Computerised cognitive-behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study

Abstract

Background: Computerised cognitive-behavioural therapy (CCBT) in the care pathway has the potential to improve access to psychological therapies and reduce waiting lists within Child and Adolescent Mental Health Services, however, more randomised controlled trials (RCTs) are needed to assess this.

Aims: This single-centre RCT pilot study compared a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression at referral to evaluate the clinical and cost-effectiveness of CCBT (trial registration: ISRCTN31219579).

Method: The trial ran within community and clinical settings. Adolescents (aged 12-18) presenting to their primary mental health worker service for low mood/depression support were assessed for eligibility at their initial appointment, 139 met inclusion criteria (a 33-item Mood and Feelings Questionnaire score of ≥20) and were randomised to Stressbusters (n = 70) or self-help websites (n = 69) using remote computerised single allocation. Participants completed mood, quality of life (QoL) and resource-use measures at intervention completion, and 4 and 12 months post-intervention. Changes in self-reported measures and completion rates were assessed by group.

Results: There was no significant difference between CCBT and the website group at 12 months. Both showed improvements on all measures. QoL measures in the intervention group showed earlier improvement compared with the website group. Costs were lower in the intervention group but the difference was not statistically significant. The cost-effectiveness analysis found just over a 65% chance of Stressbusters being cost-effective compared with websites. The 4-month follow-up results from the initial feasibility study are reported separately.

Conclusions: CCBT and self-help websites may both have a place in the care pathway for adolescents with depression.

Keywords: Randomised controlled trial; adolescents; computerised cognitive behaviour therapy; depression; twelve month outcomes.

Fig. 1

CONSORT flow diagram.

Fig. 2

Proportion who scored ≥29 on the Mood and Feelings Questionnaire (MFQ).

Fig. 3

Health-related quality of life (utility QoL) levels of children in Stressbusters and websites groups during the study.

Fig. 4

Cost-effectiveness acceptability curve for probability of Stressbusters being cost-effective at different levels of willingness to pay for an additional quality-adjusted life-year (QALY).