Background. The COVID-19 pandemic has caused families nationwide extreme financial hardship, social isolation, and distress. These compounding stressors collectively increase risk for adolescent depression-already the leading cause of disability in youth. However, even before the pandemic, < 50% of youth with depression accessed care, and youth do not uniformly benefit from existing treatments. It is thus critical to identify effective, rapidly-scalable strategies to reduce youth depression, during and beyond the COVID-19 pandemic.
Method. This randomized-controlled trial tested online single-session interventions (SSIs) designed to improved proximal targets (hopelessness, perceived agency) and 3-month depression, anxiety, and COVID-19-related trauma during the COVID-19 pandemic in adolescents with elevated depression symptoms (N=2,452, ages 13-16). Youth living across the United States recruited via social media were randomized to 1 of 3 self-guided SSIs: a behavioral activation SSI (BA-SSI), an SSI teaching growth mindset-the belief that personal traits are malleable (GM-SSI), or a supportive control. We tested each SSI's effects on post-SSI (hopelessness, agency) and 3-month outcomes (depression, generalized anxiety, COVID-related trauma).
Results. Compared to the control, both active SSIs reduced 3-month depressive symptoms (BA: d=.18, p < .001; GM: d=.18, p < .001), reduced post-intervention hopelessness (BA: d=.26, p < .001; GM: d=.30, p < .001) and increased post-intervention perceived agency (BA: d=.36, p < .001; GM: d=0.18, p < .001). The GM-SSI, but not the BA-SSI, reduced 3-month generalized anxiety symptoms (d=.10, p=0.03) and COVID-related trauma (d=.10, p=0.03) versus the control. The BA-SSI outperformed the GM-SSI in strengthening agency (d=.16, p=.001); the GM-SSI outperformed the BA-SSI in reducing generalized anxiety (d=.10, p=.04).
Conclusions. Results confirm the effectiveness of two free-of-charge, online SSIs for adolescents experiencing depression, even when delivered in the high-stress context of the COVID-19 pandemic.
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