Computer-assisted cognitive-behavioral therapy for adolescent depression in primary care clinics in Santiago, Chile (YPSA-M): study protocol for a randomized controlled trial

Vania Martínez, Pablo Martínez, Paul A Vöhringer, Ricardo Araya, Graciela Rojas, Vania Martínez, Pablo Martínez, Paul A Vöhringer, Ricardo Araya, Graciela Rojas

Abstract

Background: Depression is a common and disabling condition. In Chile, assistance is guaranteed by law through a national program for depression in primary care services, and there is evidence of effective treatment for depressed women. However, there is a shortage of evidence-based treatments for depression in adolescents. The incorporation of technology to expand therapeutic options is becoming more common. This proposal aims to compare the efficacy of therapy that enhances traditional face-to-face cognitive-behavioral therapy (CBT) with a computer-based program versus usual care to treat depression in adolescents in primary care clinics in Santiago, Chile.

Methods and design: This is a two-arm, single-blind, randomized controlled trial with a target enrollment of 216 depressed adolescents between 15 and 19 years of age, attending four primary care clinics in Santiago, Chile. In the active arm, depressed adolescents will receive eight sessions of computer-assisted CBT, led by trained psychologists on a weekly basis. In the control arm, depressed adolescents will receive treatment as usual from the primary care centers. Mean depression scores and indicators of dysfunctional thoughts, problem-solving strategies, and health-related quality of life will be measured at baseline and four and six months after randomization.

Discussion: As far as we know, this is the first randomized controlled trial of a computer-assisted CBT intervention for depressed adolescents in a Latin American country.

Trial registration: Clinical Trials: NCT01862913.

