Evaluation of ReachOut.com, an Unstructured Digital Youth Mental Health Intervention: Prospective Cohort Study.

BACKGROUND: Young people experience a disproportionate burden associated with mental illness that Australia's mental health care system is ill-equipped to handle. Despite improvements in the provision of mental health services, the rates of service utilization among young people remain suboptimal, and there are still considerable barriers to seeking help. Digital mental health services can overcome a number of barriers and connect young people requiring support; however, the evidence base of digital interventions is limited. OBJECTIVE: The aim of this study is to examine the effectiveness of a brief, self-directed, unstructured digital intervention, ReachOut.com (hereafter ReachOut), in reducing depression, anxiety, stress, and risk of suicide. METHODS: A cohort of 1982 ReachOut users participated in a 12-week longitudinal study, with a retention rate of 81.18% (1609/1982) across the duration of the study. Participants completed web-based surveys, with outcome measures of mental health status and suicide risk assessed at 3 time points across the study period. RESULTS: The results demonstrated that over the 12-week study period, young people using ReachOut experienced modest yet significant reductions in symptoms of depression, anxiety, and stress. Significant, albeit modest, reductions in the proportion of participants at high risk of suicide were also observed. CONCLUSIONS: The findings of this research provide preliminary evidence of the promise of an unstructured digital mental health intervention, ReachOut, in alleviating symptoms of mental ill-health and promoting well-being in young people. These findings are particularly important given that digital services are not only acceptable and accessible but also have the potential to cater to the diverse mental health needs of young people at scale, in a way that other services cannot.

Parents in prevention: A meta-analysis of randomized controlled trials of parenting interventions to prevent internalizing problems in children from birth to age 18.

PURPOSE OF THE RESEARCH: Burgeoning evidence that modifiable parental factors can influence children's and adolescents' risk for depression and anxiety indicates that parents can play a crucial role in prevention of these disorders in their children. However, it remains unclear whether preventive interventions that are directed primarily at the parent (i.e. where the parent receives more than half of the intervention) are effective in reducing child internalizing (including both depression and anxiety) problems in the longer term. PRINCIPAL RESULTS: Compared to a range of comparison conditions, parenting interventions reduced child internalizing problems, at a minimum of 6months after the intervention was delivered. Mean effects were very small for measures of internalizing and depressive symptoms, and small for measures of anxiety symptoms. Pooled effects for anxiety diagnoses were significant and indicated a number needed to treat (NNT) of 10. Pooled effects for depression diagnoses approached significance but suggested a NNT of 11. These results were based on effects reported at the longest follow-up interval for each included study, which ranged from 6months up to 15years for internalizing measures, 5.5years for depressive measures, and 11years for anxiety measures. MAJOR CONCLUSIONS: Our findings underscore the likely benefits of increasing parental involvement in preventing internalizing problems, particularly anxiety problems, in young people.

Enhancing reciprocal partner support to prevent perinatal depression and anxiety: a Delphi consensus study.

BACKGROUND: Systematic reviews have established that partner support protects against perinatal mood problems. It is therefore a key target for interventions designed to prevent maternal and paternal depression and anxiety. Nonetheless, the extant literature is yet to be translated into specific actions that parents can implement. Prevention efforts aiming to facilitate reciprocal partner support within the couple dyad need to provide specific guidance on how partners can support one another to reduce their vulnerability to perinatal depression and anxiety. METHOD: Two panels of experts in perinatal mental health (21 consumer advocates and 39 professionals) participated in a Delphi consensus study to establish how partners can support one another to reduce their risk of developing depression and anxiety during pregnancy and the postpartum period. RESULTS: A total of 214 recommendations on how partners can support each other were endorsed by at least 80 % of both panels as important or essential in reducing the risk of perinatal depression and anxiety. The recommendations were grouped under the following categories: becoming a parent, supporting each other through pregnancy and childbirth, communication, conflict, division of labor, practical support, emotional support, emotional closeness, sexual satisfaction, using alcohol and drugs, encouraging self-care, developing acceptance, and help-seeking. CONCLUSION: This study established consensus between consumers and professionals in order to produce a set of guidelines on how partners can support each other to prevent depression and anxiety during pregnancy and following childbirth. It is hoped that these guidelines will inform the development of perinatal depression and anxiety prevention efforts.

Identifying prevention strategies for adolescents to reduce their risk of depression: A Delphi consensus study.

