Evaluation of a spirituality informed e-mental health tool as an intervention for major depressive disorder in adolescents and young adults - a randomized controlled pilot trial

Badri Rickhi, Ania Kania-Richmond, Sabine Moritz, Jordan Cohen, Patricia Paccagnan, Charlotte Dennis, Mingfu Liu, Sonya Malhotra, Patricia Steele, John Toews, Badri Rickhi, Ania Kania-Richmond, Sabine Moritz, Jordan Cohen, Patricia Paccagnan, Charlotte Dennis, Mingfu Liu, Sonya Malhotra, Patricia Steele, John Toews

Abstract

Background: Depression in adolescents and young adults is a major mental health condition that requires attention. Research suggests that approaches that include spiritual concepts and are delivered through an online platform are a potentially beneficial approach to treating/managing depression in this population. The purpose of this study was to evaluate the effectiveness of an 8-week online spirituality informed e-mental health intervention (the LEAP Project) on depression severity, and secondary outcomes of spiritual well-being and self-concept, in adolescents and young adults with major depressive disorder of mild to moderate severity.

Methods: A parallel group, randomized, waitlist controlled, assessor-blinded clinical pilot trial was conducted in Calgary, Alberta, Canada. The sample of 62 participants with major depressive disorder (DSM-IV-TR) was defined by two age subgroups: adolescents (ages 13 to 18 years; n = 31) and young adults (ages 19 to 24 years; n = 31). Participants in each age subgroup were randomized into the study arm (intervention initiated upon enrolment) or the waitlist control arm (intervention initiated after an 8-week wait period). Comparisons were made between the study and waitlist control arms at week 8 (the point where study arm had completed the intervention and the waitlist control arm had not) and within each arm at four time points over 24-week follow-up period.

Results: At baseline, there was no statistical difference between study and waitlist participants for both age subgroups for all three outcomes of interest. After the intervention, depression severity was significantly reduced; comparison across arms at week 8 and over time within each arm and both age subgroups. Spiritual well-being changes were not significant, with the exception of an improvement over time for the younger participants in the study arm (p = 0.01 at week 16 and p = 0.0305 at week 24). Self-concept improved significantly for younger participants immediately after the intervention (p = 0.045 comparison across arms at week 8; p = 0.0175 in the waitlist control arm) and over time in the study arm (p = 0.0025 at week 16). In the older participants, change was minimal, with the exception of a significant improvement in one of six factors (vulnerability) in study arm over time (p = 0.025 at week 24).

Conclusions: The results of the LEAP Project pilot trial suggest that it is an effective, online intervention for youth ages 13 to 24 with mild to moderate major depressive disorder with various life situations and in a limited way on spiritual well-being and self-concept.

Trial registration: ClinicalTrials.gov NCT00985686. Registered 24 September 2009.

Figures

Fig. 1
Fig. 1
a Study Protocol. Schematic providing an overview of the study identifying recruitment, randomization, data collection points, and time points where intervention is implemented. b CONSORT Flow Chart. Standardized summary of enrolment, study group allocation, loss to follow-up and discontinuation of the intervention at follow-up, and participants included in the analysis
Fig. 2
Fig. 2
a Depression Severity - CDRS-Revised Mean Scores (Younger subgroup). Results of the statistical analysis comparing mean scores within each study group across time and across study groups at week 8 are presented in the text of the results section. Level of significance: p ≤ 0.05. b Depression Severity - HAMD Mean Scores (Older subgroup). Results of the statistical analysis comparing mean scores within each study group across time and across study groups at week 8 are presented in the text of the results section. Level of significance: p ≤ 0.05
Fig. 3
Fig. 3
a Spiritual Well-Being – SWBS Mean Scores (Younger subgroup). Results of the statistical analysis comparing mean scores within each study group across time and across study groups at week 8 are presented in the text of the results section. Level of significance: p ≤ 0.05. b Spiritual Well-Being - SIBS Means Scores (Older subgroup). Results of the statistical analysis comparing mean scores within each study group across time and across study groups at week 8 are presented in the text of the results section. Level of significance: p ≤ 0.05
Fig. 4
Fig. 4
Self-Concept - Piers Harris 2 Mean Scores (Younger subgroup). Results of the statistical analysis comparing mean scores within each study group across time and across study groups at week 8 are presented in the text of the results section. Level of significance was set at p ≤ 0.05

