JMIR Publications

ABSTRACT

Background:

Anxiety and depression are common in adolescents, but adolescents are often uninterested in formal mental health treatments or are unable to access them. Digital interventions can be delivered at scale to bridge critical gaps in mental health care but must address the needs and preferences of adolescents.

Objective:

We recruited older adolescents (18 years of age) to participate in a series of human-centered design activities to inform both the design of digital mental health interventions for adolescents broadly as well as refinements to an automated text messaging intervention, Small Steps SMS, that was originally designed for young adults.

Methods:

Non-treatment engaged 18-year-olds in the USA with experiences of depression and/or anxiety were recruited through social media advertising and online self-screeners hosted by Mental Health America, a mental health advocacy organization. Participants (N=12) answered researcher prompts and engaged with one another in an asynchronous online discussion group for 24 days, with a new discussion prompt released every 3 days. In parallel, participants used Small Steps SMS, an automated text messaging intervention which delivers daily interactive dialogues supporting mental health self-management. Questions in the discussion group asked about mental health challenges, help-seeking attitudes, perceptions of Small Steps SMS, and ways the program and other digital mental health interventions should be adapted to the needs of older adolescents. A subset of participants (N=4) also completed interviews to elaborate on their responses. Thematic analysis was applied to transcripts of the discussion group and interviews to characterize user needs and design priorities when making Small Steps SMS and similar interventions available to adolescents.

Results:

Participants reported factors that contributed to their experience of mental health symptoms, including the transition from adolescence to adulthood, fears that the world is unstable and that their futures are uncertain, and ineffective use of social media for coping. Participants were proud of their generation’s mental health acceptance, but also observed a generational divide in mental health stigma and literacy that could impede seeking help from parents and other adults. Participants appreciated that Small Steps SMS allowed them to pursue mental health self-management conveniently and independently. They suggested that the program address adolescent-specific challenges and facilitate inter-generational communication about mental health. They also recommended possible ways to increase engagement through peer-to-peer communication, gamification, and greater explanation of self-management strategies.

Conclusions:

Major life transitions affect adolescents’ mental health needs and their preferences for digital mental health tools. While interactive automated messaging programs have potential to support self-management in this population, program content and features should be adapted to adolescents.