Research projects

Improving the engagement, detection and management of adolescent depression: Applying the mobiletype program to general practice settings

Principal Researchers

Dr Sophie Reid (1)

Dr Lena Sanci (2)

Professor George Patton (3)

Institution

(1) Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital

(2) Department of General Practice, University of Melbourne

(3) Centre for Adolescent Health, Murdoch Children’s Research Institute, Royal Children’s Hospital

Funding

$70,000

Award Type

beyondblue Victorian Centre of Excellence

Project completion year

2007

Project brief

The aim of this project was to adapt the mobiletype program, IT systems and website interface for use in the primary care setting, the setting where young people with early mental health problems are most likely to present. A small utility, feasibility, and usefulness trial of the use of the program in two rural primary care clinics was undertaken so that the helpfulness and ease of use of the systems could be examined. This was the first application of the mobiletype program to the primary care setting and with general practitioners. Our previous trial had been in a adolescent outpatient clinic with adolescent physicians. Resolving the issues regarding utility, ease of access, feasibility and usefulness in the primary care setting were the critical components of this trial. This trial was the necessary step before a large scale Victoria wide randomized controlled trial of the mobiletype program and associated IT systems.

In close partnership with the Central Victorian Division of General Practitioners, the trial was conducted at two general practices in Bendigo. Two general practitioners with a substantial case-load of young patients and 22 young people were involved in this project. Each patient was lent a study mobile phone and asked to complete the mobiletype program four times a day for 2- 4 weeks. The mobiletype program started automatically and young people were able to select an answer from a list of responses or text in answers to open-ended questions. At the end of the monitoring period, the data from the mobiletype program was collated and synthesised into an individualised feedback report, with an overall summary of their monitoring period and individual graphs and tables displaying experiences of negative mood, stresses, coping strategies, alcohol and cannabis use, exercise and eating patterns displayed on the mobiletype website. The summary also included possible avenues and recommendations for intervention were appropriate. The participants and doctors reviewed this information together. Detailed feedback regarding the use of the mobiletype program was sought from both participants and doctors.

Main outcomes / key project findings

Approximately half of the project time was spent updating the mobiletype program and reporting procedure based upon participant and doctor feedback from previous trials. It was also necessary to alter some of the systems to account for the anticipated needs of externally located general practitioners (GPs), as the previous trial of the program took place at the same clinic at which this project is physically located. We added more detailed questions and reporting on the stress and mood modules and altered the layout of the program to suit the dimensions and characteristics of the Sony Ericsson phones that were donated to us to carry out the study.

External IT systems had to be developed so that the data sent from the mobiletype program could be securely accessed by doctors and other professionals outside the Royal Children’s Hospital’s Network and we made the website more user-friendly. In addition, a number of the IT systems in which the MCRI interfaces with Telstra Corporation and Be.Interactive (the company who provide the SMS data capture service) were updated and streamlined. All these developments were done in accord with the principle of “future proofing” the mobiletype program and IT systems, which tend to be more labour intensive than present-project specific programming, to avoid redesign in the planned widespread distribution of the program.

We were very pleased with the response we received from the 22 young people and two GPs who participated in the study. Twenty one participants completed the feedback forms, 19 (90.5%) of which rated the way in which the diaries captured their situation as ‘good’ or ‘excellent’, 19 (90.5%) rated the way their feelings were captured as ‘good’ or ‘excellent’, and 14 (66.7%) rated the way their thoughts were captured as ‘good’ or ‘excellent’. Twenty participants (95.24%) said that the information captured by the diaries accurately reflected their experiences and 19 participants (90.48%) said that the information was helpful/useful.

Particularly pleasing was the finding that 18 participants (85.71%) said that the information helped their doctor to understand them better and 16 (76.19%) said it helped them understand themselves better. In addition, the mobiletype program appeared to have a direct therapeutic effect, as depression and stress were levels significantly reduced from pre to post monitoring.

This finding replicates our earlier work, and is in accord with patient’s qualitative comments that using the program assisted them to understand their moods and stressors better, allowing them to think about more helpful ways of managing their moods and coping.

The feedback provided by the GPs who participated in the study was similarly positive. Both GPs reviewed the summary of the data with every participant who returned, and they found the data provided by the mobiletype program assisted them to gain a good picture of current functioning for 100% of the patients they trialled the program with. Furthermore, the GPs reported that the data assisted 17 (80.95%) of these participants to understand their own situation/functioning ‘a lot.’ Overall, the GPs rated that the program accurately captured the young person’s mood, stresses, coping strategies, drug and alcohol use and sleeping, exercise and eating patterns.

The qualitative comments from the two GPs also suggested that they found the program easy to use, a good way of communicating with their patients, and that for a number of patients, being asked to record their feelings and stresses was therapeutic.

Overall, these findings are more positive than our first trial in an adolescent outpatient clinic with adolescent physicians, suggesting that the mobiletype program has considerable potential in the primary care setting, especially a rural setting, in assisting GPs to assess and manage youth mental health problems.

Implications for policy and practice – including any recommendations for stakeholders and plans for implementation in practice

This study was a world first-trial in which a mobile phone mental health assessment and management tool was implemented into general practice, with the provision of feedback to assist GPs in dealing with mental health problems in young people. The findings from this primary care trial and our previous clinical trial in an adolescent outpatient clinic (also supported by the beyondblue Victorian Centre for Excellence in Depression and Related research) suggests that the mobiletype program assists patients in understanding and managing their own mental health symptoms, assists GPs in detecting and managing youth mental health problems, and leads to enhanced youth engagement in health care, and a better understanding and relationship between young person and GP.

From these findings, the long term aims of the mobiletype program and mobiletype team are to provide all Australian GPs and young people with a free to low cost mental health mobile phone monitoring program which aids improves engagement of young people into health services, increases detection rates of mental health problems in primary care, and leads to enhanced pathways to care and better mental health outcomes. The next critical step in providing such a service is to conduct a randomized controlled trial of the moblietype program to test the above findings in a rigorous scientific manner. The findings from this pilot, have provided us with the necessary evidence to secure the funding for a large randomized controlled trial of 200 young Victorians, with more than a third being from a rural setting, in 2009-2010.

We are currently developing partnerships with other mental health care stakeholders to work towards the national dissemination of the mobiletype program, so that all young people and their doctors may readily access what we believe is a practical and effective tool in the early detection of mental health problems.

We have maintained our collaborations with Telstra Corporation and Be.Interactive (formerly Legion Interactive). The continued attention and interest we have received from both the wider community and the key telecommunications bodies suggests that the mobiletype mental health assessment and management program will be well accepted and utilised when it is incorporated into general practices around Australia.

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