References

    1. Cheung A, Dewa C. Canadian community health survey: major depressive disorder and suicidality in adolescents. Health Policy. 2006;2:77–89.
    1. Naicker K, Galambos N, Zeng Y, Senthilselvan A, Colman I. Social, demographic and health outcomes in the 10 years following adolescent depression. J Adolesc Health. 2013;52:533–538. doi: 10.1016/j.jadohealth.2012.12.016.
    1. Public Health Agency of Canada. A report on mental illness in Canada. []
    1. Jaycox L, Stein B, Paddock S, Miles J, Chandra A, Meredith L, et al. Impact of teen depression on academic, social, and physical functioning. Pediatrics. 2009;124 doi: 10.1542/peds.2008-3348.
    1. Thapar A, Collishaw S, Pine D, Thapar A. Depression in adolescence. The Lancet. 2012;379:1056–1067. doi: 10.1016/S0140-6736(11)60871-4.
    1. Lemstra M, Neudorf C, D’Arcy C, Kunst A, Warren L, Bennett N. A systematic review of depressed mood and anxiety by SES in youth aged 10–15 years. Can J Public Health. 2008;99:125–129.
    1. Mood Disorders Society of Canada . Quick Facts: Mental illness and addiction in Canada. 3 2009.
    1. Patten S, Juby H. A profile of clinical depression in Canada. Research Data Centre Network Research Synthesis Series #1. 2008.
    1. Ruble A, Leon P, Gilley-Hensley L, Hess S, Swartz K. Depression knowledge in high school students: Effectiveness of the adolescent depression awareness program. J Affect Disord. 2013;150:1025–1030. doi: 10.1016/j.jad.2013.05.033.
    1. Kessler R, Berglund P, Demler O, Jin R, Merikangas K, Walters E. Lifetime prevalence and age-of-onset distributions of DSM–IV disorders in the national comorbidity survey replication. Arch Gen Psychiatr. 2005;62:593–602. doi: 10.1001/archpsyc.62.6.593.
    1. Thombs B, Roseman M, Kloda L. Depression screening mental health outcomes in children and adolescents: A systematic review protocol. Syst Rev. 2012;1:58. doi: 10.1186/2046-4053-1-58.
    1. Boydell K, Pong R, Volpe T, Wilson E, Lemieux S, Cote D et al. The rural perspective on continuity of care: Pathways to care with children with emotional and behavioral disorders. Canadian Health Services Foundation 2004 []
    1. The Canadian Association of Paediatric Health Centres, The National Infant, Child, and Youth Mental Health Consortium Advisory, & The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO. Access and wait times in child and youth mental health: A background paper. Submitted to: Institute of Human Development, Child and Youth Health. October 2010
    1. Lingley-Pottie P, McGrath P, Andreou P. Barriers to mental health care: Perceived delivery system differences. ANS Adv Nurs Sci. 2013;36:51–61. doi: 10.1097/ANS.0b013e31828077eb.
    1. Mukolo A, Heflinger C, Wallston K. The stigma of childhood mental disorders: a conceptual framework. J Am Acad Child Adolesc Psychiatry. 2010;49:92–103.
    1. Power T, Eiraldi R, Clarke A, Mazzuca L, Krain A. Improving mental health service utilization for children and adolescents. Sch Psychol Q. 2005;20:187–205. doi: 10.1521/scpq.20.2.187.66510.
    1. Eisenberg D, Golberstein E, Gollust SE. Help-seeking and access to mental health care in a university student population. Med Care. 2007;45:594–601. doi: 10.1097/MLR.0b013e31803bb4c1.
    1. Gulliver A, Griffiths K, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010;10:113. doi: 10.1186/1471-244X-10-113.
