Brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression during the COVID-19 pandemic: a randomised controlled trial protocol

Abstract

Background: The COVID-19 pandemic has had major impacts in many different spheres, including mental health. Children and adolescents are especially vulnerable because their central nervous system is still in development and they have fewer coping resources than do adults. Increases in the prevalence of depressive and anxiety symptomatology have been reported worldwide. However, access to mental health care is limited, especially for the paediatric population and in low- and middle-income countries. Therefore, we developed a brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression. The aim of this proposed study is to test the efficacy of the intervention.

Methods: We will conduct a two-arm, parallel randomised controlled trial involving children and adolescents (8-11 and 12-17 years of age, respectively) with symptoms of anxiety, depression or both, according to the 25-item Revised Child Anxiety and Depression Scale (t-score > 70). A total of 280 participants will be randomised to the intervention group or the active control group, in a 1:1 ratio. Those in the intervention group will receive five weekly sessions of cognitive-behavioural therapy via teleconference. The sessions will focus on stress responses, family communication, diaphragmatic breathing, emotions, anger management, behavioural activation and cognitive restructuring. Participants in both groups will have access to 15 videos covering the same topics. Participant-guardian pairs will be expected to attend the sessions (intervention group), watch the videos (control group) or both (intervention group only). A blinded assessor will collect data on symptoms of anxiety, depression and irritability, at baseline, at the end of the intervention and 30 days thereafter. Adolescents with access to a smartphone will also be invited to participate in an ecological momentary assessment of emotional problems in the week before and the week after the intervention, as well as in passive data collection from existing smartphone sensors throughout the study.

Discussion: Internet-delivered interventions play a major role in increasing access to mental health care. A brief, manualised, internet-delivered intervention might help children and adolescents with anxiety or depressive symptomatology, even outside the context of the COVID-19 pandemic.

Trial registration: ClinicalTrials.gov NCT05139433. Registered prospectively in November 2021. Minor amendments made in July 2022.

Keywords: Anxiety; COVID-19 pandemic; Children and adolescents; Cognitive-behavioural therapy; Depression; Irritability; Stress; Telemedicine.

Fig. 1

Schedule of enrolment, interventions and assessments. ARI: Affective Reactivity Index; CGAS: Children’s Global Assessment Scale; CGI-I: Clinical Global Impression-Improvement; CGI-S: Clinical Global Impression-Severity; DASS-21: 21-item Depression, Anxiety and Stress Scale; EMA: Ecological momentary assessment; MFQ-SI: Mood and Feelings Questionnaire-Suicidal Ideation; PedsQL: Pediatric Quality of Life Inventory; RCADS-25-C: 25-item version of the Revised Children’s Anxiety and Depression Scale, child report; RCADS-25-P: 25-item version of the Revised Children’s Anxiety and Depression Scale, parent report; SDQ: Strengths and Difficulties Questionnaire; TSQ: Telemedicine Satisfaction Questionnaire