Adolescent Depression: Feasibility Trial of a Blended e-Therapy App in a Naturalistic Outpatient Setting (e-MICHI) (Preprint)

BACKGROUND Major Depressive Disorder (MDD) is a common diagnosis among adolescents. Cognitive-behavioral therapy (CBT) is recommended as the first line of treatment. Digital Health Interventions (DHIs), such as apps, could contribute to treatment. Advantages could be easy accessibility and availability, reduced time for face to face (f2f) therapy, and the ability to intensify therapy by incorporating it into the everyday lives of patients. Challenges such as low adherence rates are common in DHIs. Therefore, they need to undergo rigorous testing for feasibility and effectiveness. OBJECTIVE An evaluated, CBT-based f2f therapy program for depression in adolescents was transformed into an app called e-MICHI. This study examined its feasibility and efficacy for use in blended therapy in out-patient settings. METHODS Adolescents aged 12 to18 with MDD were recruited from two university hospitals. Participants were actively recruited based on defined eligibility criteria. The intervention combined 3-weekly f2f sessions with daily app engagement over a six-week period. Feasibility was measured using various variables, including adherence and engagement rates, satisfaction ratings, and transfer of techniques to everyday practice; efficacy was assessed using the Beck Depression Inventory-II (BDI-II) and the Children’s Depression Rating Scale-Revised (CDRS-R), among other measures. Data was analyzed using a repeated measures ANOVA. RESULTS e-MICHI was positively evaluated by both, participants and therapists. Participants demonstrated high adherence rates and reported consistent practice of the e-MICHI techniques. Use of the app was associated with a significant reduction of depressive symptoms (before app use vs. three-month follow-up, BDI-II: mean -7.09, P<.001; CDRS-R: mean -10.56, P<.001). CONCLUSIONS While acknowledging its limitations, the study confirms the feasibility of e-MICHI for treating adolescent depression in outpatient settings. CLINICALTRIAL DRKS (German Clinical Trial Register): DRKS00022420