Sylvia Kauer

Self-monitoring Using Mobile Phones in the Early Stages of Adolescent Depression: Randomized Controlled Trial

Background The stepped-care approach, where people with early symptoms of depression are stepped up from low-intensity interventions to higher-level interventions as needed, has the potential to assist many people with mild depressive symptoms. Self-monitoring techniques assist people to understand their mental health symptoms by increasing their emotional self-awareness (ESA) and can be easily distributed on mobile phones at low cost. Increasing ESA is an important first step in psychotherapy and has the potential to intervene before mild depressive symptoms progress to major depressive disorder. In this secondary analysis we examined a mobile phone self-monitoring tool used by young people experiencing mild or more depressive symptoms to investigate the relationships between self-monitoring, ESA, and depression. Objectives We tested two main hypotheses: (1) people who monitored their mood, stress, and coping strategies would have increased ESA from pretest to 6-week follow-up compared with an attention comparison group, and (2) an increase in ESA would predict a decrease in depressive symptoms. Methods We recruited patients aged 14 to 24 years from rural and metropolitan general practices. Eligible participants were identified as having mild or more mental health concerns by their general practitioner. Participants were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored), and both groups self-monitored for 2 to 4 weeks. Randomization was carried out electronically via random seed generation, by an in-house computer programmer; therefore, general practitioners, participants, and researchers were blinded to group allocation at randomization. Participants completed pretest, posttest, and 6-week follow-up measures of the Depression Anxiety Stress Scale and the ESA Scale. We estimated a parallel process latent growth curve model (LGCM) using Mplus to test the indirect effect of the intervention on depressive symptoms via the mediator ESA, and calculated 95% bias-corrected bootstrapping confidence intervals (CIs). Results Of the 163 participants assessed for eligibility, 118 were randomly assigned and 114 were included in analyses (68 in the intervention group and 46 in the comparison group). A parallel process LGCM estimated the indirect effect of the intervention on depressive symptoms via ESA and was shown to be statistically significant based on the 95% bias-corrected bootstrapping CIs not containing zero (–6.366 to –0.029). The proportion of the maximum possible indirect effect estimated was κ2 =.54 (95% CI .426–.640). Conclusions This study supported the hypothesis that self-monitoring increases ESA, which in turn decreases depressive symptoms for young people with mild or more depressive symptoms. Mobile phone self-monitoring programs are ideally suited to first-step intervention programs for depression in the stepped-care approach, particularly when ESA is targeted as a mediating factor. Trial Registration ClinicalTrials.gov NCT00794222; http://clinicaltrials.gov/ct2/show/NCT00794222 (Archived by WebCite at http://www.webcitation.org/65lldW34k)

A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial

BackgroundOver 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review.MethodsWe conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale.ResultsOf the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes.ConclusionsMonitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole.Trial RegistrationClinicalTrials.gov NCT00794222.

Do Online Mental Health Services Improve Help-Seeking for Young People? A Systematic Review

Background Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people. Objective This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years. Results Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified. Conclusions Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people.

Temporal mood changes associated with different levels of adolescent drinking: using mobile phones and experience sampling methods to explore motivations for adolescent alcohol use

INTRODUCTION AND AIMS Alcohol use during adolescence is associated with the onset of alcohol use disorders, mental health disorders, substance abuse as well as socially and physically damaging behaviours, the effects of which last well into adulthood. Nevertheless, alcohol use remains prevalent in this population. Understanding motivations behind adolescent alcohol consumption may help in developing more appropriate and effective interventions. This study aims to increase this understanding by exploring the temporal relationship between mood and different levels of alcohol intake in a sample of young people. DESIGN AND METHODS Forty-one secondary school students used a purpose-designed mobile phone application to monitor their daily mood and alcohol use for 20 random days within a 31 day period. Generalised estimating equations were used to examine the relationship between differing levels of alcohol consumption (light, intermediate and heavy) and positive and negative mood three days before and after drinking episodes. RESULTS While there was no relationship between light and heavy drinking and positive mood, there was an increase in positive mood before and after the drinking event for those that drank intermediate amounts. No statistically significant relationships were found between negative mood and any of the three drinking categories. DISCUSSION AND CONCLUSION Adolescents who drank in intermediate amounts on a single drinking occasion experienced an increase in positive mood over the three days leading up to and three days following a drinking event. These findings contribute to an understanding of the motivations that underpin adolescent alcohol use, which may help inform future interventions.

