The COVID-19 pandemic caused financial hardship, social isolation, and distress, increasing risk for adolescent depression. Even before the pandemic, <50% of youth with depression accessed care, and not all benefited from existing treatments. Accordingly, this randomized-controlled trial tested online single-session interventions (SSIs) during COVID-19 in adolescents with elevated depression (N=2,452, ages 13-16). Adolescents recruited via social media were randomized to 1 of 3 SSIs: a behavioral activation SSI, an SSI teaching that personal traits are malleable, or a supportive control. We tested each SSI’s effects on post-intervention (hopelessness, agency) and 3-month outcomes (depression, hopelessness, agency, generalized anxiety, COVID-related trauma). Compared to the control, both active SSIs reduced 3-month depressive symptoms; decreased post-intervention and 3-month hopelessness; and increased post-intervention agency. Several differences between active SSIs emerged. Results confirm the effectiveness of two free-of-charge, online SSIs for adolescents with elevated depression, even in the high-stress context of COVID-19.

Background. The demand for psychological services outpaces the number of available providers. Waitlists at mental health clinics range from weeks to months in length, and longer wait-times predict less favorable outcomes once treatment begins. There is a need for efficient, sustainable service models that provide faster access to care. Offering interim, low-intensity supports to treatment-seekers may both strengthen clinically-relevant proximal outcomes and prevent clinical deterioration while waiting for longer-term treatment. Thus, we tested the acceptability and short-term effects of a solution-focused single-session consultation (SSC), offered to individuals waiting for therapy at two outpatient mental health clinics. Method. Clients wait-listed for outpatient therapy at either clinic were offered an SSC. Participants self-reported overall psychological distress at baseline and two-week follow-up, along with levels of hopelessness and perceived agency at baseline and post-intervention. Participants also rated the SSC’s acceptability. Results. Of 90 treatment-seeking individuals offered an SSC, 46 (51.11%) scheduled an appointment, and 30 (65.21%) attended the session (M age = 31.2, 72.67% female). SSC recipients reported significant pre- to post-intervention improvements in perceived agency (d_z = 1.11, p < .001) and hopelessness (d_z = 1.43, p < .001). Psychological distress significantly decreased from baseline to follow-up (d_z = .73, p = .002). Participants rated SSC sessions as highly acceptable, useful, and worth recommending to others. Conclusions. A solution-focused single-session consultation was associated with improvements in hopelessness, agency, and psychological distress in treatment-seeking adults. Pending larger-scale controlled trials, the SSC may help prevent clinical deterioration among individuals on therapy wait-lists.

Research that fails to include sufficient representation from socially disadvantaged groups cannot make strong inferences about those groups. This relative lack of knowledge poses theoretical and clinical problems for health research. More effective community engagement with socially disadvantaged groups is often proposed as a way to increase research engagement. However, community engagement is a heterogeneous construct, including everything from how participants are contacted to whether researchers work with an organization within the community. Further, community engagement efforts vary widely in their effectiveness in recruiting and retaining participants from socially disadvantaged groups. Therefore, some types of community engagement may be more effective than others. We conducted a systematic review of randomized controlled trials attempting to increase recruitment or retention of socially disadvantaged groups. We then applied systematic distillation procedures to examine which components of community engagement interventions were associated with successful recruitment or retention outcomes. Generally, we found research process related variables (e.g. having a systematic contact plan) most frequently differentiated effective vs. ineffective recruitment or retention outcomes. Partial associations between components in effective interventions, including negative associations, were descriptively stronger than partial associations in the ineffective interventions, indicating targeted interventions may be more effective than more generalized interventions. The literature was also relatively sparse and at unclear-to-high-risk for bias. Future pre-registered, research process-oriented, and targeted recruitment and retention interventions may increase the research participation of socially disadvantaged groups in health research.

Repetitive negative thinking and experiential avoidance have been hypothesized to be related, transdiagnostic maintenance factors for depression and anxiety. Work to date has not examined these maintenance factors in a comorbid clinical sample using a symptom-level approach. Adults presenting for treatment to an intensive CBT program (n = 492) completed measures of depression and anxiety symptom severity, repetitive negative thinking, and experiential avoidance. Permutation testing indicates that repetitive negative thinking improved the predictability of excessive worrying and concentration, whereas experiential avoidance improved the predictability of feeling like a failure, difficulties relaxing, and being afraid something bad was going to happen. Applying network analysis helps to more precisely identify which symptoms of depression and anxiety are associated with transdiagnostic maintenance factors, thus providing insight into how these factors may contribute to the maintenance of co-occurring disorders.

Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental healthcare. Anxiety is not necessarily pathological; however, increased worrying about COVID-19 shows links to more severe anxiety pathology. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. Our registered report will test whether a no-therapist, single-session online intervention adapted for the COVID-19 context can: 1) decrease generalized anxiety and increase perceived control over anxiety, versus a placebo intervention 2) without decreasing social-distancing intentions. We will test these questions using a between-subjects design in a weighted-probability U.S. sample (N=500). Findings will inform whether a highly-scalable intervention can decrease anxiety without yielding unwanted secondary effects.