An online parenting intervention to prevent affective disorders in high-risk adolescents: The PIPA trial

Depression is a leading cause of disease burden in young people in the UK and globally. The incidence of depression rises sharply during adolescence, making early adolescence a particularly opportune time to target preventive efforts. Moreover, there is evidence that preventative strategies can be effective. Whilst many preventative approaches have targeted young people themselves and demonstrated effects up to two years post-intervention, there is evidence that preventative interventions that target parents are effective in the longer term (up to 11 years)(1). Recent policy documents such as the Five Year Forward View for Mental Health and Future in Mind have advocated for public mental health interventions for young people that include parents. Our collaborators in Australia have developed Partners in Parenting (PiP), an evidence-based personalised online parenting intervention, and demonstrated that it can improve depressive symptoms in their adolescent child with early internalising problems. We aim to adapt this well-developed and evidenced-based intervention to a UK setting. We then aim to test the acceptability and effectiveness of the intervention delivered to parents in improving depressive symptoms in their high-risk offspring, as well as other clinical and non-clinical outcomes in the adolescents, using a RCT design. We propose an initial adaptation phase, which will consist of focus group consultations with parents, teachers and adolescents to make adaptations of the PiP intervention for a UK setting and establish the feasibility and acceptability of the assessment battery. We plan to conduct an internal pilot with a priori stop-go progression criteria based on recruitment and intervention adherence and then a definitive RCT, recruiting 433 families from participating UK schools and direct from the community. We will screen pupils aged 11-15 years with the Strengths and Difficulties Questionnaire and those scoring highly will be invited to participate in the trial with their parents/caregivers. Parents will be randomly allocated to either the online modular PiP intervention or an online control programme which consists of a standardised package of educational materials about adolescent development and wellbeing. Each intervention is delivered over a 3-month period with assessments completed online by the parent and child at baseline, 6 months later, and 12 months post-intervention (15 months later) including parenting self-efficacy. The primary outcome will be adolescent depressive symptoms measured at 12 months post-intervention using the Short Mood and Feelings Questionnaire. There will be a number of secondary outcomes including anxiety, parenting behaviour, child wellbeing and resilience and parent and adolescent quality of life to measure QALYS and economic utility. To maintain programme adherence, and in line with the Australian protocol, parents will receive weekly check-in phone calls/texts during the intervention period. At the end of the trial, we will be able to demonstrate whether such a tailored online approach is effective and could be rolled out nationally. We will create an exploitation plan based on the results. We will disseminate the findings to national and international audiences including a national launch event with stakeholders from health, education and third sector organisations.