Perry Yael, Werner-Seidler Aliza, Calear Alison, Mackinnon Andrew, King Catherine, Scott Jan, Merry Sally, Fleming Theresa, Stasiak Karolina, Christensen Helen, Batterham Philip J
Black Dog Institute, University of New South Wales, Randwick, Australia.
National Institute for Mental Health Research, The Australian National University, Canberra, Australia.
J Med Internet Res. 2017 Nov 2;19(11):e369. doi: 10.2196/jmir.8241.
Depression often emerges for the first time during adolescence. There is accumulating evidence that universal depression prevention programs may have the capacity to reduce the impact of depression when delivered in the school environment.
This trial investigated the effectiveness of SPARX-R, a gamified online cognitive behavior therapy intervention for the prevention of depression relative to an attention-matched control intervention delivered to students prior to facing a significant stressor-final secondary school exams. It was hypothesized that delivering a prevention intervention in advance of a stressor would reduce depressive symptoms relative to the control group.
A cluster randomized controlled trial was conducted in 10 government schools in Sydney, Australia. Participants were 540 final year secondary students (mean 16.7 [SD 0.51] years), and clusters at the school level were randomly allocated to SPARX-R or the control intervention. Interventions were delivered weekly in 7 modules, each taking approximately 20 to 30 minutes to complete. The primary outcome was symptoms of depression as measured by the Major Depression Inventory. Intention-to-treat analyses were performed.
Compared to controls, participants in the SPARX-R condition (n=242) showed significantly reduced depression symptoms relative to the control (n=298) at post-intervention (Cohen d=0.29) and 6 months post-baseline (d=0.21) but not at 18 months post-baseline (d=0.33).
This is the first trial to demonstrate a preventive effect on depressive symptoms prior to a significant and universal stressor in adolescents. It demonstrates that an online intervention delivered in advance of a stressful experience can reduce the impact of such an event on the potential development or exacerbation of depression.
Australian New Zealand Clinical Trials Registry ACTRN12614000316606; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365986 (Archived by WebCite at http://www.webcitation.org/ 6u7ou1aI9).
抑郁症通常在青少年时期首次出现。越来越多的证据表明，在学校环境中开展的普遍性抑郁症预防项目可能有能力减轻抑郁症的影响。
本试验调查了SPARX-R的有效性，SPARX-R是一种游戏化的在线认知行为疗法干预措施，用于预防抑郁症，与在学生面临重大压力源——中学毕业考试之前提供的注意力匹配对照干预措施相比。研究假设是，在压力源出现之前提供预防干预措施相对于对照组将减少抑郁症状。
在澳大利亚悉尼的10所政府学校进行了一项整群随机对照试验。参与者为540名中学毕业班学生（平均年龄16.7岁[标准差0.51]），学校层面的整群被随机分配到SPARX-R或对照干预组。干预措施每周以7个模块的形式进行，每个模块大约需要20至30分钟完成。主要结局是通过《重度抑郁量表》测量的抑郁症状。进行了意向性分析。
与对照组相比，SPARX-R组（n = 242）的参与者在干预后（科恩d = 0.29）和基线后6个月（d = 0.21）相对于对照组（n = 298）抑郁症状显著减轻，但在基线后18个月（d = 0.33）未减轻。
这是第一项证明在青少年面临重大且普遍的压力源之前对抑郁症状有预防作用的试验。它表明在压力经历之前提供的在线干预可以减少此类事件对抑郁症潜在发展或加重的影响。
澳大利亚新西兰临床试验注册中心ACTRN12614000316606；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365986（由WebCite存档于http://www.webcitation.org/ 6u7ou1aI9）。
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