Title: A feasibility study and pilot trial of computerised cognitive behaviour therapy for depression in adolescents.
Funder: Department of Health (England)

Abstract: Background The prevalence of depression in adolescents is about 2% [1]. Anti-depressant treatment is not favoured due to evidence of poor efficacy and high side effects [2]. Reviews of cognitive behavioural therapy (CBT) suggest it is a more effective option [3] but demand for CBT typically outstrips local CAMHS resources. Computerised CBT (cCBT) represents an alternative form of therapy with the potential to enhance CBT access for young people. Existing packages have been found to be effective in treatment of adult depression [4], but very few studies have trialled cCBT interventions for depression in adolescents. The cCBT programme “Stressbusters” has been produced for adolescents and an initial case study (n=30) has shown good results [5]. Aims At the present time it would be premature to fund a fully powered randomised trial of clinical and cost effectiveness of cCBT in this population. Since there is no published randomised controlled trial in adolescence on the use of cCBT for depression we plan to conduct a pilot study to establish: • Acceptability of treatment in adolescents • Qualitative information about recruitment, acceptability and satisfaction with programme and venue (CAMHS clinic and young persons advisory drop-in centre). • Feasibility of recruitment to a larger multi-centre study • Numbers needed to plan a fully-powered RCT of clinical and cost effectiveness Plan of Investigation A randomised groups design will be used to compare patients receiving cCBT with those given equivalent access to computer-based general information about mood and coping strategies. Participants will be recruited from 12-18 year olds referred to CAMHS with low mood. Those randomised into the treatment group will receive eight 45 minute sessions on the cCBT programme “Stressbusters”. As with all young people referred with mood problems participants will have an allocated primary mental health worker monitoring their progress and both groups will also receive treatment as usual. Outcomes will be assessed using the Mood and Feelings Questionnaire, Beck Depression Inventory and need for further intervention (i.e. through progression to further treatment, self-harm or in-patient admission). Potential Impact This pilot study is considered necessary preparatory work in advance of a larger application for a fully powered RCT of cCBT in adolescents. It will provide qualitative information about acceptability, delivery, venue, attrition rates and numbers needed to treat. The pilot RfPB study will produce important research evidence in its own right that will inform the care of young people in the UK NHS. However the successful endpoint of this programme of research will be an application for a fully powered definitive RCT, funded by a major NIHR/MRC trial funding scheme. The potential impact for young people is provision of an easy to access, low stigma intervention at an early stage and prevention of progress to more severe illness. Cost savings for the NHS are potentially large.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH