Closing the gap between needs and access: improving adolescents’ access to early help for depression symptoms

Background: Many adolescents, particularly those who are stigmatised and marginalised, feel unable to ask for help for depression symptoms and must wait to access it. My research programme aims to improve early help for adolescent depression symptoms by (1) increasing the reach and relevance of public health information and (2) evaluating one-off anonymous internet-based self-help interventions, single session interventions (SSIs), to extend existing provision. Objectives: To close the needs-access gap for adolescent depression symptoms, we need to establish: how best to make public health information about early help, including SSIs, available in ways that maximise the reach, credibility, and relevance with diverse adolescents. where within existing 'getting advice and signposting' early help provision, messaging about early help, including SSIs, could be embedded. whether existing American SSIs for reducing depressive symptoms in adolescents, are effective when adapted for the UK context. Methods: I propose three work packages: Discover (years 1-2): I will use mapping review methods to analyse existing information provision strategies ('messaging') targeting adolescent mental health in both research studies and by UK NHS and voluntary sector providers. I will use participatory research workshops and individual semi-structured interviews to collect qualitative and quantitative data from a diverse, inclusive sample of adolescents, to understand how adolescents experience early help messaging and the offer of online SSIs and how this could be optimised. Based on implementation science principles, I will work with primary care and educational professionals, using online surveys, to collect descriptive quantitative and qualitative data about what they provide as getting advice and signposting for adolescent depression, and how this could be improved. Co-Design & Co-Build (years 2-3): I will work with relevant stakeholders, my YPAG and expert advisory group to address the following uncertainties - Negotiate Intellectual Property arrangements for using USA SSIs in the UK. Adapt two active SSIs and a third attention control SSI from the USA for the UK context, including iterative piloting to ensure safety (n ~ 10). Design a recruitment strategy for online SSIs for adolescents with elevated depression symptoms. Build a website on which to host the SSIs with in-built analytics tracking capability. Develop an ethically acceptable process enabling 13-15-year-olds to demonstrate Gillick competence, waiving the need for parental consent. Test (years 3-5): Recruit 470 adolescents to a 3-arm effectiveness RCT with embedded process evaluation to determine whether there are 1-month and 6-month follow-up reductions in depressive symptoms from completing one of the two active SSIs compared to a supportive control SSI. Anticipated impact: Through a co-produced dissemination plan, I will share my findings widely with adolescents (infographics, zines), health/educational professionals (dissemination event, podcasts, blogs), policy makers (webinars, blogs) and fellow academics (conferences, publications). The outputs will inform improvements in the credibility, relevance and reach of public health information about early help for adolescent depression, and how best to implement effective online SSIs as an openly accessible, scalable and low-cost addition to existing commissioned child and adolescent mental health provision. This will close the needs-access gap, reducing the burden of adolescent depression.