That's [not] so gay: Computerised therapy for sexual minority youth with depression A case study of sexual minority youth in New Zealand Dr Mathijs Lucassen Lecturer, Faculty of Wellbeing, Education, & Language Studies, The Open University & Honorary Research Fellow in Psychological Medicine, University of Auckland

Youth mental health in NZ Highest rate of completed suicides in the developed world (for those aged 15–19 years); In a nationally representative survey of 8,500 secondary school students (in 2012),12.8% had depressive symptoms; Most youth with mental health issues get no formal support. Fleming, T. M., Clark, T., Denny, S., Bullen, P., Crengle, S., Peiris-John, R., ... & Lucassen, M. (2014). Stability and change in the mental health of New Zealand secondary school students 2007–2012: Results from the national adolescent health surveys. Australian and New Zealand Journal of Psychiatry, 48(5), 472-480. 12.8% had depressive symptoms (95% CI 11.6%–13.9%) 4.5% had attempted suicide (95% CI 3.8%–5.2%)

Computerised CBT – why? Cognitive behavioural therapy (CBT) is effective. Computerized CBT (cCBT) has been recommended. Young people are ‘Digital Natives’. cCBT private and accessible – when most treatments are not. Stasiak, K., Fleming, T.M., Shepherd, M., Lucassen, M.F.G. & Merry, S.N. (2016). Computer-based and online therapy for depression and anxiety in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 26(3), 235-245. doi:10.1089/cap.2015.0029

SPARX = cCBT Smart, Positive, Active, Realistic, X-factor thoughts. Now nationally available in New Zealand to everyone – funded by the Prime Minister’s Youth Mental Health Project. Post-intervention, there was a mean reduction of 10.32 in SPARX and 7.59 in treatment as usual in raw scores on the children’s depression rating scale-revised. Remission was defined as a raw score on children’s depression rating scale-revised of less than 30.

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SPARX = cCBT Randomised controlled trial of SPARX vs. usual care (n=187) in adolescents aged 12-19 with depressive symptoms. Remission rates in the SPARX group (43.7%) vs. treatment as usual group (26.4%) p=0.030. SPARX was not inferior to treatment as usual. Merry, S. N., Stasiak, K., Shepherd, M., Frampton, C., Fleming, T., & Lucassen, M. (2012). A randomised controlled non-inferiority trial of the effectiveness of SPARX, a computerised self-help intervention for adolescents seeking help for depression. British Medical Journal, 344(7857), e2598. Post-intervention, there was a mean reduction of 10.32 in SPARX and 7.59 in treatment as usual in raw scores on the children’s depression rating scale-revised. Remission was defined as a raw score on children’s depression rating scale-revised of less than 30.

Why cCBT with sexual minority youth?

Youth’2000 Across survey waves (2001, 2007 & 2012) 6% sexual minority youth (i.e. same/both-sex attracted or not sure). Sexual minority youth more likely to have depression (in 2012 OR = 3.73). Sexual minority youth ↑ difficulties getting help for emotional worries (p<.0001). Lucassen, M. F., Clark, T. C., Denny, S. J., Fleming, T. M., Rossen, F. V., Sheridan, J., ... & Robinson, E. M. (2015). What has changed from 2001 to 2012 for sexual minority youth in New Zealand? Journal of Paediatrics and Child Health, 51(4), 410-418. Lucassen, M.F.G., Merry, S.N., Robinson, E.M., Denny, S., Clark, T., Ameratunga, S., ... & Rossen, F.V. (2011). Sexual attraction, depression, self-harm, suicidality and help-seeking behaviour in New Zealand secondary school students. Australian and New Zealand Journal of Psychiatry, 45(5), 376-383. Nationally representative surveys of high school students. Hard to access ‘culturally appropriate’ help…

Sexual minority youth & SPARX… Focus groups conducted with sexual minority youth trying out prototypes of SPARX. We made changes based on feedback from participants and created Rainbow SPARX. Lucassen, M.F.G., Hatcher, S., Stasiak, K., Fleming, T., Shepherd, M., & Merry, S.N. (2013). The views of lesbian, gay and bisexual youth regarding computerised self-help for depression: An exploratory study. Advances in Mental Health, 12(1), 22-33.

Is Rainbow SPARX acceptable, feasible to deliver and a promising intervention?

Rainbow SPARX Study carried out in Auckland, New Zealand. Lucassen, M.F.G., Merry, S.N., Hatcher, S., & Frampton, C.M. (2015). Rainbow SPARX: A novel approach to addressing depression in sexual minority youth. Cognitive and Behavioral Practice, 22(2), 203-216.

Rainbow SPARX Find SPARX Defeat Gnats Acceptability: 90.5% (n=19) completed ≥4 levels (17 completed all levels), 80% (n=16) would recommend it to friends, 85% (n=17) thought it would appeal to other youth. Feasibility: 21 participants recruited over 14 months (after extensive advertising). Preliminary efficacy data: Depressive symptoms  significantly from pre- to post-intervention (p<0.0001) with a large pre to post effect size (d=1.01) & this positive change was maintained at follow-up. Find SPARX Defeat Gnats

Rainbow SPARX Post Rainbow SPARX interviews conducted with 25 participants (i.e. all open trial participants, plus those without depressive symptoms ‘trying it out’). Consensus that Rainbow SPARX helped them feel better, but that it was best suited to younger adolescents (13 to 17 years old), suggestions for improving the program were made. Lucassen, M.F.G., Hatcher, S., Fleming, T.M., Stasiak, K., Shepherd, M.J., & Merry, S.N. (2015). A qualitative study of sexual minority young people’s experiences of computerised therapy for depression. Australasian Psychiatry, 23(3), 268-273.

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