Quality social connection as an active ingredient in digital interventions for young people with depression and anxiety: systematic scoping review and meta-analysis

Background Disrupted social connections may negatively impact youth mental health. In contrast, sustained quality social connections (QSC) can improve mental health outcomes. However, few studies have examined how these quality connections impact depression and anxiety outcomes within digital interventions, and conceptualisation is limited. Objective The study aim was to conceptualise, appraise and synthesise evidence on quality social connection within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people (14-24). Methods A systematic scoping review and meta-analysis was conducted using the Johanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Medline, Embase, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched against a comprehensive combination of key concepts on 24th June 2020. Search concepts included young people, digital intervention, depression/anxiety, and social connection. Google was also searched. One reviewer independently screened abstracts/titles and full-text and 10% were screened by a second reviewer. A narrative synthesis was used to structure findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from included studies were synthesised to produce a conceptual framework. Results 5715 publications were identified and 42 were included. Of these, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness and feeling ignored indicated D-QSC was not present. In ten applicable studies, a meta-analysis showed a significant decrease in ...