The TrACY Study
The long-term costs of mental illness in children and adolescents are considerable and long lasting, yet services often do not deliver the best available treatment because of practical difficulties with current evidence-based therapies (EBTs). MATCH-ADTC (Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct problems) is a new flexible modular system that combines EBTs for common mental health problems. MATCH-ADTC was developed by Professor John Weisz and colleagues from Harvard University and has been successfully evaluated in the United States.Training in MATCH-ADTC is relatively brief.
The main objective of the TrACY study (Treatment Approaches for Children and Young people) is to improve the clinical outcomes for those attending child and adolescent mental health services (CAMHS) in New Zealand, thus impacting on the burden to society of long-term mental illness. The TrACY study has been funded by the Health Research Council of New Zealand and it will involve carrying out a rigorous real world clinical trial to test whether training in MATCH-ADTC results in the delivery of more EBT and better mental health outcomes for children and adolescents than usual care. The study design ensures that we can show effectiveness separately for Māori and Pacific children. If the results are positive funding will be sought to implement national MATCH-ADTC training using existing expertise at the Werry Centre. The co-principal investigators for the TrACY study are Associate Professor Sally Merry and Dr Sue Crengle. For more information about the study please contact Dr Sarah Hopkins (study manager) firstname.lastname@example.org.
E-therapy for depressed adolescents
Associate Professor Sally Merry heads the Youth E-therapy Research Group. Members of the group include Drs Karolina Stasiak, Terry Fleming, Mathijs Lucassen and Matt Shepherd. We have developed SPARX - a computer program that helps young people with mild to moderate depression. It was developed with the help of young people and is based on a type of ‘talking therapy’ called Cognitive Behavioural Therapy (CBT). SPARX received two international awards for digital innovation. SPARX is now available to all New Zealand residents at www.sparx.org.nz
We tested SPARX in a large randomised controlled trial in New Zealand and the results were published in the British Medical Journal in 2012. The trial involved 187 young people seeking help for low mood. We compared SPARX with standard care provided to young people with mild to moderate depression e.g., face-to-face therapy with a counsellor or clinical psychologist. We found that SPARX was as effective as standard care for youths 12 to 19 years old seeking help for depression. SPARX reduced depression, anxiety, feelings of hopelessness and improved quality of life. In addition, three doctoral projects evaluated SPARX with specific groups of young people.
In 2013, we have developed an e-monitoring system to allow clinicians to ‘prescribe’ SPARX to their patients and monitor their progress and outcome. We piloted it in a collaborative project with Kapiti Youth Support. We continue to work on the e-monitoring system and hope to integrate it with clinical systems soon.
In 2013, we have developed an online depression screening (‘mood quiz’). Anne Marie Barr (under the supervision of Dr Karolina Stasiak) evaluated it with adolescents from 10 Auckland high schools as part of her Master’s research. Young people can use the ‘mood quiz’ to help them decide if SPARX is a suitable intervention for them or whether they should seek specialist care.
We continue researching SPARX:
Terry Fleming has developed a version of SPARX that helps young people deal with ‘life’s hassles’. This version is currently tested with young people attending a youth justice program. This study is in partnership with Foundation for Youth Development.
Dr Stasiak and Dr Josephine Stanton are supervising a visiting medical student (Emma Drake) who is trialing SPARX in an inpatient unit. Patients and staff are also interviewed about their attitudes to computerised therapy in a hospital setting.
We have a number of international collaborations underway including researchers from Australia, UK, USA, Canada, Japan, and the Netherlands.