    1. Cotton S, Zebracki K, Rosenthal S, Tsevat J, Drotar D. Religion/spirituality and adolescent health outcomes: a review. J Adolesc Health. 2006;38:472–480. doi: 10.1016/j.jadohealth.2005.10.005.
    1. Dew R, Daniel S, Goldston D, McCall W, Kuchibhatla M, Schleifer C, et al. A prospective study of religion/spirituality and depressive symptoms among adolescent psychiatric patients. J Affect Disord. 2010;120:149–157. doi: 10.1016/j.jad.2009.04.029.
    1. Rew L, Wong J. A systematic review of associations among religiosity/spirituality and adolescent health attitudes and behaviors. J Adolesc Health. 2006;38:433–442. doi: 10.1016/j.jadohealth.2005.02.004.
    1. Williams D, Sternthal M. Spirituality, religion and health: evidence and research directions. Med J Aust. 2007;186:S47–S50.
    1. Mohr D, Burns M, Schueller S, Clarke G, Klinkman M. Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. Gen Hosp Psychiatry. 2013;35:332–338. doi: 10.1016/j.genhosppsych.2013.03.008.
    1. Mental Health Commission of Canada. E-Mental health in Canada: Transforming the mental health system using technology. A briefing document. []
    1. Stjernsward S, Ostman M. Potential of e-health in relation to depression: short survey of previous research. J Psychiatr Ment Health Nurs. 2006;13:698–703. doi: 10.1111/j.1365-2850.2006.01017.x.
    1. Andersson G, Bergstrom J, Hollandare F, Carbring P, Kaldo V, Ekselius L. Internet-based self-help for depression: randomized controlled trial. BJP. 2005;187:456–461. doi: 10.1192/bjp.187.5.456.
    1. Christensen H, Petrie K. Information technology as the key to accelerating advances in mental health care. Aust N Z J Psychiatry. 2013;47:114. doi: 10.1177/0004867412471088.
    1. Burns J, Davenport T, Durkin L, Luscombe G, Hickie I. The internet as a setting for mental health services utilization by young people. MJA. 2010;192:22.
    1. Cuijpers P, van Straten A, Warmerdam L, Andersson G. Psychological treatment of depression: A meta-analytic database of randomized studies. BMC Psychiatry. 2008;8:36. doi: 10.1186/1471-244X-8-36.
    1. Posternak M, Miller I. Untreated short term course of major depression: A meta-analysis of outcomes from studies using wait-list control groups. J Affect Disorders. 2001;66:196–146.
    1. Rongrong T, Emslie G, Mayes T, Nakonezny P, Kennard B, Hughes C. Early prediction of acute antidepressant treatment response and remission in pediatric major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2009;48:71. doi: 10.1097/CHI.0b013e318190043e.
    1. Findling R, Pagano M, McNamara N, Stansbrey R, Faber J, Lingler J, et al. The short-term safety and efficacy of fluoxetine in depressed adolescents with alcohol and cannabis use disorders: a pilot randomized placebo controlled trial. Child Adolesc Psychiatry Ment Health. 2009;3:11. doi: 10.1186/1753-2000-3-11.
    1. Mayes T, Bernstein I, Haley C, Kennard B, Ernslie G. Psychometric properties of the Children’s depression rating scale – revised in adolescents. J Child Adolesc Psychopharmacol. 2010;20:513–6. doi: 10.1089/cap.2010.0063.
    1. Cusin C, Yang H, Yeung A, Fava M. Chapter 2 – Rating Scales for Depression. In: Baer L, Blais MA, editors. Handbook of Clinical Rating Scales and Assessment in Psychiatry and Mental Health. New York, NY: Humana Press; 2010.
