Internet-based interventions increase access to psychological treatments and cost-effectiveness

The need of development of early, short and focused interventions for depressed adolescents is urgent. Internet-based interventions are designed to increase access to psychological treatments and cost-effectiveness.

Internet-based cognitive behavioural therapy (I-CBT) with added chat sessions for depressed adolescents, has recently shown efficacy in two randomized controlled trials. However, in both internet-based and face-to-face cognitive behavioural therapy for depressed adolescents, there is a large proportion of patients who do not reach an adequate improvement

Read more: NOK 5.7 million to research on internet-delivered treatments for depressed adolescents

“The rate of treatment responders is only about 60%. The high rate of non-responders points to the need of finding new treatment methods that can complement current treatments,” says doctoral candidate Jakob Mechler.

“In the planned project, we will develop internet-delivered psychodynamic therapy (I-PDT) for depressed adolescents and test its efficacy and cost-effectiveness,” says associate professor Björn Philips.

The project supported by the Kavli Trust addresses the following evidence gaps highlighted in the funding call:

• What is the effect and cost effectiveness of digital health interventions for children and adolescents with mental health problems?

• What is the effect of feedback-informed measures on treatment effectiveness in children and adolescents?

The main aim of the project is to develop a new treatment for depressed adolescents (I-PDT) and compare it in terms of efficacy and cost-effectiveness with an evidence-based treatment (I-CBT).

The second aim is to study the effect of feedback-informed measures in Internet-delivered treatment for depressed adolescents.

“After a pilot study in which we investigate the feasibility of I-PDT in order to optimize the treatment programme, two randomized controlled trials will be carried out,” says doctoral candidate Karin Lindqvist.

The first is a so-called non-inferiority randomized trial that compares I-PDT and I-CBT for 230 depressed adolescents aged 15-18 years. Besides testing the efficacy and cost-effectiveness of the two treatments, the research group will analyse other important factors, namely general predictors, patient factors for differential suitability (moderators) and change processes that explains outcomes (mediators).

Results from theses analyses will be used to develop feedback-informed measures based on the identification of patients who are at risk for dropout, deterioration or non-improvement. The second randomized trial will use these feedback-informed measures for comparing I-PDT with enhanced feedback to therapists to I-PDT with no feedback to therapists for 126 depressed adolescents aged 15-18 years.

The interventions in both trials consist of eight therapist-supported self-help modules delivered over ten weeks with added chat sessions. Primary outcome variable will be severity of depression.

Secondary outcomes will be anxiety symptoms, psychiatric diagnoses, and cost-effectiveness.

• The first RCT will be conducted in 2020-2021, with follow-up and publications in 2022.

• The second RCT will be conducted in 2023.

The project is expected to show that I-PDT is non-inferior to I-CBT with regard to depressive symptoms and cost-effectiveness.

“We also expect that moderator analyses of the non-inferiority trial will provide information about which adolescents will benefit more from I-CBT and I-PDT, respectively. Furthermore, the final trial in the project will show whether enhanced feedback to therapists increases the effect of treatment,” says professor Per Carlbring.