Original Manuscript

Clinical Child Psychology

and Psychiatry
Frontline professionals’ use of and 2023, Vol. 0(0) 1–13
© The Author(s) 2023
attitudes towards technology to
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DOI: 10.1177/13591045231212523
with depression symptoms: A mixed journals.sagepub.com/home/ccp

methods survey

Maria E Loades1 , Bethany Cliffe2  and Grace Perry1

1
Department of Psychology, University of Bath, UK
2
Department of Psychology, University of Southampton, UK

Abstract
Depression is common in adolescence, and subthreshold symptoms even more so. Untreated, it is
disabling. Yet, upscaling traditional clinic-based provision would be prohibitively expensive. We
aimed to investigate frontline, non-specialist professionals’ use of and attitudes towards technology
to increase the availability of early help.
Method: Cross-sectional survey of a convenience sample of professionals in the UK (N = 115,
including low intensity practitioners, GPs, education staff, school nurses). The survey included rating
scales and free text boxes. Quantitative data were analysed descriptively, and we used reflexive
thematic analysis for the qualitative data.
Results: Frontline professionals rate their technological competence as good and have favourable
attitudes towards using technology to support adolescents with depression symptoms. They rated
online resources as most useful with mild-moderate symptoms, compared to severe symptoms
(t(110) = 14.54, p < .001, Cohen’s d = 1.49). Technology was viewed as important to bridge the
needs-access gap and professionals were interested in learning about online SSIs due to usefulness
(r = .32, p < .001).
Conclusion: Technology, such as SSIs, are of interest to mental health professionals and may be
useful for supporting adolescents with depression. Future research should explore the use of SSIs
for treating adolescent depression.

Keywords
Attitudes, children, adolescents, digital mental health interventions, single session interventions,
frontline professionals

Corresponding author:
Maria E Loades, Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK.
Email: [email protected]
2 Clinical Child Psychology and Psychiatry 0(0)

key practitioner message

· Digital technology offers an effective way to deliver evidence-based treatment at scale.
· Frontline, non-specialist professionals may often be the first point of contact for adolescents
when they begin to struggle with their mental health, including with depression symptoms.
· Therefore, they may be well-placed to signpost adolescents to digital mental health inter-
ventions, including single session interventions (SSIs).
· We found that UK based frontline professionals have favourable attitudes towards using
technology to support adolescents with depression symptoms, particularly for those with
mild-moderate symptoms as compared to those with severe symptoms.
· Technology was viewed as important to bridge the needs-access gap.
· Professionals were interested in learning about online SSIs.

Introduction
Depression becomes more common during adolescence (Lu, 2019; Rapee et al., 2019). By age 18,
one in ten adolescents will have had depression (Solmi et al., 2021), characterised by sadness and/or
irritability and lack of enjoyment/motivation (A.P.A., 2013), and one in three adolescents has
elevated depression symptoms currently (Shorey et al., 2021). Adolescent depression has sub-
stantial short- and long-term consequences and costs, which prompt treatment can decrease
(Goodyer et al., 2017). Yet, despite the burden of adolescent depression, we do not have the clinic-
based resources to treat every adolescent with elevated depression symptoms and upscaling existing
provision would be prohibitively expensive. Unsurprisingly, need far outweighs capacity, even in
early help services, so adolescents must wait for help and this needs-access gap has increased further
post-pandemic (Huang & Ougrin, 2021). Therefore, we need low cost, widely available, acceptable,
and effective interventions to prevent adolescents’ depression symptoms from escalating.
Digital technology offers an effective way to deliver evidence-based treatment at scale (Taylor
et al., 2020). Digital mental health interventions are effective (Grist et al., 2018; Lehtimaki et al.,
2021; Vigerland et al., 2016) and can overcome many help-seeking barriers, including stigma and
practicalities like travel and timings of appointments, with reduced costs to the healthcare system.
However, uptake and engagement in using digital mental health interventions has been problematic;
effective treatments like internet-based cognitive behaviour therapy (iCBT) suffer from significant
drop out; for example, one third of anxious children and adolescents (N = 4425) who enrolled in an
open access 10 session self-help iCBT programme only used one session, and less than a third of
those who started the programme completed ≥3 sessions (March et al., 2018). Digital single session
interventions (SSIs) intentionally designed as one-off therapeutic self-help interventions with no
assumption of a return visit may therefore be a particularly scalable public health solution as an
addition to current provision for adolescent depression symptoms (Loades & Ching, 2021; Loades
& Schleider, 2023).
Most often, frontline education and healthcare professionals, such as General Practitioners
(GPs), teachers, school nurses, and low-intensity (non-specialist) wellbeing practitioners (Education
Mental Health Practitioners - EMHPs, Child Wellbeing Practitioners - CWPs) based in Mental
Health Support Teams (MHSTs) in schools and in community settings, will be the first professional
source from whom adolescents and their families will seek support. We therefore need to understand
how these frontline professionals, who signpost adolescents to early help and/or act as gatekeepers
to specialist services view digital mental health intervention options, including single session
Loades et al. 3

