title: Evaluation of a spirituality informed e-mental health tool as an intervention for major depressive disorder in adolescents and young adults - a randomized controlled pilot trial.
abstract: BACKGROUND
  Depression in adolescents and young adults is a major mental health condition that requires attention. Research suggests that approaches that include spiritual concepts and are delivered through an online platform are a potentially beneficial approach to treating/managing depression in this population. The purpose of this study was to evaluate the effectiveness of an 8-week online spirituality informed e-mental health intervention (the LEAP Project) on depression severity, and secondary outcomes of spiritual well-being and self-concept, in adolescents and young adults with major depressive disorder of mild to moderate severity.
  
  
  METHODS
  A parallel group, randomized, waitlist controlled, assessor-blinded clinical pilot trial was conducted in Calgary, Alberta, Canada. The sample of 62 participants with major depressive disorder (DSM-IV-TR) was defined by two age subgroups: adolescents (ages 13 to 18 years; n = 31) and young adults (ages 19 to 24 years; n = 31). Participants in each age subgroup were randomized into the study arm (intervention initiated upon enrolment) or the waitlist control arm (intervention initiated after an 8-week wait period). Comparisons were made between the study and waitlist control arms at week 8 (the point where study arm had completed the intervention and the waitlist control arm had not) and within each arm at four time points over 24-week follow-up period.
  
  
  RESULTS
  At baseline, there was no statistical difference between study and waitlist participants for both age subgroups for all three outcomes of interest. After the intervention, depression severity was significantly reduced; comparison across arms at week 8 and over time within each arm and both age subgroups. Spiritual well-being changes were not significant, with the exception of an improvement over time for the younger participants in the study arm (p = 0.01 at week 16 and p = 0.0305 at week 24). Self-concept improved significantly for younger participants immediately after the intervention (p = 0.045 comparison across arms at week 8; p = 0.0175 in the waitlist control arm) and over time in the study arm (p = 0.0025 at week 16). In the older participants, change was minimal, with the exception of a significant improvement in one of six factors (vulnerability) in study arm over time (p = 0.025 at week 24).
  
  
  CONCLUSIONS
  The results of the LEAP Project pilot trial suggest that it is an effective, online intervention for youth ages 13 to 24 with mild to moderate major depressive disorder with various life situations and in a limited way on spiritual well-being and self-concept.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00985686. Registered 24 September 2009.
authors.affiliation: Canadian Institute of Natural and Integrative Medicine (CINIM), Calgary, AB, Canada. b.rickhi@cinim.org.|Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. b.rickhi@cinim.org.
authors.forename: Badri
authors.initials: B
authors.lastname: Rickhi
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. akania@ucalgary.ca.
authors.forename: Ania
authors.initials: A
authors.lastname: Kania-Richmond
authors.affiliation: Tom Baker Cancer Center, Calgary, AB, Canada. Sabine.Moritz@albertahealthservices.ca.
authors.forename: Sabine
authors.initials: S
authors.lastname: Moritz
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. Jordan.Cohen@albertahealthservices.ca.|Mental health Urgent Services, Foothills Hospital, Calgary, AB, Canada. Jordan.Cohen@albertahealthservices.ca.|Child and Adolescent Addiction and Mental Health Programming NW Clinic, Calgary, AB, Canada. Jordan.Cohen@albertahealthservices.ca.
authors.forename: Jordan
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Canadian Institute of Natural and Integrative Medicine (CINIM), Calgary, AB, Canada. paccagnan@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Paccagnan
authors.affiliation: Canadian Institute of Natural and Integrative Medicine (CINIM), Calgary, AB, Canada. c.dennis@cinim.org.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Dennis
authors.affiliation: Alberta Health Services, Calgary, AB, Canada. liumf@yahoo.com.
authors.forename: Mingfu
authors.initials: M
authors.lastname: Liu
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. smalh067@gmail.com.
authors.forename: Sonya
authors.initials: S
authors.lastname: Malhotra
authors.affiliation: Canadian Institute of Natural and Integrative Medicine (CINIM), Calgary, AB, Canada. p.steele@cinim.org.
authors.forename: Patricia
authors.initials: P
authors.lastname: Steele
authors.affiliation: Canadian Institute of Natural and Integrative Medicine (CINIM), Calgary, AB, Canada. j.toews@cinim.org.|Department of Psychiatry, Faculty of Medicine, University of Calgary, Calgary, AB, Canada. j.toews@cinim.org.
authors.forename: John
authors.initials: J
authors.lastname: Toews
mesh_terms: D000293:Adolescent; D000328:Adult; D003865:Major Depressive Disorder / Q000523:psychology* / Q000628:therapy; D000068237:Distance Counseling; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008603:Mental Health; D011788:Quality of Life; D029181:Spirituality; D055815:Young Adult