What was our focus?
Our second workshop focussed on our next priority "What are the best early interventions (treatments and therapies) for depression? And how early should they be used in order to result in the best patient outcomes?".
Who was there?
We are inclusive of young people, parents, researchers, clinicians, and charity partners. Having members from different and diverse backgrounds is so important when coming together to think about how best treat depression in young people and to ensure no perspectives are overlooked.
Alongside our ADvaNCE coordinators and fantastic members, we were thrilled to have guest speakers Dr Bryony Gee and Professor Nick Midgley present their research in this field.
Dr Gee presented her research on barriers and facilitators to the implementation of indicated psychological interventions for adolescents in schools and colleges and Professor Midgley presented his findings of a recent online treatment study. After our guest speaker presentations, our lived experience researcher Georgia Herring presented young people’s perspectives about how we can improve how we treat depression in young people through our survey findings.
What did we do?
As the attendees who had signed up to the workshop arrived at the meeting, we were super excited to meet and greet our members! Once we were all present, our senior co-coordinators Dr Victoria Pile and Dr Faith Orchard introduced ADvaNCE and our key priorities which are the basis for each workshop, these priorities are Identification, Intervention and Empowerment.
We then introduced our guest speakers who presented short talks about their recent research in this field. We then held Q&A sessions where the group could ask questions about the research. This was a great way to inform our understanding of the research in this area and also gave us a chance to share information and allowed people from different backgrounds and disciplines to network with people.
After our short Q&A sessions, our lived experience researcher Georgia Herring presented our survey findings from young people to help inform our understanding of young people’s perspectives. This focussed on the ‘What’ (the focus of the intervention), ‘Where’ (the context of the intervention and ‘When’ (How early should interventions be facilitated?).
After taking a short comfort break, we returned to our screens to be randomly allocated in to break-out rooms, including an ADvaNCE coordinator to guide the discussions. In our groups we reflected on the presentations and young people’s perspectives and came up with two solutions for how we could improve how we treat depression in young people. We then reconvened with the wider group and the ADvaNCE coordinator for each break-out room group feedback their groups solutions. Once every groups solutions had been shared, we then openly discussed our solutions, building on idea’s using the knowledge and expertise from our diverse members.
Once again, it was 11am and time to say goodbye! After the workshop, our members were sent a list of the solutions we had generated and asked to rank them, along with some feedback questions. We were excited for our next workshop and the important discussions we would have about our next priority which will focus on empowering young people in their treatment:
“What are the best ways to tell young people with depression about treatment options and their effectiveness to help them feel more in control and to manage their difficulties?”
Whats did we learn?
Young people’s perspectives
What do you think young people experiencing depression/ low mood would find helpful for psychological interventions to focus on?
The component which young people rated as being most helpful was ‘Being able to talk about your difficulties without judgment’.
Although all components were rated as more helpful than unhelpful, the components which received minority unhelpful and very unhelpful ratings were:
1)‘How your thoughts feelings and behaviour impact on your mood’.
2) ‘Setting clear goals, you can work towards’.
3) Learning to be kinder to yourself’.
These are some responses from young people when they were asked to add anything they think might be helpful for interventions to focus on:
"How to safely deal with your emotions and express them to the outside world.”
"From personal experience I find CBT based help not particularly helpful.
I never managed to get to the root of my problem because the focus would always be on 'homework' and goals which would cause me more anxiety and as it never actually got the root of my problems, any success from it was quickly lost as soon as I stopped."
This individuals experience of CBT reflects the minority (very) unhelpful rating given to the component ‘How your thoughts and feelings impact your mood and behaviour’.
When asked how helpful they thought these types of interventions would be for a young person experiencing depression/ low mood? The options which young people expressed as being most helpful were:
1) Individual and school-based interventions were rated as most helpful compared to other types of interventions.
2) Family-based and digital platform interventions were perceived as being less helpful.
Although young people expressed exploring relationships with friends and family would be a helpful component to therapy, it was seen as less helpful than other intervention types.
Why do you think the type of intervention you rated as being the most helpful would be helpful for young people experiencing depression / low mood?
School based interventions:
"I think it is important to trust a particular person and be able to regularly communicate with them. If this is in school, then it makes them a little more accessible and also means teachers can be made aware of additional support academically if needed.”
Group based interventions:
"It exposes them to the idea that they are not the only ones dealing with depression and that there are indeed others who feel like they are in the same place. Therefore, they would find it safer and easier to bare all”
Individual based interventions:
"Individual so no judgement etc”
When do you think young people would first be most willing to receive support?
Young people jointly rated ‘When they start to experience difficulties’ and ‘When they struggle to cope day to day’ as most appropriate, as opposed to ‘Once diagnosed with depression’ and ‘Before they experience depression’.