interventions, as their attitudes towards these options are likely to influence whether and how they
offer them to adolescents.
Several prior studies have investigated child and adolescent mental health professional’s attitudes
towards digital mental health interventions. In the UK, a survey of a convenience sample of
43 specialist cognitive behaviour therapists’ attitudes towards the use of computerised CBT (cCBT)
with children and adolescents found cautious optimism, with particular relevance perceived to be for
preventative and early intervention approaches (Stallard et al., 2010). A subsequent UK survey of
154 specialist Child and Adolescent Mental Health Service (CAMHS) professionals found that
perceived benefits of technology to provide and support interventions included accessibility, con-
venience and appeal, although similar to the prior study, it was perceived to be more useful for
prevention or psychoeducation (Cliffe et al., 2019). A Swedish study also surveyed 156 child and
adolescent mental health professionals from 15 services, finding generally low knowledge of cCBT,
and again, more optimism about its use for prevention and mild-moderate problems (Vigerland et al.,
2014). However, these studies all focused on specialist staff to whom an adolescent would typically be
referred, rather than frontline professionals working in community settings who might first encounter
an adolescent who is struggling and help them to navigate the pathways to accessing help.
Studies examining perceptions and attitudes of frontline workers have tended not to focus
specifically on those working with children and adolescents, except for one study in New Zealand,
using focus groups and interviews with 40 frontline youth workers and social service staff to explore
their attitudes towards cCBT. This study found some enthusiasm for the approach with cCBT being
seen as a potential gateway to getting help (Fleming & Merry, 2013). However, participants also
expressed concerns about displacing human contact and about ensuring that it did not cause harm. A
survey of 124 mental health workers in Australia found that those with greater knowledge of cCBT
also endorsed more advantages and less disadvantages of the approach (Donovan et al., 2015), and a
mixed methods study of 11 Swedish primary care therapists found that most thought iCBT should be
introduced into their setting, although implementation barriers identified included lack of
knowledge and skills, lack of time and resources and unsuitable organisational systems and
processes (Kivi et al., 2015); however, neither of these surveys were specific to those working with
adolescents.
Given needs-provision gap for adolescents with depression symptoms, it is important to un-
derstand how those professionals who work with adolescents but are not mental health specialists
view potential solutions like digitally mediated support and treatment. We aimed to investigate
frontline professionals’ use of and attitudes towards technology to support adolescents with de-
pression symptoms, including exploring their views on how online self-help SSIs could be used to
supplement provision.

Method
A mixed method, cross-sectional online survey.

Participants
Anyone working in the UK who self-identified as working in a professional capacity with ado-
lescents, including (but not limited to) education or healthcare professionals, in both public and
voluntary sector services, was eligible to participate, providing they were also able to complete
measures in English. We particularly targeted recruitment at: General Practitioners (GPs), teachers,
school mental health leads, school nurses, Education Mental Health Practitioners (EMHPs) and
4 Clinical Child Psychology and Psychiatry 0(0)

Child Wellbeing Practitioners (CWPs). The project advert and details were shared via social media
(mainly Twitter), university held mailing lists and voluntary sector organisations which support
youth mental health, such as Off the Record, Bristol. To incentivize professionals to take part, we
offered a prize draw of three £20 shopping vouchers.

Procedure
All study processes took place online via the Qualtrics platform, and the study was open to re-
cruitment from May to July 2023. Prior to taking part in the study, potential participants accessed the
study information sheet by clicking on a link/QR code from the study advert. If they wished to
proceed, they were invited to complete the online consent form, followed by the study specific
measures. EMHP and CWP participants were asked to complete additional measures (via branching
logic) for other projects. At the end of the survey, participants were presented with debrief in-
formation including links to helpful resources about adolescent depression and information about
where participants could seek further support if needed. Responses were anonymous.
Ethical approval was granted by the University of Bath Psychology Research Ethics committee
(ref: 23–058). At planning stage, frontline professionals (a GP and an Education Mental Health
Practitioner) reviewed the draft study materials and provided feedback and suggestions about how
these could be improved. They subsequently offered ideas about how to recruit participants. The
study team also included a researcher who had previously worked as a Child Wellbeing Practitioner.

