Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
Nuffield Trust, 59 New Cavendish Street, London, W1G 7LP, UK.
Eur Child Adolesc Psychiatry. 2023 May;32(5):783-795. doi: 10.1007/s00787-021-01902-7. Epub 2021 Nov 16.
We have evaluated a novel early intervention for adolescent depression (age 16-18) in a feasibility randomised controlled trial. This nested process evaluation aimed to understand how this complex intervention worked. We sought to understand participants' views and experiences of receiving and interacting with the intervention to evaluate whether the underpinning theoretical basis of the intervention is justified and whether it contributes to valued outcomes for participants. Twelve participants were invited to take part in semi-structured interviews. Framework analysis was employed to identify important aspects of adolescents' experiences. The active ingredients identified by participants were consistent with and extended our understanding of the theoretical basis of the intervention. Four principle themes were identified: understanding how memory works and being able to remember memories in more detail; processing negative experiences and letting go; imagining positive future events; and understanding and being kinder to myself. The outcomes of the intervention were valued by participants. Six principle themes were identified: improving mood and well-being; reducing impact of negative memories; motivation and goal-directed behaviour; overcoming avoidance and rumination; relationships, communication and being open; and self-understanding and acceptance. A simplified logic model is also proposed to connect the intervention components, active ingredients, and valued outcomes. The findings provide an in-depth understanding of how participants interacted with the intervention and what they derived from it. For example, the findings establish processing negative experiences as a core intervention component, extend it to include letting go of these memories, and highlight that reducing the impact of negative memories is valued by participants. This richer understanding guides further intervention development and future implementation.
我们在一项可行性随机对照试验中评估了一种针对青少年抑郁症（16-18 岁）的新型早期干预措施。这项嵌套式过程评估旨在了解这种复杂干预措施是如何发挥作用的。我们试图了解参与者接受和参与干预的看法和经验，以评估干预措施的潜在理论基础是否合理，以及它是否有助于参与者获得有价值的结果。我们邀请了 12 名参与者参加半结构化访谈。采用框架分析法来确定青少年体验的重要方面。参与者确定的有效成分与我们对干预措施理论基础的理解一致，并对其进行了扩展。确定了四个主要主题：了解记忆的工作原理并能够更详细地记住记忆；处理负面体验并放手；想象积极的未来事件；以及理解和善待自己。参与者认为干预措施的结果具有价值。确定了六个主要主题：改善情绪和幸福感；减少负面记忆的影响；动机和目标导向行为；克服回避和沉思；关系、沟通和开放；以及自我理解和接受。还提出了一个简化的逻辑模型，以连接干预措施的组成部分、有效成分和有价值的结果。研究结果深入了解了参与者如何与干预措施互动以及他们从中获得了什么。例如，研究结果将处理负面体验确立为核心干预措施，将其扩展为包括放手这些记忆，并强调减轻负面记忆的影响是参与者所重视的。这种更深入的理解指导了进一步的干预措施的开发和未来的实施。
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