Re: The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial
28 June 2012
Adolescent depression is common, distressing for individuals, families and carers and is associated with self-harm, suicide, poor physical health and social and educational impairment. It also shows strong continuities with adult mental health problems and psychosocial disadvantage (1). The need for new, pragmatic prevention and treatment strategies for adolescent depression has been repeatedly highlighted but rarely addressed.
The SPARX game-based intervention is an innovative approach that is both accessible and relevant to the young person. Engaging the young person with primary and secondary health care is a great challenge, in part because of the stigma associated with mental health difficulties and services. This embraces new technologies and a inter-disciplinary approach in that it capitalises on the skills of multimedia designers as well as health professionals and researchers. We also note the sensitivity to cultural and geographical aspects of New Zealand, for example in the design of the characters and provinces of the game. Presumably it would have to be adapted to culture and country to ensure its relevance. Furthermore, much of the global burden of adolescent depression falls in LAMI countries and other types of strategies may need to be considered here.
Its success in treating depression in this clinical population is encouraging. It will be interesting in future to examine whether this approach could be used in high-risk individuals to add to Merry et al’s recent Cochrane review on preventative interventions in adolescent depression, which highlighted the lack of well-researched computerised CBT packages (2). However, a RCT showed that a CBT prevention program in adolescents was less effective when they had a parent who was depressed and therefore at ‘high-risk’ (3).
Whilst this study targeted help-seeking adolescents, a high proportion of young people with depression go unrecognised and we wonder whether this approach would be more accessible to those reluctant to seek help and to engage with health services. Assessment of its longer term effectiveness would also provide valuable evidence to support its use. Overall, we applaud this innovative, engaging and accessible intervention which could benefit young people, their families and carers and could be a useful resource for professionals.
(1) Thapar A, Collishaw S, Pine S, Thapar AK. Depression in Adolescence. Lancet, 2012; 379: 1056-67.
(2) Merry SN, Hetrick SE, Cox GR, Brudevold-Iversen T, Bir JJ, McDowell H. Psychological and educational interventions for preventing depression in children and adolescents. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD003380. DOI: 10.1002/14651858.CD003380.pub3.
(3) Garber J, Clarke GN, Weersing VR, Beardslee WR et al. Prevention of depression in at-risk adolescents: a randomised controlled trial. JAMA, 2009; 301(21): 2215-24.
Competing interests: None declared
Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Room 91, 4th Floor, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN
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