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.

[1]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[2]  Anthony F Jorm,et al.  An analysis of the re-test artefact in longitudinal studies of psychiatric symptoms and personality , 1989, Psychological Medicine.

[3]  E. Frydenberg,et al.  Adolescent coping: the different ways in which boys and girls cope. , 1991, Journal of adolescence.

[4]  Jacob Cohen,et al.  A power primer. , 1992, Psychological bulletin.

[5]  O. Aasland,et al.  Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. , 1993, Addiction.

[6]  John R. Seeley,et al.  Erratum: Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students (Journal of Abnormal Psychology 102:1 (133-144)) , 1993 .

[7]  P. Lewinsohn,et al.  Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. , 1993, Journal of abnormal psychology.

[8]  E. Frydenberg,et al.  Boys play sport and girls turn to others: age, gender and ethnicity as determinants of coping. , 1993, Journal of adolescence.

[9]  J. Mayer,et al.  An Emerging Understanding of the Reflective (Meta-) Experience of Mood , 1994 .

[10]  P. Lovibond,et al.  The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. , 1995, Behaviour research and therapy.

[11]  J. Carlin,et al.  Patterns of common drug use in teenagers. , 2010, Australian Journal of Public Health.

[12]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[13]  Donald Hedeker,et al.  Application of random-efiects pattern-mixture models for miss-ing data in longitudinal studies , 1997 .

[14]  K. Wells,et al.  Evidence-based care for depression in managed primary care practices. , 1999, Health affairs.

[15]  N. Black,et al.  Patient determinants of mental health interventions in primary care. , 2000, The British journal of general practice : the journal of the Royal College of General Practitioners.

[16]  C. Sherbourne,et al.  Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. , 2000, JAMA.

[17]  N. Kazantzis.  Power to detect homework effects in psychotherapy outcome research. , 2000, Journal of consulting and clinical psychology.

[18]  Anthony F Jorm,et al.  Mental health literacy , 2000, British Journal of Psychiatry.

[19]  K. Fielding,et al.  Do the attitudes and beliefs of young teenagers towards general practice influence actual consultation behaviour? , 2000, The British journal of general practice : the journal of the Royal College of General Practitioners.

[20]  I. Hickie,et al.  Conclusions about the assessment and management of common mental disorders in Australian general practice , 2001, The Medical journal of Australia.

[21]  D. Moher,et al.  The Revised CONSORT Statement for Reporting Randomized Trials: Explanation and Elaboration , 2001, Annals of Internal Medicine.

[22]  G. Andrews,et al.  Interpreting scores on the Kessler Psychological Distress Scale (K10) , 2001, Australian and New Zealand journal of public health.

[23]  L. Vitetta,et al.  Does drinking carrot juice affect cancer of the prostate? , 2001, The Medical journal of Australia.

[24]  L. Oakley,et al.  Health promotion for adolescents in primary care: randomised controlled trial , 2002, BMJ : British Medical Journal.

[25]  G. Andrews,et al.  Preventing major depression in young people , 2002, British Journal of Psychiatry.

[26]  David J Miklowitz,et al.  Psychosocial intervention development for the prevention and treatment of depression: promoting innovation and increasing access , 2002, Biological Psychiatry.

[27]  A. Grant,et al.  The Self-Reflection and Insight Scale: A new measure of private self-consciousness , 2002 .

[28]  D. Torgerson,et al.  Evidence for risk of bias in cluster randomised trials: review of recent trials published in three general medical journals , 2003, BMJ : British Medical Journal.

[29]  Simon Gilbody,et al.  Educational and organizational interventions to improve the management of depression in primary care: a systematic review. , 2003, JAMA.

[30]  R. Kane,et al.  The Prevention of Depressive Symptoms in Rural School Children: A Follow-up Study , 2004 .

[31]  D. Rickwood,et al.  Educating Young People about Mental Health and Mental Illness: Evaluating a School - Based Programme , 2004 .

[32]  S. Nolen-Hoeksema,et al.  Rumination Reconsidered: A Psychometric Analysis , 2003, Cognitive Therapy and Research.

[33]  G. Elwyn,et al.  BMC Family Practice , 2005 .

[34]  P. Truax,et al.  The differential effects of weekly, monthly, and bimonthly administrations of the beck Depression Inventory-II: Psychometric properties and clinical implications , 2005 .

[35]  F. Abueg,et al.  A study of reactivity: The effects of increased relevance and saliency of self-monitored smoking through enhanced carbon monoxide feedback , 1985, Cognitive Therapy and Research.

[36]  Olga V. Demler,et al.  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[37]  Craig K. Ewart.  Self-observation in natural environments: Reactive effects of behavior desirability and goal-setting , 1978, Cognitive Therapy and Research.

[38]  I. Hickie,et al.  Australian mental health reform: time for real outcomes , 2005, The Medical journal of Australia.

[39]  Alaattin Erkanli,et al.  Is there an epidemic of child or adolescent depression? , 2006, Journal of child psychology and psychiatry, and allied disciplines.

[40]  Understanding how young people cope with distress: the development of a mobile phone momentary sampling program (Mobile_TYPE) , 2006, Acta Neuropsychiatrica.

[41]  C. Gross,et al.  Design of control-group conditions in clinical trials of behavioral interventions. , 2007, Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing.

[42]  I. Hickie,et al.  Responding to experiences of young people with common mental health problems attending Australian general practice , 2007, The Medical journal of Australia.

[43]  Matthew S. Fritz,et al.  PSYCHOLOGICAL SCIENCE Research Article Required Sample Size to Detect the Mediated Effect , 2022 .

[44]  W. Gardner,et al.  Trial of Computerized Screening for Adolescent Behavioral Concerns , 2008, Pediatrics.

[45]  Jason Martin,et al.  Identity construction on Facebook: Digital empowerment in anchored relationships , 2008, Comput. Hum. Behav..

[46]  S. Walsh,et al.  Over-connected? A qualitative exploration of the relationship between Australian youth and their mobile phones. , 2008, Journal of adolescence.

[47]  Wonca Uk,et al.  Integrating mental health into primary care: a global perspective. , 2008 .

[48]  George C. Patton,et al.  A mobile phone program to track young people’s experiences of mood, stress and coping , 2009, Social Psychiatry and Psychiatric Epidemiology.

[49]  P. Bower,et al.  The General Practice Assessment Questionnaire (GPAQ) – Development and psychometric characteristics , 2008, BMC family practice.

[50]  Lena Sanci,et al.  Investigating the utility of mobile phones for collecting data about adolescent alcohol use and related mood, stress and coping behaviours: lessons and recommendations. , 2009, Drug and alcohol review.

[51]  Eric Stice,et al.  A meta-analytic review of depression prevention programs for children and adolescents: factors that predict magnitude of intervention effects. , 2009, Journal of consulting and clinical psychology.

[52]  A. Hayes.  Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium , 2009 .

[53]  G. Patton,et al.  The identification of young people's emotional distress: a study in primary care. , 2009, The British journal of general practice : the journal of the Royal College of General Practitioners.

[54]  G. R. Gladstone,et al.  Use of inexpensive technology to enhance adolescent health screening and counseling. , 2009, Archives of pediatrics & adolescent medicine.

[55]  General practice and e‐health reform , 2010, The Medical journal of Australia.

[56]  T. Kaptchuk,et al.  Biological, clinical, and ethical advances of placebo effects , 2010, The Lancet.

[57]  P. Cuijpers,et al.  Stepped care for depression in primary care: what should be offered and how? , 2010, The Medical journal of Australia.

[58]  G. Patton,et al.  A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype , 2013, BMC Family Practice.