A Depression Prevention Intervention for Adolescents in the Emergency Department.
To evaluate acceptability and feasibility of a theoretically based two-part (brief in-person + 8-week automated text message) depression prevention program, "intervention for DepressiOn and Violence prevention in the Emergency department" (iDOVE), for high-risk adolescents.



English-speaking emergency department (ED) patients (age 13-17, any chief complaint) were sequentially approached for consent on a convenience sample of shifts and screened for inclusion based on current depressive symptoms and past-year violence. After consent, baseline assessments were obtained; all participants were enrolled in the two-part intervention (brief in-ED + 8-week two-way text messaging). At 8 weeks, quantitative and qualitative follow-up assessments were obtained. Measures included feasibility, acceptability, and preliminary data on efficacy. Qualitative data were transcribed verbatim, double coded, and interpreted using thematic analysis. Quantitative results were analyzed descriptively and with paired t tests.



As planned, 16 participants (eight each gender) were recruited (75% of those who were eligible; 66% nonwhite, 63% low income, mean age 15.4). The intervention had high feasibility and acceptability: 93.8% completed 8-week follow-up; 80% of daily text messages received responses; 31% of participants requested ≥1 "on-demand" text message. In-person and text message portions were rated as good/excellent by 87%. Qualitatively, participants articulated: (1) iDOVE was welcome and helpful, if unexpected in the ED; (2) the daily text message mood assessment was "most important"; (3) content was "uplifting"; and (4) balancing intervention "relatability" and automation was challenging. Participants' mean ΔBDI-2 (Beck Depression Inventory) from baseline to 8-week follow-up was -4.9, (p = .02).



This automated preventive text message intervention is acceptable and feasible. Qualitative data emphasize the importance of creating positive, relevant, and interactive digital health tools for adolescents.
Department of Emergency Medicine, Emergency Digital Health Innovation Program, Alpert Medical School, Brown University, Providence, Rhode Island. Electronic address: mranney@lifespan.org.
Megan L
ML
Ranney
Department of Emergency Medicine, Emergency Digital Health Innovation Program, Alpert Medical School, Brown University, Providence, Rhode Island.
Joshua R
JR
Freeman
Department of Emergency Medicine, Emergency Digital Health Innovation Program, Alpert Medical School, Brown University, Providence, Rhode Island.
Gerianne
G
Connell
Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.
Anthony
A
Spirito
Department of Emergency Medicine, University of Massachusetts Worcester, North Worcester, Massachusetts.
Edward
E
Boyer
Department of Psychiatry, Addiction Center, Injury Center, University of Michigan, Ann Arbor, Michigan.
Maureen
M
Walton
Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.
Kate Morrow
KM
Guthrie
Department of Psychiatry, Addiction Center, Injury Center, University of Michigan, Ann Arbor, Michigan.
Rebecca M
RM
Cunningham
D000293:Adolescent; D000339:Affect; D015928:Cognitive Behavioral Therapy / Q000295:instrumentation*; D003863:Depression / Q000517:prevention & control* / Q000628:therapy; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D065228:Non-Randomized Controlled Trials as Topic; D017060:Patient Satisfaction; D010865:Pilot Projects; D036301:Qualitative Research; D012307:Risk Factors; D011795:Surveys and Questionnaires; D060145:Text Messaging; D014754:Violence / Q000517:prevention & control* / Q000523:psychology
Adolescents; Behavior change; Depression; Health promotion; Mixed methods; Text messaging