Advertisement

Rapid Evidence Review of Digital Cognitive-Behavioral Therapy for Adolescents With Depression

      Abstract

      Purpose

      We conducted a rapid evidence review to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents.

      Methods

      We searched MEDLINE, PsycINFO, CENTRAL through December 6, 2021, for controlled trials conducted in settings highly applicable to the United States. Additionally, we searched relevant systematic reviews for eligible studies. Results were summarized qualitatively.

      Results

      We included 12 trials (n = 1,575) that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to comparators in improving depression symptoms immediately post-intervention, but not at a longer follow-up. The use of dCBT did not appear to result in an increased risk for suicidal attempts or ideation; however, the number of events was very small. Potential barriers to implementing/maintaining dCBT are challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. Data on harms or unintended negative consequences were not reported in the included studies.

      Conclusions

      A limited body of evidence suggests that dCBT programs might outperform control interventions for reducing depressive symptoms immediately post-intervention, but not at a longer follow-up. The safety of dCBT programs for adolescents with depression is understudied.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Twenge J.M.
        • Cooper A.B.
        • Joiner T.E.
        • et al.
        Age, Period, and Cohort trends in mood disorder Indicators and suicide-related outcomes in a nationally Representative Dataset, 2005-2017.
        J Abnorm Psychol. 2019; 128: 185-199
        • National Institute of Mental Health
        Major depression: Prevalence of major depressive episode among adolescents.
        (Available at:)
        • National Institute of Mental Health
        Treatment of major depressive episode among adolescents.
        (Available at:)
        • Merikangas K.R.
        • He J.P.
        • Burstein M.
        • et al.
        Service Utilization for Lifetime mental disorders in U.S. Adolescents: Results of the national Comorbidity survey-adolescent supplement (NCS-A).
        J Am Acad Child Adolesc Psychiatry. 2011; 50: 32-45
        • Cadigan J.M.
        • Lee C.M.
        • Larimer M.E.
        Young Adult mental health: A Prospective Examination of service Utilization, Perceived Unmet service needs, Attitudes, and barriers to service Use.
        Prev Sci. 2019; 20: 366-376
        • Auerbach R.P.
        • Alonso J.
        • Axinn W.G.
        • et al.
        Mental disorders among College Students in the World health Organization World mental health surveys.
        Psychol Med. 2016; 46: 2955-2970
        • Mojtabai R.
        • Olfson M.
        • Han B.
        National trends in the prevalence and treatment of depression in adolescents and young Adults.
        Pediatrics. 2016; 138: e20161878
        • Babajide A.
        • Ortin A.
        • Wei C.
        • et al.
        Transition Cliffs for young Adults with anxiety and depression: Is integrated mental health care a Solution?.
        J Behav Health Serv Res. 2020; 47: 275-292
        • Gulliver A.
        • Griffiths K.M.
        • Christensen H.
        Perceived barriers and facilitators to mental health help-Seeking in young people: A systematic review.
        BMC Psychiatry. 2010; 10: 113
        • Wartella E.
        • Rideout V.
        • Montague H.
        • et al.
        Teens, Health and technology: A national survey.
        Media Commun. 2016; 4: 13-23
        • Aschbrenner K.A.
        • Naslund J.A.
        • Tomlinson E.F.
        • et al.
        Adolescents' Use of digital Technologies and Preferences for mobile health Coaching in public mental health settings.
        Front Public Health. 2019; 7: 178
        • Andersson G.
        • Titov N.
        Advantages and limitations of Internet-based interventions for common mental disorders.
        World Psychiatry. 2014; 13: 4-11
        • MacDonell K.W.
        • Prinz R.J.
        A review of technology-based Youth and Family-focused interventions.
        Clin Child Fam Psychol Rev. 2017; 20: 185-200
        • Christ C.
        • Schouten M.J.
        • Blankers M.
        • et al.
        Internet and computer-based cognitive behavioral therapy for anxiety and depression in adolescents and young Adults: Systematic review and meta-analysis.
        J Med Internet Res. 2020; 22: e17831
        • Grist R.
        • Croker A.
        • Denne M.
        • et al.