Cheek C, Bridgman H, Fleming T, Cummings E, Ellis L, ...Skinner, T (2014) Views of Young People in Rural Australia on SPARX, a Fantasy World Developed for New Zealand Youth With Depression, J Med Internet Res 16, (1): 1-12. - http://games.jmir.org/article/viewFile/games_v2i1e3/2
Clark T, Lucassen M, Bullen P, Denny S, Fleming T, Robinson E, Rossen F (2014). The Health and Well-Being of Transgender High School Students: Results From the New Zealand Adolescent Health Survey (Youth'12). J Adolescent Health. 2014 Jan 14 [Epub ahead of print]
Fleming, T., Clark, T.C., Denny, S., Bullen, P., Crengle, S., Peiris-John, R., Robinson, E., Rossen, F., Sheridan, J, Lucassen, M. Stability and change in the mental health of New Zealand secondary school students 2007–2012: results from the national adolescent health surveys. Australia New Zealand Journal of Psychiatry 48(5):472-80. DOI: 10.1177/0004867413514489
Fleming, T., R. Dixon, et al. (2012). "'It’s mean!’ the views of young people alienated from mainstream education on depression, help seeking and computerised therapy." Advances in Mental Health 10(2): 196 - 204
Fleming, T. and S. Merry (2012). "Youth Work Service Providers' Attitudes Towards Computerized CBT for Adolescents." Behavioural and Cognitive Psychotherapy FirstView: 1-15.
Fleming, T., R. Dixon, et al. (2012). "A Pragmatic Randomized Controlled Trial of Computerized CBT (SPARX) for Symptoms of Depression among Adolescents Excluded from Mainstream Education." Behavioural and Cognitive Psychotherapy 40(05): 529-541.
Lambert M, Fleming T, Ameratunga S, Robinson E, Crengle S,… Merry, S (2014) Looking on the bright side: an assessment of factors associated with adolescents’ happiness. Advances in Mental Health. [Epub ahead of print]
3-year follow-up study of infants exposed antenatally to methamphetamine
This is the study of infant development, environment and lifestyle where the children are born to mothers using methamphetamine. The Werry Centre has been funded to study a cohort of infants which can be compared to others from Los Angeles, Honolulu, Des Moines and Tulsa. The infants studied are compared to a non-exposed control group of infants. At this stage, the earliest recruited infants are 2 years old, and recruitment continues until the target of 120 exposed and 120 non-exposed infants is achieved.
(Principal Investigator – Dr Trecia Wouldes. Study Manager – Carolyn Ho)
Youth2000 survey series: National youth health and wellbeing surveys (Overview)
The Youth2000 survey series ask a large, representative sample of secondary school students from over approximately a third of all high school in New Zealand a wide range of questions that contribute to health and wellbeing of young people in New Zealand. These include questions about ethnicity & culture, physical health, food & activities, substance use, sexual health, injuries and violence, home and family health, school achievement and participation, neighbourhood environment, spirituality and access to healthcare.
Over the past eleven years the Adolescent Health Research Group (AHRG) has collected data on these topics from a total of 28,000 students who completed the Youth ’12, Youth ’07 and Youth’01 surveys. This comprehensive questionnaire allows the AHRG to take an ecological approach to identifying the risks and protective factors in young people’s lives. In addition the AHRG has carried out surveys with Alternative Education students, Teen Parent Unit students and school staff.
Werry Centre researchers Dr Theresa (Terry) Fleming and Dr Mathijs Lucassen are current members of the AHRG, and Associate Professor Sally Merry and Terry (Theresa) Fleming were members of the AHRG for previous surveys.
A full list of reports and papers from the AHRG and how to work with the AHRG can be found on the website.
Mental health specific outputs from AHRG include:
• Fleming, T., Clark, T., Denny, S., Bullent, P., Crengle, S., Peiris-John, R., Robinson, E., Rossen, F., Sheridan, J., Lucassen, M. (2013). Stability and change in the mental health of New Zealand secondary school students 2007–2012: Results from the national adolescent health surveys. Australian & New Zealand Journal of Psychiatry.
