Automated Interactive Text Messaging to Assess Adolescent Depression

描述（由申请人提供）：新的交互式通信技术在现代社会中不断扩展。儿童和青少年往往是最早采用新技术的人。经由短消息服务（SMS）“文本消息”的通信是一个示例。本申请提出开发用于使用动态分支SMS“文本”消息传递交互地评估儿童和青少年的临床状态的计算机自动化方法。抑郁症的评估将被用作拟议研究的模板。研究目的是（1）评估计算机自动化交互式短信系统的技术可行性，（2）评估抑郁儿童和青少年对该技术的接受程度，（3）收集专为青少年设计并通过短信传递的抑郁症状快速量表（QIDS-A-SMS）的可靠性和有效性数据。开发交互式SMS技术的长期目标是提供临床有效、广泛可用、国际可及、易于使用和用户可接受的工具，以获得儿科患者人群中各种疾病的患者报告结局。如果成功，本申请提出的研究将支持在儿科抗抑郁药临床试验中使用QIDS-A-SMS作为有效的治疗结局指标。将从NIH申办的“儿科MDD：氟西汀序贯治疗和复发预防CBT”（MH 039188; Graham Emslie博士，PI）中招募25例诊断为重度抑郁症的8-17岁门诊患者。在基线和氟西汀治疗6周结束时的门诊访视期间，研究参与者将使用手机通过对一系列动态分支的计算机自动化SMS消息的“文本回复”来完成交互式QIDS-A-SMS评估。将收集有关评估体验的用户反馈。德克萨斯大学西南医学院的独立评估人员也将使用儿童抑郁评定量表修订版（CDRS-R）评估抑郁严重程度，以与QIDS-A-SMS数据进行比较。系统性能的技术措施，如在时间完成评估和错误频率，用户接受反馈，心理测量的QIDS-A-SMS的可靠性和有效性将进行分析。 公共卫生相关性：现代技术，如通过移动电话发送“短信”，对青少年具有吸引力，并可能为提供行为和心理健康干预提供新的机会。该技术也可能有助于评估此类干预措施对儿科人群的影响。重度抑郁症是一种致残性疾病，通常在15-19岁之间开始，破坏发育，损害功能，增加药物滥用，自杀和成年抑郁症的风险。最近对服用抗抑郁药的青少年自杀风险增加的担忧使公众注意到需要更密切地监测青少年抑郁症的体征和症状。

DESCRIPTION (provided by applicant): New interactive communication technologies continue to expand in modern society. Children and adolescents are frequently among the earliest adopters of new technologies. Communication via Short Message Service (SMS) "text messaging" is one example. This application proposes to develop computer-automated methods for interactively assessing clinical states in children and adolescents using dynamically branching SMS "text" messaging. Assessment of depression will be used as a template for the proposed research. Study aims are to (1) evaluate the technical feasibility of a computer-automated interactive SMS messaging system, (2) assess acceptance of the technology among depressed children and adolescents, and (3) collect reliability and validity data on a version of the Quick Inventory of Depressive Symptomatology specifically designed for use by adolescents and delivered by SMS (QIDS-A-SMS). Long-term objectives for the development of an interactive SMS technology are to provide clinically valid, widely available, internationally accessible, easily used, and user- acceptable tools for obtaining patient reported outcomes across a wide range of conditions in pediatric patient populations. If successful, the research proposed by this application will support use of the QIDS-A-SMS as a valid treatment outcome measure in pediatric antidepressant clinical trials. Twenty-five outpatients, 8-17 years old, diagnosed with major depression will be recruited from the NIH-sponsored "Pediatric MDD: Sequential Treatment with Fluoxetine and Relapse Prevention CBT" (MH039188; Dr. Graham Emslie, PI). During office visits at baseline and at the end of 6 weeks of treatment with fluoxetine, study participants will use cell phones to complete interactive QIDS-A-SMS assessments via "text replies" to a series of dynamically branching, computer-automated SMS messages. User feedback regarding the assessment experience will be collected. Independent evaluators at the University of Texas - Southwestern Medical School will also assess depression severity using the Child Depression Rating Scale-Revised (CDRS-R) for comparison with the QIDS-A-SMS data. Technical measures of system performance such at time to complete the assessments and error frequencies, user acceptance feedback, and psychometric reliability and validity of the QIDS-A-SMS will be analyzed. PUBLIC HEALTH RELEVANCE: Modern technologies, such as "text messaging" via cellular telephone, are attractive to adolescents and may provide new opportunities to provide behavioral and mental health interventions. The technology may also be helpful for assessing the impact of such interventions in pediatric populations. Major depression is a disabling condition that often begins between the ages of 15-19 years, disrupting development, impairing functioning, and increasing risk for substance abuse, suicide, and adulthood depression. Recent concerns about an increased risk of suicide in adolescents being treated with antidepressants have focused public attention on the need for closer monitoring of adolescent signs and symptoms of depression.