JMIR Publications

ABSTRACT

Background:

Depression, anxiety and related suicidal ideation and self-harm are common among adolescents, and have increased in prevalence and severity during the pandemic to crisis levels, exacerbated by the long-standing workforce shortage of child mental health professionals. As a result, primary care providers are often called on to provide first-line care for these youth. Digital health interventions extend mental health specialty care to youth with moderately severe symptoms, but few are evidence-based. Here, we describe the feasibility of delivering an evidence-based intervention that utilizes a relational conversational agent embedded in a smartphone application (app) to deliver cognitive behavioral therapy (CBT) to adolescents presenting to their PCP for treatment of moderately severe depression and/or anxiety.

Objective:

In this 12-week pilot randomized controlled study, we evaluated the feasibility of the app-based intervention to adolescents ages 13-17 years with moderate depressive symptoms presenting in ambulatory pediatric primary care clinics.

Methods:

We evaluated change in depressive symptom severity as measured by the 9-item Patient Health Questionnaire (PHQ-9), anxiety symptoms via the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and self-efficacy for mental health via the Mental Health Self-efficacy Scale (MHSES) at 4 and 12 weeks. Data on acceptability, feasibility and usability were collected from participants, and qualitative interviews were conducted with referring primary care providers (PCPs).

Results:

The pilot randomized 18 participants to treatment plus usual care (n=10) or usual care alone (n=8). There were no difference between groups on baseline characteristics, and all randomized participants completed the program. Although participants in the active treatment group experienced a greater reduction in depressive symptoms than the usual care group, mental health outcomes between groups was not statistically significant. Teen- and parent-reported usability, feasibility and acceptability of the app was high; PCPs reported preference for introducing the app early in the course of care for individuals presenting with mild or moderate symptoms.

Conclusions:

In this small randomized study, we demonstrated the feasibility, acceptability, usability and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in real-world primary care settings. Further study is needed to fully determine effectiveness of both the intervention and implementation in primary care settings. Clinical Trial: NCT04603053 (https://clinicaltrials.gov/ct2/show/NCT04603053)