• Clark, T. C., Lucassen, M. F. G., Bullen, P., Denny, S. J., Fleming, T. M., Robinson, E. M., & Rossen, F. V. (2014). The Health and Well-Being of Transgender High School Students: Results From the New Zealand Adolescent Health Survey (Youth'12). Journal of Adolescent Health, (0) 1-7.
http://dx.doi.org/10.1016/j.jadohealth.2013.11.008 (Open Access - free to access this article)
• Clark, T., Fleming, T., Bullen, P., Crengle, S., Denny, S., Dyson, B., et al. (2013). Health and well-being of secondary school students in New Zealand: Trends between 2001, 2007 and 2012. Journal of Paediatrics and Child Health, 49(11), 925-934. doi:10.1111/jpc.12427
• Clark, T., Robinson, E., Crengle, S., Fleming, T., Ameratunga, S., Denny, S., Bearinger, L., Sieving, R., Saewyc, E. (2011) Risk and protective factors for suicide attempt among indigenous Māori youth in New Zealand: The role of family connection as a moderating variable. Journal of Aboriginal Health. 7(1), 16‐31.
• Clark, T.C., Smith, J., Raphael, D., Jackson, C., Denny, S.J., Fleming, T., Ameratunga, S. & Crengle, S. (2010) Kicked out of school and suffering: The health needs of youth in Alternative Education. Youth Studies Australia 29(4), 10‐17
• Denny, S., Robinson, E., Utter, J., Fleming, T., Grant, S., Milfont, T., Crengle, S., Ameratunga, S., Clark, T. (2011) Do schools influence student risk behaviours and emotional health symptoms. Journal of Adolescent Health. 48(3), 259‐267.
• Lucassen, M., Merry, S., Robinson, E., Denny, S., Clark, T., Ameratunga, S., Crengle, S., Rossen, F. (2011) Sexual attraction, depression, self‐harm, suicidality and help‐seeking behaviour in New Zealand secondary school students. Australian and New Zealand Journal of Psychiatry. 45(5), 376‐383
• Milfont, T.L., Merry, S., Robinson, E.M., Denny, S., Crengle, S., & Ameratunga, S.N. (2008) Evaluating the short form of the Reynolds Adolescent Depression scale in New Zealand adolescents. Australian and New Zealand Journal of Psychiatry. 42(11), 950‐954.
• Milfont, T., Denny, S., Ameratunga, S., Robinson, E., Merry, S. (2008) Burnout and Wellbeing: Testing the Copenhagen Burnout Inventory in New Zealand Teachers. Social Indicators Research, 89(1), 169-177.
• Noel, H., Denny, S., Farrant, B., Rossen, F., Teevale, T., Clark, T., Fleming, T., Bullen, P., Sheridan, J., Fortune, S. (2013). Clustering of adolescent health concerns: A latent class analysis of school students in New Zealand. Journal of Paediatrics and Child Health, Vol 49, 935-941.
• Teevale, T., Denny, S., Percival, T., Fleming, T. (2013) Pacific secondary school students' access to primary health care in New Zealand. The New Zealand Medical Journal, Vol 126, No 1375.
Mobile phone-based depression prevention programme for adolescents
This study involved the development and randomised controlled trial of an intervention to promote resilience in adolescents via the mobile phone. The study was completed in 2011.
(Principal Investigators – Dr Robyn Whittaker and Dr Sally Merry email@example.com. Study Manager – Shireen Chua)
Infant Mental Health Project (Mellow Parenting/Hoki ki te Rito)
We carried out two studies to evaluate an intensive parenting support programme in Counties Manukau in partnership with the DHB. The programme is an adaptation of a successful intervention (called Mellow Parenting) for Māori mothers. The program was delivered by the Ohomairangi Trust and the Anglican Trust for Women in Children. The studies showed that the program had significant benefits for mothers/caregivers (maternal mental health and parenting stress) and for children’s behavioural and developmental outcomes. Lyn Doherty continues to research Hoki ki te Rito as part of her PhD study.
Depression prevention and intervention
A bicultural randomised control trial of depression prevention was carried out under Health Research Council funding between 1999 and 2003.
Research Team: Dr S Merry, Dr H McDowell, N Muller, C Wild, J Bir.
2004 Merry SN, McDowell H, Wild CJ, Bir J and Cunliffe R. A randomized placebo controlled trial of a school-based depression prevention program. Journal of the American Academy of Child and Adolescent Psychiatry. 43(5) 538-547. 2004.
2003 Faculty of Child and Adolescent Psychiatry, Royal College of Psychiatrists. York. England. “School based depression prevention – a randomized controlled trial.” Merry SN, McDowell H, Wild C, Bir J Cunliffe R.
