![]() ![]() This low accessibility stems from the formats of predominant treatments, which span many weeks and are intended for delivery in brick-and-mortar clinics by highly trained clinicians, creating major dissemination barriers 13. Large trials of brief interventions may also reveal solutions to the low accessibility of many depression interventions. Large-scale trials can rigorously and definitively gauge the promise of treatments that are designed for brevity, containing just one or two treatment elements rather than ten or more separate modules. This heterogeneity has spurred the creation of interventions that target wide-ranging difficulties, some of which may be unrelated to an individual’s needs-suggesting the utility of highly focused, targeted interventions rather than those characterized by extreme comprehensiveness (for example, cognitive behavioural therapy) 11, 12. Diagnostic criteria for depression place youths with five of nine diverse symptoms (such as activity withdrawal, fatigue and hopelessness) into a single category including >1,400 possible symptom combinations 9. The difficulties underlying limited treatment potency are thought to reflect depression’s heterogeneity 9, 10. Well-powered trials of brief, focused and rapidly scalable interventions may overcome long-standing challenges to reducing adolescent depression-namely, the challenges of limited potency of existing treatments and of low accessibility in predominant modes of care. Accordingly, in a nationwide randomized controlled trial, we tested whether two self-guided, online, single-session interventions (SSIs) for adolescent depression-one teaching a growth mindset of personality (the belief that personal traits and symptoms can change) and another teaching behavioural activation (the practice of managing one’s mood via engagement in valued, enjoyable activities)-could reduce hopelessness, strengthen perceived agency and mitigate symptoms of depression, anxiety and COVID-19-related trauma in high-symptom youth, versus a supportive control. It is critical to identify effective, scalable strategies to reduce adolescent depression, both during and beyond COVID-19. A generation of youth exposed to unprecedented psychosocial adversity is thus poised to fall through the cracks of the mental health-care system. Newfound financial strain may further preclude families’ capacity to afford treatment for their children. Even before the pandemic, fewer than 50% of adolescents with depression accessed services 5, 6 among those who did, 40–65% have failed to respond 7, 8. Together, these stressors might increase risk for adolescent depression-already the world’s leading cause of disability in young people 2, 3, 4. School closures affecting >50 million students led to isolation and the disruption of educational and social–emotional supports simultaneously, families grappled with collective trauma and economic recession 1. In the early months of 2020, the COVID-19 pandemic swiftly and profoundly transformed the lives of youths nationwide. These results confirm the utility of free-of-charge, online SSIs for high-symptom adolescents, even in the high-stress COVID-19 context. Several differences between active SSIs emerged. Compared with the control, both active SSIs reduced three-month depressive symptoms (Cohen’s d = 0.18), decreased post-intervention and three-month hopelessness ( d = 0.16–0.28), increased post-intervention agency ( d = 0.15–0.31) and reduced three-month restrictive eating ( d = 0.12–17). We tested each SSI’s effects on post-intervention outcomes (hopelessness and agency) and three-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-19-related trauma and restrictive eating). Adolescents from all 50 US states, recruited via social media, were randomized to one of three SSIs: a behavioural activation SSI, an SSI teaching that traits are malleable and a supportive control. ![]() Accordingly, this randomized controlled trial (: NCT04634903) tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression symptoms ( N = 2,452, ages 13–16). Even pre-pandemic, <50% of youth with depression accessed care, highlighting needs for accessible interventions. The COVID-19 pandemic has potentially increased the risk for adolescent depression.
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