Abstract
BackgroundDepression often emerges for the first time during adolescence. There is accumulating evidence that universal depression prevention programs may have the capacity to reduce the impact of depression when delivered in the school environment.ObjectiveThis trial investigated the effectiveness of SPARX-R, a gamified online cognitive behavior therapy intervention for the prevention of depression relative to an attention-matched control intervention delivered to students prior to facing a significant stressor—final secondary school exams. It was hypothesized that delivering a prevention intervention in advance of a stressor would reduce depressive symptoms relative to the control group.MethodsA cluster randomized controlled trial was conducted in 10 government schools in Sydney, Australia. Participants were 540 final year secondary students (mean 16.7 [SD 0.51] years), and clusters at the school level were randomly allocated to SPARX-R or the control intervention. Interventions were delivered weekly in 7 modules, each taking approximately 20 to 30 minutes to complete. The primary outcome was symptoms of depression as measured by the Major Depression Inventory. Intention-to-treat analyses were performed.ResultsCompared to controls, participants in the SPARX-R condition (n=242) showed significantly reduced depression symptoms relative to the control (n=298) at post-intervention (Cohen d=0.29) and 6 months post-baseline (d=0.21) but not at 18 months post-baseline (d=0.33).ConclusionsThis is the first trial to demonstrate a preventive effect on depressive symptoms prior to a significant and universal stressor in adolescents. It demonstrates that an online intervention delivered in advance of a stressful experience can reduce the impact of such an event on the potential development or exacerbation of depression.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12614000316606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365986 (Archived by WebCite at http://www.webcitation.org/ 6u7ou1aI9)
Highlights
Depression carries the greatest burden of disease in young people, with an annual prevalence in adolescence of 8% and approximately 80% of these cases experiencing a moderate to severe impact on functioning [1]
Compared to controls, participants in the SPARX-R condition (n=242) showed significantly reduced depression symptoms relative to the control (n=298) at post-intervention (Cohen d=0.29) and 6 months post-baseline (d=0.21) but not at 18 months post-baseline (d=0.33). This is the first trial to demonstrate a preventive effect on depressive symptoms prior to a significant and universal stressor in adolescents
It demonstrates that an online intervention delivered in advance of a stressful experience can reduce the impact of such an event on the potential development or exacerbation of depression
Summary
Depression carries the greatest burden of disease in young people, with an annual prevalence in adolescence of 8% and approximately 80% of these cases experiencing a moderate to severe impact on functioning [1]. A number of recent reviews and meta-analyses have found small but consistent effects for the prevention of depression in young people [4]. These reviews indicate mixed findings regarding the relative superiority of universal prevention programs (which target all individuals in a given population regardless of risk) compared to targeted programs (which are directed at high-risk individuals on the basis of the presence of existing risk factors or subthreshold symptoms). There is accumulating evidence that universal depression prevention programs may have the capacity to reduce the impact of depression when delivered in the school environment
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