2003 CAMHS conference. “The Effectiveness of a School-Based Bi-cultural Depression Prevention Programme.” Bir J, Wharemate R, Merry S, McDowell H, Wild C and Cunliffe R
2002 McDowell H, McPherson N, Merry S, Wild C, Bir J, Cunliffe R, Wharemate D, & Dutt V. Cross-cultural use of RAP-Kiwi (Resourceful Adolescent Programme New Zealand). Poster session. Third International Conference on Child and Adolescent Mental Health, Brisbane, Australia
2001 McDowell H, Merry S, McPherson N, Wild C, Bir J & Wills L. Preventing depression: the effectiveness of a school-based CBT programme. New Zealand Psychological Society Conference, Auckland
2001 Joint American Academy of Child and Adolescent Psychiatry and RANZCP Child and Adolescent Faculty Conference. “Effectiveness Of Universal School-Based Depression Prevention” Merry SN, McDowell H, Wild CJ, Muller N, Bir J in symposium “Preventing Depression in Adolescents: Cognitive Behavioral Approaches” Gilham JE, Clarke GN, Hamilton JD, Merry SN, & Spence SH
A meta-analysis of depression prevention programmes
This was carried out between 2001-2003 and updated in 2006.
Research team: Dr S Merry, S Hetrick, Dr H McDowell, J Bir
2004 Merry SN, Hetrick S, McDowell H and Bir J. The effectiveness of psychological and/or educational interventions for the prevention of depression in children and adolescents. The Cochrane Library. Issue 1, 2004.
2006 17th Congress for the International Association for Child Psychiatrists and Allied Professionals. Merry S. “Depression prevention programmes: a meta-analysis” in symposium on “Early Intervention: School based programs for Mental Health”. Symposium coordinated by N Kawalenko.
2003 International Society for Research in Child and Adolescent Psychopathology. 11th Scientific Meeting, Sydney, Australia. “Depression Prevention Programmes – a meta-analysis.” Merry S, Hetrick S, McDowell H and Bir J in a Symposium on “Prevention and early intervention in adolescent depression: school-based approaches—the lessons we have learned”. Sheffield J, Patton G, Shochet I, Burns J, Sawyer M, Spence S, Glover S, Rapee R, Merry S.
2002 Faculty of Child and Adolescent Psychiatry Conference RANZCP. Merry SN, Hetrick S, Bir J, and McDowell H. “Effectiveness of depression prevention – a meta-analysis”
Other depression studies:
A meta-analysis of specific serotonin re-uptake inhibitors for depression in children and adolescents.
Research team: S Hetrick, M Proctor, S Merry, P Sindahl, A Ward
2005 Hetrick S, Proctor M, Merry S, Sindahl P, Ward A. Selective serotonin reuptake inhibitors (SSRIs) for depression in children and adolescents. [Protocol] Cochrane Depression, Anxiety and Neurosis Group Cochrane Database of Systematic Reviews. 3, 2005.
The role of mobile phone technology in delivery interventions.
Research team: Dr A Rodgers and Dr S Merry
Supported by the Oakley Mental Health Foundation
Computerised delivery of cognitive behavioural therapy for adolescents. (PhD thesis)
Research team: K Stasiak, Dr S Merry, Dr S Hatcher and Dr I Doherty
Supported by the Oakley Mental Health Foundation
The role of school guidance counsellors in the management of teenage depression (PhD thesis)
Research team: B Bulkeley, Dr S Hatcher, Dr S Merry and Dr H McDowell
An investigation of the views of clinicians and consumers about proposed outcome measurement in child and adolescent mental health services
2004 - Merry SN, Stasiak K, Parkin A, Seymour F, Lambie I, Crengle S and Pasene-Mizziebo E. Child and Youth Outcome Measures: examining current use and acceptability of measures in mental health services, and recommending future directions. MHRDS and HRC.
