A Social Media Website (Supporting Our Valued Adolescents) to Support Treatment Uptake for Adolescents With Depression and/or Anxiety and Their Parents: Protocol for a Pilot Randomized Controlled Trial

Ana Radovic, Yaming Li, Douglas Landsittel, Bradley D Stein, Elizabeth Miller, Ana Radovic, Yaming Li, Douglas Landsittel, Bradley D Stein, Elizabeth Miller

Abstract

Background: Few adolescents who experience depression or anxiety connect to mental health treatment. Supporting Our Valued Adolescents (SOVA) is a stakeholder-informed technology intervention that consists of 2 blog-format websites-one for adolescents and another for parents. SOVA is designed to intervene on targets, which may increase the mental health treatment uptake when adolescents with depression or anxiety are identified in primary care settings.

Objective: This study aims to describe the protocol for a pilot randomized controlled trial designed to refine recruitment and retention strategies, document intervention fidelity and implementation outcomes, and assess changes in health beliefs and knowledge, emotional or informational support, and parent-adolescent communication quality in adolescents and their parents.

Methods: Adolescents identified with symptoms of depression or anxiety, for which a health care provider recommends treatment, and their parents will be recruited from clinics where adolescents are seen for primary care. Adolescent-parent dyads will be randomized at 1:1 to both receive the SOVA websites and enhanced usual care or enhanced usual care alone. Baseline measures and 6-week and 3-month outcomes will be collected by Web-based self-report surveys and electronic health record review. The main pilot outcome is the 6-week study retention rate. Analyses will also assess changes in health beliefs and knowledge, emotional support, and parent-adolescent communication in both adolescents and their parents.

Results: The project was funded in 2017. Recruitment commenced in April 2018 and enrollment is ongoing, with completion anticipated at the end of 2019 with subsequent plans for data analysis and publication submission in early 2020.

Conclusions: The findings of this research will inform the design of a multisite hybrid effectiveness-implementation randomized controlled trial examining the effectiveness and optimal implementation strategies for using SOVA in community primary care settings.

Trial registration: ClinicalTrials.gov NCT03318666; https://ichgcp.net/clinical-trials-registry/NCT03318666.

International registered report identifier (irrid): PRR1-10.2196/12117.

Keywords: adolescent; adolescent health services; anxiety; depression; technology.

Conflict of interest statement

Conflicts of Interest: None declared.

©Ana Radovic, Yaming Li, Douglas Landsittel, Bradley D Stein, Elizabeth Miller. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 23.01.2019.

Figures

Figure 1
Figure 1
Conceptual model. SOVA: Supporting Our Valued Adolescents.
Figure 2
Figure 2
Randomized controlled trial study design. SOVA: Supporting Our Valued Adolescents.
Figure 3
Figure 3
Examples of blog posts (source: SOVA, University of Pittsburgh).

