Online half-hour single-session interventions (SSI) are effective for reducing depression symptoms in adolescents even amid the stress of the COVID-19 pandemic, according to research results published in Nature Human Behaviour.
The researchers recruited 2452 youth (88% girls) aged 13 to 16 years with a score of at least 10 on the Children’s Depression Inventory 2 (CDI-SF) from across the United States via social media to participate in one of three self-guided online SSIs as part of a randomized controlled trial (ClinicalTrials.gov: NCT04634903). The individuals represented American Indian, Asian, Black, Native Hawaiian, Hispanic, and White ancestries.
They participated in a behavioral activation SSI (BA-SSI ABC Project) that addressed activity withdrawal and low agency, a growth mindset SSI (GM-SSI Project Personality) that teaches that personal traits can be changed and addresses hopelessness, and a supportive control SSI. The researchers analyzed the benefits of the SSI from November 2020 to March 2021.
Compared with individuals in the control group, adolescents who completed the BA-SSI or GM-SSI experienced significant decreases in depression symptom severity from baseline to three-month follow-up (Cohen’s d = 0.18). Within-group reductions from baseline to three-month follow-up were larger among the BA-SSI and GM-SSI groups compared with the control group.
Adolescents in the BA-SSI group and GM-SSI groups were more likely compared with the control group individuals to report reduced hopelessness at post-intervention and three-month follow-up (d = 0.16-0.28) and increased perceived agency after intervention (d = 0.15-0.31).
The GM-SSI group reported more significant decreases in generalized anxiety symptom severity and COVID-19 related trauma symptoms at three-month follow-up compared with control group individuals and greater reductions compared with the BA-SSI group in generalized anxiety symptom severity.
The BA-SSI and the GM-SSI were each associated with reductions in past-month restrictive eating from baseline to three-month follow-up (d = 0.12-17).
In listwise deletion analysis of solely those who completed the follow-ups, the GM-SSI did not have a significant impact on COVID-19 related trauma symptoms at three-month follow-up compared with the control treatment. It had a stronger impact on generalized anxiety symptoms at three-month follow-up compared with the BA-SSI. In analysis of completers-only, with imputation for non-completers, BA-SSI reduced COVID-19 related trauma symptoms at three-month follow-up.
There were some study limitations reported. In order to be screened, adolescents had to have interest in completing an online study and thus required access to the internet. Other individuals may not have the time for to complete a study while others might speak languages other than English. Thus, the findings may not apply across adolescents.
“Some adolescents will still require longer-term services, and policy changes remain needed to improve youth access to higher-intensity treatments in addition to brief, immediately accessible resources,” the investigators said.
“Nonetheless, the SSIs in this trial may offer rapidly scalable, evidence-based support for all youths with depressive symptoms — many of whom would otherwise access no support at all. Given the brevity and flexibility of these programs, they may be offered within diverse youth care systems (for example, primary care, emergency rooms and schools), complementing existing support structures while retaining the potential to benefit youths unable to access further care.”
Schleider JL, Mullarkey MC, Fox KR, et al. A randomized trial of online single-session interventions for adolescent depression during COVID-19. Nat Hum Behav. Published online December 9, 2021. doi: 10.1038/s41562-021-01235-0