Further development and feasibility trial of an online psychoeducational intervention for adolescent depression

Background:

Depression is common in adolescence, and leads to distress and impairment. Guidelines highlight the key role of information and evidence-based psychosocial interventions for individuals and families/carers. There has been growing interest in psychoeducation to provide accurate information about health issues and to enhance and develop self-management skills. As part of a National Institute for Health Research/Health and Care Research Wales Doctoral Research Fellowship, I developed and conducted an early stage evaluation of an online psychoeducation programme for adolescent depression, 'MoodHwb' ('hwb' is a Welsh translation for 'hub', and also means a 'lift' or 'boost'). The rigorous development process consisted of i) a systematic review of psychoeducation programmes, ii) co-design through semi-structured interviews and focus groups with potential users - adolescents (with depressive symptoms/at high-risk), parents/carers and professionals working with young people, iii) workshops with a multimedia company and clinical/research experts. The prototype was designed to be multiplatform, person-centred, engaging and interactive, including moodmonitoring and goal-setting components, and an 'app'. For the early stage evaluation, a small number of adolescents and parents/carers completed questionnaires before and after using the programme. A subsample was interviewed, and online usage was monitored. There was also a focus group for professionals. These preliminary results showed that the programme was acceptable, feasible and easy to use.

Aims:

1. To further develop the intervention,
2. assess the feasibility and acceptability of delivering it to young people,
3. pilot methods for a full-scale effectiveness trial.

Plan of investigation

This work will follow the next phase of the Medical Research Council's guidance for complex interventions, and guidelines on person-centred digital health.

During stage 1, I will:

i) update the literature review,
ii) hold workshops with the multimedia company to update the programme (based on findings from my doctorate),
iii) interview adolescents for feedback on the changes.

During stage 2 (feasibility trial), I will recruit young people with depressive difficulties (and families/carers) from school nurses/counsellors and primary mental health services (n=120). The participants will be assigned randomly into the intervention (Treatment as usual (TAU) plus MoodHwb) or control (TAU plus information sheet) groups. They will complete questionnaires at baseline and at 3 and 9 months follow-up. A subsample will also be interviewed, and professionals will give their views in a focus group. The primary outcomes will relate to the feasibility and acceptability of the intervention/trial methods (including recruitment, retention, adherence). Secondary outcomes will include depression/anxiety symptoms, depression literacy, stigma, help-seeking behaviour and self-efficacy. There will be a pilot economic evaluation and process evaluation.

During the final stage, I will reassess the programme, disseminate the findings, and plan the next stage of the research.

Potential benefits to public/patients:

Following further development and evaluation, the online programme MoodHwb has the potential to help young people and families/carers in health, education, social, and youth services/charities.

The work outlined in this application will increase awareness of adolescent depression through public events, newsletters, conference presentations, and academic publications. The project will also engage researchers and medical students with mental health work.