Computerised cognitive–behavioural therapy for depression in adolescents: feasibility results and 4-month outcomes of a UK randomised controlled trial

Abstract

ObjectivesComputer-administered cognitive–behavioural therapy (CCBT) may be a promising treatment for adolescents with depression, particularly due to its increased availability and accessibility. The feasibility of delivering a randomised controlled trial (RCT) comparing a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression was evaluated.DesignSingle centre RCT feasibility study.SettingThe trial was run within community and clinical settings in York, UK.ParticipantsAdolescents (aged 12–18) with low mood/depression were assessed for eligibility, 91 of whom met the inclusion criteria and were consented and randomised to Stressbusters (n=45) or websites (n=46) using remote computerised single allocation. Those with comorbid physical illness were included but those with psychosis, active suicidality or postnatal depression were not.InterventionsAn eight-session CCBT program (Stressbusters) designed for use with adolescents with low mood/depression was compared with an attention control (accessing low mood self-help websites).Primary and secondary outcome measuresParticipants completed mood and quality of life measures and a service Use Questionnaire throughout completion of the trial and 4 months post intervention. Measures included the Beck Depression Inventory (BDI) (primary outcome measure), Mood and Feelings Questionnaire (MFQ), Spence Children's Anxiety Scale (SCAS), the EuroQol five dimensions questionnaire (youth) (EQ-5D-Y) and Health Utility Index Mark 2 (HUI-2). Changes in self-reported measures and completion rates were assessed by treatment group.ResultsFrom baseline to 4 months post intervention, BDI scores and MFQ scores decreased for the Stressbusters group but increased in the website group. Quality of life, as measured by the EQ-5D-Y, increased for both groups while costs at 4 months were similar to baseline. Good feasibility outcomes were found, suggesting the trial process to be feasible and acceptable for adolescents with depression.ConclusionsWith modifications, a fully powered RCT is achievable to investigate a promising treatment for adolescent depression in a climate where child mental health service resources are limited.Trial registration numberISRCTN31219579.

Is Digital Treatment the Holy Grail? Literature Review on Computerized and Blended Treatment for Depressive Disorders in Youth

“…The results also showed that the intervention was equally effective for boys and girls [35]. The findings of two studies showed that the decrease of depressive symptoms was larger in the participants in the unguided CBT condition when compared to the participants in the psychoeducational control condition [36,38]. Changes in mental health literacy after unguided computerized treatment were not reported.…”

“…Table 1 presents details of the included studies (k = 33). Sixteen studies were aimed at computerized treatments, of which nine were unguided computerized treatments (four computer-based and five internet-based) [30][31][32][33][34][35][36][37][38] and seven studies were guided computerized treatments (one computer-based and six internet-bases) [39][40][41][42][43][44][45], two studies at blended treatment [46,47], two studies compared unguided computerized, blended-and face-to-face treatment to no treatment [48,49], and eight studies were aimed at self-help internet-based games [50][51][52][53][54][55][56][57]. Furthermore, two studies that were focused on the use of an online monitoring tool aimed at registering and monitoring treatment progression [58,59] and three studies were aimed at characteristics of online interventions or studied the preferred modes of help seeking [60][61][62].…”

“…Fourteen studies were mainly focused on the evaluation of the effects of the intervention. In these studies, the designs varied between randomized controlled trials (k = 10) [34][35][36]38,39,44,45,49,52,57], pre-post designs with control group (k = 2) [33,42], and pre-post designs without control group (k = 2) [30,40]. Sixteen studies were mainly focused on the feasibility, usability, and acceptability of computerized and blended interventions.…”

Parent-child discrepancy in the assessment of health- related quality of life using the EQ-5D-Y questionnaire

“…In addition, the questionnaire has been extensively used worldwide in different populations with special health features, [22][23][24][25] and its metric properties have been described in its Spanish version for Spain, 6 as well as its comprehensibility and cultural adaptation in the general population. 7 In this regard, a pilot test was done in advance to assess the questionnaire's comprehensibility using query and paraphrasing methods in the target population, and it demonstrated an optimal comprehensibility.…”

Discrepancia en la evaluación de la calidad de vida relacionada con la salud entre niños y padres a través del cuestionario EQ-5D-Y

“…Además, el uso de este cuestionario está muy extendido internacionalmente en diferentes poblaciones con características especiales de salud, [22][23][24][25] cuyas propiedades métricas han sido descritas en su versión española para España, 6 así como su comprensibilidad y adaptación cultural en población general. 7 En este sentido, se ha realizado previamente un estudio piloto para evaluar la comprensibilidad mediante métodos de indagación y parafraseo en la población objetivo y se ha presentado una óptima comprensibilidad.…”