MoodRing: A multi-stakeholder platform to monitor and manage adolescents' depression in primary care with passive mobile sensing.

摘要 随着青少年抑郁和自杀率持续上升，医疗保健系统举步维艰 以解决精神卫生服务使用的需求和不足。以病人为中心的儿科医疗之家 该模型还可以通过增加获得和协调护理的机会来改善青少年抑郁症的结果 提供持续的监测。不幸的是，尽管有指南建议，超过三分之二的青少年 在初级保健中发现有抑郁症状的人没有接受症状监测，19%的人没有重新接受 接受症状重新评估。这种缺乏症状监测和重新评估可能会导致不愉快 健康结果，包括功能下降、急诊和危急服务的使用增加以及住院-- 自杀导致的死亡。当前的技术结合了从智能手机被动收集的数据 为患者就诊之间的并行监控提供机会，从而将患者的负担限制为自我 报告并限制医疗系统的负担，允许初级保健团队分流接触和AS- 向患者灌输一种系统，认为这意味着疾病严重程度的增加。这项形成性研究将证明 MoodRing的可用性和潜在的临床实用价值，这是一种收集被动运动的技术干预 关于青少年使用手机与抑郁症状严重程度相关的方面的胆汁电话传感器数据(例如 通信模式、社交媒体使用、旅行)，并将这些数据集成到多用户(青少年、父母、老年人)中 Mary护理提供者/护理经理)平台，从该平台可以查看症状和安全通信 可能会发生。在健康信念模型的支持下，MoodRing可能会提高抑郁症患者的质量- 通过提高自我效能来管理(增加症状重新评估、治疗/服药依从性)， 来自父母和照顾团队的社会支持，以及鼓励应用自我管理技能 通过增加自我管理知识、技能和症状反馈。MoodRing建立在固体基础上 在设计技术干预措施以增加青少年启蒙能力方面经验丰富的调查人员基础 他们已经开发了被动感知的机器算法和一个小的 在与健康研究人员合作开发多用户网络/移动设备方面拥有丰富经验的业务合作伙伴 站台。这项STTRI期研究旨在实现两个目标。第一个是应用机器学习 为大学年龄段的青少年抑郁症患者开发了渠道，并确定是否自我报告 抑郁症状可以从被动数据中可靠地预测出来，准确率至少为85%。第二个是 MoodRing的用户设计和系统架构。如果达到了模型成功的里程碑 预测抑郁症状和拟议的MoodRing干预对青少年来说是可以接受的， ENTS和初级保健提供者/保健管理人员，然后我们将继续进行STTR第二阶段研究。的目标是 第二阶段包括MoodRing的开发和随后的疗效试验。具体来说，我们将进行一项 MoodRing初级保健环境下与常规护理相比的整群随机对照试验。

ABSTRACT As rates of adolescent depression and suicidality continue to trend upwards, the healthcare system struggles to address the need for and lack of mental health service use. The pediatric patient-centered medical home model may improve adolescent depression outcomes by enhancing access to and coordinating care, as well as providing ongoing monitoring. Unfortunately, despite guideline recommendations, over 2/3 of adolescents identified with depression symptoms in primary care do not receive symptom monitoring and 19% do not re- ceive symptom reassessment. This lack of symptom monitoring and reassessment can result in untoward health outcomes including a decrease in functioning, increased use of acute and crisis services, and hospitali- zations due to suicidality. Current technologies which incorporate data passively collected from smartphones offer an opportunity for intercurrent monitoring between patient visits which limits burden on the patient to self- report and limits burden on the healthcare system, allowing primary care teams to triage contacting and as- sessing patients a system identifies with an increase in disease severity. This formative study will demonstrate the usability and potential clinical utility of MoodRing, a technology intervention which will collect passive mo- bile phone sensor data on aspects of adolescent phone use related to depressive symptom severity (e.g. com- munication patterns, social media use, travel) and integrate this data into a multi-user (adolescent, parent, pri- mary care provider/care manager) platform from which symptoms can be viewed and secure communication can occur. MoodRing, as supported by Health Belief Model, may lead to improved quality of depression man- agement (increased symptom reassessment, therapy/medication adherence) through increasing self-efficacy, social support from parent and care team, as well as encouraging application of self-management skills through increased self-management knowledge, skills, and symptom feedback. MoodRing builds on a solid foundation of investigators experienced in design of technology interventions to increase adolescent initiation of depression treatment, who have already developed machine algorithms for passive sensing and a small business partner with vast experience in working with health researchers to develop multi-user web/mobile platforms. This STTR Phase I study seeks to accomplish two aims. The first is to apply a machine learning pipeline developed for college-aged youth to adolescents with depression and determine whether self-reported depressive symptoms can be reliably predicted from passive data with at least 85% accuracy. The second is the user design and system architecture of MoodRing. If milestones are achieved that models are successful at predicting depressive symptoms and the proposed MoodRing intervention is acceptable to adolescents, par- ents, and primary care providers/care managers, then we will pursue the STTR Phase II study. The aims of Phase II include the development and subsequent efficacy trial of MoodRing. Specifically, we will conduct a cluster randomized controlled trial in a primary care setting of MoodRing as compared to usual care.