Measures
Brief demographic information was completed by the participant, including age, gender, geo-
graphical area of the UK, and ethnicity. They were then asked to complete some questions about
their professional background and experience.
To explore how they currently use/recommend digital mental health interventions to adolescents
struggling with their mental health, we used an abbreviated version of Cliffe et al. (2019)’s survey
(see supplementary materials S1.). This survey consists of a combination of free text and forced
choice responses. Part 1 assesses whether professionals currently use/recommend technology with/
to adolescents who are struggling with depression symptoms by asking participants to rate how
often they are currently using a range of technologies such as smartphone apps, online CBT and
social media: ‘never’, ‘every 6 months’, ‘every 3 months’, ‘monthly’ or ‘weekly’. Part 2 assesses
professional’s attitudes towards technology by asking them to indicate their level of agreement to
27 statements: ‘strongly disagree’, ‘disagree’, ‘neither agree/disagree’, ‘agree’, ‘strongly agree’.
We created additional rating scales and free-text boxes to explore what information participants
signpost (i.e. direct/make aware of) adolescents with depression symptoms to, exploring barriers
and potential solutions, including how online self-help SSIs could be used to supplement provision
(see supplementary materials S1. for questions and response options).

Data analysis
Quantitative data were analysed descriptively (counts, percentages, means). All items were
completed by at least 95% of participants, and missingness was <5% per item. Comparison of means
was undertaken using pairwise T-tests, with effect sizes (Cohen’s d) interpreted as small (d = .2),
medium (d = .5), and large (d = .8) (Cohen, 1988). Bivariate correlations were calculated using
Pearson’s, 2 tailed tests.
Loades et al. 5

Table 1. Demographic and Professional Characteristics of the Sample (N = 115).

Characteristic Categories N %

Age (years) <30 51 44.3

31–40 29 25.2
41–50 22 19.1
51–60 10 8.7
Not known 3 2.6
Ethnic group White: English/Welsh/Scottish/Northern Irish/British 96 83.5
White: (Other) 5 5.2
Mixed/Multiple ethnic groups 5 5.2
Asian/Asian British 2 1.7
Black/African/Caribbean/Black British 3 2.6
Sex (as per official documents) Male 16 13.9
Female 96 83.5
Gender Cisgender 110 95.7
Transgender 1 0.9
Not known 4 3.5
Geographical region England – North East 4 3.5
England – North West 1 0.9
England – Yorkshire and the Humber 22 19.1
England – East Midlands 1 0.9
England – West Midlands 5 4.3
England – East of England 5 4.3
England – London 3 2.6
England – South East 21 18.3
England – South West 48 41.7
Wales 2 1.7
Not known 3 2.6
Professional background Clinical/counselling psychologist 5 4.3
Teacher/teaching assistant/SENCo 20 17.4
Pastoral staff working in education settings 9 7.8
School nurse 4 3.5
GP/GP specialty trainee 8 7
Counsellor 3 2.6
Trainee/assistant psychologist 1 0.9
Child wellbeing practitioner 22 19.1
Education mental health practitioner 38 33.0
Other 2 1.7
Not known 3 2.6
Years working in a professional capacity <1 6 5.2
with adolescents 1–5 49 42.6
6–10 25 21.7
11–15 16 13.9
16–20 11 9.6
>20 5 4.3
Not known 3 2.6
6 Clinical Child Psychology and Psychiatry 0(0)

We used qualitative framework analysis (Gale et al., 2013), combined with principles of reflexive
thematic analysis (Braun & Clarke, 2006, 2013; Braun et al., 2020) for more detailed text responses.
The steps taken were familiarisation with the data by reading it several times, followed by initial
coding and then refinement of codes into themes. We assumed a post-positivist approach, i.e., there
is an objective reality, but also acknowledging that people are prone to biases and therefore that
knowledge is applicable within the context it is generated. The research team are female psy-
chologists, at different career stages. All have had training in conducting thematic analysis. MEL
has extensive experience of working clinically including with adolescents with depression, BC has
previously investigated digital mental health interventions and similar topics to the current study
albeit in a different group of professionals (i.e., mental health specialists), and GP is a relatively
naı̈ve researcher.

