Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden: a randomised, clinical, non-inferiority trial

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Therapist-guided internet-based psychodynamic therapy versus cognitive behavioural therapy for adolescent depression in Sweden : a randomised, clinical, non-inferiority trial

Mechler, Jakob (author): Stockholms universitet,Klinisk psykologi

Lindqvist, Karin (author): Stockholms universitet,Klinisk psykologi

Carlbring, Per (author): Stockholms universitet,Klinisk psykologi

Topooco, Naira (author)

Falkenström, Fredrik (author)

Lilliengren, Peter (author)

Andersson, Gerhard (author)

Johansson, Robert (author): Stockholms universitet,Klinisk psykologi

Midgley, Nick (author)

Edbrooke-Childs, Julian (author)

Dahl, Hanne-Sofie J. (author)

Sandell, Rolf (author)

Thorén, Agneta (author)

Ulberg, Randi (author)

Lindert Bergsten, Katja (author)

Philips, Björn (author): Stockholms universitet,Klinisk psykologi

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Elsevier, 2022
2022
English.
In: The Lancet Digital Health. - : Elsevier. - 2589-7500. ; 4:8, s. e594-e603

Related links:: https://doi.org/10.1...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Background: Adolescent major depressive disorder (MDD) is highly prevalent and associated with lifelong adversity. Evidence-based treatments exist, but accessible treatment alternatives are needed. We aimed to compare internet-based psychodynamictherapy (IPDT) with an established evidence-based treatment (internet-based cognitive behavioural therapy [ICBT]) for the treatment of adolescents with depression.Methods: In this randomised, clinical trial, we tested whether IPDT was non-inferior to ICBT in the treatment of adolescent MDD. Eligible participants were 15–19 years old, presenting with a primary diagnosis of MDD according to DSM-5. Participants were recruited nationwide in Sweden through advertisements on social media, as well as contacts with junior and senior high schools, youth associations, social workers, and health-care providers. Adolescents who scored 9 or higher on the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR) in an initial online screening were contacted by telephone for a diagnostic assessment using the Mini International Neuropsychiatric Interview. Participants were randomly assigned to ICBT or IPDT. Both interventions comprised eight self-help modules delivered over 10 weeks on a secure online platform. The primary outcome was change in depression severity measured weekly by the QIDS-A17-SR. Primary analyses were based on an intention-to-treat sample including all participants randomly assigned. A non-inferiority margin of Cohen's d=0·30 was predefined. The study is registered at ISRCTN, ISRCTN12552584.Findings: Between Aug 19, 2019, and Oct 7, 2020, 996 young people completed screening; 516 (52%) were contacted for a diagnostic interview. 272 participants were eligible and randomly assigned to ICBT (n=136) or IPDT (n=136). In the ICBT group, 51 (38%) of 136 participants were classified as remitted, and 54 (40%) of 136 participants were classified as remitted in the IPDT group. Within-group effects were large (ICBT: within-group d=1·75, 95% CI 1·49 to 2·01; IPDT: within-group d=1·93, 1·67 to 2·20; both p<0·0001). No statistically significant treatment difference was found in the intention-to-treat analysis. Non-inferiority for IPDT was shown for the estimated change in depression during treatment (d=–0·18, 90% CI –0·49 to 0·13; p=0·34). All secondary outcomes showed non-significant between-group differences.Interpretation: IPDT was non-inferior to ICBT in terms of change in depression for the treatment of adolescents with MDD. This finding increases the range of accessible and effective treatment alternatives for adolescents with depression.

Subject headings

SAMHÄLLSVETENSKAP -- Psykologi -- Tillämpad psykologi (hsv//swe)
SOCIAL SCIENCES -- Psychology -- Applied Psychology (hsv//eng)

Keyword

adolescent major depressive disorder
internet-based psychodynamic therapy
IPDT
ICBT
depression
psykologi
Psychology

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ref (subject category)
art (subject category)

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By the author/editor: Mechler, Jakob; Lindqvist, Karin; Carlbring, Per; Topooco, Naira; Falkenström, Fre ...; Lilliengren, Pet ...; show more...; Andersson, Gerha ...; Johansson, Rober ...; Midgley, Nick; Edbrooke-Childs, ...; Dahl, Hanne-Sofi ...; Sandell, Rolf; Thorén, Agneta; Ulberg, Randi; Lindert Bergsten ...; Philips, Björn; show less...

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SOCIAL SCIENCES: SOCIAL SCIENCES; and Psychology; and Applied Psycholo ...

Articles in the publication: The Lancet Digit ...

By the university: Stockholm University

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