BackgroundTreatments for depression and anxiety have several behavioral and psychological targets and rely on varied strategies. Digital mental health treatments often employ feature-rich approaches addressing several targets and strategies. These treatments, often optimized for desktop computer use, are at odds with the ways people use smartphone applications. Smartphone use tends to focus on singular functions with easy navigation to desired tools. The IntelliCare suite of apps was developed to address the discrepancy between need for diverse behavioral strategies and constraints imposed by typical app use. Each app focuses on one strategy for a limited subset of clinical aims all pertinent to depression and anxiety. This study presents the uptake and usage of apps from the IntelliCare suite following an open deployment on a large app marketplace.MethodsThirteen lightweight apps, including 12 interactive apps and one Hub app that coordinates use across those interactive apps, were developed and made free to download on the Google Play store. De-identified app usage data from the first year of IntelliCare suite deployment were analyzed for this study.ResultsIn the first year of public availability, 5210 individuals downloaded one or more of the IntelliCare apps, for a total of 10,131 downloads. Nearly a third of these individuals (31.8%) downloaded more than one of these apps. The modal number of launches for each of the apps was 1, however the mean number of app launches per app ranged from 3.10 to 16.98, reflecting considerable variability in the use of each app.ConclusionsThe use rate of the IntelliCare suite of apps is higher than public deployments of other comparable digital resources. Our findings suggest that people will use multiple apps and provides support for the concept of app suites as a useful strategy for providing diverse behavioral strategies.

BackgroundThe ability to successfully recruit participants for electronic health (eHealth) clinical trials is largely dependent on the use of efficient and effective recruitment strategies. Determining which types of recruitment strategies to use presents a challenge for many researchers.ObjectiveThe aim of this study was to present an analysis of the time-efficiency and cost-effectiveness of recruitment strategies for eHealth clinical trials, and it describes a framework for cost-effective trial recruitment.MethodsParticipants were recruited for one of 5 eHealth trials of interventions for common mental health conditions. A multipronged recruitment approach was used, including digital (eg, social media and Craigslist), research registry-based, print (eg, flyers and posters on public transportation), clinic-based (eg, a general internal medicine clinic within an academic medical center and a large nonprofit health care organization), a market research recruitment firm, and traditional media strategies (eg, newspaper and television coverage in response to press releases). The time costs and fees for each recruitment method were calculated, and the participant yield on recruitment costs was calculated by dividing the number of enrolled participants by the total cost for each method.ResultsA total of 777 participants were enrolled across all trials. Digital recruitment strategies yielded the largest number of participants across the 5 clinical trials and represented 34.0% (264/777) of the total enrolled participants. Registry-based recruitment strategies were in second place by enrolling 28.0% (217/777) of the total enrolled participants across trials. Research registry-based recruitment had a relatively high conversion rate from potential participants who contacted our center for being screened to be enrolled, and it was also the most cost-effective for enrolling participants in this set of clinical trials with a total cost per person enrolled at US $8.99.ConclusionsOn the basis of these results, a framework is proposed for participant recruitment. To make decisions on initiating and maintaining different types of recruitment strategies, the resources available and requirements of the research study (or studies) need to be carefully examined.

The current study examined the unique and interactive effects of family and community violence across types of violence (weapon, physical, and death) and relationship proximity (self, family/friend, and strangers) in African American adolescents (mean age = 12.63, SD = 0.99, 54% female). Items from the community violence and family violence measures were categorized into a three-factor model of cross-contextual violence exposure that characterized violence by type and relationship proximity. Results of structural equation modeling showed that the proposed model fit the current data, and all three factors of violence significantly predicted symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). Exposure to violence directed at a friend or family member significantly predicted anxiety beyond the other domains. The interaction between being victimized and the victimization of acquaintances or strangers predicted depressive symptoms. Finally, latent profile analysis revealed a two-class model: low-exposure and high-exposure groups, with the high-exposure group reporting more mental health symptoms.

BackgroundThere is an ongoing need for effective and accessible preventive interventions for adolescent depression and substance abuse. This paper reports on a field trial of an online indicated preventive intervention, ProjectTECH, which is based on cognitive-behavioral therapy (CBT) techniques. The study aims to gather information about the feasibility and acceptability of this program. Secondary aims of this study were to examine the impact of the program on depression symptoms, perceived stress, positive affect, and substance use and to compare differences between groups that were led by a peer versus those that were led by a licensed clinician.MethodsHigh school students (n = 39) were recruited primarily through social media advertisements, and assigned to four groups of 8–12 individuals to collaboratively participate in an 8 week peer network-based online preventive intervention which were led by a trained peer guide or a licensed clinician. Participants were provided with didactic lessons, CBT-based mood management tools, and peer networking features, and completed quantitative and qualitative feedback at baseline, midpoint, end of intervention, and 1 month follow-up.ResultsThe program attracted and retained users primarily from social media and was used frequently by many of the participants (system login M = 25.62, SD = 16.58). Participants rated the program as usable, and offered several suggestions for improving the program, including allowing for further personalization by the individual user, and including more prompts to engage with the social network. From baseline to end of intervention, significant decreases were observed in depressive symptoms and perceived stress (p's < 0.05). Significant increases in positive affect were observed from baseline to midpoint (p < 0.05) and no changes were observed in substance use, although the rate of substance use was low in this sample. While this study had low power to detect group differences, no consistent differences were observed between participants in a peer-led group and those in a clinician-led group.ConclusionsResults of this study indicate that ProjectTECH, an indicated preventive intervention for high school-aged adolescents, demonstrates both feasibility, acceptability, and short-term, longitudinal psychological benefits for participants. Future iterations of the program may benefit from close attention to user interface design and the continued use of trained peer support guides.

Objective: Guided by continuous traumatic stress theory (Eagle & Kaminer, 2013) and trauma coping theory (Ford et al., 2006), the present study examined hostility and callous-unemotional traits as mediators between chronic community violence exposure in adolescence and violent offending in early adulthood. Method: Baseline surveys and data over 5 years (8 follow-up time points) were analyzed from 1,354 justiceinvolved adolescents (86% male) Ages 14-19 (M = 16.04, SD = 1.14) in the Pathways to Desistance Project. Results: Results demonstrated that callous-unemotional traits, but not hostility, mediated the association between violence exposure and aggressive offending such that increased chronic violence exposure predicted increases in callous-unemotional traits, and subsequent increased aggressive offending. Moderated mediation analyses revealed that the association between chronic violence (both witnessed and victimization) and callous-unemotional traits was stronger for males and females who were younger at the time of their first offense. When gender was examined as a moderator, the callous-unemotional traits mediation model was significant for males, but not for females. However, the interaction effects between gender and chronic violence exposure were not significant at the more stringent p < .01 level. Conclusions: Findings call attention to the need to reduce youth exposure to violence via community-based crime prevention. For youth who are already justice-involved, trauma-informed personality assessments and interventions that build emotion regulation and healthy interpersonal interactions may help reduce recidivism rates. These community and therapeutic interventions may decrease future aggressive offending as youth age into early adulthood.