2006 17th Congress for the International Association for Child Psychiatrists and Allied Professionals. Merry S, “Perspectives on outcome measures from children, adolescents and families who use mental health services in New Zealand” in Symposium on “International perspectives on outcome measurement: from science to practice”. Merry S, Gowers S, Brann P, Bilenberg N, Hanssen Bauer K and Heyerdahl S. Symposium coordinated by S Merry
2004 10th Annual Health Outcomes Conference, Canberra, Australia. ‘New Zealand child and youth outcome measures: Examining their current use and acceptability in mental health services, and recommendations for the future.” Merry S,Seymour F, Lambie I, Parkin A, Crengle S, Pasene-Mizziebo E, & Stasiak K. (September, 2004). Paper presented by A/Prof Seymour
2003 Health Outcomes Conference 2003. Canberra. Merry SN, Lambie I, Parkin A, Seymour F, Crengle S, Pasene-Mizziebo E and Stasiak K. Child and Youth Outcome Measures: examining current use and acceptability of measures in mental health services, and recommending future directions. Presented by S Merry
2003 Royal Australian and New Zealand College of Psychiatrists Child & Adolescent Psychiatry Conference, Melbourne, Australia. Child and Youth Outcome Measures: examining current use and acceptability of measures in mental health services, and recommending future directions. Merry S, Lambie I, Parkin A, Seymour F, Crengle S, Pasene-Mizziebo E and Stasiak K. October 2003. Presented by A Parkin
Validation of the Reynolds Adolescent Depression rating scale in New Zealand
Research team: Student dissertation L Walker under supervision from Dr S Merry and Mrs E Robinson. Data from Youth 2000 collected by the Adolescent Health Research Group. Principal Investigator P Watson.
2004 Walker L, Merry S, Watson PD, Robinson E, Crengle S, & Schaaf D. The Use of the Reynolds Adolescent Depression Scale in New Zealand Adolescents. Australian and New Zealand Journal of Psychiatry 39: 136-140.
2002 Faculty of Child and Adolescent Psychiatry Conference RANZCP. Merry SN, and Watson P. “Validation of the Use of RADS with New Zealand Young People”
International reliability of HoNOSCA
Research team: Hanssen Bauer K (Principal Investigator), Heyerdahl S, Gowers S, Brann P, Bilenberg N, Merry S.
Hanssen-Bauer K, Gowers S, Aalen O, Bilenberg N, Brann P, Garralda E, Merry S & Heyerdahl S.Inter-rater reliability of routine outcome measures in child and adolescent mental health services. II. Cross-national differences in HoNOSCA, CGAS and GAPD
2003 17th Congress for the International Association for Child Psychiatrists and Allied Professionals. Merry S “Perspectives on outcome measures from children, adolescents and families who use mental health services in New Zealand” in Symposium on “International perspectives on outcome measurement: from science to practice”. Merry S, Gowers S, Brann P, Bilenberg N, Hanssen Bauer K and Heyerdahl S.. Symposium coordinated by S Merry
Workforce and training issues
Impact of training in child and adolescent mental health on career intentions of nurses, social workers and occupational therapists
Research team: M Lucassen and S Merry
2006 Lucassen M and Merry S. 'Training in Child & Adolescent Mental Health for Nursing, Occupational Therapy & Social Work Students: Does it Influence Career Intentions?' ISBN 0-9582630-0-0. Werry Centre for Child and Adolescent Mental Health, University of Auckland. 91pp
2005 Lucassen M, Doherty I & Merry S. Child and Adolescent Mental Health in Aotearoa/New Zealand: An Overview. Edition: 1.ISBN: 187737119X. Book With CD ; 56 pp.
Mathijs Lucassen “'Training in child and adolescent mental health for nursing, occupational therapy and social work students: does it influence career intentions?' Awarded first class honours 2005.
Factors that contribute to retention of staff in child and adolescent mental health services
Research team: L Emmerson and S Merry
Lorraine Emmerson “Why do clinicians stay in child and adolescent mental health services? A qualitative study.” Awarded with honours 2006.
Factors affecting retention and recruitment of child and adolescent psychiatrists. A qualitative study
Research team: Dr L Webster