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Abstract
BackgroundOver 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.MethodsWe 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.ResultsOf 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.ConclusionsMonitoring 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 RegistrationClinicalTrials.gov NCT00794222.
Highlights
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
Of the 103 general practitioners (GPs) who agreed to participate, 35 actively recruited young people for the study. These contributing GPs were from 26 different practices in the three recruitment areas: 12 in greater Melbourne, 7 in Albury/Wodonga and 7 in the Goulburn Valley, resulting in an overrepresentation of general practices recruited in rural areas; 75% of Australian general practices are located in capital cities and suburbs [48]
Four participants were excluded post randomisation (2 became too unwell to participate, one was incarcerated, and one gave invalid responses to all pre-test measures), resulting in a final sample of 114 young people which was sufficient to detect the primary aim of a medium-sized indirect effect [50]
Summary
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. Adolescence is likely to be an important phase for early intervention with primary care identified as the target setting in the World Health Organisation strategy for mental health [2]. General Practitioners (GPs) are often the providers of first step interventions for mental health (i.e. screening, monitoring, and psychoeducation), initially managing mental health concerns within their own clinical practice, becoming conduits or gatekeepers to second step and further mental health care services (i.e. psychotherapy, medication, hospitalisation) when necessary [3,4]. Detection and management of mental health problems in primary care remains a challenge with young people [5]; it is estimated that GPs detect at best 50% of mental health disorders [6,7]. New methods are needed that focus on the early stages of mental health problems before clinically diagnosable mental health disorders are identified
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