Results
The survey was started 234 times during the data collection period, and of these, 115 (49.1%)
participants fully completed the survey and submitted their responses and were retained for analysis.
As can be seen in Table 1, most participants were young and cisgender females from a White ethnic
group. Most were based in the Southwest region of England, and professional background varied,
including staff working in different roles in education, health, and mental health settings.
To contextualise the sample, we asked participants to self-rate their technological competence on
a 0–10 scale ranging from 2 (intermediate) to 10 (expert). The mean of the sample was 6.41 (SD
1.48). Most participants (n = 65, 56.5%) rated themselves as ranging from competent (5) to
advanced (7).
Most participants indicated that if they were concerned that an adolescent is struggling with
depression symptoms, they would signpost to resources online (n = 84, 73%) and arrange a follow-
up conversation (n = 84, 73%). Just under a third indicated that they would refer the adolescent to
mental health services (n = 67, 58.3%), and speak to their parents (n = 66, 57.4%), and around a half
would ask them to fill in a mood questionnaire (n = 57, 49.6%). Other responses given in the free text
box included undertaking an assessment, providing brief therapeutic support, signposting them to
resources within the organisation, and discussing with colleagues.
The most common barriers endorsed to timely help for adolescents struggling with depression
were the length of service waiting lists (n = 98, 85.2%), and lack of motivation preventing the
adolescent from engaging in what is offered (n = 78, 67.8%). More than half of the participants
indicated that stigma prevents adolescents from engaging in help-seeking (n = 65, 56.5%) and that
reluctance to tell their parents that they are struggling means adolescents cannot access help (n = 60,
52.2%). More than a third endorsed the barriers of services rejecting referrals for help (n = 53,
46.1%), it being hard to find an appropriate service to help (n = 50, 43.5%) and adolescents not
having the resources to travel to service locations (N = 39, 33.9%). Less frequently endorsed were
the barriers adolescents do not have enough time (n = 12, 10.4%), and lack of a confirmed diagnosis
means that it is hard to know what to offer (n = 24, 20.9%). Other responses given in the free text box
included lack of problem recognition by the adolescent or their parents, low mood being more
difficult to spot than anxiety, particularly if a young person is ‘quiet but engaging in work’, and lack
of early help services. One participant stated that ‘reluctance to engage in virtual support’ could be a
barrier.
Figure 1 shows the frequencies with which participants reported using or recommending each of
a range of digital media with adolescents struggling with depression symptoms and shows that many
frontline professionals recommend online supports like Kooth and emergency helplines like
Loades et al. 7

Figure 1. Frequency with which participants are currently using or recommending various media to
adolescents struggling with depression symptoms (%).

Samaritans fairly regularly, as well as smartphone apps and websites, but social media, instant
messaging, blogs and podcasts are much more infrequently used or recommended. When given a
free text box and invited to specify resources which they find helpful for adolescents with depression
symptoms, participants listed online supports like Kooth and the Mix, digital mental health

Figure 2. Participant ratings of attitudes towards technology (%).

8 Clinical Child Psychology and Psychiatry 0(0)

interventions and apps like Silvercloud, the CalmHarm app and a thinkdiary app, specific YouTube
videos, specific websites, (e.g. Young Minds website for adolescents and parents, handouts from the
CCI website) and voluntary sector organisations such as Off the Record. They also mentioned
resources within their service such as an online wellbeing hub, and specific questionnaires like the
goal-based outcomes measure and the low mood subscale of the Revised Children’s Anxiety and
Depression Scale (RCADS).
Overall, participants rated technology as more helpful for adolescents with mild-moderate
depression symptoms (mean 6.67, SD 1.70, range 2–10 on a 0–10 scale where 10 = very helpful) as
compared to for those with moderate-severe depression symptoms (mean 4.63, SD 1.85, range 1–
10), with a large effect size (t(110) = 14.54, p < .001, Cohen’s d = 1.49, 95% CI 1.12–1.64). Ratings
of perceived helpfulness were not significantly correlated with participant’s self-rated technology
competence (r = .75, p = .495 for mild-moderate depression symptoms, r = .05, p = .642 for
moderate-severe depression symptoms), see Figure 2.
When invited to say what groups of adolescents may be less able to benefit from technology, free
text responses included adolescents with comorbidities such as ADHD or autism spectrum con-
ditions, those with learning difficulties/Special Educational Needs, those from low-income
households where finances limit availability of devices/Wi-Fi, those who are low in motivation,
those whose parents limit access to digital devices, and specific populations e.g. traveller com-
munities, those with limited English language, those who are visually impaired.

