Chen Robert Yuzen, Feltes Jordan Robert, Tzeng William Shun, Lu Zoe Yunzhu, Pan Michael, Zhao Nan, Talkin Rebecca, Javaherian Kavon, Glowinski Anne, Ross Will
Washington University School of Medicine, St. Louis, MO, United States.
Saint Louis University School of Medicine, St. Louis, MO, United States.
JMIR Res Protoc. 2017 Jun 16;6(6):e114. doi: 10.2196/resprot.7245.
Telemedicine has emerged as an innovative platform to diagnose and treat psychiatric disorders in a cost-effective fashion. Previous studies have laid the functional framework for monitoring and treating child psychiatric disorders electronically using videoconferencing, mobile phones (smartphones), and Web-based apps. However, phone call and text message (short message service, SMS) interventions in adolescent psychiatry are less studied than other electronic platforms. Further investigations on the development of these interventions are needed.
The aim of this paper was to explore the utility of text message interventions in adolescent psychiatry and describe a user feedback-driven iterative design process for text message systems.
We developed automated text message interventions using a platform for both depression (EpxDepression) and autism spectrum disorder (ASD; EpxAutism) and conducted 2 pilot studies for each intervention (N=3 and N=6, respectively). The interventions were prescribed by and accessible to the patients' healthcare providers. EpxDepression and EpxAutism utilized an automated system to triage patients into 1 of 3 risk categories based on their text responses and alerted providers directly via phone and an online interface when patients met provider-specified risk criteria. Rapid text-based feedback from participants and interviews with providers allowed for quick iterative cycles to improve interventions.
Patients using EpxDepression had high weekly response rates (100% over 2 to 4 months), but exhibited message fatigue with daily prompts with mean (SD) overall response rates of 66.3% (21.6%) and 64.7% (8.2%) for mood and sleep questionnaires, respectively. In contrast, parents using EpxAutism displayed both high weekly and overall response rates (100% and 85%, respectively, over 1 to 4 months) that did not decay significantly with time. Monthly participant feedback surveys for EpxDepression (7 surveys) and EpxAutism (18 surveys) preliminarily indicated that for both interventions, daily messages constituted the "perfect amount" of contact and that EpxAutism, but not EpxDepression, improved patient communication with providers. Notably, EpxDepression detected thoughts of self-harm in patients before their case managers or caregivers were aware of such ideation.
Text-message interventions in adolescent psychiatry can provide a cost-effective and engaging method to track symptoms, behavior, and ideation over time. Following the collection of pilot data and feedback from providers and patients, larger studies are already underway to validate the clinical utility of EpxDepression and EpxAutism.
Clinicaltrials.gov NCT03002311; https://clinicaltrials.gov/ct2/show/NCT03002311 (Archived by WebCite at http://www.webcitation.org/6qQtlCIS0).
远程医疗已成为一种创新平台，能够以具有成本效益的方式诊断和治疗精神疾病。先前的研究已经构建了使用视频会议、手机（智能手机）和基于网络的应用程序对儿童精神疾病进行电子监测和治疗的功能框架。然而，与其他电子平台相比，青少年精神病学中电话和短信（短消息服务，SMS）干预的研究较少。需要对这些干预措施的发展进行进一步调查。
本文旨在探讨短信干预在青少年精神病学中的效用，并描述一种用户反馈驱动的短信系统迭代设计过程。
我们使用一个平台开发了针对抑郁症（EpxDepression）和自闭症谱系障碍（ASD；EpxAutism）的自动短信干预措施，并针对每种干预措施进行了2项试点研究（分别为N = 3和N = 6）。这些干预措施由患者的医疗服务提供者开出处方并可供其使用。EpxDepression和EpxAutism利用一个自动化系统，根据患者的短信回复将其分为3个风险类别之一，并在患者符合提供者指定的风险标准时通过电话和在线界面直接提醒提供者。参与者的快速基于文本的反馈以及对提供者的访谈允许进行快速迭代循环以改进干预措施。
使用EpxDepression的患者每周回复率较高（2至4个月内为100%），但每日提示会导致信息疲劳，情绪和睡眠问卷的平均（标准差）总体回复率分别为66.3%（21.6%）和64.7%（8.2%）。相比之下，使用EpxAutism的家长每周和总体回复率都很高（1至4个月内分别为100%和85%），且不会随时间显著下降。针对EpxDepression（7次调查）和EpxAutism（18次调查）的每月参与者反馈调查初步表明，对于这两种干预措施，每日信息构成了“完美的”联系量，并且EpxAutism改善了患者与提供者的沟通，但EpxDepression没有。值得注意的是，EpxDepression在患者的个案管理员或护理人员意识到之前就检测到了患者的自伤想法。
青少年精神病学中的短信干预可以提供一种具有成本效益且引人入胜的方法，用于长期跟踪症状、行为和想法。在收集了试点数据以及提供者和患者的反馈之后，更大规模的研究已经在进行中，以验证EpxDepression和EpxAutism的临床效用。
Clinicaltrials.gov NCT03002311；https://clinicaltrials.gov/ct2/show/NCT03002311（由WebCite存档于http://www.webcitation.org/6qQtlCIS0）
