Abstract
Background
Early adolescence is a stage of development associated with increasing prevalence of common mental health disorders like anxiety and depression, and a key opportunity for intervention for these disorders. Supporting parents is an important part of care for young people seen by Child Adolescent Mental Health Services (CAMHS), however current interventions for anxiety/depression focus on the individual. Tuning in to Teens (TINT) is an emotion-focused programme for parents of teenagers that aims to strengthen parents’ relationships with their children and support both parental and child emotional wellbeing, with positive outcomes for early adolescents in a community setting. This thesis investigated impacts of parent involvement in early-adolescence interventions for anxiety and depression and included a feasibility study for evaluating TINT in a clinical setting in Aotearoa New Zealand.
Methods
The thesis followed a mixed-methods approach. The first study was a systematic review (with meta-analysis) of parent involvement in interventions for early adolescent anxiety/depression. The second study developed a novel co-design approach to identify priority outcomes for young people (age 10-14) and parents at CAMHS. The third study was a feasibility Randomised Control Trial (RCT) to assess how a larger-scale trial could run in a clinical CAMHS setting. The feasibility RCT was a multi-site, individually randomised trial comparing TINT as an additional to usual care, with outcomes collected at baseline, following the 8-week intervention, and 16 weeks from baseline.
Results
Thirty-six studies were included in the systematic review. Meta-analyses (n=15 studies) showed no consistent difference between parent-involved versus child-focused interventions on symptom-based outcomes (SMD=0.02, 95% CI = 0.18, 0.23). There was some evidence for improved parenting/family related outcomes with parent-focused interventions, however, most studies did not include such outcomes.
The co-design study indicated misalignment with symptom-based outcome measures that dominate research, with relationship-based outcomes being prioritised for measures created with parents (increased connection with their child) and young people (wanting to be listened to more). Other identified priorities for care included a wish for greater knowledge, inclusion, and choice.
The feasibility RCT in CAMHS successfully recruited 34 participants over one quarter (68% retained at 16-week follow-up). Feedback about the programme was generally positive from families and clinicians, with high attendance rates in the intervention group (84%). Secondary outcomes on parent and child emotional functioning suggested potential for better outcomes with TINT (considered in context of this small-scale feasibility study).
Conclusion
This thesis identified important gaps in involving parents in early adolescent intervention for anxiety and depression, including lack of high-quality studies, limited interventions beyond CBT, and outcome measures focusing on symptom change (reinforced by young people and parents choosing relationship-based outcomes as most important measures of change). While the feasibility study met criteria for progression to a fuller trial, and TINT appears to be a promising addition to care in CAMHS, ongoing service resourcing challenges will impact feasibility of larger-scale research. It is important to continue exploring how interventions can be evaluated given gaps for this age group and the potential for improved outcomes to have far-reaching benefits for individuals, families, and communities.