title: An Online Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Primary Outcomes From a Randomized Controlled Trial.
abstract: BACKGROUND
  Depression and problematic alcohol use represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this is associated with increased harm and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective; however, there remains a significant gap between those in need of treatment and those receiving it. The increased availability of eHealth programs presents a unique opportunity to treat these conditions.
  
  
  OBJECTIVE
  This study aimed to evaluate the feasibility and preliminary efficacy of an automated Web-based self-help intervention (DEAL Project) in treating co-occurring depressive symptoms and problematic alcohol use in young people.
  
  
  METHODS
  Young people (aged 18 to 25 years) with moderate depression symptoms and drinking at hazardous levels (recruited largely via social media) were randomly allocated to the DEAL Project (n=60) or a Web-based attention-control condition (HealthWatch; n=44). The trial consisted of a 4-week intervention phase with follow-up assessment at posttreatment and at 3 and 6 months postbaseline. The primary outcomes were change in depression severity according to the Patient Health Questionnaire-9 as well as quantity and frequency of alcohol use (TOT-AL).
  
  
  RESULTS
  The DEAL Project was associated with statistically significant improvement in depression symptom severity (d=0.71) and reductions in alcohol use quantity (d=0.99) and frequency (d=0.76) in the short term compared to the control group. At 6-month follow-up, the improvements in the intervention group were maintained; however, the differences between the intervention and control groups were no longer statistically significant, such that between-group effects were in the small to moderate range at 6 months (depression symptoms: d=0.39; alcohol quantity: d=-0.09; alcohol frequency: d=0.24).
  
  
  CONCLUSIONS
  Overall, the DEAL Project was associated with more rapid improvement in both depression symptoms and alcohol use outcomes in young people with these co-occurring conditions relative to an attention-control condition. However, long-term outcomes are less clear.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6fpsLEGOy).
authors.affiliation: National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, Kensington, Australia. m.deady@unsw.edu.au.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0002-5230-2401
authors.initials: M
authors.lastname: Deady
authors.forename: Katherine L
authors.identifier: http://orcid.org/0000-0002-9714-1832
authors.initials: KL
authors.lastname: Mills
authors.forename: Maree
authors.identifier: http://orcid.org/0000-0003-0450-1999
authors.initials: M
authors.lastname: Teesson
authors.forename: Frances
authors.identifier: http://orcid.org/0000-0002-4252-5572
authors.initials: F
authors.lastname: Kay-Lambkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000628:therapy*; D000437:Alcoholism / Q000150:complications / Q000628:therapy*; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000150:complications / Q000628:therapy*; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy*; D017831:Diagnosis, Dual (Psychiatry); D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D012720:Severity of Illness Index; D017216:Telemedicine / Q000379:methods; D013813:Therapy, Computer-Assisted / Q000379:methods*; D055815:Young Adult
keywords: Internet; alcohol use, alcohol abuse, problem drinking; comorbidity; depression; intervention online therapy, eHealth; young people at risk populations