References

    1. Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A) J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980–9. doi: 10.1016/j.jaac.2010.05.017.
    1. Avenevoli S, Swendsen J, He J, Burstein M, Merikangas KR. Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment. J Am Acad Child Adolesc Psychiatry. 2015 Jan;54(1):37–44.e2. doi: 10.1016/j.jaac.2014.10.010.
    1. Torio CM, Encinosa W, Berdahl T, McCormick MC, Simpson LA. Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions. Acad Pediatr. 2015;15(1):19–35. doi: 10.1016/j.acap.2014.07.007.
    1. Substance Abuse Mental Health Services Administration, National Survey on Drug Use and Health. 2009. Apr 28, [2018-12-10]. The NSDUH Report: Major Depressive Episode Treatment among Adolescents .
    1. Wang PS, Berglund PA, Olfson M, Kessler RC. Delays in initial treatment contact after first onset of a mental disorder. Health Serv Res. 2004 Apr;39(2):393–415. doi: 10.1111/j.1475-6773.2004.00234.x.
    1. Merikangas KR, He J, Burstein M, Swendsen J, Avenevoli S, Case B, Georgiades K, Heaton L, Swanson S, Olfson M. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A) J Am Acad Child Adolesc Psychiatry. 2011 Jan;50(1):32–45. doi: 10.1016/j.jaac.2010.10.006.
    1. March J, Silva S, Petrycki S, Curry J, Wells K, Fairbank J, Burns B, Domino M, McNulty S, Vitiello B, Severe J, Treatment FAWDS(T. Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial. JAMA. 2004 Aug 18;292(7):807–20. doi: 10.1001/jama.292.7.807.
    1. O'Connor BC, Lewandowski RE, Rodriguez S, Tinoco A, Gardner W, Hoagwood K, Scholle SH. Usual Care for Adolescent Depression From Symptom Identification Through Treatment Initiation. JAMA Pediatr. 2016 Apr;170(4):373–80. doi: 10.1001/jamapediatrics.2015.4158.
    1. Merikangas KR, He J, Rapoport J, Vitiello B, Olfson M. Medication use in US youth with mental disorders. JAMA Pediatr. 2013 Feb;167(2):141–8. doi: 10.1001/jamapediatrics.2013.431.
    1. Keenan-Miller D, Hammen CL, Brennan PA. Health outcomes related to early adolescent depression. J Adolesc Health. 2007 Sep;41(3):256–62. doi: 10.1016/j.jadohealth.2007.03.015.
    1. Richardson LP, Ludman E, McCauley E, Lindenbaum J, Larison C, Zhou C, Clarke G, Brent D, Katon W. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. JAMA. 2014 Aug 27;312(8):809–16. doi: 10.1001/jama.2014.9259.
    1. Asarnow Joan Rosenbaum, Rozenman Michelle, Wiblin Jessica, Zeltzer Lonnie. Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis. JAMA Pediatr. 2015 Oct;169(10):929–37. doi: 10.1001/jamapediatrics.2015.1141.
    1. Anderson LE, Chen ML, Perrin JM, Van Cleave J. Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions. Pediatrics. 2015 Nov;136(5):e1178–85. doi: 10.1542/peds.2015-0807.
    1. Breland DJ, McCarty CA, Zhou C, McCauley E, Rockhill C, Katon W, Richardson LP. Determinants of mental health service use among depressed adolescents. Gen Hosp Psychiatry. 2014;36(3):296–301. doi: 10.1016/j.genhosppsych.2013.12.003.
    1. Hacker K, Arsenault L, Franco I, Shaligram D, Sidor M, Olfson M, Goldstein J. Referral and follow-up after mental health screening in commercially insured adolescents. J Adolesc Health. 2014 Jul;55(1):17–23. doi: 10.1016/j.jadohealth.2013.12.012.
    1. Tanielian T, Jaycox LH, Paddock SM, Chandra A, Meredith LS, Burnam MA. Improving treatment seeking among adolescents with depression: understanding readiness for treatment. J Adolesc Health. 2009 Nov;45(5):490–8. doi: 10.1016/j.jadohealth.2009.03.005.
    1. Van Voorhees BW, Cooper LA, Rost KM, Nutting P, Rubenstein LV, Meredith L, Wang N, Ford DE. Primary care patients with depression are less accepting of treatment than those seen by mental health specialists. J Gen Intern Med. 2003 Dec;18(12):991–1000.
    1. Dhingra SS, Zack M, Strine T, Pearson WS, Balluz L. Determining prevalence and correlates of psychiatric treatment with Andersen's behavioral model of health services use. Psychiatr Serv. 2010 May;61(5):524–8. doi: 10.1176/ps.2010.61.5.524.
    1. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995 Mar;36(1):1–10.
    1. Wahlin T, Deane F. Discrepancies between parent- and adolescent-perceived problem severity and influences on help seeking from mental health services. Aust N Z J Psychiatry. 2012 Jun;46(6):553–60. doi: 10.1177/0004867412441929.
    1. Wu P, Hoven CW, Cohen P, Liu X, Moore RE, Tiet Q, Okezie N, Wicks J, Bird HR. Factors associated with use of mental health services for depression by children and adolescents. Psychiatr Serv. 2001 Feb;52(2):189–95. doi: 10.1176/appi.ps.52.2.189.
    1. Breland DJ, McCarty CA, Zhou C, McCauley E, Rockhill C, Katon W, Richardson LP. Determinants of mental health service use among depressed adolescents. Gen Hosp Psychiatry. 2014;36(3):296–301. doi: 10.1016/j.genhosppsych.2013.12.003.
