Elsevier

Applied Nursing Research

Volume 26, Issue 1, February 2013, Pages 45-48
Applied Nursing Research

Research Briefs
Avatar-based depression self-management technology: promising approach to improve depressive symptoms among young adults

https://doi.org/10.1016/j.apnr.2012.08.003Get rights and content

Abstract

Major depressive disorder is prevalent among American young adults and predisposes young adults to serious impairments in psychosocial functioning. Without intervention, young adults with depressive symptoms are at high risk for worsening of depressive symptoms and developing major depressive disorder. Young adults are not routinely taught effective depression self management skills to reduce depressive symptoms and preempt future illness. This study reports initial results of a randomized controlled trial among young adults (18–25 years of age) with depressive symptoms who were exposed to an avatar-based depression self-management intervention, eSMART-MH. Participants completed self-report measures of depressive symptoms at baseline and at 4, 8, and 12 weeks follow-up. Participants who received eSMART-MH had a significant reduction in depressive symptoms over 3 months, while individuals in the attention-control condition had no change in symptoms. In this study, eSMART-MH demonstrated initial efficacy and is a promising developmentally appropriate depression self-management intervention for young adults.

Introduction

Major depressive disorder (MDD) afflicts 9% of American young adults and predisposes young adults to serious impairments in psychosocial functioning (CDC, 2010, Kessler et al., 2007). Because of MDD, young adults are at increased lifetime risk for disability, morbidity, mortality, and a decreased quality of life (Kessler et al., 2007). Depressive symptoms usually first occur in adolescence and young adulthood (Kessler, Berglund, Demler, Jin, & Walters, 2005). Without intervention, young adults with depressive symptoms are at high risk for these symptoms to progress into MDD, a serious debilitating chronic illness that affects most young adults for a decade before receiving treatment (Kessler, Zhao, Blazer, & Swartz, 1997). A critical time in human development, young adulthood, delineates the transition from parental dependence to a state of growing independence and autonomy. Young adults are not routinely taught effective depression self-management skills to reduce depressive symptoms and pre-empt future illness (Yeung, Feldman, & Fava, 2010). Therefore, depression self-management interventions that focus on depression self-management skill building and problem solving among young adults may prove to significantly blunt the lifetime risks of morbidity and disability associated with early onset depressive symptoms.

Depression self-management is the self-directed behaviors individuals enact on a daily basis to reduce and mitigate depressive symptoms, which includes effective communication with healthcare providers. There is no established evidence-based practice for depression self-management behaviors among young adults that will attenuate depressive symptom and pre-empt MDD (Yeung et al., 2010). Young adults are a unique population because they possess a high comfort level in interacting with technology, and they often prefer this form of interaction over face-to-face encounters. Thus, developmentally-appropriate and innovative approaches are needed to engage this population in depression self-management. We have developed and pilot tested a novel three-dimensional avatar-based depression self-management intervention for young adults with depression, called Electronic Self-Management Resource Training for Mental Health (eSMART-MH).

The purpose of this pilot study is to report preliminary evidence on the efficacy of an avatar-based depression self-management intervention, eSMART-MH, among young adults (18–25 years of age).

Section snippets

Design

This study is a longitudinal randomized controlled trial. Participants were randomly assigned to receive the experimental condition, eSMART-MH, or the attention-control condition, screen-based education on health living (sleep hygiene, physical activity, and nutrition). eSMART-MH is a novel avatar-based depression self-management intervention in which young adults interact with virtual healthcare providers and a virtual health coach in a virtual primary care environment to practice effective

Sample characteristics

Table 1 shows the sample characteristics of the participants (N = 28). This convenience sample of community-dwelling young adults had a mean age of 22 years (SD = 2.2). Most participants were non-white (82%), were female (64%), earned a high school diploma (75%), and were not taking psychotropic medications or receiving psychotherapy (71%) at baseline. When stratified by depressive symptom severity, 69% (HAD-S cut-off score  8) of the participants reported a depressive symptom severity consistent

Discussion

Depressive symptoms were prevalent among young adults in this study. Based on the HAD-S depression subscale cut score of 8, roughly one third of young adults had scored below the cut score, indicating subclinical depressive symptoms at baseline. Sixty-nine percent of participants were above the cut score, possessing depressive symptoms consistent with a DSM-IV-TR diagnosis of MDD. Despite the small sample size, initial efficacy of eSMART-MH was demonstrated. Participants who received eSMART-MH

Conclusion

This was the first evaluation of an avatar-based depression self-management of this kind among young adults. This study establish the feasibility of administering a depression self-management intervention using this novel avatar-based methodology, and the initial efficacy of using avatars as health providers and coaches in virtual primary care environments, to reduce depressive symptoms over time in a group of young adults.

References (9)

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This publication was made possible by Grant Number 2KL2TR000440-06 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

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