Text-Message-Based Depression Prevention for High-Risk Youth in the ED
Condition: Depressive Disorder; Violence
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      The purpose of this randomized controlled study is to evaluate acceptability and feasibility,
      and to gather preliminary data about efficacy, of "iDOVE," a brief emergency department
      introductory session + longitudinal automated text-message depression prevention program for
      high-risk teens.
    

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 test the feasibility and acceptability of a novel
      text-message augmented depression prevention intervention, "iDOVE." Drawing on effective
      cognitive behavioral therapy (CBT) and motivational interviewing (MI) depression and violence
      prevention interventions, a brief in-ED session will introduce basic cognitive and behavioral
      strategies. Following ED discharge, eight weeks of tailored CBT-informed daily text messages
      will be sent, to enhance skills and remind participants of self-determined goals.

      Participants will be identified in the course of usual ED care. If eligible, parents will be
      consented and participants assented. Participants will complete a baseline assessment and
      will be randomized to experimental (ED+text, n=50) or enhanced usual care (EUC, n=50) care,
      using stratified block randomization.

      ED+text group participants will participate in a brief, structured in-ED introduction on CBT
      and the iDOVE program, followed by 8 weeks of tailored, two-way, CBT-and MI-informed
      automated text messages (short message service, SMS). EUC group participants will participate
      in a brief, structured, in-ED introduction to home safety & nutrition, followed by 8 weeks of
      automated SMS regarding home safety & nutrition. The current standard of care for these
      patients is no care: no depression or violence screening assessment protocols are currently
      used in our ED. Both ED+text and EUC conditions therefore exceed current levels of care.

      At baseline, 8 week follow-up, and 16 week follow-up, participants will complete assessments
      on depressive symptoms, violence, cognitive/behavioral skill-sets, and resource utilization.
      At the 8-week follow-up, standardized qualitative and quantitative process measures will be
      administered to assess efficacy, acceptability, usability, and feasibility.
    

Intervention name(s): iDOVE Intervention (ED+text); Control (EUC)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In-ED brief session, introducing basic principles of cognitive behavioral theory and the structure of the text-message portion of the intervention
Eight-week longitudinal tailored text-message program; In-ED brief session, discussing home safety & nutrition
Eight-week longitudinal home safety & nutrition text-message program
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: depression; violence; emergency department; mhealth; text message