Designing for all youth: a scoping review of equity and participation in mental health apps

Why This Matters for Young People and Families

Millions of young people live with anxiety, depression, or thoughts of self-harm, yet many never get the help they need. Smartphone apps promise support that fits in a pocket, available any time. But this review shows that most mental health apps are still not designed with all youth in mind—especially those from marginalized communities. Understanding where apps fall short, and how to fix that, matters for any parent, educator, or young person who hopes digital tools can truly narrow, rather than widen, the mental health gap.

Many Apps, But Not for Everyone

The authors examined 114 research studies on smartphone apps for young people aged 10 to 25 dealing with depression, anxiety, or suicidal thoughts. Most of these studies were recent and came from high-income countries, especially the United States. University and college students were heavily represented, while youth in lower-income settings, shelters, or less formal education pathways appeared far less often. On paper, the apps used a range of approaches—such as cognitive behavioral therapy, mindfulness, or peer support—and several studies showed promising effects on symptoms. Yet the central question was not whether apps can work, but whether they are built and tested in ways that serve the wide range of young people who might need them.

Who Has a Say in How Apps Are Built?

A key concern is how often young people are actually involved in shaping these tools. Fewer than half of the studies described any youth participation in the design of the app. In many cases, young people only appeared at the final stage, as test users in a trial, rather than as partners who help decide what the app should do or look like. Only a small handful of projects set up youth advisory boards or gave youth formal roles on the research team, and just two papers described youth leading parts of the research process. Details about how youth input changed the app were often missing, making it hard to judge how meaningful their involvement really was.

Equity Gaps: Culture, Access, and Privacy

The review also shows that basic fairness and access issues are rarely built into app design. Over half of the studies did not mention any diversity, equity, and inclusion (DEI) considerations at all. Important factors such as unreliable internet, expensive data plans, or older phones were rarely addressed. Only a small minority of studies discussed making apps work offline or reducing data use. Very few adapted language, reading level, or design for young people with different literacy skills or disabilities. Cultural differences and representation were similarly neglected: less than one in eight studies described tailoring content to local languages, stories, or values. Almost half of studies did not report race or ethnicity, and nearly 90% did not report family income. Meanwhile, privacy protections—crucial for young people who may fear stigma or family conflict—were discussed in only one in five studies.

Missed Voices and Hidden Risks

Because research samples are skewed toward White, female, highly educated youth in wealthier countries, the field knows far less about how apps work for those facing the greatest barriers: youth of color, Indigenous youth, LGBTQIA+ youth, migrants, and those in low-income or rural settings. Without their voices at the table, apps are less likely to address issues like discrimination, racial trauma, or identity conflict. The authors argue that continuing to design and evaluate apps this way wastes resources and may deepen existing gaps in care. It also makes it difficult to understand which design choices actually improve engagement or outcomes, because co-design processes and DEI features are poorly reported.

Building Fairer Digital Support for Youth

The review concludes that digital mental health tools are far from living up to their inclusive promise. To change course, the authors call for stronger youth participation from the earliest design stages through testing and rollout, with a focus on young people from communities that are usually left out. They recommend clearer standards for reporting who participates, how co-design is done, and which equity steps are taken, as well as specific DEI guidelines tailored to youth and to each phase of app development. As newer technologies such as artificial intelligence enter mental health care, the stakes grow even higher: without an equity lens and real youth partnership, these tools could reinforce old biases instead of easing them. Truly helpful mental health apps, the authors argue, will emerge only when all young people—not just the most reachable—help shape how digital care looks and works.

Citation: Figueroa, C., Pérez-Flores, N.J., Guan, K.W. et al. Designing for all youth: a scoping review of equity and participation in mental health apps. npj Digit. Public Health 1, 8 (2026). https://doi.org/10.1038/s44482-026-00012-y

Keywords: youth mental health apps, digital equity, co-design with young people, inclusive technology design, diversity in health research