        Technology delivered interventions for depression and anxiety in children and adolescents: A systematic review and meta-analysis.
        Clin Child Fam Psychol Rev. 2019; 22: 147-171
        • Ebert D.D.
        • Zarski A.C.
        • Christensen H.
        • et al.
        Internet and computer-based cognitive behavioral therapy for anxiety and depression in Youth: A meta-analysis of randomized controlled outcome trials.
        PLoS ONE. 2015; 10: e0119895
        • Hollis C.
        • Falconer C.J.
        • Martin J.L.
        • et al.
        Annual Research Review: Digital health interventions for children and young people with mental health problems - a systematic and meta-review.
        J Child Psychol Psychiatry. 2017; 58: 474-503
        • Carlbring P.
        • Andersson G.
        • Cuijpers P.
        • et al.
        Internet-based vs. Face-to-Face cognitive behavior therapy for psychiatric and Somatic disorders: An Updated systematic review and meta-analysis.
        Cogn Behav Ther. 2018; 47: 1-18
        • Garritty C.
        • Gartlehner G.
        • Nussbaumer-Streit B.
        • et al.
        Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews.
        J Clin Epidemiol. 2021; 130: 13-22
        • Hartling L.
        • Guise J.-M.
        • Kato E.
        • et al.
        EPC methods: An Exploration of methods and context for the Production of rapid reviews. Research white Paper..
        (Prepared by the Scientific Resource Center under Contract No. 290-2012-00004-C.) AHRQ Publication No. 15-EHC008-EF Agency for Healthcare Research and Quality, Rockville, MD2015 (Available at:)
        • Makarushka M.
        Efficacy of an Internet-based intervention targeted to adolescents with Subthreshold depression [PhD Thesis].
        University of Oregon, Eugene, OR2011
        • Van Voorhees B.
        • Gladstone T.R.G.
        • Sobowale K.
        • et al.
        24-Month outcomes of Primary care web-based depression prevention intervention in adolescents: Randomized clinical trial.
        J Med Internet Res. 2020; 22: e16802
        • Poppelaars M.
        • Tak Y.R.
        • Lichtwarck-Aschoff A.
        • et al.
        A randomized controlled trial comparing two cognitive-behavioral programs for adolescent girls with Subclinical depression: A school-based program (Op Volle Kracht) and a Computerized program (SPARX).
        Behav Res Ther. 2016; 80: 33-42
        • Merry S.N.
        • Stasiak K.
        • Shepherd M.
        • et al.
        The effectiveness of SPARX, a Computerised self help intervention for adolescents Seeking help for depression: Randomised controlled non-inferiority trial.
        Bmj. 2012; 344: e2598
        • O'Kearney R.
        • Kang K.
        • Christensen H.
        • et al.
        A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls.
        Depress Anxiety. 2009; 26: 65-72
        • Wright B.
        • Tindall L.
        • Hargate R.
        • et al.
        Computerised cognitive-Behavioural therapy for depression in adolescents: 12-Month outcomes of a UK Randomised controlled trial Pilot study.
        BJPsych Open. 2019; 6: e5
        • Wright B.
        • Tindall L.
        • Littlewood E.
        • et al.
        Computerised cognitive-Behavioural therapy for depression in adolescents: Feasibility results and 4-month outcomes of a UK Randomised controlled trial.
        BMJ Open. 2017; 7: e012834
        • Ranney M.L.
        • Pittman S.K.
        • Dunsiger S.
        • et al.
        Emergency department text messaging for adolescent violence and depression prevention: A Pilot randomized controlled trial.
        Psychol Serv. 2018; 15: 419-428
        • Smith P.
        • Scott R.
        • Eshkevari E.
        • et al.
        Computerised CBT for depressed adolescents: Randomised controlled trial.
        Behav Res Ther. 2015; 73: 104-110
        • Berg M.
        • Rozental A.
        • Johansson S.
        • et al.
        The role of Knowledge in Internet-based cognitive Behavioural therapy for adolescent depression: Results from a Randomised controlled study.
        Internet Interv. 2019; 15: 10-17
        • Topooco N.
        • Andersson G.
        Digital cognitive-behavioral therapy in the treatment of adolescent depression: A randomized controlled trial.
        J Am Acad Child Adolesc Psychiatry. 2017; : S299-s300
        • Topooco N.
        • Berg M.
        • Johansson S.
        • et al.
        Chat- and Internet-based cognitive-Behavioural therapy in treatment of adolescent depression: Randomised controlled trial.
        BJPsych Open. 2018; 4: 199-207
        • Topooco N.
        • Bylehn S.
        • Dahlstrom Nysater E.
        • et al.
