The Dual Role of Nurses in Adolescent Mental Health: A Systematic Review of Stigma, Policy Barriers, and Digital Health Challenges in Indonesia
DOI:
https://doi.org/10.31674/mjn.2026.v18i01.017Abstract
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.
Keywords:
Adolescent Mental Health, Digital Technology, Indonesia, Mental Health NursingDownloads
References
Balhara, Y. P. S., Mahapatra, A., Sharma, P., & Bhargava, R. (2018). Problematic internet use among students in South-East Asia: Current state of evidence. Indian Journal of Public Health, 62(3), 197–210. https://doi.org/10.4103/ijph.IJPH_288_17
Barker, T. H., Habibi, N., Aromataris, E., Stone, J. C., Leonardi-Bee, J., Sears, K., Hasanoff, S., Klugar, M., Tufanaru, C., Moola, S., & Munn, Z. (2024). The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies. JBI Evidence Synthesis, 22(3), 378–388. https://doi.org/10.11124/JBIES-23-00268
Bond, R. R., Mulvenna, M. D., Potts, C., Neill, S. O., Ennis, E., & Torous, J. (2023). Digital transformation of mental health services. Mental Health Research, 2(13), 1–9. https://doi.org/10.1038/s44184-023-00033-y
Badan Pusat Statistik. (2020). Statistik Indonesia 2020 [Indonesian Statistics 2020]. Badan Pusat Statistik. https://www.bps.go.id/publication/2020/04/29/e9011b3155d45d70823c141f/statistik-indonesia-2020.html
Chan, S. L., Ho, C. Z. H., Khaing, N. E. E., Ho, E., Pong, C., Guan, J. S., Chua, C., Li, Z., Lim, T., Lam, S. S. W., Low, L. L., & How, C. H. (2024). Frameworks for measuring population health: A scoping review. PLoS ONE, 19(2 February), 1–18. https://doi.org/10.1371/journal.pone.0278434
Düzgün, N., & Demir, S. (2023). Professional experiences of nurses working in community mental health centers: A phenomenological study. Journal of Psychiatric Nursing, 14(3), 224–231. https://doi.org/10.14744/phd.2023.17037
Endriyani, S., Martini, S., & Pastari, M. (2024). Youth Mental Health Education and Screening with Application. Madaniya, 5(1), 192–198. https://doi.org/10.53696/27214834.687
Hernandez, J. (2022). Impacts of Telehealth on Access-to-Care for Mental Health Patients. International Neuropsychiatric Disease Journal, 18(2), 1–7. https://doi.org/10.9734/indj/2022/v18i2345
Hidayat, M. T., Lawn, S., Muir-Cochrane, E., & Oster, C. (2020). The use of pasung for people with mental illness: a systematic review and narrative synthesis. International Journal of Mental Health Systems, 14(1), 1–21. https://doi.org/10.1186/s13033-020-00424-0
Hidayat, M. T., Oster, C., Muir-Cochrane, E., & Lawn, S. (2023). Indonesia free from pasung: a policy analysis. International Journal of Mental Health Systems, 17(1), 1–22. https://doi.org/10.1186/s13033-023-00579-6
Isni, K., Fitri, M., Emma, S., Jatmika, D., Marie, J., Leon, G. De, Rachmayanti, R. D., Qomariyah, N., & Sulistyawati, S. (2024a). The implementation of adolescent mental health services: opportunities and challenges. International Journal of Public Health Science, 13(2), 810–819. https://doi.org/10.11591/ijphs.v13i2.23597
Isni, K., Lugiana, N. A., Trisnowati, H., Santri, N., & Qomariyah, N. (2024b). How Can Adolescents Get Mental Health Services Without the Availability of Professionals? A Lesson Learned from Rural Primary Health Care. Jurnal Promkes: The Indonesian Journal of Health Promotion and Health Education, 12(1), 133–145. https://doi.org/10.20473/jpk.V12.ISI1.2024.133-145
Konstantinos, G. (2024). Thematic analysis: A practical guide. European Journal of Psychotherapy & Counselling, 26(3–4), 461–464. https://doi.org/10.1080/13642537.2024.2391666
Kuusisto, A., Santavirta, J., Saranto, K., Suominen, T., & Asikainen, P. (2022). Nursing staff’s assessments of medication management process in the psychiatric and operative domains: A cross‐sectional study after introduction of an electronic medication chart. Scandinavian Journal of Caring Sciences, 36(4), 935-946. https://doi.org/10.1111/scs.12989
Li, M., Gao, Q., & Yu, T. (2023). Kappa statistic considerations in evaluating inter-rater reliability between two raters: which, when and context matters. BMC Cancer, 23(1), 1–5. https://doi.org/10.1186/s12885-023-11325-z
Maravilla, J. C., Fine, S. L., Ramaiya, A., Li, M., Wado, Y. D., Wahdi, A. E., ... & Erskine, H. E. (2025). Social support and mental health among adolescents in Kenya, Indonesia, and Vietnam: A latent class analysis using the National Adolescent Mental Health Surveys. Child and Adolescent Psychiatry and Mental Health, 19(Suppl 1), 1–13. https://doi.org/10.1186/s13034-025-00923-3
Marthoenis, M., Sari, H., Martina, M., Alfiandi, R., Asnurianti, R., Hasniah, H., Safitri, S. D., & Fathiariani, L. (2023). The prevalence of and perception toward mental illness: a cross-sectional study among Indonesian mental health nurses. BMC Psychiatry, 23(1), 1–6. https://doi.org/10.1186/s12888-023-05063-6
