J. Med. Internet Res. - Self-monitoring using mobile phones in the early stages of adolescent depression: randomized controlled trial.


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CKGROUND: 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 (2 )=.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).

Resumo Limpo

ckground steppedcar approach peopl earli symptom depress step lowintens intervent higherlevel intervent need potenti assist mani peopl mild depress symptom selfmonitor techniqu assist peopl understand mental health symptom increas emot selfawar esa can easili distribut mobil phone low cost increas esa import first step psychotherapi potenti interven mild depress symptom progress major depress disord secondari analysi examin mobil phone selfmonitor tool use young peopl experienc mild depress symptom investig relationship selfmonitor esa depressionobject test two main hypothes peopl monitor mood stress cope strategi increas esa pretest week followup compar attent comparison group increas esa predict decreas depress symptomsmethod recruit patient age year rural metropolitan general practic elig particip identifi mild mental health concern general practition particip random assign either intervent group mood stress daili activ monitor attent comparison group daili activ monitor group selfmonitor week random carri electron via random seed generat inhous comput programm therefor general practition particip research blind group alloc random particip complet pretest posttest week followup measur depress anxieti stress scale esa scale estim parallel process latent growth curv model lgcm use mplus test indirect effect intervent depress symptom via mediat esa calcul biascorrect bootstrap confid interv cisresult particip assess elig random assign includ analys intervent group comparison group parallel process lgcm estim indirect effect intervent depress symptom via esa shown statist signific base biascorrect bootstrap cis contain zero proport maximum possibl indirect effect estim ci conclus studi support hypothesi selfmonitor increas esa turn decreas depress symptom young peopl mild depress symptom mobil phone selfmonitor program ideal suit firststep intervent program depress steppedcar approach particular esa target mediat factortri registr clinicaltrialsgov nct httpclinicaltrialsgovctshownct archiv webcit httpwwwwebcitationorglldwk

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