Preventing relapse of major depressive disorder in youth: Randomised Controlled Trial of a novel mindfulness-based cognitive online social therapy

The intervention under investigation is a moderated online social networking system, called Rebound. Rebound is an online intervention specifically designed to prevent relapse in youth Major Depressive Disorder (MDD) and includes therapeutic activities and information about mental health, mindfulness, personal strengths, and other topics relevant for young people recovering from MDD. Rebound also includes a social network where participants can communicate via posts and comments in a news feed and a problem-solving forum. The online platform will be moderated by experienced mental health workers based at Orygen Youth Health. Trained peer workers with lived experience of mental ill-health will also provide support to participants through the Rebound social network. Following randomisation, participants allocated to the Rebound intervention will complete an online orientation and follow-up phone call with the online moderator. Participants will access Rebound (including individualised therapist support) for 18 months. During this period, participants may access Rebound as often as they like, at any time, from any internet-enabled device. Rebound integrates online personal therapist support (by clinical psychologists). Their role is to provide guidance, monitor participant’s activity and clinical status and ensure the safety of the social network. Each therapist is assigned a caseload, which they follow for the duration of the trial. Moderators send each client tailored content suggestions weekly (e.g. a module or action) based on their needs and interests. Clients can rate the helpfulness of the suggestions, which moderators use to recommend subsequent content. Participant logins are monitored by the moderator. When a participant has not logged in for more than 7 days, this will be reviewed at moderator supervision. To promote engagement, retention of participants, and behavioural change, Rebound was developed following persuasive system design including primary task support (i.e., modularisation and personalisation of content), social support (i.e., fully integrated, purpose-built social network) and dialogue support (i.e., reward provided by therapists, peer-supporters and automated functions). Users will be invited by moderators to meet other users at ‘Rebound meet-ups’. Meet-ups will consist of an interactive 1-hour session on ‘how to make Rebound work for you’ and will provide users with the opportunity to ask questions and give feedback on the system. Participants will be reimbursed for their time. In the event of a clinically significant deterioration of depressive symptoms, increased risk or a hospital admission, the clinical moderators in conjunction with the CI team will perform an assessment to determine the risks and benefits of a temporary withdrawal from Rebound. Based on this assessment, and in consultation with the young person, the team will determine whether the account is temporarily suspended, or level of access restricted (e.g., participant can access therapeutic content and support from moderators, and view content in the social network, but cannot post comments or participate in existing threads within the social network). All instances of depressive relapse will be reported to the Project Manager and recorded as an Adverse Event. Following suspensions or restrictions to a user’s account, the study coordinator or moderator will contact the young person at fortnightly intervals to ascertain whether the account is to be reactivated. All participant activity (frequency, duration, pattern of use etc.) on the system is recorded by system data analytics.