Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial.

Karin Lindqvist,Hanne-Sofie J Dahl,Fredrik Falkenström,Agneta Thorén,Rolf Sandell,Julian Edbrooke-Childs,Per Carlbring,Nick Midgley,Naira Topooco,Gerhard Andersson,Björn Philips,Jakob Mechler,Peter Lilliengren,Robert Johansson,Katja Lindert Bergsten,Randi Ulberg

doi:10.2196/18047

Abstract

BackgroundAdolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments.ObjectiveThis trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents.MethodsThe trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment.ResultsIPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P<.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P<.001) and increasing emotion regulation (d=0.97, P<.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules.ConclusionsIPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments.Trial RegistrationInternational Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254

Highlights

According to the World Health Organization [1], adolescent depression is the fourth-leading cause of illness and disability among young people 15-19 years of age
A total of 4 participants randomized to internet-based psychodynamic therapy (IPDT) never entered treatment, meaning that they never participated in any of the exercises or chat sessions and had no contact with the therapist, except in 2 cases to say that they wanted to drop out
A total of 3 of these participants never opened the initial study message, meaning that they dropped out without knowing their allocation. These 4 nonstarters were still included in the ITT analysis for the primary outcome measure, but not for the secondary outcome measures

Summary

Introduction

According to the World Health Organization [1], adolescent depression is the fourth-leading cause of illness and disability among young people 15-19 years of age. Only a minority of young people suffering from depression seek and/or receive professional help [3,4]. Barriers to seeking help include practical issues of accessing services, perceived stigma and feelings of shame, desire to be self-reliant, and difficulties recognizing symptoms of mental health disorders [5]. Internet-based interventions may address some of the barriers to seeking and receiving treatment. Internet-based interventions may potentially reach patients who otherwise would avoid seeking treatment due to social stigma [7]. Making treatment more accessible for adolescents via the internet may lead to future health benefits in the population as it enables people to receive treatment at an earlier stage of their psychiatric illness. Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments

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