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Gladstone TRG, Zhong C, Lowther M, Feinstein RT, Fitzgibbon ML, Gussin HA, Schiffer L, Diviak K, Berbaum ML, Rusiewski C, Ramirez P, Lefaiver C, Canel J, Mitchell J, Buchholz KR, Van Voorhees BW. PATHway: Intervention optimization of a prevention program for adolescents at-risk for depression in the primary care setting. Contemp Clin Trials 2024; 137:107413. [PMID: 38114047 PMCID: PMC10923135 DOI: 10.1016/j.cct.2023.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
With as many as 13% of adolescents diagnosed with depressive disorders each year, prevention of depressive disorders has become a key priority for the National Institute of Mental Health (NIMH). Currently, we have no widely available interventions to prevent these disorders. To address this need, we developed a multi-health system collaboration to develop and evaluate the primary care based technology "behavioral vaccine," Competent Adulthood Transition with Cognitive-Behavioral Humanistic and Interpersonal Therapy (CATCH-IT). The full CATCH-IT program demonstrated evidence of efficacy in prevention of depressive episodes in clinical trials. However, CATCH-IT became larger and more complex across trials, creating issues with adherence and scalability. We will use a multiphase optimization strategy approach to optimize CATCH-IT. The theoretically grounded components of CATCH-IT include: behavioral activation, cognitive-behavioral therapy, interpersonal psychotherapy, and parent program. We will use a 4-factor (2x2x2x2) fully crossed factorial design with N = 16 cells (25 per cell, after allowing 15% dropout) to evaluate the contribution of each component. Eligible at-risk youth will be high school students 13 through 18 years old, with subsyndromal symptoms of depression. The study design will enable us to eliminate non-contributing components while preserving efficacy and to optimize CATCH-IT by strengthening tolerability and scalability by reducing resource use. By reducing resource use, we anticipate satisfaction and acceptability will also increase, preparing the way for an implementation trial.
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Affiliation(s)
- Tracy R G Gladstone
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02903, USA.
| | - Cordelia Zhong
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI 02903, USA
| | - Matthew Lowther
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Rebecca T Feinstein
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Marian L Fitzgibbon
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA; Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois, Chicago, IL 60612, USA; Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Hélène A Gussin
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Linda Schiffer
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Kathleen Diviak
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois, Chicago, IL 60608, USA; University of Illinois, Cancer Center, Chicago, Il 60612, USA
| | - Calvin Rusiewski
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Paula Ramirez
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
| | - Cheryl Lefaiver
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL 60515, USA
| | - Jason Canel
- NorthShore University Health System, Evanston, IL 60201, USA
| | - James Mitchell
- Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL 60637, USA
| | | | - Benjamin W Van Voorhees
- Department of Pediatrics, College of Medicine, University of Illinois, Chicago, IL 60612, USA
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Smith MVA, Grohmann D, Trivedi D. Use of social media in recruiting young people to mental health research: a scoping review. BMJ Open 2023; 13:e075290. [PMID: 38016791 PMCID: PMC10685975 DOI: 10.1136/bmjopen-2023-075290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES This review explored the literature on the use of social media in recruiting young people, aged 13-18 years, to mental health research. It aimed to identify barriers and facilitators to recruitment and strategies to improve participation in future research. DESIGN Scoping review. DATA SOURCES Articles published between January 2011 and February 2023 were searched for on PubMed, Scopus, Medline (via EBSCOhost) and Cochrane Library databases. ELIGIBILITY CRITERIA Studies that outlined social media as a recruitment method and recruited participants aged 13-18 years. DATA EXTRACTION AND SYNTHESIS Data was extracted by two reviewers independently and cross-checked by a third reviewer. Data on study design, aims, participants, recruitment methods and findings related specifically to social media as a recruitment tool were collected. RESULTS 24 journal articles met the inclusion criteria. Studies were predominantly surveys (n=13) conducted in the USA (n=16) recruiting via Facebook (n=16) and/or Instagram (n=14). Only nine of the included articles provided a summary of success and reviewed the efficacy of social media recruitment for young people in mental health research. Type of advertisement, the language used, time of day and the use of keywords were all found to be factors that may influence the success of recruitment through social media; however, as these are based on findings from a small number of studies, such potential influences require further investigation. CONCLUSION Social media recruitment can be a successful method for recruiting young people to mental health research. Further research is needed into recruiting socioeconomically marginalised groups using this method, as well as the effectiveness of new social media platforms. REGISTRATION Open Science Framework Registry (https://osf.io/mak75/).