    1. Mojtabai R, Olfson M, Sampson NA, Jin R, Druss B, Wang PS, Wells KB, Pincus HA, Kessler RC. Barriers to mental health treatment: results from the National Comorbidity Survey Replication. Psychol Med. 2011 Aug;41(8):1751–61. doi: 10.1017/S0033291710002291.
    1. Radovic A, Reynolds K, McCauley HL, Sucato GS, Stein BD, Miller E. Parents' Role in Adolescent Depression Care: Primary Care Provider Perspectives. J Pediatr. 2015 Oct;167(4):911–8. doi: 10.1016/j.jpeds.2015.05.049.
    1. Van Voorhees BW, Fogel J, Houston TK, Cooper LA, Wang N, Ford DE. Attitudes and illness factors associated with low perceived need for depression treatment among young adults. Soc Psychiatry Psychiatr Epidemiol. 2006 Sep;41(9):746–54. doi: 10.1007/s00127-006-0091-x.
    1. Owens PL, Hoagwood K, Horwitz SM, Leaf PJ, Poduska JM, Kellam SG, Ialongo NS. Barriers to children's mental health services. J Am Acad Child Adolesc Psychiatry. 2002 Jun;41(6):731–8. doi: 10.1097/00004583-200206000-00013.
    1. Johnson EM, Coles ME. Failure and delay in treatment-seeking across anxiety disorders. Community Ment Health J. 2013 Dec;49(6):668–74. doi: 10.1007/s10597-012-9543-9.
    1. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry. 2010 Dec 30;10:113. doi: 10.1186/1471-244X-10-113.
    1. Goldstein RB, Olfson M, Martens EG, Wolk SI. Subjective unmet need for mental health services in depressed children grown up. Adm Policy Ment Health. 2006 Nov;33(6):666–73. doi: 10.1007/s10488-006-0082-y.
    1. Sawyer MG, Borojevic N, Ettridge KA, Spence SH, Sheffield J, Lynch J. Do help-seeking intentions during early adolescence vary for adolescents experiencing different levels of depressive symptoms? J Adolesc Health. 2012 Mar;50(3):236–42. doi: 10.1016/j.jadohealth.2011.06.009.
    1. Davidson L, Bellamy C, Guy K, Miller R. Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry. 2012 Jun;11(2):123–8.
    1. Blakemore S, Robbins TW. Decision-making in the adolescent brain. Nat Neurosci. 2012 Sep;15(9):1184–91. doi: 10.1038/nn.3177.
    1. Buckley GI, Malouff JM. Using modeling and vicarious reinforcement to produce more positive attitudes toward mental health treatment. J Psychol. 2005 May;139(3):197–209.
    1. Perlick DA, Nelson AH, Mattias K, Selzer J, Kalvin C, Wilber CH, Huntington B, Holman CS, Corrigan PW. In our own voice-family companion: reducing self-stigma of family members of persons with serious mental illness. Psychiatr Serv. 2011 Dec;62(12):1456–62. doi: 10.1176/appi.ps.001222011.
    1. Berkowitz SA, Bell RA, Kravitz RL, Feldman MD. Vicarious experience affects patients' treatment preferences for depression. PLoS One. 2012;7(2):e31269. doi: 10.1371/journal.pone.0031269.
    1. McMiller WP, Weisz JR. Help-seeking preceding mental health clinic intake among African-American, Latino, and Caucasian youths. J Am Acad Child Adolesc Psychiatry. 1996 Aug;35(8):1086–94. doi: 10.1097/00004583-199608000-00020.
    1. Kelleher KJ, Hoagwood K. Beyond Blame: Parents as Partners. J Pediatr. 2015 Oct;167(4):795–6. doi: 10.1016/j.jpeds.2015.07.039.
    1. Williams KA, Chapman MV. Unmet health and mental health need among adolescents: the roles of sexual minority status and child-parent connectedness. Am J Orthopsychiatry. 2012 Oct;82(4):473–81. doi: 10.1111/j.1939-0025.2012.01182.x.
    1. Logan DE, King CA. Parental identification of depression and mental health service use among depressed adolescents. J Am Acad Child Adolesc Psychiatry. 2002 Mar;41(3):296–304. doi: 10.1097/00004583-200203000-00009.
    1. Seiffge-Krenke I. Children at risk: Assessment, Longitudinal Research, and Intervention. Berlin: Walter de Gruyter; 1989. Problem intensity and disposition of adolescents to take therapeutic advice.
    1. Richardson LP, Russo JE, Lozano P, McCauley E, Katon W. Factors associated with detection and receipt of treatment for youth with depression and anxiety disorders. Acad Pediatr. 2010;10(1):36–40. doi: 10.1016/j.acap.2009.09.011.
    1. Mueller J, Callanan MM, Greenwood K. Communications to children about mental illness and their role in stigma development: an integrative review. J Ment Health. 2016;25(1):62–70. doi: 10.3109/09638237.2015.1021899.
    1. Locke J, Eichorn M. JED Foundation. 2008. [2018-12-10]. Mental Health: What do Parents Think? .
    1. Radovic A, DeMand AL, Gmelin T, Stein BD, Miller E. SOVA: Design of a stakeholder informed social media website for depressed adolescents and their parents. J Technol Hum Serv. 2018;35(3):169–182. doi: 10.1080/15228835.2017.1347552.
    1. Radovic A, Gmelin T, Hua J, Long C, Stein BD, Miller E. Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study. JMIR Ment Health. 2018 Feb 26;5(1):e17. doi: 10.2196/mental.9441.
    1. Richardson LP, Rockhill C, Russo JE, Grossman DC, Richards J, McCarty C, McCauley E, Katon W. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics. 2010 May;125(5):e1097–103. doi: 10.1542/peds.2009-2712.
