Preventing Depression of Chinese American Adolescents through Mobile Health Application

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Preventing Depression of Chinese American Adolescents through Mobile Health Application Project Summary/Abstract Chinese American adolescents (CAAs), traditionally perceived as a model minority, experience serious acculturative stress and depression, with the highest rates of suicide ideation and race-related stress and depression. These mental health problems, coupled with cultural barriers to mental health care due to stigma, constitute a major mental health disparity. Recent discrimination against Chinese Americans since the COVID-19 pandemic has exacerbated CAAs’ distress. This proposal addresses the disparity by developing a new mobile health application (MHA) RRE (Relax, Reflect, Empower) to provide a culturally tailored, personalized, and interactive prevention to reduce CAA depressive symptoms and improve their psychological wellbeing. The proposed RRE will build upon our previous work and integrate theoretical concepts of Mindfulness-Based Cognitive Therapy and Critical Consciousness. Aim 1. Develop RRE for CAAs. To develop a culturally and developmentally tailored prevention for CAAs, we will apply the ecological validity framework by soliciting input from 20 CAAs (balanced by gender, age, acculturation level, and SES) at all stages of the RRE development for cultural and age appropriateness in language, persons, contents, concepts, methods, contexts, and design. In consideration of within-group diversities, the RRE will be personalized to help CAAs generate their own strategies to prevent depression. We will collaborate with the Florida Center for Interactive Media to develop RRE and have six CAAs test RRE functionality and usability and provide feedback for improvement. To Examine Preliminary Efficacy of RRE, we will conduct a pilot study of a community sample of 110 CAAs, ages 14-18. We will use adaptive randomization to assign 55 participants to RRE for 5 days/week for 3 months and 55 to the control group who will receive a weekly wellness check-in text message for 3 months. Aim 2. Evaluate Feasibility and Acceptability. Assessments include both subjective (CAAs’ responses on feasibility and acceptability of RRE through Mobile Application Rating Scale and open-ended questions) and objective (CAAs’ frequency and duration of RRE access automatically recorded) measures. Aim 3. Investigate CAAs’ Changes in Depressive Symptoms, Coping Self-Efficacy, and Psychological Wellbeing. Participants in both RRE and control groups will complete measures of outcomes (depression, coping self-efficacy, psychological wellbeing) and influencing factors (acculturative stress, experiences of discrimination, life events) at three time points: baseline, the end of 12th week and 16th week. We expect CAAs in RRE group to exhibit lower levels of depressive symptoms and higher levels of coping self-efficacy and psychological well-being than the control group at Weeks 12 and 16. Additionally, CAAs in the RRE group will exhibit greater improvement than the control group in the outcome measures from baseline to Weeks 12 and 16. The development and testing of RRE to address CAA mental health disparities will have significant public health impact as RRE is highly scalable for other minority groups.