Facilitating mental health help-seeking by young adults with a dedicated online program: a feasibility study of Link.

OBJECTIVE: To explore the feasibility of a dedicated online youth mental health help-seeking intervention and to evaluate using a randomised controlled trial (RCT) study design in order to identify any modifications needed before commencement of the full-scale RCT. DESIGN: A pilot RCT with 1:1 randomisation to either the intervention or comparison arm. SETTING: An online study conducted Australia-wide. PARTICIPANTS: 18-25 year olds living in Australia were recruited via social media. INTERVENTION: Link is a dedicated online mental health help-seeking navigation tool that matches user's mental health issues, severity and service-type preferences (online, phone and face-to-face) with appropriate youth-friendly services. The comparison arm was usual help-seeking strategies with a link to Google.com. MAIN OUTCOME MEASURES: The primary outcome was the number of acceptability and feasibility criteria successfully met. Intervention and study design acceptability and feasibility were assessed by nine criteria. Secondary outcomes, via online surveys (at baseline, 1 week and 1 month) measured service use, help-seeking intentions, psychological distress, barriers to help-seeking, attitudes towards mental health help-seeking, mental health literacy, satisfaction and trust. RESULTS: Fifty-one participants were randomised (intervention: n=24; comparison: n=27). Three out of four of the intervention and two out of five of the study design criteria were met. Unmet criteria could be addressed by modifications to the study design. Qualitative analysis demonstrated that Link was useful to participants and may have increased their positive experiences towards help-seeking. There were no observable differences between arms in any outcome measures and no harms were detected. CONCLUSION: Generally, the Link intervention and study design were acceptable and feasible with modifications suggested for the four out of nine unmet criteria. The main trial will hence have shorter surveys and a simpler recruitment process, use positive affect as the primary outcome and will not link to Google.com for the comparison arm. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry, ACTRN12614000386639.

Road safety risks in young people attending general practice: A cross-sectional study of road risks and associated health risks.

BACKGROUND: Young people have a large burden of death and disease from risky road behaviours. Guidelines recommend injury prevention and harm minimisation counselling; however, little is known about road risks in youth attending primary care. OBJECTIVE: The aim of this study was to examine the type of road risks and associated behaviours in young people attending general practice. METHODS: A cross-sectional analysis was undertaken on health risk survey data from a sample of 901 patients, aged 14-24 years, attending 40 Victorian general practices in a stratified cluster randomised trial. RESULTS: Frequently occurring road risks included travelling with people under the influence of alcohol or drugs (55%), speeding (43%) and mobile phone use (40%). These behaviours were strongly associated with other health risks, including use of tobacco, alcohol and illicit drugs, and unprotected sex. DISCUSSION: High proportions of youth attending general practice engage in road risks, making this a potential setting to discuss road risks along with broader health risk prevention activities.

Does screening for and intervening with multiple health compromising behaviours and mental health disorders amongst young people attending primary care improve health outcomes? A systematic review.

BACKGROUND: Adolescence and young adulthood are important developmental periods. Screening for health compromising behaviours and mental health disorders during routine primary care visits has the potential to assist clinicians to identify areas of concern and provide appropriate interventions. The objective of this systematic review is to investigate whether screening and subsequent interventions for multiple health compromising behaviours and mental health disorders in primary care settings improves the health outcomes of young people. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in Medline, PsycINFO, Scopus and Cochrane Library databases (Prospero registration number CRD42013005828) using search terms representing four thematic concepts: primary care, young people, screening, and mental health and health compromising behaviour. To be eligible for inclusion, studies had to: include a measure of health outcome; include at least 75 % of participants aged under 25 years; use a screening tool that assessed more than one health domain; and be conducted within a primary care setting. Risk of bias was assessed using the Quality Rating Scale. RESULTS: From 5051 articles identified, nine studies fulfilled the inclusion criteria and were reviewed: two randomised controlled trials (RCTs), one pilot RCT, two clustered RCTs, one randomised study with multiple intervention groups and no control group, one cluster RCT with two active arms, one longitudinal study and one pre-post study. Seven studies, including two RCTs and one clustered RCT, found positive changes in substance use, diet, sexual health or risky sexual behaviour, alcohol-related risky behaviour, social stress, stress management, helmet use, sleep and exercise. Of only two studies reporting on harms, one reported a negative health outcome of increased alcohol use. CONCLUSIONS: There is some evidence that the use of screening and intervention with young people for mental health disorder or health compromising behaviours in clinical settings improves health outcomes. Along with other evidence that young people value discussions of health risks with their providers, these discussions should be part of the routine primary care of young people. Further quality studies are needed to strengthen this evidence.

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype.

BACKGROUND: GPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people's reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care. METHODS: We conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project's Exit Interview. RESULTS: Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care. CONCLUSIONS: We conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222.

Temporal mood changes associated with different levels of adolescent drinking: using mobile phones and experience sampling methods to explore motivations for adolescent alcohol use.