Health profiles of overweight and obese youth attending general practice

Background Literature suggests that overweight and obese young people use healthcare services more often, but this awaits confirmation in primary care. Objective To identify health profiles of underweight, overweight and obese young people attending general practice and compare them to normal-weight youth and also to explore the weight-related health risks of eating and exercise behaviour in the four different weight categories. Methods This study used a cross-sectional design with baseline data from a trial including 683 young people (14–24 years of age) presenting to general practice. Through computer-assisted telephone interviews data were obtained on number and type of health complaints and consultations, emotional distress, health-related quality of life (HRQoL) and eating and exercise behaviour. Results General practitioners (GPs) were consulted more often by overweight (incidence rate ratio (IRR): 1.28, 95% CI (1.04 to 1.57)) and obese youth (IRR: 1.54, 95% CI (1.21 to 1.97), but not for different health problems compared with normal-weight youth. The reason for presentation was seldom a weight issue. Obese youth reported lower physical HRQoL. Obese and underweight youth were less likely to be satisfied with their eating behaviour than their normal-weight peers. Exercise levels were low in the entire cohort. Conclusions Our study highlights the need for effective weight management given that overweight and obese youth consult their GP more often. Since young people do not present with weight issues, it becomes important for GPs to find ways to initiate the discussion about weight, healthy eating and exercise with youth. Trial registration number ISRCTN16059206.

Facilitating mental health help seeking in young adults: the underlying theory and development of an online navigation tool

ABSTRACT Objective: This paper describes the theoretical basis of the Link program, a world-first dedicated online navigation tool to facilitate mental health help-seeking for young adults. Method: Several theories of help-seeking and behaviour change were explored to determine a useful theoretical framework for the Link program, a world-first dedicated online navigation tool to facilitate mental health help-seeking for young adults. Results: Four commonly used theories of behavioural change were examined with the Theory of Planned Behaviour found to best match the objectives of the Link program. Previous interventions aimed at increasing help-seeking behaviour and intentions using the Theory of Planned Behaviour found that attitudes, subjective norms, and perceived control beliefs have a role in help-seeking. Combined with elements of the Help Seeking Model, due to its specificity in mental health help-seeking, the Theory of Planned Behaviour was selected as the theoretical framework of the Link program. The resultant prototype allows young adults to enter information about an issue they are facing, the severity of the issue, and the type of services they prefer. Recommendations for information or services are then presented based upon these individual needs. Discussion: Little is known about the effects online services have on emotional affect and whether these services facilitate help-seeking in young people. Detailed description of this developmental work will assist in understanding the mechanisms underpinning the Link program. Further research will evaluate the effectiveness of the Link program in improving help-seeking, emotions, and mental health outcomes.

Designing a health screening tool to help young people communicate with their general practitioner

Adolescence is an important developmental period for physical, cognitive, social and emotional development when a wide range of health problems and risky health-related behaviours may emerge and co-occur. General Practitioners (GPs) are ideally positioned to deliver preventive health and early intervention as part of young peoples routine health care. A quick and effective way for GPs to identify areas of concern is through technology-based health screening tools, which are acceptable to young people and facilitate self-disclosure about sensitive topics. Despite these advantages, the rate of using this technology remains low. This is the first study that involves all end users and stakeholders in the design of a health screening technology for young people in general practice settings. Our rich findings on the design needs and concerns of young people, GPs, practice staff and parents regarding technologies for health communication will be useful to any researchers and practitioners designing health technologies in a general practice setting.

