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  • Perspective
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Advancing youth co-design of ethical guidelines for AI-powered digital mental health tools

Nature Mental Health volume 3, pages 870–878 (2025)Cite this article

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Abstract

Adolescents and young adults (AYA) often face mental health challenges and are heavily influenced by technology. Digital health interventions (DHIs), leveraging smartphone data and artificial intelligence, offer immense potential for personalized and accessible mental health support. However, ethical guidelines for DHI research fail to address AYA’s unique developmental and technological needs and leave crucial ethical questions unanswered. This gap creates risks of either over- or under-protecting AYA in DHI research, slowing progress and causing harm. This Perspective examines ethical gaps in DHI research for AYA, focusing on three critical domains: challenges of passive data collection and artificial intelligence, consent practices, and risks of exacerbating inequities. We propose an agenda for ethical guidance based on bioethical principles autonomy, respect for persons, beneficence and justice, developed through participatory research with AYA, particularly marginalized groups. We discuss methodologies to achieve this agenda, ensuring ethical, youth-focused and equitable DHI research for the mental health of AYA.

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References

  1. Chavira, D. A., Ponting, C. & Ramos, G. The impact of COVID-19 on child and adolescent mental health and treatment considerations. Behav. Res. Ther. 157, 104169 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lee, C. M., Cadigan, J. M. & Rhew, I. C. Increases in loneliness among young adults during the COVID-19 pandemic and association with increases in mental health problems. J. Adolesc. Health 67, 714–717 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cotton, N. K. & Shim, R. S. Social determinants of health, structural racism, and the impact on child and adolescent mental health. J. Am. Acad. Child Adolesc. Psychiatry 61, 1385–1389 (2022).

    Article  PubMed  Google Scholar 

  4. Copeland, W. E. et al. Increase in untreated cases of psychiatric disorders during the transition to adulthood. Psychiatr. Serv. 66, 397–403 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Stroud, C., Walker, L. R., Davis, M. & Irwin, C. E. Jr. Investing in the health and well-being of young adults. J. Adolesc. Health 56, 127–129 (2015).

    Article  PubMed  Google Scholar 

  6. Lehtimaki, S., Martic, J., Wahl, B., Foster, K. T. & Schwalbe, N. Evidence on digital mental health interventions for adolescents and young people: systematic overview. JMIR Ment. Health 8, e25847 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ferrante, M., Esposito, L. E. & Stoeckel, L. E. From palm to practice: prescription digital therapeutics for mental and brain health at the National Institutes of Health. Front. Psychiatry 15, 1433438 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Wright, M., Reitegger, F., Cela, H., Papst, A. & Gasteiger-Klicpera, B. Interventions with digital tools for mental health promotion among 11–18 year olds: a systematic review and meta-analysis. J. Youth Adolesc. 52, 754–779 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Chen, T., Ou, J., Li, G. & Luo, H. Promoting mental health in children and adolescents through digital technology: a systematic review and meta-analysis. Front. Psychol. 15, 1356554 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Piers, R., Williams, J. M. & Sharpe, H. Review: can digital mental health interventions bridge the ‘digital divide’ for socioeconomically and digitally marginalised youth? A systematic review. Child Adolesc. Ment. Health 28, 90–104 (2023).

    Article  PubMed  Google Scholar 

  11. Chen, B. et al. Comparative effectiveness and acceptability of internet-based psychological interventions on depression in young people: a systematic review and network meta-analysis. BMC Psychiatry 25, 321 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jahedi, F., Fay Henman, P. W. & Ryan, J. C. Personalization in digital psychological interventions for young adults. Int. J. Hum. Comput. Interact. 40, 2254–2264 (2024).

