The internet is an increasingly important resource for clinicians to access training materials and resources for treatment delivery of evidence-based treatments such as cognitive behavioral therapy (CBT) and antidepressant medications. This project proposes to develop a secure, web-based resource to provide therapists with instructional materials for scheduling tailored, interactive text messages for delivery to depressed adolescents in treatment. The content of the selectable, short message service (SMS) interactions will be designed to engage the adolescents, encourage compliance, and support clinical objectives of various treatment modules available through the password-protected website. The therapists will be able to review clients'responses to the automated SMS queries, permitting treatment plan adjustments to be based on measured progress between visits. Eight therapists (4 from the University of Texas Southwestern and 4 from University of Nebraska Medical School) will be asked to complete the training materials developed for the website. They will incorporate the SMS-augmented treatment modules into a 12-week treatment protocol for four depressed adolescents (12-17 years old). The treatment protocol will include weekly therapeutic sessions (total N = 32, 16 from each site). Clinician-based ratings (QIDS-A, CGI-S, CGI-C) and patient-reported outcomes (internet K-SADs depression module, QIDS-A-Pat) will be obtained at baseline, and at weeks 6, 12, and 24. The Center for Psychological Consultation will recruit a cohort of community-based therapists who treat depressed adolescents to identify a community-control sample of 32 adolescents receiving treatment-as-usual (TAU). The community-control TAU patients will also be assessed at baseline and weeks 6, 12, and 24 with the same outcome measures. Primary comparisons will be clinical outcome differences between the SMS- augmented treated patients and those receiving TAU at weeks 6, 12, and 24. Secondary clinical analyses will examine whether more rapid onset of symptomatic improvement at week 6, particularly in the SMS-augmented group, is predictive of sustained remission from depression at week 24.
Major depression is a disabling condition that often begins in adolescence, disrupting development, impairing functioning, and increasing risk for substance abuse, suicide, and adulthood depression. Technologies to facilitate new modes of communication, such as text-messaging, are often adopted earliest by younger members of our modern society. The internet has also become an increasingly important resource to both clinicians and patients. Innovative methods are needed to take advantage of multi- media training opportunities to assist clinicians to incorporate automated interactive text- messaging assessments into therapeutic homework assignments, monitor medication side effects, assess symptom severities, and provide encouragement.