Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Adolescent health promotion is important in prevent risk behaviors and improve mental health. Health promotion in adolescence has been shown to contribute to the prevention of later onset of the mental health disease. However, scalable interventions have not yet been established. OBJECTIVE This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit with a risk assessment interview and counseling (WCV) and self-monitoring with a smartphone cognitive behavioral therapy application (CBT app). METHODS Participants were 217 adolescents aged 13–18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a non-intervention group. WCV comprised a standardized physical examination with a structured interview and counseling for youth risk assessment. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models. RESULTS In total, 94% of participants completed the 4 month evaluation. Both intervention groups showed a significant effect in reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cut-off for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. There were no significant effects in scores for the secondary outcomes. CONCLUSIONS Although adolescent health promotion interventions may have short-term benefits, the frequency of the WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness. CLINICALTRIAL University Hospital Medical Information Network Clinical Trials Registry [UMIN-CTR] UMIN 000036343