    Article  Google Scholar 

  13. Hightow-Weidman, L. B., Horvath, K. J., Scott, H., Hill-Rorie, J. & Bauermeister, J. A. Engaging youth in mHealth: what works and how can we be sure? MHealth 7, 23 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Zhu, S., Wang, Y. & Hu, Y. Facilitators and barriers to digital mental health interventions for depression, anxiety, and stress in adolescents and young adults: scoping review. J. Med. Internet Res. 27, e62870 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Götzl, C. et al. Artificial intelligence-informed mobile mental health apps for young people: a mixed-methods approach on users’ and stakeholders’ perspectives. Child Adolesc. Psychiatry Ment. Health 16, 86 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hornstein, S., Zantvoort, K., Lueken, U., Funk, B. & Hilbert, K. Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms. Front. Digit. Health 5, 1170002 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Li, H., Zhang, R., Lee, Y.-C., Kraut, R. E. & Mohr, D. C. Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being. npj Digit. Med. 6, 236 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Heinz, M. V. et al. Randomized trial of a generative AI chatbot for mental health treatment. NEJM AI https://doi.org/10.1056/AIoa2400802 (2025).

  19. Gutierrez, G., Stephenson, C., Eadie, J., Asadpour, K. & Alavi, N. Examining the role of AI technology in online mental healthcare: opportunities, challenges, and implications, a mixed-methods review. Front. Psychiatry 15, 1356773 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ehtemam, H. et al. Role of machine learning algorithms in suicide risk prediction: a systematic review-meta analysis of clinical studies. BMC Med. Inform. Decis. Mak. 24, 138 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Atmakuru, A. et al. Artificial intelligence-based suicide prevention and prediction: a systematic review (2019–2023). Inf. Fusion 114, 102673 (2025).

    Article  Google Scholar 

  22. Goodin, P., Van Kolfschooten, H. B. & Centola, F. Artficial Intelligence in Mental Healthcare (Mental Health Europe, 2025).

  23. Young, J. et al. The role of AI in peer support for young people: a study of preferences for human- and AI-generated responses. In Proc. CHI Conference on Human Factors in Computing Systems (CHI ’24) 1006 (Association for Computing Machinery, 2024).

  24. Schaaff, C. et al. Youth perspectives on generative AI and its use in health care. J. Med. Internet Res. 27, e72197 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Smith, K. A. et al. Digital mental health: challenges and next steps. BMJ Ment. Health 26, e300670 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Laacke, S., Mueller, R., Schomerus, G. & Salloch, S. Artificial intelligence, social media and depression. A new concept of health-related digital autonomy. Am. J. Bioeth. 21, 4–20 (2021).

    Article  PubMed  Google Scholar 

  27. Seroussi, B. & Zablit, I. Implementation of digital health ethics: a first step with the adoption of 16 European ethical principles for digital health. Stud. Health Technol. Inform. 310, 1588–1592 (2024).

    PubMed  Google Scholar 

  28. Nebeker, C., Gholami, M., Kareem, D. & Kim, E. Applying a digital health checklist and readability tools to improve informed consent for digital health research. Front. Digit. Health 3, 690901 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nebeker, C., Torous, J. & Bartlett Ellis, R. J. Building the case for actionable ethics in digital health research supported by artificial intelligence. BMC Med. 17, 137 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Psihogios, A. M., King-Dowling, S., Mitchell, J. A., McGrady, M. E. & Williamson, A. A. Ethical considerations in using sensors to remotely assess pediatric health behaviors. Am. Psychol. 79, 39–51 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chng, S. Y. et al. Ethical considerations in AI for child health and recommendations for child-centered medical AI. npj Digit. Med. 8, 152 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mello, M. M. & Cohen, I. G. Regulation of health and health care artificial intelligence. JAMA 333, 1769–1770 (2025).

    Article  PubMed  Google Scholar 

  33. Tavory, T. Regulating AI in mental health: ethics of care perspective. JMIR Ment. Health 11, e58493 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  34. van Kolfschooten, H. & van Oirschot, J. The EU Artificial Intelligence Act (2024): implications for healthcare. Health Policy 149, 105152 (2024).

