Efficacy of Solution-Focused Brief Therapy versus case management for psychological distress in help-seeking adolescents and young adults in Singapore: protocol for a randomised controlled trial

Introduction: There are insufficient scalable, evidence-based treatments to meet the increasing mental health needs of young persons in Singapore. Offering interim, brief interventions for distressed treatment-seekers can improve care access and mitigate adverse effects of long waiting times. This study proposes to test the efficacy of Solution-Focused Brief Therapy (SFBT), a strengths-based, goal-directed intervention, for psychological distress in help-seeking adolescents and young adults. Methods: We will conduct a fully-powered, randomised, single-centre, two-armed, parallel, superiority, controlled trial. From September 2023 to March 2025, the study will recruit 124 participants (ages 16-30) presenting at a national youth mental health service in Singapore (CHAT, Centre of Excellence for Youth Mental Health) with clinically-assessed non-specific psychological distress, subthreshold or prodromal symptoms, or a first episode of a mood disorder. Participants will be excluded if they have high suicidal risk, psychosis, cognitive impairments, or current psychological treatments. Participants will be randomised in a 1:1 ratio to receive six-session, case manager-delivered SFBT or treatment as usual (TAU), case management. Participants receiving SFBT are hypothesized to have greater improvements in self-reported psychological distress, from baseline to eight weeks, compared to the control group. Secondary outcomes are self-reported depression and anxiety symptoms, and functional impairment. The study will additionally explore if SFBT is associated with: 1) increased self-efficacy and decreased hopelessness; 2) decreased downstream referrals at post-intervention; and 3) sustained clinical gains at three months post-intervention, compared to TAU. Significance: Results have implications for expanding capacity of mental health services and enhancing capabilities of frontline case managers to provide timely and low-intensity evidence-based interventions to improve the mental health of young persons in Singapore.