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Abstract
Depression and problematic alcohol use represent two of the major causes of disease burden in young adults. 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 in treating this comorbidity, however, there remains significant unmet need, particularly in young people. This unmet need is a function of ineffectual health-system responses, a lack of evidence-based, youth-targeted treatments, and a range of motivational challenges inherent to this population. Due to a lack of uptake of traditional services among young adults, other forms of treatment require exploration. The aim of this thesis was to develop and evaluate the first online intervention (the DEAL Project) for co-occurring depression and problematic alcohol use in young people (aged 18 to 25 years).
Development of the innovative program involved a systematic review of youth comorbidity treatments to direct the program content and aspects of delivery. Following this, both delivery, structural, and clinical components were considered and integrated via an analysis of an existing eHealth intervention for comorbidity in the general population, a working discussion group, and evidence-based practice. Finally, young people and key experts were engaged to enhance and refine the program and explore the acceptability and feasibility of program elements.
To establish the efficacy of the DEAL Project an Australia-wide randomised controlled trial was conducted (N = 104). The DEAL Project was associated with significant improvement in depression and alcohol use outcomes in the short-term, relative to an attention-control group that showed no change. Over the course of the 6-month follow-up the significant difference between the two groups disappeared, however, the improvements in the treatment group observed at post-treatment were maintained.
This thesis provides support for the use of brief, self-guided online interventions in this population. Strategies to increase program adherence and engagement require further research and are discussed in turn.