    Article  PubMed  Google Scholar 

  35. Dignum, V., Penagos, M., Pigmans, K. & Vosloo, S. Policy Guidance on AI for Children (UNICEF, 2021); https://www.unicef.org/innocenti/reports/policy-guidance-ai-children

  36. Atabey, A. et al. Children & AI Design Code (5Rights Foundation); https://5rightsfoundation.com/children-and-ai-code-of-conduct/

  37. Artificial Intelligence for Children (World Economic Forum, 2022); https://www3.weforum.org/docs/WEF_Artificial_Intelligence_for_Children_2022.pdf

  38. APA’s AI Tool Guide for Practitioners (APA, 2024); https://www.apaservices.org/practice/business/technology/tech-101/evaluating-artificial-intelligence-tool

  39. Urging the Federal Trade Commission to Take Action on Unregulated AI (APA, 2025); https://www.apaservices.org/advocacy/news/federal-trade-commission-unregulated-ai

  40. National Academy of Medicine. An Artificial Intelligence Code of Conduct for Health and Medicine: Essential Guide for Aligned Action (National Academies Press, 2025); https://nap.nationalacademies.org/catalog/29087/an-artificial-intelligence-code-of-conduct-for-health-and-medicine

  41. The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research: Appendix (Department of Health, Education, and Welfare, National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978).

  42. Cassell, E. J. The principles of the Belmont report revisited. How have respect for persons, beneficence, and justice been applied to clinical medicine? Hastings Cent. Rep. 30, 12–21 (2000).

    Article  PubMed  Google Scholar 

  43. McNeilly, E. A. et al. Adolescent social communication through smartphones: linguistic features of internalizing symptoms and daily mood. Clin. Psychol. Sci. 11, 1090–1107 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Stiles-Shields, C. et al. mHealth uses and opportunities for teens from communities with high health disparities: a mixed-methods study. J. Technol. Behav. Sci. 8, 282–294 (2022).

  45. Movahed, S. V. & Martin, F. Ask me anything: exploring children’s attitudes toward an age-tailored AI-powered chatbot. Preprint at https://arxiv.org/abs/2502.14217 (2025).

  46. Duffy, C. 'There are no guardrails.' This mom believes an AI chatbot is responsible for her son’s suicide. CNN Buisness https://edition.cnn.com/2024/10/30/tech/teen-suicide-character-ai-lawsuit/ (2024).

  47. Kurian, N. ‘No, Alexa, no!’: designing child-safe AI and protecting children from the risks of the ‘empathy gap’ in large language models. Learn. Media Technol. https://doi.org/10.1080/17439884.2024.2367052 (2024).

  48. Hadar-Shoval, D., Asraf, K., Mizrachi, Y., Haber, Y. & Elyoseph, Z. Assessing the alignment of large language models with human values for mental health integration: cross-sectional study using Schwartz’s theory of basic values. JMIR Ment. Health 11, e55988 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  49. Mansfield, K. L. et al. From social media to artificial intelligence: improving research on digital harms in youth. Lancet Child Adolesc. Health 9, 194–204 (2025).

    Article  PubMed  Google Scholar 

  50. Xu, Y., Prado, Y., Severson, R. L., Lovato, S. & Cassell, J. in Handbook of Children and Screens 611–617 (Springer Nature, 2025).

    Chapter  Google Scholar 

  51. Wong, Q. California lawmakers consider possible dangers of AI chatbots. Los Angeles Times (9 April 2025); https://www.govtech.com/artificial-intelligence/california-lawmakers-consider-possible-dangers-of-ai-chatbots

  52. Sanderson, C., Douglas, D. & Lu, Q. Implementing responsible AI: tensions and trade-offs between ethics aspects. In Proc. 2023 International Joint Conference on Neural Networks (IJCNN) 1–7 (IEEE, 2023).

