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

OBJECTIVES: Computer-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. DESIGN: Single centre RCT feasibility study. SETTING: The trial was run within community and clinical settings in York, UK. PARTICIPANTS: Adolescents (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. INTERVENTIONS: An 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 MEASURES: Participants 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. RESULTS: From 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. CONCLUSIONS: With 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 NUMBER: ISRCTN31219579.

Computerised CBT for depressed adolescents: Randomised controlled trial.

BACKGROUND: Depression in adolescents is a common and impairing problem. Effective psychological therapies for depression are not accessed by most adolescents. Computerised therapy offers huge potential for improving access to treatment. AIMS: To test the efficacy of Stressbusters, a Computerised-CBT (C-CBT) programme for depression in young people. METHOD: Multi-site, schools-based, RCT of C-CBT compared to Waiting List, for young people (N = 112; aged 12-16) with significant symptoms of depression, using multiple-informants (adolescents, parents, teachers), with follow-up at 3 and 6 months. RESULTS: Relative to being on a Waiting List, C-CBT was associated with statistically significant and clinically meaningful improvements in symptoms of depression and anxiety according to adolescent self-report; and with a trend towards improvements in depression and anxiety according to parent-report. Improvements were maintained at follow-up. Treatment gains were similar for boys and girls across the participating age range. Treatment effect was partially mediated by changes in ruminative thinking. Teachers rated adolescents as having few emotional or behavioural problems, both before and after intervention. C-CBT had no detectable effect on academic attainment. In the month after intervention, young people who received C-CBT had significantly fewer absences from school than those on the Waiting List. CONCLUSIONS: C-CBT shows considerable promise for the treatment of mild-moderate depression in adolescents.

Does parental anxiety cause biases in the processing of child-relevant threat material?

OBJECTIVES: Anxiety leads to biases in processing personally relevant information. This study set out to examine whether anxious parents also experience biases in processing child-relevant material. DESIGN AND METHODS: Ninety parents acted as a control condition, or received a social anxiety or child-related anxiety induction. They completed a task examining attentional biases in relation to child-threat words and social-threat words, and a task examining ability to categorize emotion in children's faces and voices. RESULTS: There was a trend indicating group differences in attentional bias towards social-threat words, and this appears to have been only in the social anxiety condition, but not the child anxiety or control conditions. For child-threat words, attentional bias was present in the child anxiety condition, but not the social anxiety or control conditions. In the emotion recognition task, there was no difference between the control and child anxiety conditions, but the social anxiety condition were more likely to erroneously label children's faces and voices as sad. CONCLUSIONS: Parents' anxious biases may spill over into their child's world. PRACTITIONER POINTS: Parents' anxious biases may spill over into their child's world. Anxious parents may have attentional biases towards threats in their children's environment. Anxious parents may over-attribute negative emotion to children.

Computerized CBT for adolescent depression ("Stressbusters") and its initial evaluation through an extended case series.

BACKGROUND: "Stressbusters" is an interactive computer software programme based on a clinically effective face-to-face CBT protocol for young people with depression. It was designed for teenagers with mild to moderate depression, and comprises eight 45-minute sessions. METHOD: Twenty-three young people (aged 12-16; mean age 14.87 years) with symptoms of depression were recruited from CAMHS teams in Manchester and London, and received the Stressbusters treatment (range 1 - 8 sessions, mode 8 sessions). RESULTS: On the K-SADS at initial assessment, 95% met diagnostic criteria for a depressive disorder, with a high group mean score of 35.48 (SD 9.84) on the MFQ. Post-treatment, 22% of young people met criteria for a depressive disorder, with the group mean score on the MFQ falling significantly below clinical cut-off to 20.32 (SD 11.75). These gains were maintained at 3-month follow-up. Significant improvements were also found in the adolescents' global functioning (CGAS), self-reported anxiety (RCMAS), depressive cognitions and attributions (ATQ and CTI-C), and in adolescent- and parent-reported emotional and behavioural difficulties (SDQ). CONCLUSIONS: Taken together, these results provide promising preliminary data for the clinical efficacy of Stressbusters as a valid form of CCBT for adolescents with depression.

CAMHS dependency scoring: clarity and clinical relevance of the CAMHS-AID.

AIM: A dependency measure (the CAMHS-AID) was developed in Birmingham and Manchester to support more accurate decisions about whether a young person can be accommodated on a child and adolescent mental health services (CAMHS) inpatient unit. This study aimed to test the content and face validity of the scale. METHOD: Eighty-six nursing staff were provided with booklets of the randomly ordered CAMHS-AID items and asked to rate the clarity of the items and how well they reflected clinical practice on a 5-point scale. RESULTS: The majority of the items were given a score of four or five, indicating that the majority of the CAMHS nurses felt that the CAMHS-AID items were very clear and understandable and accurately reflected clinical practice. There was greater variance when rating the clinical relevance of the items; the higher the grade of nurse the more likely they were to rate the items a 5 for clinical relevance. CONCLUSION: The CAMHS-AID has good content and face validity. We are continuing to investigate other aspects of validity and reliability of this context specific dependency scoring tool.

Measuring patient dependency in child and adolescent mental health.

Within the context of child and adolescent mental health inpatient services, a literature review was undertaken to understand the concept of inpatient dependency and how it can be measured. Articles and books relating to patient dependency and its measurement in various contexts were retrieved, and other published measures were identified. It was found that dependency has been defined in many different ways, and various techniques have aimed to quantify or categorize patients' dependencies. This article focuses particularly on measures used in adult psychiatry and paediatric services. At present, there is no available established measure of patient dependency in child and adolescent inpatients. This article identifies the need to develop a measure of inpatient dependency that is specifically designed for these services, and outlines a tool that the authors have recently designed.

Dependency scoring for child and adolescent inpatient mental health services.

Child and adolescent mental health services (CAMHS) inpatient units provide multi-disciplinary treatment for young people with a wide range of complex needs, many of whom have co-morbid presentations. There is no reliable, validated measure of CAMHS patient dependency. This article reports the first stages of a project to develop a properly researched dependency measure for use before (i.e. by those referring the young person) and during the young person's stay. Expert opinion was sought to develop a list of statements regarding a young person's care which could be rated according to level of need. Initial piloting demonstrated face and concurrent validity; next steps include exploring issues of item ambiguity and weighting.