    1. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606–13.
    1. Johnson JG, Harris ES, Spitzer RL, Williams JBW. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002 Mar;30(3):196–204.
    1. Spitzer RL, Kroenke K, Williams JBW, Löwe Bernd. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–7. doi: 10.1001/archinte.166.10.1092.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81. doi: 10.1016/j.jbi.2008.08.010.
    1. Peters KM, Sadler G, Miller E, Radovic A. An Electronic Referral and Social Work Protocol to Improve Access to Mental Health Services. Pediatrics. 2018 Nov;142(5) doi: 10.1542/peds.2017-2417.
    1. Supporting Our Valued Adolescents: A place to learn, share your strength, be positive, and grow. [2018-12-12].
    1. WiseSOVA. [2018-12-12].
    1. Reineck LA, Kahn JM. Quality measurement in the Affordable Care Act: a reaffirmed commitment to value in health care. Am J Respir Crit Care Med. 2013 May 15;187(10):1038–9. doi: 10.1164/rccm.201302-0404ED.
    1. National Institute of Mental Health. [2018-12-10]. Anxiety Disorders .
    1. National Institute of Mental Health. [2018-12-10]. Depression in Children and Adolescents (Fact Sheet) .
    1. Psychiatry, American Academy of Child and Adolescent Psychiatry. [2018-12-10]. Anxiety Disorders Resource Center .
    1. Rickwood D, Deane FP, Wilson CJ, Ciarrochi JV. Young people's help-seeking for mental health problems. Australian e-Journal for the Advancement of Mental Health. 2005;4(3):34.
    1. Rickwood DJ, Braithwaite VA. Social-psychological factors affecting help-seeking for emotional problems. Soc Sci Med. 1994 Aug;39(4):563–72.
    1. Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C. Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry. 2004 Oct;185:342–9. doi: 10.1192/bjp.185.4.342.
    1. Cohane G. Psychological Barriers to Antidepressant Use in Adolescents, Dissertation for Clinical Psychology. Worcester, MA: Clark University; 2008.
    1. Kuhl J, Jarkon-Horlick L, Morrissey Rf. Measuring Barriers to Help-Seeking Behavior in Adolescents. Journal of Youth and Adolescence. 1997 Dec;26(6):637–650. doi: 10.1023/A:1022367807715.
    1. Wilson CJ, Deane FP, Ciarrochi J. Can hopelessness and adolescents' beliefs and attitudes about seeking help account for help negation? J Clin Psychol. 2005 Dec;61(12):1525–39. doi: 10.1002/jclp.20206.
    1. Bates L. Predictors of Help Seeking Among Early Adolescents: Stages and Factors? Electronic Theses and Dissertations. University of Windsor. 2010:490.
    1. Gulliver A, Griffiths KM, Christensen H, Mackinnon A, Calear AL, Parsons A, Bennett K, Batterham PJ, Stanimirovic R. Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. J Med Internet Res. 2012 Jun 29;14(3):e69. doi: 10.2196/jmir.1864.
    1. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.
    1. Wang Y, Kraut RE, Levine JM. Eliciting and receiving online support: using computer-aided content analysis to examine the dynamics of online social support. J Med Internet Res. 2015 Apr 20;17(4):e99. doi: 10.2196/jmir.3558.
    1. Barnes H, Olson DL. Family inventories: Inventories used in a national survey of families across the family life cycle. In: Olson DH, editor. Parent-adolescent communication scale. St Paul: Family Social Science, University of Minnesota; 1982. pp. 33–48.
    1. McNab C, Meadows G. National Depression Initiative. Australia: Monash University; 2004. Brief assessment of perceived need for mental health care - development of an instrument for primary care use.
    1. Wardenaar KJ, Wigman JTW, Lin A, Killackey E, Collip D, Wood SJ, Ryan J, Baksheev G, Cosgrave E, Nelson B, Yung AR. Development and validation of a new measure of everyday adolescent functioning: the multidimensional adolescent functioning scale. J Adolesc Health. 2013 Feb;52(2):195–200. doi: 10.1016/j.jadohealth.2012.06.021.
    1. Bird HR, Canino G, Rubio-Stipec M, Ribera JC. Further measures of the psychometric properties of the Children's Global Assessment Scale. Arch Gen Psychiatry. 1987 Sep;44(9):821–4.
    1. Lezin N, Rolleri LA, Bean S, Talor J. Parent-child connectedness: Implications for research, interventions and positive impacts on adolescent health. ETR Associates. 2004
    1. Carlton PA, Deane FP. Impact of attitudes and suicidal ideation on adolescents' intentions to seek professional psychological help. J Adolesc. 2000 Feb;23(1):35–45. doi: 10.1006/jado.1999.0299.
    1. SAMSHA The NSDUH Report: Substance Use Mental Health Estimates from the 2013 National Survey on Drug Use Health: Overview of Findings. Substance Abuse Mental Health Services Administration Center or Behavioral Health Statistics Quality. 2014

Source: PubMed

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