P01-307-Emotional self-awareness: preliminary analyses of a rct using a cellular phone self-monitoring program (mobiletype) to decrease early symptoms of depression

Background Behavioural therapy often involves self-monitoring techniques to increase awareness about mood and stressful events. In turn, emotional self-awareness is likely to decrease symptoms of depression. Self monitoring also has potential as an early intervention tool for young people, particularly when mobile phones are used as a medium. Previous qualitative research indicates that self-monitoring via mobile phones increase emotional self-awareness with five categories proposed: awareness, identification, communication, contextualisation and decision-making. Aims This RCT investigates the relationships between self-monitoring, emotional self-awareness and depression using an early intervention mobile phone self-monitoring tool with young people at risk of developing depression. Methods Young people (between 14 and 24 years of age) identified by their GP as being at risk of depression were recruited by GPs in rural and metropolitan Victoria and randomly assigned to either the intervention group (where they monitored their mood, stress and daily activities) or the comparison group (where the questions about mood and stress were excluded). Participants completed baseline and follow-up measures of depression as well as measures of emotional self-awareness. Results Results will be presented on the effects of self-monitoring on emotional self-awareness, the effects of self-monitoring on depression, anxiety and stress and the relationship between emotional self-awareness and depression, anxiety and stress. Conclusion Emotional self-awareness as a mediator in the relationship between self-monitoring and depression will be discussed focusing on the relationships between (i) self-monitoring, (ii) emotional self-awareness and (iii) symptoms of depression, anxiety and stress. Possible avenues for early intervention are suggested.

Facilitating mental health help-seeking by young adults with a dedicated online program: a feasibility study of Link

Objective To explore the feasibility of a dedicated online youth mental health help-seeking intervention and to evaluate using a randomised controlled trial (RCT) study design in order to identify any modifications needed before commencement of the full-scale RCT. Design A pilot RCT with 1:1 randomisation to either the intervention or comparison arm. Setting An online study conducted Australia-wide. Participants 18–25 year olds living in Australia were recruited via social media. Intervention Link is a dedicated online mental health help-seeking navigation tool that matches user’s mental health issues, severity and service-type preferences (online, phone and face-to-face) with appropriate youth-friendly services. The comparison arm was usual help-seeking strategies with a link to Google.com. Main outcome measures The primary outcome was the number of acceptability and feasibility criteria successfully met. Intervention and study design acceptability and feasibility were assessed by nine criteria. Secondary outcomes, via online surveys (at baseline, 1 week and 1 month) measured service use, help-seeking intentions, psychological distress, barriers to help-seeking, attitudes towards mental health help-seeking, mental health literacy, satisfaction and trust. Results Fifty-one participants were randomised (intervention: n=24; comparison: n=27). Three out of four of the intervention and two out of five of the study design criteria were met. Unmet criteria could be addressed by modifications to the study design. Qualitative analysis demonstrated that Link was useful to participants and may have increased their positive experiences towards help-seeking. There were no observable differences between arms in any outcome measures and no harms were detected. Conclusion Generally, the Link intervention and study design were acceptable and feasible with modifications suggested for the four out of nine unmet criteria. The main trial will hence have shorter surveys and a simpler recruitment process, use positive affect as the primary outcome and will not link to Google.com for the comparison arm. Trial registration number Australian New Zealand Clinical Trials Registry, ACTRN12614000386639.

FC27-06 - Using mobile phones to detect, treat, and manage adolescent mental halth: A randomised controlled trial of the mobiletype program in rural and metro primary care

The mobiletype program is a cell/mobile phone mental health assessment and management tool designed specifically for young people aged 14–24 years to assist in detecting, managing, and treating of youth mental health problems. The mobiletype self-starts 4 times per day and the patient completes a brief survey of their current mood, stresses, coping, alcohol and cannabis use, exercise, sleeping and eating patterns. This data is transmitted in real- time to a website interface which collates it and produces individual reports for young people to share with their doctor. Methods 118 young people identified with mild or more mental health symptoms were blindly randomly allocated at the individual level, to either the intervention group (mobiletype plus usual care) or the comparison group (abbreviated mobiletype plus usual care) according to CONSORT guidelines. Participants and doctors completed baseline and follow-up questionnaires measuring mental health, patient-doctor relationship, and pathways to care (i.e. referrals, medication, and testing). Participants were followed-up at 6 weeks and 6 months. Results Results from fixed effects analyses of covariance examining the differences between the experimental and control groups on the main outcome measures, with the baseline values as the covariates will be presented. The extent to which the mobiletype program reduces mental health symptoms, enhances the patient-doctor relationship and assists patients in pathways to care will be explored in detail. Conclusions Mobile and new information and connected technologies have much to offer clinical care in terms of increased efficiencies in data collection, increased engagement of participants and overall enhanced care.