Maria Lalouni

Research idea and purposeIn Sweden, there is a lack of evidence-based methods to reduce and prevent young children´s emotional problems, such as worry and anxiety. In the project, researchers collaborate with clinics and parents to jointly adapt cognitive behavioral therapy to the online intervention Tiny Heroes. The aim of the project is to develop Tiny Heroes and to assess its preliminary effectiveness.Research questions: ·       What components and modes of delivery are perceived as helpful by clinicians and parents?·       What support or change in clinical routines are needed to implement Tiny Heroes within first-line mental healthcare?·       Is Tiny Heroes preliminary effective in reducing children’s anxiety problems compared to treatment as usual?The next step after the planning project will be to apply for funding to conduct a randomized controlled trial.Workplan, methods and project realisationInternationally, there are a number of treatments with parent-based cognitive behavioral therapy, which have shown good effects for children with anxiety problems. Based on these, Tiny Heroes will be co-developed and fitted into first-line mental healthcare for young children, to the so-called MALINA clinics within Region Stockholm.In the project, a structured scientific method will be used to adapt parent-based cognitive behavioral therapy to MALINA – the clinics for first-line mental healthcare for young children 0-5 years in Region Stockholm. After this development phase, Tiny Heroes will be preliminary evaluated in a pilot study. Societal relevance and utilisationAnxiety problems have increased among children and young people in recent years in Sweden. Parent-based cognitive behavioral therapy is recommended to help young children with anxiety problems and to prevent future difficulties, but access to cognitive behavioral therapy is very limited for young children and their parents. One way to increase access to cognitive behavioral therapy is to deliver it via the internet. It enables the intervention to be scaled up, and parents can participate without taking time off from work. Other advantages are that internet interventions can be easily translated into different languages and that fidelity of the intervention is ensured (patients get the exact intervention that has been evaluated).

Research questionsPrimary: Does physical exercise have an effect on depression in adolescents?Secondary: Is there a correlation between changes in the degree of depression, in fitness and in strength towards biomarkers for neuroinflammation and neuroprotection? What is the cost-effectiveness compared with regular care? How are young people´s lifestyles affected by and how to increase adherence to exercise?Data and MethodMaterial: 122 adolescents with mild to moderate depression in CAMHS specialist care in Halmstad, Kungsbacka, Stockholm and Malmö who participated in at least three sessions and still depressed.Methods: Randomised multicenter study with active control group.Inclusion after psychiatric interview (K-SADS-PL) with psychiatrist. Control group with group leisure activity where the positive effect of social activation is controlled for. Measurement at baseline, after intervention at 3 months and at 6 months (RCT) and after one year (open phase) of investigator assessed depressive symptoms and function via interview CDRS-R and C-GAS, fitness via submaximal VO2 max test, three tests on muscle strength, nine biomarkers for neuroprotection and inflammation, questionnaire for cost assessment to parents and for quality of life to adolescents and qualitative interviews with both adolescents, parents and group leaders. Self-report of symptoms every two weeks during the intervention and every month thereafter.ImplementationGroup activity for 12 weeks with 60 minutes x3 per week of either physical exercise or calm leisure activity in a group. Training group with the same structure has been used for several years. Leisure group has been tested in a pilot study during 2021. Data collection via surveys is web-based. Interviews for depression and qualitatively takes place via video link to minimize the number of assessors and simplify for participants. A centre has experience in methods, weekly video link meetings with local monitors are planned for support in the implementation. Reliability in the primary outcome measure was good when co-estimating prior to the pilot study.RelevancePhysical exercise for depression in adolescents is promising but the quality of evidence is inadequate due to method shortcomings. Thus, National guidelines do not recommend physical exercise for depression. This RCT addresses the shortcomings in today´s knowledge base and can answer the question of whether group training should be included in care for young people with depression.