The development and evaluation of an Internet-based treatment for co-occurring depression and hazardous alcohol use in young Australians (The DEAL Project)

image - The Deal Project Square
Date Commenced:
01/2012
Expected Date of Completion:
03/2016
Project Supporters:

National Health & Medical Research Council

Drug Type:
Project Members: 
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Conjoint Associate Professor
Ph 02 4985 4309
image - Maree Teesson Square
Professor
Ph EA Jasmin Bartlett: 02 9385 0167 / j.bartlett@unsw.edu.au
Dr Mark Deady
Post-Doc Res Fellow (UNSW)
image - Kath Mills Sq
Senior Res Fellow (NH&MRC)
Ph +612 9385 0253
Project Main Description: 

This project focuses on a common clinical problem that causes substantial functional, economic, and health impacts; comorbid depression and alcohol use. These conditions are under-treated and peak in young adulthood. This project involves the development and evaluation of an Internet-based treatment for co-occurring depression and hazardous alcohol use in young Australians (The DEAL Project). If found to be viable and effective, this project offers a low cost, wide reach, youth-appropriate treatment, which will have profound implications for service design and health policy. It relates to current Commonwealth initiatives in e-health and e-Psychology.

Project Collaborators: External: 

Professor Amanda Baker
University of Newcastle

Professor Kathleen Brady
Medical University of South Carolina

A/Professor Terry Lewin
University of Newcastle

Professor Bonnie Spring
Northwestern University

Louise Thornton
University of Newcastle

Rationale: 

Depression and alcohol misuse represent two of the major causes of disease burden in young people today. These conditions frequently co-occur and this co-occurrence is associated with increased risks 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, particularly in young people (16-25 years). The increased availability of Internet-based programs to complement health care presents a unique opportunity in the treatment of these conditions.

Aims: 

To develop and determine whether a brief, Internet-based, psychological intervention (the DEAL Project) can be effective in treating co-occurring moderate depression and problematic alcohol use in young people (aged 18 to 25 years).

This program can easily be translated into primary care, clinical, and real world settings for use by young people experiencing these conditions. Via this study, we aim to:

  1. Demonstrate that young people, aged 18-25 years, who are experiencing low mood and  hazardous alcohol use will engage with web-based treatments that target their multiple problems simultaneously; and
  2. Demonstrate that young people with these problems will benefit from web-based treatment targeting low mood and hazardous alcohol use simultaneously. 
Design and Method: 

The development of the program consisted of three phases.  After a review of current interventions for the target population, the first phase utilised, considered, and modified core concepts of an existing eHealth intervention—the Self Help for Alcohol/other drug use and Depression (SHADE) resource—for a youth population. This involved working with the SHADE CD-ROM package and original dataset to determine which elements of the program require preservation, abandonment, modification, and emphasis. Following this, the second phase of the development consolidated this structure, integrating additional elements to further tailor the intervention to young people. This involved measures to optimise program engagement, and delivery, along with vignette case study development. The final phase of development of the program (entitled the DEAL Project) explored the acceptability and feasibility of the program, and revision of the program based on feedback from a series of focus groups with young people and interviews with key experts. This stage culminated in program finalisation.

Evaluation of the program will take the form of a randomised controlled trial (RCT), comparing the DEAL Project with an attention-control condition (HealthWatch). The RCT consisted of a four-week intervention phase and a 24-week follow-up. It will be conducted entirely online and Australia-wide amongst young people aged 18 to 25 years. The primary outcomes will be change in depression symptoms and alcohol use at 5, 12, and 24 weeks post-baseline. Secondary outcomes include change in general functioning and quality of life, anxiety/stress symptomatology, and a number of other depression/alcohol related outcomes. 

Progress/Update: 

The development and evaluation have now been completed and the write up is currently underway.

Findings: 

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 control. At 6-month follow-up the improvements in the intervention group were maintained, however, the differences between intervention and control group 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).

