Intervention to Prevent Peer Violence & Depressive Symptoms Among At-Risk Adolescents (iDOVE2)

A Technology-Augmented Intervention to Prevent Peer Violence & Depressive Symptoms Among At-Risk Emergency Department Adolescents

The purpose of this investigation is to test the efficacy of "iDOVE2" (a brief emergency department introductory session and longitudinal automated text-message depression prevention program for high-risk teens), and to determine the most potent and parsimonious combination of intervention components for preventing peer violence and depressive symptoms among at-risk youth.

Study Overview

• Status: Completed
• Conditions: Depressive Disorder; Violence
• Intervention / Treatment: Behavioral: + Brief ED Intervention (BI); Behavioral: + Text

Detailed Description

Peer violence and depressive symptoms have mutual, reinforcing negative impacts on teens' emotional and behavioral regulation strategies.

The emergency department (ED) is the primary source of care for many high-risk teens. It provides an opportunity to initiate preventive interventions, to complement existing mental health treatment or to stand alone for those who may lack access to formal care. Personalized text-message interventions are accessible, feasible, and may be effective with these adolescents.

The purpose of this study is to expand on the PI's pilot randomized controlled trial (RCT) of iDOVE (K23 MH095866; PI: Ranney) by testing the efficacy of "iDOVE2" (a brief emergency department introductory session and longitudinal automated text-message depression prevention program for high-risk teens). The investigators will use a 2x2 factorial design to determine the most potent and parsimonious combination of intervention components for preventing peer violence and depressive symptoms among at-risk youth.

Participants will be identified in the course of usual clinical care in the ED. If eligible, parents will be consented and participants assented. Participants will complete a baseline assessment and will be randomized to one of four groups: Brief ED Intervention (BI) + Text; BI + No Text; No BI + Text; or No BI + No Text. Youth in the Text arm who show no signal of improvement at 7 days, per daily self-reported mood ratings, will be re-randomized to additional "LiveText" (once-weekly real-time micro-counseling via text) or to continue with standard, automated Text intervention curriculum.

At baseline and follow-ups at 2 months, 4 months, and 8 months, participants will complete assessments on depressive symptoms, violence, cognitive/behavioral skill-sets, and resource utilization.

• Study Type: Interventional
• Enrollment (Actual): 620
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • New Haven, Connecticut, United States, 06510
      • Yale New Haven Hospital
  • Rhode Island
    • Providence, Rhode Island, United States, 02903
      • Rhode Island Hospital/Hasbro Children's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 9 years to 13 years (Child)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• English-speaking
• presenting to the emergency department for routine care
• reporting past-year physical violence (using a modified version of The Revised Conflict Tactics Scales (CTS-2) score ≥1), as identified on a brief screen administered in the ED
• reporting past 2-week mild-to-moderate depressive symptoms (using Patient Health Questionnaire (PHQ-9) score 5-19), as identified on a brief screen administered in the ED
• Accompanied by a parent/guardian who is present and able to consent
• Possession of a cell phone with text-messaging capability

Exclusion Criteria:

• Chief complaint of suicidality, psychosis, sexual assault, or child abuse
• In police or child protective services' custody (as per state law)
• Unable to assent
• In need of emergency psychiatric care

