The Dual Role of Nurses in Adolescent Mental Health: A Systematic Review of Stigma, Policy Barriers, and Digital Health Challenges in Indonesia
Abstract
Background: Nurses in Indonesia are uniquely positioned to address adolescent mental health through digital tools while mitigating associated risks, yet no systematic review has synthesized evidence on this dual role. Objectives: This review aimed to map the scope of digital mental health resources for adolescents in Indonesia and assess digital risks impacting their care to clarify the nursing role. Methods: This systematic review followed the PRISMA framework. Four databases (PubMed, Scopus, Web of Science, and Google Scholar) were used in identifying 2,051 records. Inclusion criteria comprised peer-reviewed studies (2019-2024) focusing on mental health nursing within the Indonesian context. Exclusion criteria involved non-empirical articles, studies with non-Indonesian populations, and publications lacking full-text access or a DOI. After screening, 12 articles were selected. Methodological quality was appraised using CASP/JBI checklists by two independent reviewers, showing substantial agreement (κ = 0.71). Results: The synthesis identified three core themes: 1) pervasive systemic and socio-cultural barriers (e.g., stigma, low mental health literacy) that shape the care context; 2) notable absence of empirical research on nurses' use of digital resources or management of digital risks; and 3) consistent identified need for nursing capacity building and policy support. Quality appraisal revealed a mix of high, moderate, and low methodological rigors among the included studies, with substantial inter-rater agreement (κ = 0.71). Conclusion: This review reveals a critical socio-technical gap. Digital tools hold transformative potential, but nurses currently lack the competencies, guidelines, and systemic support needed to use them safely. To bridge this gap, the urgent development of a digital mental health competency framework for nursing education and the establishment of enabling policies are imperative.