A randomized trial of online single-session interventions for adolescent depression during COVID-19
https://www.nature.com/articles/s41562-021-01235-0
https://clinicaltrials.gov/ct2/show/NCT04634903
The COVID-19 pandemic has potentially increased the risk for adolescent depression. Even pre-pandemic, <50% of youth with depression accessed care, highlighting needs for accessible interventions.
Accordingly, this randomized controlled trial (ClinicalTrials.gov: NCT04634903) tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression symptoms (N = 2,452, ages 13–16).
Adolescents from all 50 US states, recruited via social media, were randomized to one of three SSIs: a behavioural activation SSI, an SSI teaching that traits are malleable and a supportive control. We tested each SSI’s effects on post-intervention outcomes (hopelessness and agency) and three-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-19-related trauma and restrictive eating).
Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen’s d = 0.18), decreased post-intervention and three-month hopelessness (d = 0.16–0.28), increased post-intervention agency (d = 0.15–0.31) and reduced three-month restrictive eating (d = 0.12–17).
Several differences between active SSIs emerged. These results confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context.
To date, systematic and narrative reviews have identified two types of SSI that have reduced adolescent depression symptoms16,17.
The first is a growth mindset (GM) SSI, an online programme teaching that personal traits are malleable, which has prevented and reduced adolescent depression in multiple trials18,19,20,21,22. As examples, a GM-SSI led to nine-month depression symptom reductions in high-symptom adolescents, versus a supportive control (Cohen’s d = 0.60 and 0.32 per parent and youth reports)19. In two school-based randomized trials, GM-SSIs reduced adolescent depressive symptoms versus active controls from four- to nine-month follow-ups18,21,22.
The second type, a behavioural activation (BA) SSI, promotes values-based activity engagement to elicit pleasure and accomplishment23,24,25. In randomized trials, therapist-guided BA-SSIs have reduced depressive symptoms in moderately depressed adolescents across two weeks (d = 1.61) and one month (d = 0.57)23,24. Furthermore, in an open trial, high-symptom adolescents reported increases in perceived problem-solving ability and agency after completing an online, self-guided BA-SSI; they also endorsed the BA-SSI’s overall acceptability and helpfulness20.
Notably, the GM-SSI and BA-SSI are the only two fully self-guided, single-session, digital interventions that have shown acceptability and (at minimum) short-term utility among US adolescents with elevated depressive symptoms. However, their relative effectiveness has yet to be rigorously assessed, creating a need to understand their potentially differential promise as widely scaled supports for youth depression and related difficulties.