Output: 

Papers:

Deady, M., Mills, K.L., Teesson, M., & Kay-Lambkin, F. (2016). An online intervention for co-occurring depression and problematic alcohol use in young people: Primary outcomes from a randomized controlled trial. Journal of Medical Internet Research, 18(3): e71. DOI: 10.2196/jmir.5178

Deady, M., Teesson, M., & Kay-Lambkin, F. (2014). Treatments for co-occurring depression and substance use in young people: A systematic review. Current Drug Abuse Reviews, 7(1):e1, doi: 10.2174/1874473707666 141015220608.

Deady, M., Teesson, M., & Kay-Lambkin, F. (2014). Developing an integrated, Internet-based self-help program for young people with depression and alcohol use problems. Internet Interventions, 1(3), 118–131.

Deady, M., Teesson, M., & Kay-Lambkin, F. & Mills, K.L. (2014). Evaluating a brief, Internet-based intervention for co-occurring depression and problematic alcohol use in young people: Protocol for a randomised controlled trial. JMIR Research Protocols, 3(1):e6, doi: 10.2196/resprot.3192.

Presentations:

Deady, M. Using eHealth to treat co-occurring mental health and substance use disorders in youth. NHMRC Centre of Research Excellence in Mental Health and Substance Use Webinar. https://comorbidity.edu.au/. September, 2015.

Deady, M., Teesson, M., Kay-Lambkin, F., & Mills, K. The DEAL Project: Preliminary findings. International Society for Research on Internet Interventions Conference. Valencia, Spain, October, 2014.

Deady, M., Teesson, M., Kay-Lambkin, F., & Mills, K. The DEAL Project: An online intervention for co-occurring depression and alcohol use in young people. UNSW Brain Sciences Colloquia 2014.  Sydney, July, 2014. 

Deady, M., Kay-Lambkin, F., & Teesson, M. Development of the DEAL Project: A Brief, Online Intervention for Depression and Alcohol Misuse Comorbidity in Young People. International Society for Research on Internet Interventions Conference. Chicago, USA, May, 2013.

Deady, M., Teesson, M., & Kay-Lambkin, F. Development of the DEAL Project: A Brief, Online Intervention for Depression and Alcohol Misuse Comorbidity in Young People. Australasian Society for Psychiatric Research 2012 Conference. Fremantle, December, 2012.

Posters:

Deady, M., Teesson, M., Kay-Lambkin, F., & Mills, K. The DEAL Project: A Brief, Online Intervention for Depression and Problematic Alcohol Use in Young People: Primary Outcomes [poster]. NDARC Annual Symposium. Sydney, Australia. September, 2015.

Deady, M., Teesson, M., Kay-Lambkin, F., & Mills, K. The DEAL Project: A Brief, Online Intervention for Depression and Problematic Alcohol Use in Young People: Primary Outcomes [eposter]. CREMS colloquium. Canberra, Australia. September, 2015.

Deady, M. , Kay-Lambkin, F. and Teesson, M. (2013). Development of the DEAL project: A brief online intervention for depression and problematic alcohol use in young people. NDARC Annual Symposium, Sydney, 4 September. (See 'Resources' below). 

Benefits: 

This project brings together world leaders in the treatment of depression and alcohol misuse, including the only researchers to have published on this important issue in the area of web-based interventions. The proposed project focuses on a common clinical problem that causes substantial functional, economic and health impacts; comorbid depression and hazardous alcohol use. These conditions are currently under-treated, contribute significantly to the global disease burden and are at their peak in young people. Offering treatments of low cost and with wide reach to affected people will address current inequities of treatment access for these problems, and provide a youth appropriate modality of treatment delivery. These results will have profound implications for service design and health policy, and speak to important questions about the nature of treatment effects in general. In particular, the study keys into current Commonwealth initiatives in e-health and e-Psychology, and addresses important questions with both applied and scientific significance.

Drug Type: 
Project Status: 
Completed