title: A pragmatic randomized controlled trial of computerized CBT (SPARX) for symptoms of depression among adolescents excluded from mainstream education.
abstract: BACKGROUND
  Adolescents excluded from mainstream education have high mental health needs. The use of computerized Cognitive Behavioural Therapy (cCBT) has not been investigated with this group.
  
  
  OBJECTIVE
  To test the efficacy of the SPARX cCBT programme for symptoms of depression among adolescents in programmes for students excluded or alienated from mainstream education.
  
  
  METHODS
  Adolescents (32; 34% Maori, 38% Pacific Island, 56% male) aged 13-16 with Child Depression Rating Scale Revised (CDRS-R) scores indicating possible through to almost certain depressive disorder were randomized to SPARX to be completed over the following 5 weeks (n = 20) or to waitlist control (n = 12). Assessments were at baseline, 5 weeks and 10 weeks. Those in the wait condition were invited to complete SPARX after the 5 week assessment.
  
  
  RESULTS
  Most participants (n = 26, 81%) completed at least 4 levels of SPARX and 22 (69%) completed all 7 levels. Among the 30 (94%) participants who began treatment as randomized and provided 5-week data, significant differences were found between cCBT and wait groups on the CDRS-R (baseline to 5-week mean change -14.7 versus -1.1, p<.001), remission (78% vs. 36%, p = .047) and on the Reynolds Adolescent Depression Scale (-4.6 vs. +3.2 p = .05) but not on other self-rating psychological functioning scales. In intent-to-treat analyses CDRS-R changes and remission remained significant. Gains were maintained at 10-week follow-up.
  
  
  CONCLUSIONS
  SPARX appears to be a promising treatment for students with symptoms of depression who are in alternative schooling programmes for those excluded from mainstream education.
authors.affiliation: The University of Auckland, Department of Psychological Medicine, New Zealand. t.fleming@auckland.ac.nz
authors.forename: Theresa
authors.initials: T
authors.lastname: Fleming
authors.forename: Robyn
authors.initials: R
authors.lastname: Dixon
authors.forename: Christopher
authors.initials: C
authors.lastname: Frampton
authors.forename: Sally
authors.initials: S
authors.lastname: Merry
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D009520:New Zealand; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D012073:Remedial Teaching; D012931:Social Environment; D013332:Student Dropouts / Q000523:psychology*; D013813:Therapy, Computer-Assisted / Q000379:methods*