        Evaluating the efficacy of Internet-delivered cognitive behavioral therapy Blended with Synchronous chat sessions to treat adolescent depression: Randomized controlled trial.
        J Med Internet Res. 2019; 21: e13393
        • Kobak K.A.
        • Mundt J.C.
        • Kennard B.
        Integrating technology into cognitive behavior therapy for adolescent depression: A Pilot study.
        Ann Gen Psychiatry. 2015; 14: 37
        • Stasiak K.
        • Hatcher S.
        • Frampton C.
        • et al.
        A Pilot Double Blind randomized Placebo controlled trial of a Prototype computer-based cognitive Behavioural therapy program for adolescents with symptoms of depression.
        Behav Cogn Psychother. 2014; 42: 385-401
        • Fleming T.
        • Dixon R.
        • Frampton C.
        • et al.
        A Pragmatic randomized controlled trial of Computerized CBT (SPARX) for symptoms of depression among adolescents excluded from Mainstream Education.
        Behav Cogn Psychother. 2012; 40: 529-541
        • Fleming T.M.
        • Stasiak K.
        • Moselen E.
        • et al.
        Revising Computerized therapy for wider appeal among adolescents: Youth Perspectives on a Revised version of SPARX.
        Front Psychiatry. 2019; 10: 802
        • Parker L.
        • Halter V.
        • Karliychuk T.
        • et al.
        How Private is Your mental health app data? An Empirical study of mental health app Privacy Policies and practices.
        Int J L Psychiatry. 2019; 64: 198-204
        • Parker L.
        • Bero L.
        • Gillies D.
        • et al.
        Mental health messages in prominent mental health apps.
        Ann Fam Med. 2018; 16: 338-342
        • Larsen M.E.
        • Nicholas J.
        • Christensen H.
        A systematic assessment of Smartphone tools for suicide prevention.
        PLoS ONE. 2016; 11: e0152285
        • Clarke J.
        • Draper S.
        Intermittent mindfulness practice can Be Beneficial, and daily practice can Be harmful. An in Depth, mixed methods study of the "Calm" App's (mostly Positive) effects.
        Internet Interv. 2020; 19: 100293
        • Martinengo L.
        • Van Galen L.
        • Lum E.
        • et al.
        Suicide prevention and depression apps' suicide risk assessment and management: A systematic assessment of adherence to clinical guidelines.
        BMC Med. 2019; 17: 231
        • Liverpool S.
        • Mota C.P.
        • Sales C.M.D.
        • et al.
        Engaging children and young people in digital mental health interventions: Systematic review of Modes of delivery, facilitators, and barriers.
        J Med Internet Res. 2020; 22: e16317
        • Wozney L.
        • McGrath P.J.
        • Gehring N.D.
        • et al.
        eMental healthcare Technologies for anxiety and depression in Childhood and adolescence: Systematic review of studies reporting implementation outcomes.
        JMIR Ment Health. 2018; 5: e48
        • Bergin A.D.
        • Vallejos E.P.
        • Davies E.B.
        • et al.
        Preventive digital mental health interventions for children and young people: A review of the design and reporting of research.
        NPJ Digit Med. 2020; 3: 133
        • Patel S.Y.
        • Mehrotra A.
        • Huskamp H.A.
        • et al.
        Trends in Outpatient care delivery and Telemedicine during the COVID-19 pandemic in the US.
        JAMA Intern Med. 2021; 181: 388-391
        • Weiner J.P.
        • Bandeian S.
        • Hatef E.
        • et al.
        In-person and telehealth Ambulatory Contacts and Costs in a large US Insured Cohort before and during the COVID-19 pandemic.
        JAMA Netw Open. 2021; 4: e212618
        • Moreno C.
        • Wykes T.
        • Galderisi S.
        • et al.
        How mental health care should change as a consequence of the COVID-19 pandemic.
        The Lancet Psychiatry. 2020; 7: 813-824
        • Luo J.
        • Tong L.
        • Crotty B.H.
        • et al.
        Telemedicine Adoption during the COVID-19 pandemic: Gaps and Inequalities.
        Appl Clin Inform. 2021; 12: 836-844
        • Jaffe D.H.
        • Lee L.
        • Huynh S.
        • et al.
        Health Inequalities in the Use of telehealth in the United States in the Lens of COVID-19.
        Popul Health Manag. 2020; 23: 368-377
        • Keesara S.
        • Jonas A.
        • Schulman K.
        Covid-19 and health Care's digital Revolution.
        N Engl J Med. 2020; 382: e82
        • Proctor E.K.
        • Powell B.J.
        • McMillen J.C.
        Implementation Strategies: Recommendations for Specifying and reporting.
        Implement Sci. 2013; 8: 139