  53. "Without It, I Wouldn't Be Here Today" (Born This Way Foundation, 2025); https://bornthisway.foundation/research/lgbtq-young-people-online-communities-2025/

  54. Mustanski, B. Ethical and regulatory issues with conducting sexuality research with LGBT adolescents: a call to action for a scientifically informed approach. Arch. Sex. Behav. 40, 673–686 (2011).

    Article  PubMed  Google Scholar 

  55. Chleider, J. L., Dobias, M., Sung, J., Mumper, E. & Mullarkey, M. C. Acceptability and utility of an open-access, online single-session intervention platform for adolescent mental health. JMIR Ment. Health 7, e20513 (2020).

    Article  Google Scholar 

  56. Liverpool, S. et al. Engaging children and young people in digital mental health interventions: systematic review of modes of delivery, facilitators, and barriers. J. Med. Internet Res. 22, e16317 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  57. Samdal, O. et al. Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects. Obes. Rev. 24, e13636 (2023).

    Article  PubMed  Google Scholar 

  58. Stiles-Shields, C. et al. Digital mental health screening, feedback, and referral system for teens with socially complex needs: protocol for a randomized controlled trial integrating the Teen Assess, Check, and Heal System into pediatric primary care. JMIR Res. Protoc. 14, e65245 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  59. Hein, I. M. et al. Informed consent instead of assent is appropriate in children from the age of twelve: policy implications of new findings on children’s competence to consent to clinical research. BMC Med. Ethics 16, 76 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  60. Crane, S. & Broome, M. E. Understanding ethical issues of research participation from the perspective of participating children and adolescents: a systematic review. Worldviews Evid. Based. Nurs. 14, 200–209 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  61. Stiles-Shields, C. et al. A call to action: using and extending human-centered design methodologies to improve mental and behavioral health equity. Front. Digit. Health 4, 848052 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  62. Ramos, G. & Chavira, D. A. Use of technology to provide mental health care for racial and ethnic minorities: evidence, promise, and challenges. Cogn. Behav. Pract. 29, 15–40 (2022).

    Article  Google Scholar 

  63. Whitehead, L., Talevski, J., Fatehi, F. & Beauchamp, A. Barriers to and facilitators of digital health among culturally and linguistically diverse populations: qualitative systematic review. J. Med. Internet Res. 25, e42719 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  64. Ramos, G., Ponting, C., Labao, J. P. & Sobowale, K. Considerations of diversity, equity, and inclusion in mental health apps: a scoping review of evaluation frameworks. Behav. Res. Ther. 147, 103990 (2021).

    Article  PubMed  Google Scholar 

  65. Hatef, E., Hudson Scholle, S., Buckley, B., Weiner, J. P. & Austin, J. M. Development of an evidence- and consensus-based Digital Healthcare Equity Framework. JAMIA Open 7, ooae136 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  66. McCabe, E. et al. Youth engagement in mental health research: a systematic review. Health Expect. 26, 30–50 (2023).

    Article  PubMed  Google Scholar 

  67. Zhou, B. et al. Youth Perspectives and Recommendations for the United Nations's High-Level Advisory Board on Artificial Intelligence. Foundational Papers of the United Nations High-Level Advisory Body on AI (United Nations, 2023).

  68. Gurevich, E., El Hassan, B. & El Morr, C. Equity within AI systems: what can health leaders expect? Healthc. Manage. Forum 36, 119–124 (2023).

    Article  PubMed  Google Scholar 

  69. Kotek, H., Dockum, R. & Sun, D. Gender bias and stereotypes in large language models. In Proc. ACM Collective Intelligence Conference 12–24 (Association for Computing Machinery, 2023).

  70. Kharchenko, J., Roosta, T., Chadha, A. & Shah, C. How well do LLMs represent values across cultures? Empirical analysis of LLM responses based on Hofstede cultural dimensions. Preprint at https://arXiv:2406.14805 (2024).

