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The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial
Adolescents suffering from depression can benefit just as much from specialised computer therapy as they do from one-to-one therapy with a clinician, a study published on bmj.com finds.
Depression is common in adolescents, but many are reluctant to seek professional help. So researchers from the University of Auckland, New Zealand, set out to assess whether a new innovative computerised cognitive behavioural therapy intervention called SPARX could reduce depressive symptoms as much as usual care can.
SPARX is an interactive 3D fantasy game where a single user undertakes a series of challenges to restore balance in a virtual world dominated by GNATs (Gloomy Negative Automatic Thoughts). It contains seven modules designed to be completed over a four to seven week period. Usual care mostly involved face-to-face counselling by trained clinicians.
The research team carried out a randomised controlled trial in 24 primary healthcare sites across New Zealand. All 187 adolescents were between the ages of 12 and 19, were seeking help for mild to moderate depression and were deemed in need of treatment by primary healthcare clinicians. One group underwent face-to-face treatment as usual and the other took part in SPARX.
Participants were followed up for three months and results were based on several widely used mental health and quality of life scales.
Results showed that SPARX was as effective as usual care in reducing symptoms of depression and anxiety by at least a third. In addition significantly more people recovered completely in the SPARX group (31/69 (44%) of those who completed at least four homework modules in the SPARX group compared with 19/83 (26%) in usual care).
When questioned on satisfaction, 76/80 (95%) of SPARX users who replied said they believed it would appeal to other teenagers with 64/80 (81%) recommending it to friends. Satisfaction was, however, equally high in the group that had treatment as usual.
The authors conclude that SPARX is an “effective resource for help seeking adolescents with depression at primary healthcare sites. Use of the program resulted in a clinically significant reduction in depression, anxiety, and hopelessness and an improvement in quality of life.” They suggest that it is a potential alternative to usual care and could be used to address unmet demand for treatment. It may also be a cheaper alternative to usual care and be potentially more easily accessible to young people with depression in primary healthcare settings.
Associate Professor Sally Merry, Department of Psychological Medicine, University of Auckland, New Zealand