Natalia, S. J., & Fridari, I. G. A. D. (2022). The role of collectivist culture and mental health literacy in mental illness stigma among university students in Indonesia. Psychology, 12(4), 166-175. https://doi.org/10.17265/2159-5542/2022.04.002
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ, 372. https://doi.org/10.1136/bmj.n71
Pangiras, G., Ibrahim, I. M. B., & Latif, T. B. A. (2021). A Review of the Perceptions of Mental Illness and Mental Health Literacy in Indonesia. European Journal of Behavioral Sciences, 4(2), 18–25. https://doi.org/10.33422/ejbs.v4i2.612
Pham, M. D., Wulan, N. R., Sawyer, S. M., Agius, P. A., Fisher, J., Tran, T., ... & Azzopardi, P. S. (2024). Mental Health Problems Among Indonesian Adolescents: Findings of a Cross-Sectional Study Utilizing Validated Scales and Innovative Sampling Methods. Journal of Adolescent Health, 75(6), 929–938. https://doi.org/10.1016/j.jadohealth.2024.07.016
Picalho, A. C., Lucas, E. R. de O., & Amorim, I. S. (2022). Boolean logic applied to the construction of search expressions. AtoZ: New Practices in Information and Knowledge, 11, 1–12. https://doi.org/10.5380/atoz.v11i0.81838
Putri, A. K., Gustriawanto, N., Rahapsari, S., Sholikhah, A. R., Prabaswara, S., Kusumawardhani, A. C., & Kristina, S. A. (2021). Exploring the perceived challenges and support needs of Indonesian mental health stakeholders: a qualitative study. International Journal of Mental Health Systems, 15(1), 1–9. https://doi.org/10.1186/s13033-021-00504-9
Rachmawati, I., Meigawati, D., & Trang, P. D. K. (2023). The implementation of the Sistem Inovasi Cepat Penanganan ODGJ Terpadu (SICEPOT) in Sukabumi City. Jurnal Pendidikan Vokasi, 13(3), 262-272. https://doi.org/10.21831/jpv.v13i3.70160
Sharafkhani, M., Geary, U., Kennedy, C., Browne, M., Codd, M., Dea, A. O., Shields, D., Hennessy, A., Mcdonagh, L., Hara, S. O., Kennedy, B., Mccullagh, C., Reilly, M. O., & Ward, M. E. (2025). Using Socio-Technical Systems Analysis to Understand the Enablers of Resilience in Clinical Handover in Acute Hospital Settings. Theoretical and Applied Ergonomics, 1(1), 5. https://doi.org/10.3390/tae1010005
Shoji, Y., Irwan, A. M., Ochiai, R., Syahrul, S., Shinohara, E., Fiqri, A. M., Takeuchi, S., Erfina, E., Iida, M., Saleh, A., Moriguchi, F., Nakamura, S., & Kanoya, Y. (2025). The Impact of eHealth Literacy on Health Behaviors for Non-communicable Disease Prevention among University Students in Japan and Indonesia. Cureus, 17(2), 1–13. https://doi.org/10.7759/cureus.78450
Subu, M. A., Holmes, D., Arumugam, A., Al-Yateem, N., Maria Dias, J., Rahman, S. A., Waluyo, I., Ahmed, F. R., & Abraham, M. S. (2022). Traditional, religious, and cultural perspectives on mental illness: a qualitative study on causal beliefs and treatment use. International Journal of Qualitative Studies on Health and Well-Being, 17(1), 2123090. https://doi.org/10.1080/17482631.2022.2123090
Suradi, A., & Dharma, U. W. (2025). A Theoretical Extension of Technology Organization Environment (TOE) in E-Government: A Systematic Literature Review and Theory Evaluation. Journal of Computer Science and Technology (JCS-TECH), 5(1), 29–36. https://doi.org/10.54840/jcstech.v5i1.361
Suratmini, D., Daulima, N. H. C., & Wardani, I. Y. (2024). Validity and Reliability of the Indonesian Version of the Internalized Stigma Mental Illness Instrument: Substance Abuse in Adolescents. Jurnal Keperawatan Soedirman, 19(2), 65–71. https://doi.org/10.20884/1.jks.2024.19.2.7680
Susanti, D. (2024). Description of Mental Health in Young Women Who Participate in Islamic Mentoring at Stikes Budi Luhur Cimahi. In Proceeding of The International Conference on Health Sciences (TICHes) (Vol. 3, No. 3). https://doi.org/10.62817/tiches.v3i3.328
Susanti, H., Brooks, H., Yulia, I., Windarwati, H. D., Yuliastuti, E., Hasniah, H., & Keliat, B. A. (2024). An exploration of the Indonesian lay mental health workers’ (cadres) experiences in performing their roles in community mental health services: a qualitative study. International Journal of Mental Health Systems, 18(1), 1–13. https://doi.org/10.1186/s13033-024-00622-0
Tasijawa, F. A., Sutini, T., & Maelissa, S. R. (2021). Recovery from ‘schizophrenia’: Perspectives of mental health nurses in the Eastern island of Indonesia. Belitung Nursing Journal, 7(4), 336. https://doi.org/10.33546/bnj.1621
World Health Organization (WHO). (2017). Mental health status of adolescents in South-East Asia: Evidence for action. https://www.who.int/publications/i/item/9789290225737
Yosep, I., Mediani, H. S., & Abstract, L. L. (2021). Working alliance among mental health nurses in Indonesia: A comparative analysis of socio-demographic characteristics. Belitung Nursing Journal, 7(2), 125–130. https://doi.org/10.33546/bnj.1259
Zeck, W., & Lai, J. (2020). Adolescent Mental Health Matters. UNICEF. https://www.unicef.org/media/82926/file/Adolescent-Mental-Health-Matters-Report-Final-July2020.pdf
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