A Depression Prevention Intervention for Adolescents in the Emergency Department

Abstract

PURPOSE To evaluate acceptability and feasibility of a theoretically-based two-part (brief in-person + eight-week automated text-message) depression prevention program, “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 & 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 was transcribed verbatim, double-coded and interpreted using thematic analysis. Quantitative results were analyzed descriptively and with paired t-tests. RESULTS As planned, 16 participants (8 each gender) were recruited (75% of those who were eligible; 66% non-white, 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”; (4) balancing intervention “relatability” and automation was challenging. Participants’ mean ΔBDI-2 from baseline to eight-week follow-up was −4.9 (p=0.02). 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.

Texting to Increase Contraceptive Initiation Among Adolescents in the Emergency Department

“…Recent literature suggests that pushing noninteractive messages to older teens with repetitive information or too often might cause disinterest [15]. The future of texting interventions may lie with innovative, bidirectional, tailored messaging, which changes behavior by creating an automated yet engaging conversation [4,5,7]. …”

“…Text messaging (TM) has the potential to lead to behavior change, although little data from patients in the ED exist [4–7]. Our objective was to determine the feasibility and acceptability of an ED-based texting intervention to increase contraception initiation among adolescent females at high risk of pregnancy.…”

Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test (Preprint)

“…Most interventions delivered through text messaging to youth in clinical populations have not harnessed the potential of the medium for interactive communication, instead using one-way messaging or reminders to reinforce behaviors and direct the attention of participants towards core intervention concepts. One exception to this trend is the iDOVE program [18,19] which made limited use of interactivity, providing CBT coaching to adolescents with depressive symptoms who presented in a general emergency department. In response to automated daily prompts, participants could receive a single automated daily message, or could initiate the receipt of a single additional support message if they were feeling sad, angry, or stressed.…”

“…A pilot test of an automated text-based intervention for adolescents who screened positive for depression and past-year violence in an emergency department was well-received by patients and promising in terms of symptom improvement [18,19]. Few texting interventions aimed at youth in the general population (outside of clinical contexts) have been tested for efficacy.…”

Prevention of Depression: A Review of Literature

“…A recent study, involving adolescents attending emergency department at risk of depression, has shown that brief in-person discussion in the emergency, followed by 8-week automated messaging intervention is feasible and acceptable [65]. Telephone calls has also been used to deliver these interventions for older patients unable to attend the clinic due to pain [58].…”