INTRODUCTION AND AIMS: Alcohol use during adolescence is associated with the onset of alcohol use disorders, mental health disorders, substance abuse as well as socially and physically damaging behaviours, the effects of which last well into adulthood. Nevertheless, alcohol use remains prevalent in this population. Understanding motivations behind adolescent alcohol consumption may help in developing more appropriate and effective interventions. This study aims to increase this understanding by exploring the temporal relationship between mood and different levels of alcohol intake in a sample of young people. DESIGN AND METHODS: Forty-one secondary school students used a purpose-designed mobile phone application to monitor their daily mood and alcohol use for 20 random days within a 31 day period. Generalised estimating equations were used to examine the relationship between differing levels of alcohol consumption (light, intermediate and heavy) and positive and negative mood three days before and after drinking episodes. RESULTS: While there was no relationship between light and heavy drinking and positive mood, there was an increase in positive mood before and after the drinking event for those that drank intermediate amounts. No statistically significant relationships were found between negative mood and any of the three drinking categories. DISCUSSION AND CONCLUSION: Adolescents who drank in intermediate amounts on a single drinking occasion experienced an increase in positive mood over the three days leading up to and three days following a drinking event. These findings contribute to an understanding of the motivations that underpin adolescent alcohol use, which may help inform future interventions.

Using a mobile phone application in youth mental health - an evaluation study.

BACKGROUND: This study evaluates a mobile phone self monitoring tool designed to assist paediatricians in assessing and managing youth mental health. METHODS: Patients from an adolescent outpatient clinic monitored mental health symptoms throughout each day for 2-4 weeks. Paediatricians specialising in adolescent health and participants reviewed the collated data displayed online and completed quantitative and qualitative feedback. RESULTS: Forty-seven adolescents and six paediatricians participated. Completion was high, with 91% of entries completed in the first week. Paediatricians found the program helpful for 92% of the participants and understood 88% of their patients' functioning better. Participants reported the data reflected their actual experiences (88%) and was accurate (85%), helpful (65%) and assisted their paediatrician to understand them better (77%). Qualitative results supported these findings. DISCUSSION: Self monitoring facilitates communication of mental health issues between these paediatricians and patients and is a promising tool for the assessment and management of mental health problems in young people.

A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial.

BACKGROUND: Over 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. METHODS: We conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale. RESULTS: Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes. CONCLUSIONS: Monitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole. TRIAL REGISTRATION: ClinicalTrials.gov NCT00794222.

Investigating the utility of mobile phones for collecting data about adolescent alcohol use and related mood, stress and coping behaviours: lessons and recommendations.

INTRODUCTION AND AIMS: The trajectory from alcohol use to alcohol use disorders in adolescence is yet to be understood. Momentary sampling may assist in capturing 'real-time' data on young people's alcohol use and associated motivational factors. This paper aims to review the feasibility and usefulness of a mobile phone momentary sampling program to capture data about alcohol use and related behaviours. DESIGN AND METHODS: Two studies were conducted: a school-based study with 18 Year 9 and 11 students and a clinical study with eight high-risk adolescent drinkers. Participants answered questions about their daily activities, alcohol use, stressors and negative mood four times a day for 1 week using a mobile phone momentary sampling program. RESULTS: In the school-based study, 61% of participants reported drinking alcohol. On drinking days participants spent less time studying (14% vs. 26%), more time sleeping or resting (35% vs. 12%) and more time hanging out (21% vs. 11%) than on non-drinking days. In the high-risk sample, 88% of participants reported drinking alcohol. On drinking days, these participants spent a greater proportion of their waking time with their boyfriend or girlfriend (19.2% vs. 6%) and generally had higher negative mood than on non-drinking days. DISCUSSION AND CONCLUSIONS: The current mobiletype program was well suited to capturing data on alcohol use in younger, school-attending adolescents. However, to capture alcohol use in older adolescents who lead less routine lives, it is necessary to make some amendments including targeting particular behaviours and symptoms. Recommendations for future studies are proposed.

A mobile phone program to track young people's experiences of mood, stress and coping. Development and testing of the mobiletype program.

BACKGROUND: Research examining adolescent mood, stresses, and coping has tended to use retrospective questionnaires which are affected by recall biases. The aim of this study was to develop, pilot, and evaluate a youth-friendly mobile phone program to monitor, in real-time, young people's everyday experiences of mood, stress, and their coping behaviours. METHOD AND DESIGN: A momentary sampling program was designed for mobile phones, and ran for 7 days, administering a brief questionnaire four random times each day, capturing information on current activity, mood, responses to negative mood, stresses, alcohol and cannabis use. Eleven high school students reviewed the program in focus groups, and 18 students completed 7 days of monitoring. RESULTS: Engagement with the mobiletype program was high with 76% of 504 possible entries completed and 94% (17/18) of the participants reporting that the program adequately captured their moods, thoughts, and activities. The mobiletype program captured meaningful and analyzable data on the way young people's moods, stresses, coping strategies, and alcohol and cannabis use, vary both between and within individuals. CONCLUSIONS: The mobiletype program captured a range of detailed and interesting qualitative and quantitative data about young people's everyday mood, stresses, responses, and general functioning.