A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls

Telemental Health and Web-based Applications in Children and Adolescents

The authors conducted a review of the literature with regard to child and adolescent mental health intervention, from which they identified 20 unique publications and 12 separate interventions. These interventions encompassed depression, anxiety, substance abuse, eating disorders, and mental health promotion. Studies were heterogeneous, with a wide range of study designs and comparison groups creating some challenges in interpretation. However, modest evidence was found that Internet interventions showed benefits compared with controls and preintervention symptom levels. Interventions had been developed for a range of settings, but tended to recruit middle-class participants of European ethnicity. Internet interventions showed a range of approaches toward engaging children and incorporating parents and peers into the learning process.

Practitioner-supported delivery of internet-based cognitive behaviour therapy: evaluation of the feasibility of conducting a cluster randomised trial

OBJECTIVE

To determine the feasibility of conducting a cluster randomised trial in Australia of the effectiveness of general practitioner-supported delivery of internet-based cognitive behaviour therapy (CBT) and enhanced psychological care.

DESIGN, SETTING AND PARTICIPANTS

Cluster randomised trial involving patients attending general practices in Australia. Participating practices were randomly allocated to interventions. The study was conducted between January 2004 and January 2007.

INTERVENTIONS

Enhanced GP care was delivered by doctors who had completed specific mental health training; the experimental condition consisted of enhanced GP care plus MoodGYM, an internet-based CBT intervention.

MAIN OUTCOME MEASURES

Demographic and behavioural characteristics of patients, and demographic and practice characteristics of GPs; time to resolution of psychological symptoms for patients involved in the longitudinal phase of the trial.

RESULTS

1571 patients attending 90 GPs from 84 general practices were identified as potentially suitable for recruitment. These patients had a mean age of 35 years, 76% were female, 84% had access to the internet for personal use, and 22% reported high or very high levels of psychological distress on the Kessler Psychological Distress Scale. The 90 GPs had a mean age of 49 years, 53% were female and 25% had completed formal mental health training. Of the 1571 screened patients, 340 reported high levels of psychological distress, but only 140 of these could be further assessed for eligibility in the trial. Of these 140, 83 patients with depression (attending 10 GPs in eight general practices) proceeded to randomisation. For these patients, the experimental intervention (enhanced GP care plus MoodGYM) tended to result in prompt and more sustained resolution of depressive symptoms.

CONCLUSION

Our capacity to conduct a definitive trial was limited by available resources. Preliminary data suggest that primary care patients with depression may derive additional benefits from an internet-based CBT program delivered in conjunction with enhanced psychological care from GPs.

Evaluation of an online cognitive behavioural therapy program by patients with traumatic brain injury and depression

PRIMARY OBJECTIVE

The most frequently reported psychiatric symptom after traumatic brain injury (TBI) is depression. This study examined whether internet-delivered cognitive behaviour therapy (CBT) could be appropriate and effective for patients with mild or moderate TBI and depression.

METHODS AND PROCEDURES

Patients were recruited for an at-home, 6-week internet-based CBT program (MoodGYM). Participants were assessed during this period by weekly telephone calls and at 12 months post-enrolment. Intervention completion rates, predictors of adherence, user feedback and changes in scores on validated depression scales were assessed.

MAIN OUTCOMES AND RESULTS

Twenty-one patients were recruited: 64% and 43% completed the 6-week intervention and the 12-month follow-up, respectively. Adherence rates were not predicted by demographic or injury characteristics in this small sample. Patients identified reading, memory and comprehension requirements as limitations of the program. Scores on the depression scales were significantly decreased upon completion of the intervention and at the 12-month follow-up.

CONCLUSIONS

The MoodGYM program may be effective for treating symptoms of depression in patients with TBI. While adherence rates were not predicted by age, education level or injury severity, demands upon memory and concentration which may already be compromised in these patients need to be considered.