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: + Brief ED Intervention (BI), + Text; Participants receive both the Brief ED Intervention component (a 20-minute Motivational Interviewing- and Cognitive Behavioral Therapy-based in-Emergency Department session delivered by a bachelors'-level Research Assistant) and the Text Message Intervention component (8 weeks of an automated, tailored, two-way text-message curriculum started after the ED visit, which reinforces cognitive reappraisal, emotional regulation, and self-efficacy skills).	Behavioral: + Brief ED Intervention (BI); Brief ED Intervention (BI): A 20-minute Motivational Interviewing- and Cognitive Behavioral Therapy-based in-Emergency Department session delivered by a bachelors'-level Research Assistant; Behavioral: + Text; Text: 8 weeks of an automated, tailored, two-way text-message curriculum started after the ED visit, which reinforces cognitive reappraisal, emotional regulation, and self-efficacy skills. Those that do not show improvement in mood after 7 days will be randomized into LiveText.
Experimental: + Brief ED Intervention (BI), no Text; Participants receive the Brief ED Intervention component only (which is a 20-minute Motivational Interviewing- and Cognitive Behavioral Therapy-based in-Emergency Department session delivered by a bachelors'-level Research Assistant).	Behavioral: + Brief ED Intervention (BI); Brief ED Intervention (BI): A 20-minute Motivational Interviewing- and Cognitive Behavioral Therapy-based in-Emergency Department session delivered by a bachelors'-level Research Assistant
Experimental: No Brief ED Intervention (BI), + Text; Participants receive the Text Message Intervention component only (8 weeks of an automated, tailored, two-way text-message curriculum started after the ED visit, which reinforces cognitive reappraisal, emotional regulation, and self-efficacy skills). Participants receive a brochure containing online and community resources for violence and depression prevention instead of the Brief ED Intervention component.	Behavioral: + Text; Text: 8 weeks of an automated, tailored, two-way text-message curriculum started after the ED visit, which reinforces cognitive reappraisal, emotional regulation, and self-efficacy skills. Those that do not show improvement in mood after 7 days will be randomized into LiveText.
No Intervention: No Brief ED Intervention (BI), no Text; Participants receive neither the Brief ED Intervention component, nor the Text Message Intervention component. Participants receive a brochure containing online and community resources for violence and depression prevention, instead of the Brief ED Intervention component.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Conflict Tactics Scale-2, physical subset (CTS-2)	Change from enrollment physical peer violence (score is summed, range 0 - 56)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment
Center for Epidemiologic Studies Depression Scale Revised (CESD-R)	Change from enrollment depressive symptoms (score is summed based on symptom group, range 0 - 80)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in ED Visits for Assault-Related Injury	Review of hospital system-wide Electronic Medical Record and state-wide Health Information Exchange to identify ED visits for peer assault	12 months before enrollment and 12 months after enrollment
Conflict in Adolescent Dating Relationships Inventory, physical subset (CADRI)	Change from enrollment other forms of peer violence (dating relationships)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment
Illinois Bully Scale (IBS)	Change from enrollment other forms of peer violence (bullying)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment
Student School Survey	Change from enrollment other forms of peer violence (bullying)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-Efficacy Questionnaire for Children (SEQ-C)	Measures emotional self-efficacy (mean score)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment
Emotional Regulation Questionnaire for Children and Adolescents (ERQ-CA)	Measures cognitive reappraisal (score is summed, range 6 - 30)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment
Bosworth Violence Self-Efficacy Scale	Measures self-rated ability to stay out of violence (mean score)	Enrollment, 2 months post-enrollment, 4 months post-enrollment, 8 months post-enrollment

Collaborators and Investigators

• Sponsor: Rhode Island Hospital
• Collaborators: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
• Investigators: Principal Investigator: Megan L Ranney, MD MPH, Yale School of Public Health

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2018
• Primary Completion (Actual): February 28, 2025
• Study Completion (Actual): February 28, 2025

Study Registration Dates

• First Submitted: July 23, 2018
• First Submitted That Met QC Criteria: August 7, 2018
• First Posted (Actual): August 10, 2018

Study Record Updates

• Last Update Posted (Actual): April 29, 2026
• Last Update Submitted That Met QC Criteria: April 28, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: depression; emergency department; violence; mhealth; text message
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Disease Attributes; Behavioral Symptoms; Mood Disorders; Pathological Conditions, Signs and Symptoms; Behavior; Emergencies; Depression; Depressive Disorder; Equipment and Supplies; Self-Help Devices; Communication Devices for People with Disabilities
• Other Study ID Numbers: R01HD093655 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No