References

    1. Ustun T, Ayuso-Mateos J, Chatterji S, Mathers C, Murray C. Global burden of depressive disorders in the year 2000. Br J Psychiatry. 2004;184:386–392. doi: 10.1192/bjp.184.5.386.
    1. Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJL, Vos T, Whiteford HA. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med. 2013;10(11):e1001547. doi: 10.1371/journal.pmed.1001547.
    1. Araya R, Rojas G, Fritsch R, Acuna J, Lewis G. Common mental disorders in Santiago, Chile: prevalence and socio-demographic correlates. Br J Psychiatry. 2001;178:228–233. doi: 10.1192/bjp.178.3.228.
    1. Vicente B, Kohn R, Rioseco P, Saldivia S, Baker C, Torres S. Population prevalence of psychiatric disorders in Chile: 6-month and 1-month rates. Br J Psychiatry. 2004;184:299–305. doi: 10.1192/bjp.184.4.299.
    1. Vicente B, De la Barra F, Saldivia S, Kohn R, Rioseco P, Melipillan R. Prevalence of child and adolescent psychiatric disorders in Santiago, Chile: a community epidemiological study. Soc Psychiatry Psychatr Epidemiol. 2012;47(7):1099–1109. doi: 10.1007/s00127-011-0415-3.
    1. Minoletti A, Zaccaria A. Plan Nacional de Salud Mental en Chile: 10 años de experiencia [The National Mental Health Plan in Chile: 10 years of experience] Rev Panam Salud Publica. 2005;18(4/5):346–358. doi: 10.1590/S1020-49892005000900015.
    1. Araya R, Alvarado R, Sepúlveda R, Rojas G. Lessons from scaling up a depression treatment program in primary care in Chile. Rev Panam Salud Publica. 2012;32(3):234–240. doi: 10.1590/S1020-49892012000900009.
    1. Ministerio de Salud: Segundo Régimen de Garantías Explícitas en Salud. []
    1. Ministerio de Salud: Guía Clínica Depresión en personas de 15 años y más. []
    1. Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, Peters TJ. Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet. 2003;361(9362):995–1000. doi: 10.1016/S0140-6736(03)12825-5.
    1. Rojas G, Fritsch R, Solis J, Jadresic E, Castillo C, González M, Guajardo V, Lewis G, Peters TJ, Araya R. Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial. Lancet. 2007;370(10):1629–1637. doi: 10.1016/S0140-6736(07)61685-7.
    1. Fergusson DM, Woodward LJ. Mental health, educational, and social role outcomes of adolescents with depression. Arch Gen Psychiatry. 2002;59(3):225–231. doi: 10.1001/archpsyc.59.3.225.
    1. Rohde P, Lewinsohn PM, Seeley JR. Are adolescents changed by an episode of major depression? J Am Acad Child Adolesc Psychiatry. 1994;33:1289–1298. doi: 10.1097/00004583-199411000-00010.
    1. Compton S, March J, Brent D, Albano A, Weersing R, Curry J. Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: an evidence-based medicine review. J Am Acad Child Adolesc Psychiatry. 2004;43(8):930–959. doi: 10.1097/.
    1. Harrington R, Whittaker J, Shoebridge P, Campbell F. Systematic review of efficacy of cognitive behaviour therapies in childhood and adolescent depressive disorder. BMJ. 1998;316(7144):1559–1563. doi: 10.1136/bmj.316.7144.1559.
    1. Weisz JR, Jensen AL, McLeod BD. Development and dissemination of child and adolescent psychotherapies: milestones, methods, and a new deployment-focused model. In: Hibbs ED, Jensen PS, editors. Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Approaches. 2. Washington DC, US: American Psychological Association; 2005. pp. 9–39.
    1. Eells TD, Barret MS, Wright JH, Thase M. Computer-assisted cognitive behavior therapy for depression. Psychotherapy. 2014;51(2):191–197. doi: 10.1037/a0032406.
    1. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32:329–342. doi: 10.1016/j.cpr.2012.02.004.
    1. Craske MG, Rose RD, Lang A, Welch SS, Campbell-Sills L, Sullivan G, Sherbourne C, Bystrisky A, Stein M, Roy-Byrne PP. Computer-assisted delivery of cognitive behavioral therapy for anxiety disorders in primary care settings. Depress Anxiety. 2009;26:235–242. doi: 10.1002/da.20542.
    1. Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clin Child Fam Psychol Rev. 2001;13:275–290. doi: 10.1007/s10567-010-0069-9.
    1. Stallard P, Richardson T, Velleman S, Atwood M. Computerized CBT (Think, Feel, Do) for depression and anxiety in children and adolescents: outcomes and feedback from a pilot randomized controlled trial. Behav Cogn Psychother. 2011;39(3):273–284. doi: 10.1017/S135246581000086X.
    1. Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin Psychol Rev. 1998;8:77–100. doi: 10.1016/0272-7358(88)90050-5.
    1. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. Schedule for Affective Disorders and Schizophrenia for School-age Children - Present And Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36:980–988. doi: 10.1097/00004583-199707000-00021.
    1. Alvarado R, Rojas G. Evaluation of the program for detection and treatment of depression in Chilean primary health care centers. Rev Med Chil. 2011;139(5):592–599. doi: 10.4067/S0034-98872011000500005.
    1. Schniering CA, Rapee RM. Development and validation of a measure of children’s automatic thoughts: the Children’s Automatic Thoughts Scale. Behav Res Ther. 2002;40:1091–1109. doi: 10.1016/S0005-7967(02)00022-0.
    1. D’Zurilla TJ, Nezu AM, Maydeu-Olivares A. Manual for the Social Problem-Solving Inventory - Revised (SPSI-R) New York: Multi-Health Systems, Inc; 1998.
    1. Calvete E, Cardeñoso O. Beliefs, social problem solving and psychological correlates. Psicothema. 2001;13(1):95–100.
    1. KIDSCREEN Group Europe . The KIDSCREEN Questionnaires. Quality of Life Questionnaires for Children and Adolescents-Handbook. Lengerich, Germany: Papst Science Publisher; 2006.
    1. Sepúlveda R, Molina T, Molina R, Martínez V, González E, George M, Montaño R, Hidalgo-Rasmussen C. Validation of an instrument to measure health-related quality of life in Chilean children and adolescents. Rev Med Chil. 2013;141:1283–1292. doi: 10.4067/S0034-98872013001000007.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する