SSIs
Most participants were interested in single session interventions (mean = 3.94, SD = 1.15, see
Figure 3). Interest levels appeared to be fairly evenly spread across age, gender, and professional
background of the participants. Ratings of the potential overall helpfulness of technology for ado-
lescents with mild-moderate symptoms were associated with interest in SSIs (r = .32, p < .001), less so
for overall helpfulness for moderate-severe symptoms (r = .17, p = .077). Interest in SSIs was not
significantly associated with self-rated technological competence (r = .06, p = .596). The key messages

Figure 3. Frequency with which participants agreed that they were interested in knowing more about SSIs.
Loades et al. 9

that participants rated as most useful and engaging for adolescents with depression symptoms were
‘Do more of what matters’ (n = 47, 40.9%) and ‘Learn to be kind to yourself’ (n = 31, 27%), see
Figure 4. Additional topics suggested were an SSI focused on online safety and social media risks, and
an SSI with a key message ‘You are not alone in your struggle’. Professionals gave ideas in a free text
box about how self-help online SSIs could be used for adolescents with depression symptoms, which
included as a resource to signpost them to, as a first step intervention, whilst waiting for help, as a part
of an overall treatment plan, for those adolescents who are unsure about/unable to commit to engaging
in ongoing therapy, and as a ‘top up’ for those who have completed therapy and relapsed. Some
suggested that these could be developed into psychoeducational workshops for use in schools, and
several mentioned that parents could support the use of the SSIs. One participant stated that SSIs
should be ‘only as psychoeducation…but not as a standalone’.

Discussion
Frontline professionals are adept in using technology and have favourable attitudes towards using this to
support adolescents with depression, particularly before the symptoms become too severe. Online re-
sources (e.g., websites) and digital mental health interventions (e.g., apps) are regarded as the most useful
and often recommended in the first instance, alongside crisis resources. Professionals also view technology
as important in bridging the needs-access gap in traditional mental health services. These might provide
early help and a wide range of resources, while being quick and easy to access and negating the stigma
associated with using mental health services. However, professionals were concerned that technology may
not be useful for all groups and the resources on offer might not be person-centred.
Technology as a source of support was perceived to be more useful for those adolescents with
mild-moderate problems, rather than those with more severe problems. This is consistent with
findings from surveys of specialist child and adolescent mental health professionals in both Sweden
and the UK (Cliffe et al., 2019; Vigerland et al., 2014). This may be due to depression severity
tending to be associated with risk and complexity, which may be more difficult to manage safely and
in a sufficiently personalised manner using technology. For example, more severe and enduring

Figure 4. SSI Key Messages rated as most useful and engaging for adolescents with depression symptoms (%).
10 Clinical Child Psychology and Psychiatry 0(0)