    1. Zimmerman M, Martinez J, Attiullah N, Friedman M, Toba C, Boerescu D, et al. Why do some depressed outpatients who are in remission according to the Hamilton Depression Rating Scale not consider themselves to be in remission? J Clin Psychiatry. 2012;73:790–95. doi: 10.4088/JCP.11m07203.
    1. Leucht S, Fennema H, Engel R, Kaspers-Janssen M, Lepping P, Szegedi A. What does the HAMD mean? J Affect Disord. 2013;148:243–8. doi: 10.1016/j.jad.2012.12.001.
    1. Fowler J. Stages of Faith. New York: Harper and Row; 1981.
    1. Gina V. Interreligious encounter group: a psychospiritual experience for faith development. Counsel Val. 1990;35:39–51. doi: 10.1002/j.2161-007X.1990.tb00357.x.
    1. Shek D. Spirituality as a positive youth development construct: A conceptual review. The Scientific World Journal. 2012;12: article ID: 458953
    1. Erikson E. Childhood and Society. W. W. Norton and Company 1993: New York, NY; 1950.
    1. Rickhi B, Moritz S, Reesal R, Xu T, Paccagnan P, Liu M, et al. A spirituality teaching program for depression: a randomized controlled trial. Int J Psychiatry Med. 2011;42:317–331. doi: 10.2190/PM.42.3.f.
    1. Cunningham J, Kypri K, McCambridge J. Exploratory randomized controlled trial evaluating the impact of a waiting list control design. BMC Med Res Meth. 2013;13:150. doi: 10.1186/1471-2288-13-150.
    1. Hart T, Fann J, Novack T. The dilemma of the control condition in experience-based cognitive and behavioural treatment research. Neuropsychol Rehabil. 2008;18:1–21. doi: 10.1080/09602010601082359.
    1. Miller W, Rollnick S. Motivational interviewing: Preparing people to change addictive behavior. 2. New York, NY: Guilford Press; 2002.
    1. Jorm A, Morgan A, Malhi G. The future of e-mental health. Aust N Z J of Psychiatry. 2013;47:104. doi: 10.1177/0004867412474076.
    1. Murray E. Web-based interventions for behavior change and self- management: Potential, pitfalls, and progress. Medicine 2.0. 2012;1:e3. doi: 10.2196/med20.1741.
    1. Poznanski E, Mokros H. Children’s Depression Rating Scale Revised (CDRS-R) Los Angeles CA: Western Psychological Services Publishers and Distributors; 2005.
    1. Piers EV, Herzberg D. Piers Harris 2: Piers Harris Children’s Self-Concept Scale Manual. 2. Los Angeles CA: Western Psychological Services Publishers and Distributors; 2002.
    1. Paloutzian R, Ellison C. Loneliness, spiritual well-being, and quality of life. In: Peplau L, Perlman D, editors. Loneliness: A sourcebook of current theory, research and therapy. New York NY: Wiley Publishers; 1982.
    1. Williams J, Kobak K, Bech P, Engelhardt N, Evans K, Kpsitz J, et al. The GRID-HAM: standardization fo th Hamilton dpression rating scale. Int Clin Psychopharmacol. 2008;23:120–129. doi: 10.1097/YIC.0b013e3282f948f5.
    1. Stake L. Development and validation of the Six-factor self-concept scale for adults. Educ Psychol Meas. 1994;54:56–72. doi: 10.1177/0013164494054001006.
    1. Yanico B, Lu T. A psychometric evaluation of the six-factor self-concept scale in a sample of racial/ethnic minority women. Educ Psychol Meas. 2000;60:86–99. doi: 10.1177/00131640021970385.
    1. Hatch R, Burg M, Naberhaus D, Hillmich L. The spiritual involvement and beliefs scale. Development and testing of a new instrument. J Fam Pract. 1998;46:476–486.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever