Geospatial and Ecological momentary assessment Technology and Activity Engagement for at-risk youth

青春期与自杀想法和行为(STB)的高风险有关。近年来，种族问题 性传播疾病的风险差异变得越来越明显，非洲裔美国人和其他黑人 经历过自杀行为的青少年(这里指的是黑人)比任何其他种族的青年群体都要高 因此，在美国，有必要针对STB的风险因素采取文化上适当的干预措施 种族多元化的青年人口不断增加。快感缺乏症，定义为在享受过程中失去兴趣或快乐 或有价值的活动，是抑郁症的一个核心特征，也是青年性传播疾病的独立风险因素。行为 激活(BA)疗法是一种认知行为干预，直接针对快感缺乏，通过减少 回避和孤立行为，使用积极的强化来增加对有价值的活动的参与度 奖励的体验。越来越多的证据支持BA对传统青少年的有效性 面对面的心理治疗模式，BA在一些初步调查中表现出了希望，包括 不同种族的年轻人。BA模式的一个关键优势是，对行为策略的关注非常适合 适应纳入移动传感的数字平台，并可生成有关活动的客观数据。 由于数字BA方法允许向用户和提供者实时反馈治疗目标和 与传统的面对面干预相比，它提供了一个显著的优势。到目前为止，还没有研究 已经在包括黑人青年在内的不同研究人群中测试了数字BA。因此，这项研究的目标是， 是定制和测试健康教练支持的数字BA干预，以在不同的样本中瞄准快感缺乏症 青年，使用领先的实施科学框架。最初的BA平台是由 调查人员使用智能手机技术收集移动加速度计和地理空间活动数据 与健康教练或临床医生共享，以提供反馈并通过智能手机推送BA干预内容 应用程序。我们将首先使用实施研究综合框架(CFIR)收集和分析 来自不同种族青少年、照顾者、提供者和管理人员的焦点小组的定性数据 他们对干预需求和障碍的看法以及BA干预和实施的促进者 战略。接下来，我们将使用以人为中心的设计方法，迭代地开发和适应BA干预 以满足不同种族的高危青少年的需求。然后我们将进行一项试点随机试验，比较 以数字方式将BA干预仅提供给被动的、基于智能手机的活动监控。75人的集团 青少年(35%为黑人)，年龄在12-18岁之间，有中度抑郁和重度快感缺乏症状的人将 从签名R01中招募。我们将检查对快感缺乏症(初级)的可行性、可接受性和影响 次要结果包括活动、抑郁和性传播疾病风险。这个项目将为一个更大的 BA的随机试验，有可能直接解决精神健康差距研究中的一个关键差距。

Adolescence is associated with high risk for suicidal thoughts and behaviors (STBs). In recent years, racial disparities in risk for STBs have become increasingly evident, with African American and other Black-identifying adolescents (herein, Black) experiencing higher rates of suicidal behavior than any other racial group of youth in the U.S. Thus, there is a need for culturally appropriate interventions that target risk factors for STBs among a growing population of racially diverse youth. Anhedonia, defined as the loss of interest or pleasure in enjoyable or valued activities, is a core feature of depression and an independent risk factor for STBs in youth. Behavioral Activation (BA) therapy is a cognitive behavioral intervention that directly targets anhedonia, by decreasing avoidance and isolation behaviors, using positive reinforcement to increase engagement in valued activities and the experience of reward. Growing evidence supports the effectiveness of BA for adolescents in the traditional face-to-face psychotherapy format, and BA has shown promise in the few preliminary investigations that included racially diverse youth. A key advantage of the BA model is that the focus on behavioral strategies is well suited for adaptation to digital platforms that incorporate mobile sensing and can generate objective data on activity. As the digital BA approach allows for real-time feedback to both users and providers on treatment goals and behavioral targets, it offers a significant advantage over traditional face-to-face intervention. To date, no studies have tested digital BA in a diverse study population that includes Black youth. The goal of this study, therefore, is to tailor and test a health coach supported, digital BA intervention to target anhedonia in a diverse sample of youth, using leading implementation science frameworks. The initial BA platform was developed by the investigators to collect mobile accelerometer and geospatial activity data using smartphone technology that is shared with a health coach or clinician to provide feedback and push BA intervention content via a smartphone app. We will first use the Consolidated Framework for Implementation Research (CFIR) to collect and analyze qualitative data from focus groups with racially diverse adolescents, caregivers, providers, and administrators on their perspectives of intervention needs and barriers and facilitators to BA intervention and implementation strategies. Next, using human-centered design methods, we will iteratively develop and adapt the BA intervention to the needs of racially diverse, at-risk adolescents. We will then conduct a pilot randomized trial comparing the digitally delivered BA intervention to passive, smartphone-based activity monitoring alone. A group of 75 adolescents (35% Black), ages 12-18, with moderate depression and elevated anhedonia symptoms will be recruited from the Signature R01. We will examine feasibility, acceptability, and impact on anhedonia (primary target); secondary outcomes include activity, depression, and STB risk. This project will inform a larger randomized trial of BA and has the potential to directly address a critical gap in mental health disparities research.