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A cognitive behavioural therapy (CBT) app has been found to effectively prevent depression in young people who are at high risk - and could be implemented as a cost effective public mental health measure.

Teenager curled up in a ball leaning against lockers in a school with their head in their arms.

Whilst there is emerging evidence for mental health apps being effective in treating anxiety and depression, this £3.3 million project led by the University of Exeter, and in partnership with a team the University of Oxford, is the first to rigorously test an app on a large scale across four countries.

Now published in Lancet Digital Health, two papers report the results of the ECoWeB-PREVENT and ECoWeB-PROMOTE trials, which ran concurrently in the four-year study funded by Horizon 2020 and involving 13 different partners.

The trials found the CBT app prevented an increase in depression, relative to self-monitoring in the higher risk sample, but that there was no difference between any of the interventions in their effects for the lower risk sample.

Professor Ed Watkins from the University of Exeter led the project and said: “For young people with elevated risk, our findings suggest the self-help CBT app does have a preventative effect on depression and could have a public health benefit. Participants’ quality-of-life measures were better, and their reported work and social functioning was better.

“However, we also found that it’s hard to make improvements in young people who are basically doing okay. Our findings add to the evidence that prevention for depression works best when we identify and select individuals who are more at risk, rather than take a more universal approach. This identification could be done by an online self-screening process or through professional referral.”

The Oxford team published a sub-study of the main trial to understand the acceptability and feasibility with vulnerable populations.

They argue young people from marginalised and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps – and a greater understanding is needed of what those groups prefer. 

Dr Holly Bear, Senior Postdoctoral Researcher in the Department of Psychiatry at the University of Oxford, says:

Despite the substantial financial and human investment directed to the development of mental health apps over several years, only a small proportion have empirical evidence to support their effectiveness and there have been few attempts to develop or adapt interventions to meet the needs of diverse groups of young people. Much more work is needed to improve the feasibility and potential utility of apps for young people from marginalised and underserved populations.”

The researchers say involving young people in the development and evaluation of these sorts of interventions is essential. 

The project’s aim was to test the effects of mobile apps to prevent depression and promote mental well-being for young people aged 16 to 22. In one of the largest studies of its kind ever conducted, 3,700 young people took part across four countries – UK, Germany, Belgium, Spain. Participants were allocated into two trials based on their emotional competence abilities at the start of the study. That resulted in 1,200 young people with reduced emotional competency scores that confer increased risk for depression such as increased worry and overthinking going into one trial focused on prevention, whilst 2,500 without such risk went into the other trial focused on wellbeing promotion.

Those two groups were then randomised in equal numbers to three different apps developed by the study. There was a self-monitoring app where people can report their emotions every day, a self-help app that provided personalised training in emotional competence skills, and a self-help app based on CBT principles. Participants were then followed up at three months and 12 months to see how their wellbeing and depression symptoms changed.

 

NIHR OXFORD HEALTH BIOMEDICAL RESEARCH CENTRE NEWS

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