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Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Ctr m2Hlth, CA USA.ORCID iD: 0000-0001-5972-3041
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
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2019 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, no 11, article id e13393Article in journal (Refereed) Published
Abstract [en]

Background: Depression is a common and serious problem among adolescents, but few seek or have access to therapy. Internet-delivered cognitive behavioral therapies (ICBTs), developed to increase treatment access, show promise in reducing depression. The inclusion of coach support in treatment is desired and may be needed. Objective: The aim of this study was to determine the efficacy of an ICBT protocol blended with weekly real-time therapist sessions via chat; blended treatment, for adolescent depression, including major depressive episode (MDE). The protocol has previously been evaluated in a controlled study. Methods: In a two-arm randomized controlled trial, adolescents 15 to 19 years of age were recruited through a community setting at the national level in Sweden (n=70) and allocated to either 8 weeks of treatment or to minimal attention control. Depression was assessed at baseline, at posttreatment, and at 12 months following treatment (in the intervention group). The primary outcome was self-reported depression level as measured with the Beck Depression Inventory II at posttreatment. The intervention was offered without the need for parental consent. Results: Over two weeks, 162 adolescents registered and completed the baseline screening. Eligible participants (n=70) were on average 17.5 years of age (SD 1.15), female (96%, 67/70), suffered from MDE (76%, 53/70), had no previous treatment experience (64%, 45/70), and reported guardian(s) to be aware about their depression state (71%, 50/70). The average intervention completion was 74% (11.8 of 16 modules and sessions). Following the treatment, ICBT participants demonstrated a significant decrease in depression symptoms compared with controls (Pamp;lt;.001), corresponding to a large between-group effect (intention-to-treat analysis: d=0.86, 95% CI 0.37-1.35; of completer analysis: d=0.99, 95% CI 0.48-1.51). A significant between-group effect was observed in the secondary depression outcome (P=.003); clinically significant improvement was found in 46% (16/35) of ICBT participants compared with 11% (4/35) in the control group (P=.001). Conclusions: The results are in line with our previous study, further demonstrating that adolescents with depression can successfully be engaged in and experience significant improvement following ICBT blended with therapist chat sessions. Findings on participants age and baseline depression severity are of interest in relation to used study methods.

Place, publisher, year, edition, pages
JMIR PUBLICATIONS, INC , 2019. Vol. 21, no 11, article id e13393
Keywords [en]
adolescent; depression; cognitive behavioral therapy; randomized controlled trial; internet; digital health; technology; mental health; text messaging; instant messaging
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Other Medical Sciences not elsewhere specified
Identifiers
URN: urn:nbn:se:liu:diva-162055DOI: 10.2196/13393ISI: 000493736700001PubMedID: 31682572OAI: oai:DiVA.org:liu-162055DiVA, id: diva2:1370986
Note

Funding Agencies|Queen Silvias Jubilee Fund; Sweden-America Foundation; Swedish Society of Medicine; Swedish Psychotherapy Society; Swedish Central Bank [P16-0883:1]

Available from: 2019-11-18 Created: 2019-11-18 Last updated: 2019-11-18

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Topooco, NairaBylehn, SandraDahlström Nysäter, EllenHolmlund, JennyLindegaard, JohannaJohansson, SannaÅberg, LinneaZetterqvist, MariaAndersson, Gerhard
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PsychologyFaculty of Arts and SciencesDepartment of Behavioural Sciences and LearningCenter for Social and Affective NeuroscienceFaculty of Medicine and Health SciencesDepartment of Child and Adolescent Psychiatry in Linköping
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