxiety disorders or depression by adulthood (Copeland et al., 2011, Kessler et al., 2001 and Lewinsohn et al., 1993). Around 3% of children have an anxiety disorder at any one time, but rates of depression are relatively low (<1%) (Costello et al., 2003 and Ford et al., 2003). In adolescence, rates of anxiety disorders remain similar and rates of depression rise to 3% (Costello et al., 2003, Ford et al., 2003 and Lewinsohn et al., 1993), with cumulative prevalence of anxiety disorders and depression of around 10% and 25% respectively by 18 years (Lewinsohn et al., 1993 and Merikangas et al., 2010). Both anxiety disorders and depression in children and young people are associated with significant adverse mental health and life course outcomes, with the onset of the majority of adult anxiety disorders and depression occurring in childhood or adolescence (Kim-Cohen et al., 2003, Pine et al., 1998 and Woodward and Fergusson, 2001). Collectively, these considerations highlight the significant public health burden of anxiety disorders and depression in children and young people, and the importance of access to effective treatment.
Guidelines that include children and young people recommend psychological interventions as a first line approach for anxiety disorders and depression (Connolly and Bernstein, 2007, NICE, 2005a, NICE, 2005b and NICE, 2005c). However, there is evidence that many children and young people with anxiety disorders and depression do not receive evidence-based treatment (Kataoka et al., 2002, Merikangas et al., 2010, Stallard et al., 2007 and Wang et al., 2007). This may be due to a lack of symptom awareness, poor access to services or, where services are not provided, the cost of intervention. Where mental health services are delivered, these are commonly inadequate (Wang et al., 2007). In the case of Cognitive Behavioural Therapy (CBT), which is recommended for the treatment of both anxiety disorders and depression in children and young people (Connolly and Bernstein, 2007, NICE, 2005a, NICE, 2005b and NICE, 2005c), barriers to treatment include a lack of training, infrastructure and funding (Gunter and Whittal, 2010 and Stallard et al., 2007).
It has been proposed that self-help strategies may relieve some of the burden on health care services (Jorm & Griffiths, 2006) and, with the increasing use of internet and computer technologies, the computerisation of psychological interventions appears a logical step to achieve the provision of cost-effective help to all. There is a relatively large amount of research showing the effectiveness of computerised therapy for anxiety and depression in adults (Andersson and Cuijpers, 2009, Andrews et al., 2010 and Reger and Gahm, 2009). Children and young people have shown favourable attitudes towards these types of intervention (Stallard, Velleman, & Richardson, 2010), but systematic reviews of internet-based therapies in children and young people do not include recent research and cover a limited range of computerised therapies (Calear and Christensen, 2010 and Richardson et al., 2010). The current review aims to comprehensively review the evidence for all types of computerised therapy for anxiety and depression in children and young people.
Of 9330 citations obtained through the searches, 6989 remained after removing duplicates and, on screening, 6798 were excluded as there was sufficient information in the abstract to be certain that they were not relevant to the review. 195 were selected for hard-copy review. Of these, 168 were excluded because they did not meet the inclusion criteria (detailed above) for the intervention (N = 89), population (N = 42), study design (N = 12) or outcomes (N = 18), or because data could not be obtained from publications (N = 7) ( Fig. 1). Twenty seven studies were included in the review ( Table 1).
