Kunnskapshull

What is the effect of online treatment for children and young people with mild to moderate depression

Depression among adolescents is one of the most common mental health challenges in this age group, yet many young people do not gain access to treatment early enough. Internet-based cognitive behavioural therapy (ICBT) has shown strong results, but a substantial proportion of adolescents either do not respond to treatment or drop out before completion. There has therefore been a need to develop alternative treatment approaches that can reach more young people while also offering better adaptation to individual needs.

At the same time, research on internet-based psychodynamic therapy (I-PDT) for adolescents with depression has been limited. There has been insufficient knowledge about whether this treatment approach can be as effective as ICBT, which adolescents benefit most from the intervention, and how digital therapy models can be implemented within standard mental health services.

Executive summary

The project examined the effectiveness of internet-based psychodynamic therapy (I-PDT) for adolescents with depression and compared the treatment with internet-based cognitive behavioural therapy (ICBT). The aim was to develop and evaluate a digital treatment model that could make effective mental health support more accessible to young people.

The project was conducted at Stockholm University in collaboration with Linköping University and included several studies involving adolescents aged 15–19 diagnosed with moderate to severe depression. The treatment consisted of therapist-supported online modules delivered over ten weeks, combined with digital chat sessions and follow-up support.

The findings showed that I-PDT had positive effects on depressive symptoms, anxiety, emotion regulation, and self-compassion. The study also found that I-PDT was as effective as ICBT in reducing depressive symptoms and that treatment outcomes were maintained over time. Around 70 per cent of participants in both treatment groups were considered recovered after treatment.

The project also contributed new knowledge about why some adolescents do not respond to treatment and developed models for identifying the risk of dropout and poor treatment response at an early stage.

Metode

The project consisted of several quantitative studies, including randomised controlled trials (RCTs) and a non-inferiority trial comparing I-PDT with ICBT.

Participants were adolescents aged 15–19 diagnosed with depression. A total of 272 adolescents participated in the main study comparing the two treatment approaches. Treatment was delivered digitally through the Iterapi platform and consisted of eight therapist-supported self-help modules completed over ten weeks. Participants also received support through online chat sessions with therapists.

Data collection included weekly assessments of depressive symptoms, as well as follow-up measures of anxiety, emotion regulation, self-compassion, and cost-effectiveness. Participants were followed for up to twelve months after completing treatment.

The project also included the development of predictive algorithms to identify adolescents at risk of treatment non-response or dropout. The pandemic and changes in digital advertising platforms affected recruitment in some sub-studies, making it more difficult to reach the planned sample size in the final study.

Resultater

Main Findings: I-PDT is as effective as ICBT for adolescents with depression

The study showed that internet-based psychodynamic therapy (I-PDT) was as effective as internet-based cognitive behavioural therapy (ICBT) in treating adolescents with depression. Both treatment approaches led to substantial reductions in depressive symptoms, and around 70 per cent of participants in both groups were considered recovered after treatment.

Treatment gains were maintained throughout the twelve-month follow-up period. The study also found no significant differences between the treatment approaches in terms of cost-effectiveness.

These findings suggest that I-PDT may represent an effective alternative to established digital treatment approaches for adolescents with depression.

Secondary Findings: Improved emotion regulation, self-compassion, and new insights into treatment response

The project also demonstrated positive effects across several secondary outcome measures. Adolescents reported reduced anxiety, improved emotion regulation, and increased self-compassion following treatment.

The studies also identified factors that may help explain why some adolescents respond better to treatment than others. The project developed predictive models that showed promising results in identifying adolescents at risk of dropout or poor treatment response early in the treatment process.

The project further provided important insights into adolescents’ own experiences of depression and digital treatment, including qualitative analyses of participants’ descriptions of change processes and treatment experiences.

In addition, the project demonstrated that digital treatment models can be implemented across languages and countries. The I-PDT programme was translated into both English and Norwegian, and further implementation and research are already underway in several countries.

Konklusjon

The project demonstrates that internet-based psychodynamic therapy (I-PDT) is an effective and feasible treatment approach for adolescents with depression. The findings show that the treatment can significantly reduce depressive symptoms while also improving emotion regulation and psychological coping.

The study contributes to expanding the evidence base for digital mental health services by demonstrating that psychodynamic therapy can work effectively in an online format. At the same time, the project highlights the importance of developing multiple digital treatment options so that adolescents with different needs and preferences can access support that suits them.

The findings also point to significant potential for early identification of adolescents at risk of dropping out of treatment or failing to achieve sufficient benefit. This could contribute to more personalised and effective mental health services in the future.

Further research should explore how I-PDT can be implemented within larger healthcare systems and how the treatment can be adapted to different target groups and international contexts.