Professor Robin Callister1
Professor Brian Kelly1
Dr Leanne Hides2
Professor Amanda Baker1
Dr Choong Slew Yong3
1 Hunter Medical Research Institute, University of Newcastle
2 Queensland University of Technology
3 Adolescent Mental Health Clinic, Hunter New England Area Health Service
Hunter Medical Research Institute $94,570
Project completion year
One in five young people will experience depression. It can affect relationships, academic performance, increase the likelihood of harm through risk-taking behaviour and, in extreme cases, result in suicide.
In 2010, the Newcastle community responded to the suicide of a local student by raising funds to help the Hunter Medical Research Institute (HMRl) improve the treatment options available to young people suffering anxiety and depression. This funding allowed a multi-disciplinary research team to develop a pilot study called Healthy Body, Healthy Mind.
Healthy Body, Healthy Mind will investigate the relationship between exercise and mood, and its role in improving depressive symptoms in young people. Exercise has mood elevating effects and is known to be an effective treatment for depression in adults, but it has not been investigated in youth.
Healthy Body, Healthy Mind will evaluate the effectiveness of combined motivational interviewing (MI) and regular exercise training, compared to MI alone, on depressive symptoms, social function and wellbeing in young people aged between 15 to 24 years with mild to moderate depression.
The team hope to demonstrate that the combination of physical activity and MI treatments can alleviate the debilitating effects of depression in its early stages.
The project will investigate the feasibility and effectiveness of an integrated intervention consisting of brief (introductory) MI plus structured exercise training for the treatment of youth depression of mild to moderate severity. The project will be conducted in two phases:
- A feasibility study of recruitment and delivery as well as the acceptability of the integrated Intervention to adolescents with depression.
- A randomised controlled trial (informed by Phase 1) to determine the effectiveness of the integrated intervention compared to brief MI plus usual care.
The recruitment, treatment engagement, adherence and effects of two weeks of introductory MI (Quick Fix), plus 12 weeks of planned exercise (small group personal training) integrated into a 14- week MI-exercise intervention will be investigated. As the intervention is a pilot investigation, implementation is on a small scale, trialled initially with two groups of six participants.
The purpose of this feasibility study is to inform decisions and allow refinement for the implementation of the RCT. It is designed specifically to determine:
- the capacity to recruit and engage school-age and post school youth with MOD Into the project
- the capacity to achieve adherence to the MI and exercise program in this population
- the acceptability of and compliance with all aspects of the study
- the effects of the integrated intervention on the symptoms of depression and exercise performance in the study population
- any modifications to the intervention that is required to improve the recruitment acceptability, adherence and the effectiveness of the intervention.
Whether used as stand alone or adjunct therapy, an additional option for the treatment of youth depression is clearly needed. Based on outcomes of MI-intervention research conducted in adult populations, it is anticipated that, with modifications to suit adolescents, the model will be an effective treatment option. If effective, the issues of ease of implementation and cost-effectiveness become much more important.
The intervention model has been designed with long-term implementation in a wide range of communities in mind. That is, it is designed to link in easily with existing services by adding value rather than redesigning the whole system or requiring additional infrastructure. Thus, if it is effective, it is likely that it can be readily incorporated into care plans.
In order to translate this intervention model, it must also be cost-effective and, as such, a preliminary analysis will be conducted as part of the project. Again, when developing the model, keeping it cost-effective was a prime consideration. The brief (two sessions) MI component could be delivered by psychologists and potentially funded by Medicare under a GP Care Plan strategy at minimal cost to the patient and this may be cost-effective for the government if other health care costs are subsequently reduced. The exercise component would be delivered in community gyms with appropriately trained staff. Importantly, the trial is a small group training model rather than a one-on-one training model. Having a personal trainer is a motivational tool but individual personal training is not likely to be cost-effective. Hence our decision to trial the small group model. This exercise intervention would currently be an out of pocket expense for participants, however relative to most health care interventions, this may be perceived by patients or carers as an evidence-based investment in health. In the longer term, this cost may be covered, at least in part, by health insurance.