JMIR Publications

ABSTRACT

Background:

The adolescent mental health crisis reached a crescendo during the pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that, with proper training and supervision, youth mentors can work with youth with mental health challenges like depression and anxiety and can even support use of evidence-based strategies like Cognitive Behavioral Therapy. In our increasingly connected world, youth mentors can meet with youth virtually anywhere and at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based skills for addressing depression and anxiety like CBT more accessible than ever. As such, when trained and supervised by licensed clinicians, youth mentors are an untapped resource to support youth with mental health challenges in using evidence-based skills to reduce symptoms of depression and anxiety.

Objective:

The objective of this study was to develop and assess feasibility and acceptability of Appa Health (“Appa”), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development and pilot testing process of Appa’s 12-week smartphone application program aiming to combine virtual near-peer mentorship with short-form TikTok-style videos teaching CBT skills, created by licensed mental health professionals who are also social media influencers.

Methods:

The development and testing process was executed through collaboration with key stakeholders, including youth, clinical, and research advisory boards. In the pilot study, youth experiencing symptoms of depression or anxiety (n = 14) as assessed by standard clinical measures were paired with a mentor (n = 10) based on preferred characteristics such as gender, race/ethnicity, and LGBTQ status. Quantitative survey data about youth characteristics, mental health, and well-being, as well as feasibility and reflections on the helpfulness of the program, were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content.

Results:

Participants reported finding Appa helpful, with 100% of youth expressing that they felt better after the 12-week program. Over 85% said they would strongly recommend the program to a friend. Youth were engaged, video chatting with their mentor consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from Week 1 to Week 12, supporting youth qualitative report that mentoring combined with the CBT strategies could positively impact youth mental health.

Conclusions:

Appa Health is a novel smartphone application aiming to improve youth well-being and reduce anxiety and depressive symptoms through virtual mentoring and engaging CBT video content. This formative research sets the stage for a large-scale RCT recently funded by the National Institutes of Health (NIH) Small Business Innovation Research (SBIR) program.