  71. Karnik, N. S., Afshar, M., Churpek, M. M. & Nunez-Smith, M. Structural disparities in data science: a prolegomenon for the future of machine learning. Am. J. Bioeth. 20, 35–37 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  72. Wells, K. An eating disorders chatbot offered dieting advice, raising fears about AI in health. Shots https://www.npr.org/sections/health-shots/2023/06/08/1180838096/an-eating-disorders-chatbot-offered-dieting-advice-raising-fears-about-ai-in-health (2023).

  73. Gabriel, S., Puri, I., Xu, X., Malgaroli, M. & Ghassemi, M. in Findings of the Association for Computational Linguistics: EMNLP 2024 (eds Al-Onaizan, Y. et al.) 2206–2221 (Association for Computational Linguistics, 2024).

  74. Ramos, G. et al. App-based mindfulness meditation for people of color who experience race-related stress: protocol for a randomized controlled trial. JMIR Res. Protoc. 11, e35196 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  75. Thomas et al. Leveraging data and digital health technologies to assess and impact social determinants of health (SDoH): a state-of-the-art literature review. Online J. Public Health Inform. 13, E14 (2021).

    Google Scholar 

  76. McGorry, P. D. et al. The Lancet Psychiatry Commission on youth mental health. Lancet Psychiatry 11, 731–774 (2024).

    Article  PubMed  Google Scholar 

  77. Bailey, K. et al. Benefits, barriers and recommendations for youth engagement in health research: combining evidence-based and youth perspectives. Res. Involv. Engagem. 10, 92 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  78. Zidaru, T., Morrow, E. M. & Stockley, R. Ensuring patient and public involvement in the transition to AI-assisted mental health care: a systematic scoping review and agenda for design justice. Health Expect. 24, 1072–1124 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  79. Schueller, S. M., Hunter, J. F., Figueroa, C. & Aguilera, A. Use of digital mental health for marginalized and underserved populations. Curr. Treat. Options Psychiatry 6, 243–255 (2019).

    Article  Google Scholar 

  80. Juntunen, C. L. et al. Centering equity, diversity, and inclusion in ethical decision-making. Prof. Psychol. Res. Pr. 54, 17–27 (2023).

    Article  Google Scholar 

  81. Stiles-Shields, C., Ramos, G., Ortega, A. & Psihogios, A. M. Increasing digital mental health reach and uptake via youth partnerships. npj Ment. Health Res. 2, 9 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  82. Figueroa, C. et al. Skepticism and excitement when co-designing just-in-time mental health apps with minoritized youth. Preprint at SSRN https://doi.org/10.2139/ssrn.5039034 (2024).

  83. Afkinich, J. L. & Blachman-Demner, D. R. Providing incentives to youth participants in research: a literature review. J. Empir. Res. Hum. Res. Ethics 15, 202–215 (2020).

    Article  PubMed  Google Scholar 

  84. Lyon, A. R., Brewer, S. K. & Areán, P. A. Leveraging human-centered design to implement modern psychological science: return on an early investment. Am. Psychol. 75, 1067–1079 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  85. Malloy, J., Partridge, S. R., Kemper, J. A., Braakhuis, A. & Roy, R. Co-design of digital health interventions with young people: a scoping review. Digit. Health 9, 20552076231219117 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  86. van Velsen, L., Ludden, G. & Grünloh, C. The limitations of user- and human-centered design in an eHealth context and how to move beyond them. J. Med. Internet Res. 24, e37341 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  87. Khawaja, J., Bagley, C. & Taylor, B. Breaking the silence: critical discussion of a youth participatory action research project. JCPP Adv. 4, e12283 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  88. Leman, A. M. et al. An interdisciplinary framework of youth participatory action research informed by curricula, youth, adults, and researchers. J. Res. Adolesc. 35, e13007 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  89. Figueroa, C., Marin, L., de Reuver, M. and Jaff, M. Translating well-being values into design features of social media platforms: a value sensitive design approach. Preprint at OSF https://osf.io/preprints/osf/wxtj7_v1 (2024).

