‘World-first study’ future proofing Australian youth against mental illness

Australian students are participating in Australia’s largest-ever study of the effectiveness of mental health apps in preventing anxiety and depression in youth.

Backed by the Black Dog Institute, the “world-first study” called Future Proof will be trialled in 400 schools and include 20,000 Year 8 students. The students’ mental health information will be monitored for five years.

Led by chief investigator of the project, Dr Aliza Werner-Seidler, the study will explore whether cognitive behavioural therapy (CBT) apps are effective in alleviating symptoms of depression, anxiety, eating disorders and suicide risk. At the same time the study will also examine the apps’ impact on sleep, academic performance, physical wellbeing and drug and alcohol use.

Along with the above observations, researchers will also be collecting data from smartphones including GPS, sleep patterns and activity levels. These will be linked to the information regarding a student’s mental health and hopefully help to develop “reliable indicators for the onset of depression and anxiety symptoms in young people”.

“Taken together, these two threads will give researchers unparalleled insight into how behaviour changes are linked to fluctuations in youth mental health,” the researchers say.

Wave 1 of the program has commenced, and 46 schools have already signed up. The program’s researchers are urging all NSW schools to sign up for the study ahead of Term 2, 2020, which can be done by completing an online EOI form.

The main reason behind the study is that 50 per cent of all mental health problems emerge during adolescence, The Black Dog Institute states, and in many cases can have lifelong consequences. The institute therefore believes that “prevention is better than cure”.

The Institute also contends they can prevent depression in 22 per cent of young people at risk as long as these preventions are “easily and universally” available. This, the researchers argue, is where smartphone technology can assist.

“The study aims to discover how we can use smartphones to deliver preventive interventions on a large scale. Comprehensive, technology-assisted data collection and analysis will also help to determine what triggers the development of mental health symptoms,” the researchers state.

Education Review spoke to Werner-Seidler about the program, its scope and the evidence base to support the study.

ER: How many researchers are involved in the program and how were they selected?

There are 20 key researchers involved in the program, and about 10 additional researchers who will be collaborating on aspects of the study, as well as 10 operational staff members and 25 volunteer research assistants all working together to deliver this large trial. The 20 core researchers were selected for their expertise in youth mental health, adolescent development, cognitive science, digital interventions and technology. The researchers come from seven different universities across Australia and have diverse backgrounds – as well as being academics, there are several physicians and psychologists on the team, a statistician, a health economist and a number of implementation scientists. A study of this magnitude can only be undertaken with the right experience and training and brings together Australia’s top researchers with a number of early and mid-career academics, ensuring that the knowledge and expertise of the team can be widely shared and capacity built among the junior researchers.

Is there much evidence out there that such CBT apps can alleviate a host of mental health problems among youth, or is that the aim of the study?

There is strong evidence that digitally delivered CBT programs (via app, tablet and computer) can effectively prevent and treat depression and anxiety in young people. However, the research studies that have been conducted so far have primarily tested internet-delivered CBT interventions and done so on a relatively small scale, and often under scientifically controlled conditions. While these studies are incredibly important in establishing that digital interventions really can make a difference to young people’s mental health, they have not examined whether this is still the case at a large scale under real world conditions.

The aim of this study is to investigate whether depression and anxiety can be prevented at scale using CBT apps, when delivered in a real world setting which in this case, is the school environment. If we are to develop ways to get effective programs out to as many young people as we can, schools are an ideal context in which to deliver them. Vaccinations for physical diseases are routinely delivered at school, so why not for mental health?

What kind of preparation went into the development of this research program? 

A huge amount of preparation has gone into this project. A small 10-school study was conducted in 2015 to assess the feasibility of doing this kind of study. Once we had the results from that study, which showed it could be done and the intervention worked on a small scale, the study investigators were assembled over two years and the study idea was developed, led by Professor Helen Christensen, director and chief scientist at the Black Dog Institute. The researchers then met with various stakeholders, including the NSW Department of Education to discuss ideas and plans for this project. The design of the study was finalised with input from:

• Lived Experience Advisory Panel members at the Black Dog Institute
• Input from young people via a headspace youth advisory panel and interested young people who tested the apps and questionnaires for us
• Input from parents and school counsellors via a consultation period and several group discussions
• Input from the NSW Department of Education
• Use of apps that had previously been co-designed and tested with young people’s input
• Consultation with several ethics committees about undertaking this project
• Several full-day workshops with all investigators, drawing on their expertise to select appropriate measurement methods and implementation strategies

Is the Black Dog Institute funding the project?

The Black Dog Institute is providing some funding for the project. However, the project is predominantly being funded by Australia’s largest medical research funding body, the National Health and Medical Research Council (NHMRC). A $2.1m grant was awarded to the 20 key researchers who applied for the grant in 2017, led by Professor Helen Christensen.

Click here for more information on the program and to register your school.