An investigation into the design, applicability and evaluation of a computerised cognitive behavioural therapy programme-SPARX for Māori young people experiencing mild to moderate depression

Abstract

Depression is a major health issue amongst adolescents in New Zealand particularly for Māori. This research is a part of a larger study, in which a Computerised Cognitive Behavioural Therapy programme (CCBT)-SPARX was designed and evaluated. Four studies exploring the design, applicability and efficacy of SPARX for Māori adolescents experiencing mild to moderate depression have been included in this thesis. In study one I investigated the design and content of the CCBT programme from a Māori perspective using a qualitative methodology. Three different groups were interviewed, taitamarki Kapa Haka group (N=8), taitamariki (adolescent) mothers (N=4) and whānau (7 parents and 7 taitamariki). Results revealed that SPARX taught Cognitive Behavioural Therapy (CBT) skills (particularly relaxation), it was like a computer game that helped with depression and the Māori graphics were applicable to taitamariki. In study two I recruited seven taitamariki to complete SPARX (seven modules). The Child Depression Rating Scale-Revised (CDRS-R) and secondary self-rating scales of depression, anxiety and quality of life were administered before intervention, post treatment and at fivemonth follow up. The mean scores on the CDRS-R dropped substantially to within normal range at post intervention 22.57 (CI=-8.52-36.63, p=.008) and this decrease was maintained at five month follow up 17.71 (CI=0.77-34.66, p=.043). Secondary measures showed statistically significant improvement for anxiety at months two and five and quality of life at months two and five. Both self report questionnaires at months two and five showed high satisfaction levels. In study three, participants completed a semi-structured interview (N=6) at completion of intervention. Taitamariki found SPARX to be helpful because it taught relaxation and cognitive restructuring skills and helped improve mood. The ability to customise the characters with Māori designs appeared to enhance cultural identity. In study four I analysed the Māori participant data from the main randomised control trial (N=45) comparing SPARX with treatment as usual (TAU). This study confirmed findings from the open trial with initial gains at post intervention (SPARX, -5.13, TAU -6.87) maintained at five month follow up, (SPARX, -5.50, TAU -5.40), and showed that for this cohort SPARX was as effective as treatment as usual. The generalisability is limited by the small sample sizes. These results suggest SPARX is an effective treatment for mild to moderate depression.