We also take referrals from a young persons drop in centre run by the local authority, situated in the centre of York, often accessed by young people who are out of school. Currently therefore, young people out of school with low mood are referred by these professionals. While we cannot guarantee Bay 43-9006 price that all such young people reach our service, it is set up to make it as accessible as possible. This provides a unique opportunity to monitor and assess any young person in our geographical area with low mood or depression. The PMHWs will assess all young people who present with any mood disorder referred through this system. Any young person with a mood disorder at assessment

would usually be referred to tier 2, 3 or 4 CAMHS by the PMHWs. During the study, young people who score 20 or above on the MFQ (a validated screening tool for this age group used in many research studies) will be referred to the trial by the PMHWs. They will be given an information leaflet with a copy for their parent/guardian and offered a place on the trial. Full informed

consent will be obtained from young people and, where a young person is under 16 years, their parent/guardian. Even with this comprehensive referral system, we have in place plans to conduct a second recruitment method within schools if we fail to meet our recruitment targets using the above outlined approach. Here, with informed consent from governing bodies/head teachers and local authority approval, we will recruit from local schools. In this way the study recruitment will rotate through the target schools. Children in year 7 to Upper Sixth between the ages of 12–18 in local secondary

schools will be screened using the MFQ and recruited systematically. The parents of all young people in year 7 to Upper Sixth in all recruiting schools will receive an information leaflet explaining the study to them. Participation is entirely voluntary, children and their families wishing to take part in the study will opt-in using the consent form and the stamped addressed envelope provided. Inclusion criteria Our target population will be adolescents aged 12–18 with low mood/depression. Our inclusion threshold will be a MFQ score of 20 or Carfilzomib above, which has 70% sensitivity and 81% specificity for any mood disorder.19 The cut-off for a major depressive episode is 29. We will also include participants with either comorbid physical illness or comorbid non-psychotic functional disorders, such as anxiety. Exclusion criteria We will exclude participants who are seeking to end their life, suffering psychotic symptoms or depressed in the postnatal period. Participants with previous depression or previous treatment with antidepressants or experience of cognitive therapy will not be excluded. We will exclude cases of psychotic depression, since computerised therapy for this group is not recommended within NICE guidance.20 Study design The study will be conducted between June 2011 and December 2014.