Title: An online parenting intervention to prevent affective disorders in high-risk adolescents: The PIPA trial
Funder: Department of Health and Social Care

Abstract: Depression has a huge impact on the health and wellbeing of young people. For many people, depression first starts in the early teens, so efforts to build resilience in this age group are extremely important. This has also been highlighted by recent Child Health policy documents such as Future in Mind. Researchers have designed ways to improve adolescent mental health by working with young people directly; but approaches that target the parents or carers to help them in developing supportive parenting skills appear to reduce depression in their children in both the short and long term. Our colleagues at Monash University in Australia who have developed an innovative evidence based online parenting programme to address this. They found that teaching strategies to parents using an online program tailored to their needs improved levels of depression in their teenager._x000D_ _x000D_ In this project we want to adapt and test the Australian version of this online intervention in the UK. This project has two phases. The first phase will involve asking parents, teachers and adolescents for their feedback about the interventions (though focus groups and interviews), and then adapt it to make it more appropriate and relevant for parents and adolescents in the UK. _x000D_ _x000D_ In the second phase of the project we will test whether the adapted UK online parenting programme is better than a comparison parent-education programme about adolescent development. Using the Strengths and Difficulties Questionnaire we will screen students aged 11-15 in participating schools. We expect about 1 in 5 students will score highly using this screening questionnaire, which would suggest at least mild mental health difficulties in the young person. We will then invite the parents/carers of these students to consent to participate in the study. We plan to involve 433 families (one or both parents and the adolescent) in the study. _x000D_ _x000D_ We will work with schools across the West Midlands, where we have strong links to the education departments and have previously conducted large research projects. We will approach schools to participate in a predetermined random order. Parents/adolescents who agree to take part in the trial will be randomly allocated to receive either a tailored online parenting intervention with up to 9 modules delivered one per week, or a control intervention in which parents receive online factsheets about adolescent development one per week. We will measure the levels of depression in the adolescents before and after the parents complete the intervention and then 12 months later (our most important outcome). We will also measure if parenting changes as judged by whether they parent in a similar way to that recommended by evidenced-based parenting guidelines using a questionnaire specifically designed by our Australian colleagues to do this. We will also measure parent’s parenting confidence and levels of wellbeing and resilience in the adolescent using questionnaires. We will collect information to help us understand the economic impact of the intervention._x000D_ _x000D_ At the end of the project, we hope to be in a position to suggest whether this intervention should be used UK wide as a method of reducing mental health problems in adolescents. We will work with our local and national mental health networks, as well as education authorities and youth mental health charities to communicate our results and apply for further funding should the intervention be shown to work.

Lay abstract: Depression is a leading cause of disease burden in young people in the UK and globally. The incidence of depression rises sharply during adolescence, making early adolescence a particularly opportune time to target preventive efforts. Moreover, there is evidence that preventative strategies can be effective. Whilst many preventative approaches have targeted young people themselves and demonstrated effects up to 2 years post-intervention, there is evidence that preventative interventions that target parents are effective in the longer term (up to 11 years)(1). Recent policy documents such as the Five Year Forward View for Mental Health and Future in Mind have advocated for public mental health interventions for young people that include parents. Our collaborators in Australia have developed Partners in Parenting (PiP), an evidence-based personalised online parenting intervention, and demonstrated that it can improve depressive symptoms in their adolescent child with early internalizing problems. We aim to adapt this well-developed and evidenced-based intervention to a UK setting. We then aim to test the acceptability and effectiveness of the intervention delivered to parents in improving depressive symptoms in their high risk offspring, as well as other clinical and non-clinical outcomes in the adolescents, using a RCT design._x000D_ _x000D_ We propose an initial adaptation phase, which will consist of focus group consultations with parents, teachers and adolescents to make adaptations of the PiP intervention for a UK setting and establish the feasibility and acceptability of the assessment battery. We plan to conduct an internal pilot with a priori stop-go progression criteria based on recruitment and intervention adherence and then a definitive RCT, recruiting 433 families from participating schools West Midlands wide, approaching schools in a predetermined randomised order, oversampling inner-city schools. We will screen pupils aged 11-15 years in the participating schools with the Strengths and Difficulties Questionnaire and those scoring highly will be invited to participate in the trial with their parents/caregivers. Parents will be randomly allocated to either the online modular PiP intervention or an online control program which consists of a standardised package of educational materials about adolescent development and wellbeing. Each intervention is delivered over a 3-month period with assessments completed online by the parent and child at baseline, 6 months later, and 12 months post-intervention (15 months later) including parenting self efficacy. The primary outcome will be adolescent depressive symptoms measured at 12 months post-intervention using the Short Mood and Feelings Questionnaire. There will be a number of secondary outcomes including: anxiety, parenting behaviour, child wellbeing and resilience and parent and adolescent quality of life to measure QALYS and economic utility. To maintain programme adherence, and in line with the Australian protocol, parents will receive weekly check-in phone calls/texts during the intervention period. _x000D_ _x000D_ At the end of the trial, we will be able to demonstrate whether such a tailored online approach is effective and could be rolled out nationally. We will create an exploitation plan based on the results. We will disseminate the findings to national and international audiences including a national launch event with stakeholders from health, education and third sector organisations

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: MENTAL HEALTH