depression symptoms are associated with self-harm and suicide (Zubrick et al., 2017). In the current
study participants typically rated technology as not being tailored to individual’s needs, so it may be
that professionals believe that adolescents with more severe depression symptoms may require more
individualised support to ensure that high-risk adolescents are kept safe.
The current study used a questionnaire similar to Cliffe et al. (2019) and whilst both sets of findings do
align somewhat, there are also some noteworthy differences, particularly considering the pre- and post-
pandemic contexts within which the studies took place. The period between Cliffe et al. (2019) and the
current study saw the COVID-19 pandemic and consequent rapid adoption of digital technology in mental
health services. This may explain why in the current study only 29% agreed that they did not feel skilled in
using technology, compared to 42% in Cliffe et al. (2019). Similarly, 38% here agreed that they did not
know what technology is available, compared to 60% in Cliffe et al. (2019). Pre-pandemic clinician
knowledge of technology was reported as lacking elsewhere, with only around 25% of mental health
workers knowing much about CBT in 2015 (Donovan et al., 2015). This may suggest that the accelerated
need for and use of technology during the pandemic led to increased awareness and confidence in its use.
The current study also found more negative attitudes towards technology, with twice as many participants
(83% vs. 42% in Cliffe et al. (2019)) believing that technology is not tailored to adolescents’ needs.
Moreover, only 17% believed technology to be appealing to young people, as opposed to 89% in Cliffe
et al. (2019). This stark difference may indicate that technology being ‘forced’ upon young people during
the pandemic has undermined its appeal, with issues such as digital fatigue being widely reported (e.g.,
Gregersen et al. (2023); Amponsah et al. (2022)). There is also evidence to suggest that, whilst some young
people enjoyed the transition to remote therapy during the pandemic, others found it disruptive and
struggled with the online format (Worsley et al., 2022). Lastly, most participants in the current study (87%)
believed that technology can be a solution to a lack of trained therapists, compared to only 18% in Cliffe
et al. (2019). Unfortunately, the COVID-19 pandemic exacerbated staff shortages within CAMHS, and it
may be that the increased familiarity with technology during the pandemic means that practitioners are now
more willing to trust the use of technology in CAMHS to ‘fill in the gaps’. It may also be that specialist
CAMHS professionals (who were the target population for Cliffe et al. (2019)) have different views to
frontline professionals who we recruited in the current study, so we cannot assume that the pandemic is
what accounts for the differences between the samples.
It is possible that in the current study, patterns of responses may have differed by the context in
which professionals work, for example, rural versus urban location. For example, where travel
distances to clinics are greater and public transport options are more limited, professionals may have
more favourable views of technology, than in urban centres where travel to clinic locations is likely
to be less, with more transport options available. However, we did not collect this information, so
future studies are needed to explore this in more detail.
It was encouraging that in our study, frontline professionals were interested in learning about online
single session interventions (SSIs) for adolescent depression; this was partly due to the belief that
technology might be helpful for supporting adolescents with mild-moderate depression symptoms.
Interest in SSIs was unaffected by perceptions that technology might be less useful for more severe
depression symptoms and personal technological competence. SSIs were also regarded as useful one-
off, preventative, and educational resources for adolescents waiting for treatments and as a follow up for
those who have concluded treatment. As described above, staff shortages in mental health services may
explain why the majority professionals in the current study believe that technology can help to make up
for a lack of trained professionals, contrasting to previous findings (Cliffe et al., 2019). This may also
explain the interest in SSIs seen here. Their brief nature also means that SSIs can be developed and
adapted to cater to current topics of interest. Their adaptability, diversity and accessibility could mean
they can address young people’s needs whilst easing the demand on mental health services.
Loades et al. 11

Strengths and limitations

We recruited a wide range of non-specialist professionals who work with adolescents, with coverage
across different geographical areas of the UK. However, because we used convenience sampling,
those who chose to participate who were mainly younger and female, may not necessarily be
representative of the wider population of frontline professionals. Furthermore, we relied on self-
report measures, and most of our measures were brief to prioritize completion over comprehen-
siveness. We also used free text boxes to collect explanatory responses rather than in depth in-
terviews, which could be at the expense of detail, and we were not able to probe for further
information. When asked about referrals to CAMHS, it is possible that for some participants, this
was not an option, depending on service pathways and referral criteria in their local area. There was
also high attrition between starting the survey and completing the survey.

Conclusion
Technology seems to be acceptable to mental health professionals supporting adolescents with
depression, particularly adolescents with mild-moderate depression. The increased familiarity with/
reliance on technology during the COVID-19 pandemic may have increased clinicians’ under-
standing of and willingness to trust the use of technology in their practice. There was also interest in
the use of SSIs to support adolescents with depression. Technology, including SSIs may be
particularly helpful for prevention, early intervention or supporting those on waiting lists. Future
research should seek to further evaluate the use of SSIs for adolescent depression.

Acknowledgments
With thanks to all those who supported the conduct of this study, including Leah McGillivray and Amethyst
Cunningham.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or pub-
lication of this article: MEL (Advanced Fellowship 302929) is funded by the National Institute for Health
Research (NIHR) for this research project. The views expressed in this publication are those of the author(s) and
not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.

ORCID iDs
Maria E Loades  https://orcid.org/0000-0002-0839-3190
Bethany Cliffe  https://orcid.org/0000-0002-0520-3726

Supplemental Material
Supplemental material for this article is available online.
12 Clinical Child Psychology and Psychiatry 0(0)

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Author biographies
Maria E Loades is a Clinical Psychologist and Reader on the Doctorate in Clinical Psychology
programme at the University of Bath. She holds an NIHR Advanced Fellowship to investigate
improving access to timely help for adolescents with depression symptoms.
Dr Bethany Cliffe is a Research Fellow at the University of Southampton. Her research focuses on
digital interventions and mental health.
Grace Perry is an Assistant Psychologist at Outcomes First Group and a Research Assistant to Dr.
Maria Loades. She studied MSc Applied Clinical Psychology at the University of Bath in the
academic year 2022/23.