Abstract
Computerised cognitive-behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, however, more randomised controlled trials (RCTs) are needed to assess this. This single-centre RCT pilot study compared a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression at referral to evaluate the clinical and cost-effectiveness of CCBT (trial registration: ISRCTN31219579). The trial ran within community and clinical settings. Adolescents (aged 12-18) presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation. Participants completed mood, quality of life (QoL) and resource-use measures at intervention completion, and 4 and 12 months post-intervention. Changes in self-reported measures and completion rates were assessed by group. There was no significant difference between CCBT and the website group at 12 months. Both showed improvements on all measures. QoL measures in the intervention group showed earlier improvement compared with the website group. Costs were lower in the intervention group but the difference was not statistically significant. The cost-effectiveness analysis found just over a 65% chance of Stressbusters being cost-effective compared with websites. The 4-month follow-up results from the initial feasibility study are reported separately. CCBT and self-help websites may both have a place in the care pathway for adolescents with depression.
Highlights
Computerised cognitive–behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, more randomised controlled trials (RCTs) are needed to assess this
Adolescents presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation
There was no significant difference between CCBT and the website group at 12 months
Summary
Computerised cognitive–behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, more randomised controlled trials (RCTs) are needed to assess this. The 1-year prevalence of depression in adolescents is estimated to be between 2 and 4%1,2 and is one of the most common mental health problems facing young people.[3] Given the importance of early treatment, recent government priority has focused on improving access to psychological therapies including cognitive–behavioural therapy (CBT). Reviews of CBT for adolescent depression have shown that it is effective and currently one of the main treatment options recommended for this group.[4,5] Despite this, the availability of effective mental health treatments with Child and Adolescent Mental Health Services (CAMHS) is limited, with limited staff numbers, long waiting times and severity access thresholds needed to receive treatment. In this study of 21 000 referred children, only 72% referrals were accepted, and the most common group being rejected was those with emotional and behavioural problems
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