A Depression Prevention Intervention for Adolescents in the Emergency Department

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• 作者：Megan L. Ranney ; M.D. ; M.P.H.^a ; ^{mranney@lifespan.org" class="auth_mail" title="E-mail the corresponding author} ; Joshua R. Freeman ; M.P.H.^a ; ¹ ; Gerianne Connell^a ; Anthony Spirito ; Ph.D.^b ; Edward Boyer ; M.D. ; Ph.D.^c ; Maureen Walton ; Ph.D.^d ; Kate Morrow Guthrie ; Ph.D.^b ; Rebecca M. Cunningham ; M.D.^d
• 关键词：Adolescents ; Health promotion ; Text messaging ; Behavior change ; Depression ; Mixed methods
• 刊名：Journal of Adolescent Health
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：59
• 期：4
• 页码：401-410
• 全文大小：946 K

文摘

To evaluate acceptability and feasibility of a theoretically based two-part (brief in-person + 8-week automated text message) depression prevention program, “intervention for DepressiOn and Violence prevention in the Emergency department” (iDOVE), for high-risk adolescents.

Methods

English-speaking emergency department (ED) patients (age 13–17, any chief complaint) were sequentially approached for consent on a convenience sample of shifts and screened for inclusion based on current depressive symptoms and past-year violence. After consent, baseline assessments were obtained; all participants were enrolled in the two-part intervention (brief in-ED + 8-week two-way text messaging). At 8 weeks, quantitative and qualitative follow-up assessments were obtained. Measures included feasibility, acceptability, and preliminary data on efficacy. Qualitative data were transcribed verbatim, double coded, and interpreted using thematic analysis. Quantitative results were analyzed descriptively and with paired t tests.

Results

As planned, 16 participants (eight each gender) were recruited (75% of those who were eligible; 66% nonwhite, 63% low income, mean age 15.4). The intervention had high feasibility and acceptability: 93.8% completed 8-week follow-up; 80% of daily text messages received responses; 31% of participants requested ≥1 “on-demand” text message. In-person and text message portions were rated as good/excellent by 87%. Qualitatively, participants articulated: (1) iDOVE was welcome and helpful, if unexpected in the ED; (2) the daily text message mood assessment was “most important”; (3) content was “uplifting”; and (4) balancing intervention “relatability” and automation was challenging. Participants' mean ΔBDI-2 (Beck Depression Inventory) from baseline to 8-week follow-up was −4.9, (p = .02).

Conclusions

This automated preventive text message intervention is acceptable and feasible. Qualitative data emphasize the importance of creating positive, relevant, and interactive digital health tools for adolescents.