A Randomized Trial of Online Single Session Interventions for Adolescent Depression during COVID-19

Abstract

The COVID-19 pandemic caused financial hardship, social isolation, and distress, increasing risk for adolescent depression. Even before the pandemic, <50% of youth with depression accessed care, and not all benefited from existing treatments. Accordingly, this randomized-controlled trial tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression (N=2,452, ages 13-16). Adolescents recruited via social media were randomized to 1 of 3 SSIs: a behavioral activation SSI, an SSI teaching that personal traits are malleable, or a supportive control. We tested each SSI’s effects on post-intervention (hopelessness, agency) and 3-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-related trauma). Compared to the control, both active SSIs reduced 3-month depressive symptoms; decreased post-intervention and 3-month hopelessness; and increased post-intervention agency. Several differences between active SSIs emerged. Results confirm the effectiveness of two free-of-charge, online SSIs for adolescents with elevated depression, even in the high-stress context of COVID-19.

An online, single-session intervention for adolescent self-injurious thoughts and behaviors: Results from a randomized trial

“…The present sample's overrepresentation of specific groups (e.g., girls/women, non-binary adolescents), and the underrepresentation of others (e.g., boys/men), is consistent with higher rates of NSSI and suicidal ideation among girls/women, sexual minority, and gender minority adolescents (Bakken & Gunter, 2012;Fox, Choukas-Bradley, et al, 2020). Lower representation of boys/men is also a common pattern among other studies offering digital mental health supports (Kramer et al, 2014;Sung et al, 2021;van der Zanden et al, 2012;Schleider et al, 2021); however, we cannot assume the present study's results are generalizable to adolescent boys. Additionally, the most commonly endorsed racial/ethnic identity within the present sample was White (75%).…”

“…First, true effect sizes for the Project SAVE single-session intervention on NSSI and suicidal ideation could be smaller than anticipated at this trial's outset. One meta-analysis of randomized trials evaluating single-session interventions found a small-to-medium effect across a broad range of youth mental health problems (Hedges's g = .32; Schleider & Weisz, 2017); a recent, larger-scale randomized trial (N = 2,452) of two web-based, single-session intervention programs indicate significant, small long-term improvements in depression symptoms and hopelessness 3 months later, relative to an active control (ds = .18, ps < .001 ;Schleider, et al, 2021). Thus, future trials of digital single-session intervention programs should be properly powered to detect effect sizes within this range-likely approaching 1,000 participants or more.…”

“…Relative to receiving no treatment-as is the case for many youth who experience self-injurious thoughts and behaviors-it is possible that a single session of SINGLE-SESSION INTERVENTION ADOLESCENT SELF-INJURY 31 supportive therapy provided non-zero benefit to the present control group participants. One large-N trial that utilized an identical online, supportive therapy control program showed significant within-group reductions in depression over 3 months (within-group ds = -.35; Schleider et al, 2021). However, any potential benefits introduced by the active control program are indistinguishable from the possible effects of time.…”

“…More recently, a 2021 RCT found two online single-session interventions decreased depressive symptoms 3 months later, compared to an active control (Schleider et al, 2021). Although SITBs are often considered high-severity problems, existing literature suggests shorter treatments may also help reduce clinically severe difficulties.…”

Structural Correlates of Mental Health Support Access Among Sexual Minority Youth of Color During COVID-19

“…All study procedures were approved by the University IRB prior to participant enrollment, and all adolescents provided online assent prior to beginning the study (see Schleider et al, 2021, for original study procedures). Participants learned about the study through Instagram advertisements (total costs <$2,000), which followed established ethics guidelines for passive, social media-based recruitment (Gelinas et al, 2017).…”