Developing a novel coding tool for therapeutic alliance and exploring online engagement in a digital mental health intervention for youth with major depressive disorder.

Résumé

BACKGROUND: Increased prevalence of Major Depressive Disorder (MDD) in youth and limitations in effective and accessible treatments requires treatment innovations such as digital mental health interventions (DMHI) using peer support. This study developed and assessed the interrater reliability of a novel coding protocol to detect spontaneous expression of therapeutic alliance (TA) in participants' posts with peers in a DMHI for youth with depression entitled Rebound. Contingent on good reliability, the relationships between expressed peer-to-peer TA, gender and online engagement with therapy content were assessed.METHOD: Youth aged 15-25 (M = 20.5, SD = 3.0) in remission from MDD were recruited for the Rebound trial. Data was collated from 109 participants (61% female).RESULTS: Cohen's Kappa for the coding protocol ranged from .63 to .78 for bond and task elements of TA but did not meet the a-priori cut-off for shared goals (κ = .60). A moderate and significant positive correlation was identified between Peer TA and engagement. Hierarchical regression analyses found that Peer TA significantly predicted online engagement, with this relationship not being moderated by gender.DISCUSSION: This study demonstrated the feasibility and reliability of a novel coding protocol for detecting spontaneous TA expression and highlighted the unique positive relationship between Peer TA and online engagement with therapy content on Rebound. Gender was not a significant moderator of this relationship. Findings indicate that peer-to-peer interactions in DMHIs may encourage engagement with online therapy content.TRIAL REGISTRATION NUMBER: ANZCTR, ACTRN12619001412123.

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