Web Intervention for Adolescents Affected by Disaster: Population-Based Randomized Controlled Trial

Abstract

Objective: To assess the efficacy of Bounce Back Now (BBN), a modular, Web-based intervention for disaster-affected adolescents and their parents.

Method: A population-based randomized controlled trial used address-based sampling to enroll 2,000 adolescents and parents from communities affected by tornadoes in Joplin, MO, and several areas in Alabama. Data collection via baseline and follow-up semi-structured telephone interviews was completed between September 2011 and August 2013. All families were invited to access the BBN study Web portal irrespective of mental health status at baseline. Families who accessed the Web portal were assigned randomly to 1 of 3 groups: BBN, which featured modules for adolescents and parents targeting adolescents' mental health symptoms; BBN plus additional modules targeting parents' mental health symptoms; or assessment only. The primary outcomes were adolescent symptoms of posttraumatic stress disorder (PTSD) and depression.

Results: Nearly 50% of families accessed the Web portal. Intent-to-treat analyses revealed time × condition interactions for PTSD symptoms (B = -0.24, SE = 0.08, p < .01) and depressive symptoms (B = -0.23, SE = 0.09, p < .01). Post hoc comparisons revealed fewer PTSD and depressive symptoms for adolescents in the experimental versus control conditions at 12-month follow-up (PTSD: B = -0.36, SE = 0.19, p = .06; depressive symptoms: B = -0.42, SE = 0.19, p = 0.03). A time × condition interaction also was found that favored the BBN versus BBN + parent self-help condition for PTSD symptoms (B = 0.30, SE = 0.12, p = .02) but not depressive symptoms (B = 0.12, SE = 0.12, p = .33).

Conclusion: Results supported the feasibility and initial efficacy of BBN as a scalable disaster mental health intervention for adolescents. Technology-based solutions have tremendous potential value if found to reduce the mental health burden of disasters.

Clinical trial registration information: Web-based Intervention for Disaster-Affected Youth and Families; https://ichgcp.net/clinical-trials-registry/NCT01606514" title="See in ClinicalTrials.gov">NCT01606514.

Keywords: depression; disaster mental health; posttraumatic stress; technology.

Conflict of interest statement

Disclosure: Drs. Ruggiero, Price, Adams, Stauffacher, McCauley, Kmett Danielson, Knapp, Hanson, Davidson, Amstadter, Carpenter, Saunders, Kilpatrick, and Resnick report no biomedical financial interests or potential conflicts of interest.

Copyright © 2015 American Academy of Child and Adolescent Psychiatry. All rights reserved.

Figures

Figure 1

CONSORT Diagram. Note: Families are defined as having either a teen or parent access the intervention. All families were contacted for follow-up interviews, irrespective of their involvement with the intervention. Intent-to-treat (ITT) includes all participants who accessed the intervention. Completer/Completed = completer sample; includes all participants in which a family member (teen or parent) completed at least one intervention module. Lightly shaded boxes refer to interview participation, whereas the prior two rows of unshaded boxes refer to web access and completion, respectively. BBN = Bounce Back Now. BBN+ASH = Bounce Back Now plus Adult Self Help.