JMIR Publications

ABSTRACT

Background:

Depression is a common and serious problem among adolescents but few seek or have access to therapy. While asynchronous internet-delivered cognitive behavior therapies (ICBT) show promise in reducing depression in adolescents, many adolescents may prefer and need real time online support.

Objective:

To determine the efficacy of an ICBT protocol blended with real-time therapist sessions via chat; ‘blended treatment’, for adolescent depression. The intervention, which explored access and stigma along with efficacy, was offered to adolescents at national level without the need for parental consent.

Methods:

In a two-arm randomized trial, n = 70 adolescents 15-19 years of age were recruited through community settings across Sweden and were allocated to either 8 weeks of treatment or to minimal attention control. Depression level was assessed at baseline, at post-treatment and at 12 months following treatment (in the intervention group.) The primary outcome was self-reported depression level as measured with BDI-II at post-treatment.

Results:

Over two weeks, n = 162 adolescents registered and completed the baseline screening. Eligible participants (n = 70) were on average 17.5 years of age (SD = 1.15), 96% female, suffered MDD (76%), had no prior treatment experience (56%), with guardian(s) knowing about their depression state (71%). The average treatment completion (as defined by total module and chat sessions completion) was 74%. ICBT participants demonstrated a significant decrease in depression symptoms from pre-to post treatment compared to controls (F (1,67) = 22.23, P < .001), corresponding to a large between-group effect (ITT-analysis: d = 0.86, 95%, CI: 0.37-1.35; of completer analysis: d = 0.99, 95%, CI: 0.48-1.51). Significant between-group effects were observed in secondary self-/clinician-reported depression outcomes (P’s <.005), clinically significant improvement was found in 46% of ICBT participants compared to 11% in the control group (P = .001).

Conclusions:

The approach shows high potential in reaching young individuals in need of mental health assistance. The results are in line with our previous study and further demonstrate that adolescents can successfully be engaged in and experience clinically significant improvement following ICBT blended with therapist chat sessions. Clinical Trial: ClinicalTrials.gov (NCT02363205).