Mental Health Support in the Digital Era: Examining the Effectiveness of E-Therapies Among Young Adults

The rapid movement of mental health care online means the digitally delivered therapies (e-therapies) will be one of the main responses to the increasing prevalence of psychological distress amongst young adults. The use of internet-delivered cognitive behavioural therapy, smartphone applications, and blended care models now encompasses populations disregarded by traditional services, but the evidence base underlying their use is still restricted to high-income Western contexts.  This proposal describes a convergent parallel mixed-methods study that will examine the effectiveness, mechanisms and lived experience of e-therapies among young adults (age 18 to 25 years). The study will particularly attend to the Indian context, where a wide mental-health treatment gap, pervasive stigma and uneven digital access shape help-seeking in ways that differ substantially from the settings in which most interventions were developed and validated. This study has four main objectives: to estimate the impact of guided versus self-guided e-therapy engagement on depression, anxiety and general distress, to test whether therapeutic alliance and self-efficacy mediate this impact, to examine whether engagement and outcomes are moderated by digital literacy, perceived stigma and cultural fit, and to understand how young adults experience digital care through their own accounts. The quantitative strand features a quasi-experimental two-arm longitudinal design with about 320 participants assessed at baseline 6 weeks and 12 weeks analysed using linear mixed-effects models bootstrapped mediation moderation analysis. The qualitative component consists of semi-structured interviews that were held with a purposively selected subsample of 24. This qualitative component was analysed using reflexive thematic analysis. The integration of the two strands occurs at the interpretation stage as a joint display triangulation logic. Theoretically, the study utilize Unified Theory of Acceptance and use of Technology and supporting Accountability Model. The proposal highlights three gaps in the relevant literature: geo-concentrated evidence, a lack of proper theorisation of engagement as a mechanism, and detached effectiveness and experiential research. The anticipated contribution of this work is an integrated, context-sensitive account of when, how, and for whom e‐therapies work, which is intended to inform the culturally responsive design and implementation of digital mental-health services in India and similar settings. The study will be conducted according to established ethics pertaining to research involving human subjects.