Purpose: The purpose of this efficacy replication study is to test whether Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a Tier 2 depression prevention program, is effective when delivered through telehealth in high schools. In prior school-based studies, IPT-AST improved depression and anxiety symptoms, rates of depression diagnoses, overall functioning, and school-related outcomes for adolescents with depressive symptoms.

Project Activities: The research team will randomly assign adolescents with elevated depressive symptoms to IPT-AST delivered through telehealth or services-as-usual (SAU). The research team will collect data from adolescents, parents, teachers, and school records to determine whether telehealth-delivered IPT-AST improves social, emotional, and school outcomes for depressed youth. They will also explore factors that mediate or moderate intervention impact. Through an implementation study, the research team will determine the acceptability, feasibility, fidelity, and sustainability of school-based telehealth delivery of IPT-AST. They will also calculate the cost and cost-effectiveness of the intervention.

Pre-registration Site: The research team registered this study on ClinicalTrials.gov (NCT04109716).

Products: Products include information about the efficacy of telehealth-delivered IPT-AST in high school for 9th and 10th grade students with symptoms of depression. Other products include information about costs and cost-effectiveness of telehealth-delivered IPT-AST. The research team will also produce peer-reviewed publications and a final dataset.

Structured Abstract

Setting: This study will take place in 12 high schools in Pennsylvania.

Sample: Participants will include about 240 racially and ethnically diverse 9th and 10th grade students with elevated symptoms of depression. Parents, teachers, counselors, school-support staff, and administrators will also participate in various aspects of the research.

Intervention: Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) is an evidence-based indicated depression prevention program that teaches communication and interpersonal problem-solving strategies to decrease conflict, increase support, and improve social functioning for adolescents with elevated depression. The intervention consists of eight group sessions, two individual pre-group sessions, one mid-group session that counselors invite parents to attend, and up to six individual booster sessions.

Research Design and Methods: Researchers are randomly assigning adolescents with elevated depressive symptoms to IPT-AST or services-as-usual (SAU). IPT-AST will be delivered through telehealth by research staff (alone or in collaboration with school support staff) and SAU will be delivered by counselors or other student support staff in schools. The research team will collect data from adolescents, parents, teachers, and school records to evaluate between-group differences on social, emotional, and school outcomes and to examine moderators and mediators of intervention effects. They will also conduct an implementation study to determine acceptability, feasibility, fidelity, and sustainability of school-based telehealth delivery of IPT-AST.

Control Condition: Students randomly assigned to the control condition will participate in SAU, which may include brief supportive counseling (in person or through telehealth) and/or referral for services.

Key Measures: The research team will assess social processes (interpersonal conflict, social functioning), emotional outcomes (depression and anxiety symptoms, depression diagnoses), and school outcomes (school engagement, grades) using standardized measures for adolescents, parents, and teachers and school records. Researchers will collect data on services received in IPT-AST and SAU, techniques utilized in both conditions, and feasibility, acceptability, fidelity, sustainability, and costs of IPT-AST using session logs, time diaries, standardized measures, fidelity checklists, and qualitative interviews.

Data Analytic Strategy: The research team will analyze these data using hierarchical linear models (HLM) and hierarchical generalized linear models (HGLM) to assess the effects of IPT-AST relative to SAU on proximal and distal outcomes and to explore hypothesized moderators. They will test mediation using causal mediation approaches. They will assess the acceptability, feasibility, fidelity, and sustainability of IPT-AST using mixed methods.

Cost and Cost-Effectiveness Analysis: The research team will assess overall costs and cost-effectiveness of the two study conditions from the perspective of the payer (education and health care sectors) using the resource costing method. Using the estimated mean cost and mean effect per adolescent by intervention group, they will construct an incremental cost-effectiveness ratio (ICER) for each significant outcome. They will generate a joint distribution of incremental mean costs and effects for the two intervention arms using non-parametric bootstrapping procedures. They will generate cost-effectiveness acceptability curves by plotting these probabilities for a range of ceiling ratios. Finally, they will explore cost-offset associated with IPT-AST with the aim of exploring financial benefits that might accrue through potential reductions in healthcare service use resulting from improved outcomes.