Low-burden Adaptive Mobile Interventions for Mood and Suicide Risk

项目摘要/摘要 抑郁症是全球疾病相关残疾的头号原因，抑郁症的患病率和 在过去的25年里，美国的自杀率大幅上升。年轻人，包括 大学生，抑郁症的发生率特别高，但大多数有临床意义的个人 症状不寻求正式治疗。候选人(亚当·霍维茨博士)之前的研究表明 自杀风险较高的大学生可能会因为缺乏时间等障碍而拒绝正式治疗， 感觉到的治疗需求低，或获得服务的机会有限。移动医疗技术提供了有前途的新技术 有机会克服这些障碍，改善结果。此外，移动技术在 与可穿戴传感器相结合，可以收集实时的主观和客观数据，并 能够在需要的时候通过干预直接对情绪变化做出反应。这位K23指导 职业发展奖的申请提出了一个有重点的研究和培训计划，以促进 应聘者向以患者为导向的研究和低负担专业的独立职业生涯过渡 针对情绪和自杀风险的适应性移动预防性干预。具体研究目标为：1) 使用参与式行动方法，确定目标人群的偏好、参与的障碍以及 用于生态瞬时评估和个性化反馈消息的相关域；以及2) 实施移动卫生个性化反馈干预的试点可行性微随机试验 大学生(N=60)有抑郁发作的风险。候选人将通过以下方式实现这些研究目标 获得专门的培训以获得以下方面的专门知识：1)干预的参与性行动研究方法 开发；2)移动健康、微随机试验和适应性移动干预开发和 评估；以及3)移动、传感器和生态瞬时评估的高级统计分析 数据。这些培训目标将通过这些内容领域专家的密切指导来实现， 专门的培训和教学，以及应用研究经验。来自概述的调查结果 调查将提供关于可接受性、可行性、感知的帮助和 假想的变化机制，以及可用作 干预在适应性设计中触发。总而言之，这些发现将直接为NIH R01的申请提供信息 在研究结束时，寻求评估旨在 优化个性化反馈消息的传递，并提供其他应对提示、工具和/或 资源(如有指示)。总而言之，本提案中概述的培训和研究机会将 为有前途的候选人提供必要的技能，以便在开发可访问性和 有效的适应性移动干预措施，以减少年轻人中的抑郁和自杀。

Project Summary/Abstract Depression is the #1 cause of disease-related disability worldwide and prevalence rates for depression and suicide have increased significantly in the United States over the past 25 years. Young adults, including college students, have especially high rates of depression, yet a majority of individuals with clinically significant symptoms do not seek formal treatment. Previous work by the Candidate (Dr. Adam Horwitz) suggests that college students at elevated risk for suicide may decline formal treatment due to barriers such as lack of time, low perceived need for treatment, or limited access to services. Mobile health technologies offer promising new opportunities to overcome these barriers and improve outcomes. Further, the use of mobile technologies in combination with wearable sensors allow for the gathering of real-time subjective and objective data, and an ability to respond to mood changes directly with an intervention at the time it is needed. This K23 Mentored Career Development Award application proposes a program of focused research and training to facilitate the Candidate’s transition to an independent career in patient-oriented research with a specialization in low-burden adaptive mobile preventative interventions for mood and suicide risk. The specific research aims are to: 1) using a participatory action approach, identify the target population preferences, barriers to engagement, and relevant domains for ecological momentary assessments and personalized feedback messages; and 2) conduct a pilot feasibility micro-randomized trial of a mobile health personalized feedback intervention with college students (N = 60) at risk for depressive episodes. The Candidate will pursue these research aims by obtaining specific training to gain expertise in: 1) participatory action research methods for intervention development; 2) mHealth, micro-randomized trials, and adaptive mobile intervention development and evaluation; and 3) advanced statistical analysis for mobile, sensor, and ecological momentary assessment data. These training objectives will be met through close mentorship from experts in these content areas, specialized trainings and didactics, and applied research experiences. Findings from the outlined investigations will provide invaluable pilot data regarding acceptability, feasibility, perceived helpfulness, and hypothesized mechanisms of change, as well as potential features and thresholds that can be used as intervention triggers in an adaptive design. Together, these findings will directly inform an NIH R01 application at the conclusion of the study period seeking to evaluate a just-in-time adaptive intervention designed to optimize the delivery of personalized feedback messages, and provide additional coping tips, tools, and/or resources when indicated. In summary, the training and research opportunities outlined in this proposal will provide the necessary skills for a promising Candidate to launch a career in developing accessible and impactful adaptive mobile interventions to reduce depression and suicide among young people.