Grant: Knowledge Synthesis Grant

Treating anxiety and depression in adolescence with internet-based interventions: A knowledge synthesis using realist review methodology to explore how internet-based treatments work and for whom they are effective

<html> <body>Global burden of anxiety and depressive disorders in youth is severe, with roughly 1 in 3 adolescents meeting the criteria for an anxiety disorder and 1 in 7 for a depressive disorder in their lifetime. Early intervention is key to reducing tangible long-term impacts. Important new treatments for these conditions are internet-based cognitive behavioural and interpersonal therapies (CBT and IPT). These may reduce demand for in-person therapy, save costs and give faster access to recommended treatments. Some therapies are now publicly available online or in smartphone &lsquo;app&rsquo; stores. Recent reviews conclude that internet-based CBT and IPT show promise in improving adolescent mental health outcomes, but that we need to better understand the conditions that maximize treatment effectiveness. Thus, we will examine the theoretical drivers of internet-based intervention effectiveness using realist review methodology.<br> <br> <strong>Our goal</strong> is to develop explanatory models of how internet-based CBT and IPT for anxiety and depression are effective, ineffective or inconclusive in effect, and whom these therapies are effective for, in youth aged 12 to 19 years. <strong>Our</strong> <strong>review questions</strong> are:<br> <br> <em>1)</em> What therapeutic principles (content), interactions and delivery features (technologies) have been evaluated in internet-based CBT and IPT for adolescents?<br> <br> <em>2)</em> Which content, interaction and technologies produce which outcomes for which groups?<br> <br>Our <strong>project outputs</strong> will be <em>a)</em> eHealth policy recommendations, <em>b)</em> a consumer guide created by youth for adolescents and a parallel guide for health care providers, and <em>c)</em> publications for eHealth researchers. Our national multidisciplinary team has the experience to translate our model findings into outputs for policy makers, health care providers and youth. Our models will indicate <strong>gaps in the evidence base</strong>, allowing us to <strong>offer priorities for future research</strong>.<br> <br> We use Pawson&rsquo;s steps for realist reviews. <strong>Clarify Scope.</strong> We formulated review questions on the nature and content of internet-based CBT and IPT, and will identify candidate theories for how treatment content, interaction and technology influence treatment effect. <strong>Evidence Search.</strong> We piloted search strategies with an information specialist, identifying 7,439 unique articles. During article screening, we will also track references and citations, and consult with leaders in the eHealth field as targeted search strategies. We will include evidence from clinical trials, theoretical and research articles on internet-based treatment processes, and descriptive articles on interventions evaluated. <strong>Quality Assessment.</strong> Evidence will be rated on whether it gives information on intervention components and how they affect treatment outcomes. Data will be extracted for an evaluation framework of content, interaction and technology. <strong>Data Synthesis.</strong> With Pawson&rsquo;s techniques and meta-ethnography, we will define intervention components and investigate relationships to treatment outcomes. For all interventions, we will compare unique and similar components, adolescent characteristics and outcomes. <strong>Disseminate, Implement, Evaluate.</strong> Our review will provide explanatory models of internet-based CBT and IPT for treating anxiety and depression in youth. These models will underpin policy and consumer recommendations for decision making based on evidence. Recommendations will be widely distributed to key groups already using, or considering using, internet-based CBT and IPT.</body> </html>