BACKGROUND: Adolescence is a peak time for the onset of depression, but little is known about what adolescents can do to reduce their own level of risk. METHOD: This study employed the Delphi methodology to establish expert consensus on self-help prevention strategies for adolescent depression. A literature search identified 194 recommendations for adolescents. These were presented over three questionnaire rounds to panels of 32 international research and practice experts and 49 consumer advocates, who rated the preventive importance of each recommendation and the feasibility of their implementation by adolescents. RESULTS: 145 strategies were endorsed as likely to be helpful in reducing adolescents׳ risk of developing depression by ≥80% of both panels. Endorsed strategies included messages on mental fitness, personal identity, life skills, healthy relationships, healthy lifestyles, and recreation and leisure. 127 strategies were endorsed as likely to be helpful in reducing risks for depression for both junior and senior adolescents. One strategy was rated as likely to be helpful during the period of junior adolescence only, and 17 strategies were endorsed for the senior adolescent period only. Ratings of the ease of implementing the strategies during the adolescent period accorded by panellists were typically moderate. LIMITATIONS: This study used experts from developed, English-speaking countries; hence the strategies identified may not be for relevant or minority cultures within these countries or for other countries. CONCLUSIONS: This study produced a set of self-help preventive strategies for depression that are supported by research evidence and/or international experts, which can now be promoted in developed English-speaking communities to help adolescents reduce their risk of depression.

Modifiable partner factors associated with perinatal depression and anxiety: a systematic review and meta-analysis.

BACKGROUND: Perinatal distress is a significant public health problem that adversely impacts the individual and their family. The primary objective of this systematic review and meta-analysis was to identify factors that partners can modify to protect each other from developing perinatal depression and anxiety. METHOD: In accordance with the PRISMA statement, we reviewed the risk and protective factors associated with perinatal depression and anxiety symptoms that partners can potentially modify without professional assistance (PROSPERO reference CRD42014007524). Participants were new or expectant parents aged 16 years or older. The partner factors were sub-grouped into themes (e.g., instrumental support) based on a content analysis of the scale items and measure descriptions. A series of meta-analyses were conducted to estimate the pooled effect sizes of associations. RESULTS: We included 120 publications, reporting 245 associations with depression and 44 with anxiety. Partner factors with sound evidence that they protect against both perinatal depression and anxiety are: emotional closeness and global support. Partner factors with a sound evidence base for depression only are communication, conflict, emotional and instrumental support, and relationship satisfaction. LIMITATIONS: This review is limited by the lack of generalizability to single parents and the inability to systematically review moderators and mediators, or control for baseline symptoms. CONCLUSION: The findings suggest that future prevention programs targeting perinatal depression and anxiety should aim to enhance relationship satisfaction, communication, and emotional closeness, facilitate instrumental and emotional support, and minimize conflict between partners.

Risk and protective factors for depression that adolescents can modify: a systematic review and meta-analysis of longitudinal studies.

BACKGROUND: Adolescence is a peak time for the onset of depression, but little is known about what adolescents can do to reduce their own level of risk. To fill this gap, a review was carried out to identify risk and protective factors for depression during adolescence that are modifiable by the young person. METHODS: Employing the PRISMA method, we conducted a systematic review and meta-analysis of longitudinal studies to identify risk and protective factors during the adolescent period (aged 12-18 years) that are potentially modifiable by the young person without professional intervention or assistance. Stouffer׳s method of combining p values was used to determine whether associations between variables were reliable, and meta-analyses were conducted to estimate the mean effect sizes of associations. RESULTS: We identified 113 publications which met the inclusion criteria. Putative risk factors implicated in the development of depression for which there is a sound evidence base, and which are potentially modifiable during adolescence without professional intervention, are: substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; negative coping strategies; and weight. Modifiable protective factors with a sound evidence base are healthy diet and sleep. LIMITATIONS: Limitations include not systematically reviewing moderators and mediators, the lack of generalisability across cultures or to younger children or young adults, and the inability to conduct a meta-analysis on all included studies. CONCLUSIONS: Findings from this review suggest that future health education campaigns or self-help prevention interventions targeting adolescent depression should aim to reduce substance use (alcohol, tobacco, cannabis, other illicit drugs, and polydrug use); dieting; and negative coping strategies; and promote healthy weight; diet; and sleep patterns.