  90. Farmer, N. et al. Use of a community advisory board to build equitable algorithms for participation in clinical trials: a protocol paper for HoPeNET. BMJ Health Care Inform. 29, e100453 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  91. Chang, M. A. et al. Co-design partners as transformative learners: imagining ideal technology for schools by centering speculative relationships. In Proc. CHI Conference on Human Factors in Computing Systems 1–15 (ACM, 2024).

  92. Thorn, P. et al. Developing a suicide prevention social media campaign with young people (the #chatsafe project): co-design approach. JMIR Ment. Health 7, e17520 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  93. Teixeira, S., Augsberger, A., Richards-Schuster, K. & Sprague Martinez, L. Participatory research approaches with youth: ethics, engagement, and meaningful action. Am. J. Community Psychol. 68, 142–153 (2021).

    Article  PubMed  Google Scholar 

  94. Bevan et al. Practitioner review: co-design of digital mental health technologies with children and young people. J. Child Psychol. Psychiatry 61, 928–940 (2020).

    Article  Google Scholar 

  95. Cockerham, D. Participatory action research: building understanding, dialogue, and positive actions in a changing digital environment. Educ. Technol. Res. Dev. 72, 2763–2791 (2024).

    Article  Google Scholar 

  96. Gerdes, A. & Frandsen, T. F. A systematic review of almost three decades of value sensitive design (VSD): what happened to the technical investigations? Ethics Inf. Technol. 25, (2023).

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Acknowledgements

C.A.F. is supported through the ‘High Tech for a Sustainable Future’ capacity-building program of the 4TU Federation in the Netherlands. The funders had no role in the content of the manuscript. G.R. is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number T32HL166114. N.S.K.’s work on this project is supported, in part, by the J. Usha Raj Endowed Professorship at the University of Illinois Chicago. C.S.-S.’s work is supported in part by a grant from the National Institute of Mental Health (K08 MH125069). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any of the institutions named here.

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Authors and Affiliations

  1. Technology, Policy and Management, Delft University of Technology, Delft, the Netherlands

    C. A. Figueroa

  2. School of Social Welfare, University of California Berkeley, Berkeley, CA, USA

    C. A. Figueroa

  3. Department of Psychological Science, University of California, Irvine, Irvine, CA, USA

    G. Ramos

  4. Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA, USA

    G. Ramos

  5. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    A. M. Psihogios

  6. Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    A. M. Psihogios

  7. Be Ubuntu Foundation, Amsterdam, the Netherlands

    E. Ekuban, P. Bansie & M. de Haas

  8. Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, USA

    N. S. Karnik & C. Stiles-Shields

  9. AI.Health4All Center, College of Medicine, University of Illinois Chicago, Chicago, IL, USA

    N. S. Karnik & C. Stiles-Shields

  10. Department of Psychiatry, University of Illinois Chicago, Chicago, IL, USA

    O. Ajilore

  11. Neiswanger Institute for Bioethics and Healthcare Leadership, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA

    E. E. Anderson

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Contributions

C.S.-S. drafted the initial version of the paper. C.A.F. led the development of subsequent drafts and facilitated discussion sessions among the authors. C.A.F., C.S.-S., E.E.A., G.R., N.S.K., A.M.P. and O.A. participated in at least one group discussion. P.B. and E.E. engaged in a dedicated session with C.A.F. and met with her individually to discuss their contributions, which they additionally provided in writing. C.A.F. also held a separate meeting with M.d.H. to incorporate their input. C.A.F., C.S.-S., E.E.A., G.R., N.S.K., A.M.P., O.A., P.B., E.E. and M.d.H. contributed to editing and approved the final version of the paper.

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Correspondence to C. A. Figueroa.

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Figueroa, C.A., Ramos, G., Psihogios, A.M. et al. Advancing youth co-design of ethical guidelines for AI-powered digital mental health tools. Nat. Mental Health 3, 870–878 (2025). https://doi.org/10.1038/s44220-025-00467-7

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