Clinicians' Attitudes Towards the Use of Computerized Cognitive Behaviour Therapy (cCBT) with Children and Adolescents

Background: Research has begun to examine the effectiveness of computerized cognitive behaviour therapy (cCBT) with children and adolescents. Although cCBT appears promising, the attitudes of clinicians towards this type of intervention with children and young people have not been assessed, yet these are important in determining when and if cCBT will be offered. Aims: To survey clinicians’ attitudes towards cCBT with children and adolescents. Method: A self-report questionnaire was completed by 43 mental health professionals attending a conference. Results: Clinicians were cautious but generally positive about the use of cCBT with children and adolescents, particularly for the delivery of prevention programmes and in the treatment of mild/moderate problems. Few felt that cCBT should be available freely online without any professional support. Indeed, the lack of a therapeutic relationship and professional support were identified as the biggest problems, whilst the potential to use cCBT at home was the greatest advantage identified. Conclusions: This survey suggests that clinicians are generally positive about the use of cCBT with children and adolescents for the prevention and treatment of mild/moderate problems. Further research is required to address clinicians’ concerns about the effectiveness of cCBT for more substantial problems and the level of therapeutic support required.

Population prevalence of depression and mean Beck Depression Inventory score

BACKGROUND

For some phenomena the mean of population distributions predicts the proportion of people exceeding a threshold value.

AIMS

To investigate whether in depression, too, the population mean predicts the number of individuals at the extreme end of the distribution.

METHOD

We used data from the European Outcome in Depression International Network (ODIN) study from populations in Finland, Norway and the UK to create models that predicted the prevalence of depression based on the mean Beck Depression Inventory (BDI) score. The models were tested on data from Ireland and Spain.

RESULTS

Mean BDI score correlated well with the prevalence of depression determined by clinical interviews. A model based on the beta distribution best fitted the BDI distribution. Both models predicted the depression prevalence in Ireland and Spain fairly well.

CONCLUSIONS

The mean of a continuous population distribution of mood predicts the prevalence of depression. Characteristics of both individuals and populations determine depression rates.

Health e-cards as a means of encouraging help seeking for depression among young adults: randomized controlled trial

Background

There is a need to identify interventions that increase help seeking for depression among young adults.

Objective

The aim was to evaluate a brief depression information intervention employing health e-cards (personalized emails containing links to health information presented on a Web page).

Methods

A randomized controlled trial was carried out with 348 19- to 24-year-olds drawn from the community. Participants were randomized to receive one of three conditions, all of which delivered a short series of health e-cards. Two active conditions involved the delivery of depression information designed to increase help-seeking behavior and intentions and to improve beliefs and knowledge associated with help seeking. A control arm delivered information about general health issues unrelated to depression. The primary outcome was help-seeking behavior. Secondary outcomes were help-seeking intentions; beliefs about the efficacy of depression treatments and help sources; ability to recognize depression; knowledge of the help-seeking process; and depressive symptoms. The study’s primary focus was outcomes relating to formal help seeking (consultation with a general practitioner or mental health professional) but also targeted behaviors, intentions, and beliefs relating to informal help seeking.

Results

Relative to the control condition, depression health e-cards were not associated with an increase in formal help-seeking behavior, nor were they associated with improved beliefs about depression treatments; ability to recognize depression; knowledge of the help-seeking process; or depressive symptoms. Depression e-cards were associated with improved beliefs about the overall efficacy of formal help sources (z = 2.4, P = .02). At post-intervention, participants in all conditions, relative to pre-intervention, were more likely to have higher intentions of seeking help for depression from a formal help source (t₆₄₁ = 5.8, P < .001) and were more likely to rate interpersonal psychotherapy as being helpful (z = 2.0, P = .047). Depression e-cards were not associated with any significant changes in informal help-seeking behavior, intentions, or beliefs.

Conclusions

The study found no evidence that providing depression information in the form of brief e-cards encourages help seeking for depression among young adults. Involvement in the study may have been associated with increased help-seeking intentions among participants in all conditions, suggesting that mechanisms other than depression information may increase help seeking.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN98406912; http://www.controlled-trials.com/ISRCTN98406912/ISRCTN98406912 (Archived by WebCite at http://www.webcitation.org/5k221KiMi)