Brief Web-Based Psychological Intervention for Depressive Symptoms Among Chinese Adolescents: Randomized Controlled Trial.
Adolescents with depressive symptoms are at increased risk of social functional impairment and are more likely to develop major depressive disorder. Digital interventions offer advantages, such as high accessibility, especially for adolescents. However, evidence on the effectiveness of web-based psychological interventions in alleviating depressive symptoms among adolescents remains limited.
This study aims to develop a brief web-based psychological intervention tailored to the developmental and psychological characteristics of Chinese adolescents and to evaluate its effectiveness and influencing factors.
In a 2-arm randomized controlled trial, adolescents aged 12 to 18 years with depressive symptoms were recruited from high schools in China. Eligible participants were randomly assigned in a 1:1 ratio to the intervention group (n=212) or the control group (n=224). Participants in the intervention group received a 4-week brief web-based emotional cognitive training program, whereas those in the control group received a web-based psychoeducation program. Nonprofessional helpers provided minimal support through text messages or phone calls. The primary outcome was depressive symptom severity. Secondary outcomes included the depressive symptom remission rate, changes in anxiety symptoms, suicidal ideation, and resilience. Data were collected at baseline (T0), postintervention (T1), and at 1- and 3-month follow-ups (T2 and T3). Statistical analyses included analysis of covariance (ANCOVA), logistic regression analysis, and mediation analysis.
Two-way repeated-measures ANCOVA revealed a significant time effect (F3,1461=82.515; P<.001; η2p=0.140) on depressive symptom severity, with significantly lower scores at T1, T2, and T3 than at T0. No significant group effect (F1,1461=1.039; P=.31; η2p=0.001) or time-by-group interaction (F3,1461=2.424; P=.06; η2p=0.005) for depressive symptom severity was observed. Post hoc exploratory analysis showed that among adolescents with anxiety symptoms, the intervention group exhibited a higher depressive symptom remission rate at T1 than the control group (adjusted odds ratio 1.39, 95% CI 1.05-1.85; P=.02; number needed to treat=7). Additionally, the intervention group showed significantly greater improvements in the interpersonal support dimension of resilience at T1 (least squares mean difference=1.79, 95% CI 0.53-3.06; Cohen d=0.37, 95% CI 0.11-0.63; P=.006; false discovery rate-adjusted P=.04). Exploratory mediation analysis identified a significant indirect effect between the intervention and depressive symptom remission via the interpersonal support dimension of resilience at T1 (indirect effect=0.08, 95% CI 0.02-0.14; P=.009).
The brief web-based psychological intervention showed no significant difference from web-based psychoeducation in reducing depressive symptoms across the 3-month follow-up period. Post hoc exploratory analyses detected a potential between-group difference in depressive symptom remission among adolescents with comorbid anxiety symptoms, with interpersonal support showing a significant mediating association. These exploratory findings may provide new insights into identifying the target population suitable for brief web-based psychological interventions and inform the development of tailored interventions in the future.
Chinese Clinical Trial Registry ChiCTR2400090235; https://www.chictr.org.cn/showproj.html?proj=243991.
This study aims to develop a brief web-based psychological intervention tailored to the developmental and psychological characteristics of Chinese adolescents and to evaluate its effectiveness and influencing factors.
In a 2-arm randomized controlled trial, adolescents aged 12 to 18 years with depressive symptoms were recruited from high schools in China. Eligible participants were randomly assigned in a 1:1 ratio to the intervention group (n=212) or the control group (n=224). Participants in the intervention group received a 4-week brief web-based emotional cognitive training program, whereas those in the control group received a web-based psychoeducation program. Nonprofessional helpers provided minimal support through text messages or phone calls. The primary outcome was depressive symptom severity. Secondary outcomes included the depressive symptom remission rate, changes in anxiety symptoms, suicidal ideation, and resilience. Data were collected at baseline (T0), postintervention (T1), and at 1- and 3-month follow-ups (T2 and T3). Statistical analyses included analysis of covariance (ANCOVA), logistic regression analysis, and mediation analysis.
Two-way repeated-measures ANCOVA revealed a significant time effect (F3,1461=82.515; P<.001; η2p=0.140) on depressive symptom severity, with significantly lower scores at T1, T2, and T3 than at T0. No significant group effect (F1,1461=1.039; P=.31; η2p=0.001) or time-by-group interaction (F3,1461=2.424; P=.06; η2p=0.005) for depressive symptom severity was observed. Post hoc exploratory analysis showed that among adolescents with anxiety symptoms, the intervention group exhibited a higher depressive symptom remission rate at T1 than the control group (adjusted odds ratio 1.39, 95% CI 1.05-1.85; P=.02; number needed to treat=7). Additionally, the intervention group showed significantly greater improvements in the interpersonal support dimension of resilience at T1 (least squares mean difference=1.79, 95% CI 0.53-3.06; Cohen d=0.37, 95% CI 0.11-0.63; P=.006; false discovery rate-adjusted P=.04). Exploratory mediation analysis identified a significant indirect effect between the intervention and depressive symptom remission via the interpersonal support dimension of resilience at T1 (indirect effect=0.08, 95% CI 0.02-0.14; P=.009).
The brief web-based psychological intervention showed no significant difference from web-based psychoeducation in reducing depressive symptoms across the 3-month follow-up period. Post hoc exploratory analyses detected a potential between-group difference in depressive symptom remission among adolescents with comorbid anxiety symptoms, with interpersonal support showing a significant mediating association. These exploratory findings may provide new insights into identifying the target population suitable for brief web-based psychological interventions and inform the development of tailored interventions in the future.
Chinese Clinical Trial Registry ChiCTR2400090235; https://www.chictr.org.cn/showproj.html?proj=243991.
Authors
Liu Liu, Wang Wang, Duan Duan, Situ Situ, Tao Tao, Yang Yang, Zhao Zhao, Li Li, Li Li, Jiang Jiang, Zhang Zhang, Jing Jing, Yu Yu, Huang Huang
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