When they start of experience difficulties:
“This would help the issue before it escalates into something that would be harder to support.
Being aware of depression before they experience it would be important, but this could possibly impose the issue of people mistaking other issues (e.g upset after disagreements, short periods of sadness) for depression.”
When they struggle to cope day to day:
“Because when they struggle from day to day, that’s when they realise, they’re not okay and that they need support.”
Once diagnosed with depression:
“As humans we tend to ignore a problem and seek help for said problem until the problem is staring us in the face unable to be ignored.”
“Not knowing they have depression. Lived with it so long it has become normal and accepted as part of their life. Not feeling worthy of support to have a better life.”
Barriers and Facilitators of Psychological Treatments
Effectiveness of School-based interventions
Systematic review and meta-analysis of adolescents (aged 10-19) with elevated depressive and anxious symptoms.
Findings:
Small effect on depression symptoms immediately post intervention.
Standardised mean difference of depression symptoms post treatment = 0.45. When outlier removed 0.34 effect size.
Long term follow up less than 6months effect sustained
No significant effect 6-12 months post treatment.
For a subset of the studies, when internal school staff delivered the interventions the treatment the effect was no longer significant.
Interpersonal therapy (IPT) showed a larger effect than CBT interventions.
More work needed to establish long term effects post-treatment.
Feasibility of Delivering Interventions in Schools
Systematic review thematic synthesis of adolescents with mental health difficulties who received interventions in schools.
8 electronic data bases identified 50 eligible studies.
Themes developed:
Intervention characteristics
Acceptability
Group format
Practicality of components
Flexibility/ respect for school routine
Organisational capacity
Relationships between staff
Support of school leadership
Wider school environment
logistical issues
Training and technical assistance
Quality of training and supervision
Suitability of intervention manual and other materials
Provider characteristics
Ability of staff to deliver intervention successfully
Ability of staff to identify eligible students
Community Factors
Stigma and mental health literacy
Priorities of health and educations systems
Depression Online Therapy Study (D:OTS)
With online platforms becoming evermore common and the pandemic making it harder for young people to access support, it is increasingly important that we develop accessible and effective online treatments for young people experiencing depression/ low mood.
Midgley and colleagues conducted a pilot treatment platform for adolescent depression in the UK from the IPDT online treatment study in Sweden.
The Internet based Psychodynamic treatment consists of online chapters with text, videos and worksheets
Young people are given 30-minute chat session with a therapeutic support worker.
23 participants (18female, 5 male; aged 16-18) over 50% never received formal mental health treatment (pilot study)
Interviews were conducted with young people:
Young people didn’t feel like a second-best treatment. In a number of ways young people saw online platform as a preferable way to receive treatment for depression.
Anonymity and accessibility was important.
Young people’s responses appear to fit with theoretical model: They were more aware and accepting of feelings and reported an increased compassion in relation to their emotional experiences.
Next Steps…
After each workshop we have sent a short survey to our members, asking them to rate the solutions that were generated at the workshop, along with some feedback questions to help us improve each workshop.
We have already begun planning our next workshop which will focus on ways we can help empower adolescents in their treatments through information and choice. We will also explore how we can help young people engage in their treatment both inside and outside of therapy sessions.
We plan to bring our top-rated solutions to young people for their input and feedback.
Our hope is to publish a paper containing these final solutions to guide research directions in the field to promote real action and change.
References
Lindqvist, K., Mechler, J., Carlbring, P., Lilliengren, P., Falkenström, F., Andersson, G., Johansson, R., Edbrooke-Childs, J., Dahl, H. J., Lindert Bergsten, K., Midgley, N., Sandell, R., Thorén, A., Topooco, N., Ulberg, R., & Philips, B. (2020). Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial. Journal of medical Internet research, 22(3), e18047. https://doi.org/10.2196/18047
Gee, B., Reynolds, S., Carroll, B., Orchard, F., Clarke, T., Martin, D., ... & Pass, L. (2020). Practitioner Review: Effectiveness of indicated school‐based interventions for adolescent depression and anxiety–a meta‐analytic review. Journal of Child Psychology and Psychiatry, 61(7), 739-756.
Gee, B., Wilson, J., Clarke, T., Farthing, S., Carroll, B., Jackson, C., ... & Notley, C. (2021). Delivering mental health support within schools and colleges–a thematic synthesis of barriers and facilitators to implementation of indicated psychological interventions for adolescents. Child and adolescent mental health, 26(1), 34-46.
Herring, G., T., Pile., V. Orchard., F. Loades. M., E. Chan., S. Reynolds, S. (2021). The Young People's 'Have your say' Survey. (Unpublished).
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