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Affiliation(s)
- Megan V A Smith
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - Daksha Trivedi
- Health and Social Work, University of Hertfordshire, Hatfield, UK
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Randell RL, Hornik CP, Curtis L, Hernandez AF, Denwood T, Nebeker C, Sugarman J, Tyl B, Murakami M, Oley Wilberforce L, Pagoto S, Vedin O, Andersson T, Carrasquillo O, Dolor R, Kollins SH, Pellegrino J, Ranney ML. "Click and mortar" opportunities for digitization and consumerism in trials. Contemp Clin Trials 2023; 132:107304. [PMID: 37481202 PMCID: PMC10530120 DOI: 10.1016/j.cct.2023.107304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/28/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Digitization (using novel digital tools and strategies) and consumerism (taking a consumer-oriented approach) are increasingly commonplace in clinical trials, but the implications of these changes are not well described. METHODS We assembled a group of trial experts from academia, industry, non-profit, and government to discuss implications of this changing trial landscape and provide guidance. RESULTS Digitization and consumerism can increase the volume and diversity of trial participants and expedite recruitment. However, downstream bottlenecks, challenges with retention, and serious issues with equity, ethics, and security can result. A "click and mortar" approach, combining approaches from novel and traditional trials with the thoughtful use of technology, may optimally balance opportunities and challenges facing many trials. CONCLUSION We offer expert guidance and three "click and mortar" approaches to digital, consumer-oriented trials. More guidance and research are needed to navigate the associated opportunities and challenges.
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Affiliation(s)
- Rachel L Randell
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Christoph P Hornik
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Lesley Curtis
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Adrian F Hernandez
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Tom Denwood
- Population Health Partners LLPShort Hills, NJ, USA
| | - Camille Nebeker
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine,Johns Hopkins University, Baltimore, MD, USA
| | - Benoit Tyl
- Bayer Healthcare SAS, La Garenne Colombes, France
| | | | | | - Sherry Pagoto
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | | | - Olveen Carrasquillo
- Division of General Internal Medicine Co-Director, Miami Clinical & Translational Science Institute (CTSI), University of Miami, Miami, FL, USA
| | - Rowena Dolor
- Duke University, School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Scott H Kollins
- Duke University, School of Medicine, Durham, NC, USA; Akili, Inc, Boston, MA, USA
| | | | - Megan L Ranney
- School of Public Health, Yale University, New Haven, CT, USA
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Kulikov VN, Crosthwaite PC, Hall SA, Flannery JE, Strauss GS, Vierra EM, Koepsell XL, Lake JI, Padmanabhan A. A CBT-based mobile intervention as an adjunct treatment for adolescents with symptoms of depression: a virtual randomized controlled feasibility trial. Front Digit Health 2023; 5:1062471. [PMID: 37323125 PMCID: PMC10262850 DOI: 10.3389/fdgth.2023.1062471] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Background High rates of adolescent depression demand for more effective, accessible treatment options. A virtual randomized controlled trial was used to assess the feasibility and acceptability of a 5-week, self-guided, cognitive behavioral therapy (CBT)-based mobile application, Spark, compared to a psychoeducational mobile application (Active Control) as an adjunct treatment for adolescents with depression during the COVID-19 pandemic. Methods A community sample aged 13-21, with self-reported symptoms of depression, was recruited nationwide. Participants were randomly assigned to use either Spark or Active Control (NSpark = 35; NActive Control = 25). Questionnaires, including the PHQ-8 measuring depression symptoms, completed before, during, and immediately following completion of the intervention, evaluated depressive symptoms, usability, engagement, and participant safety. App engagement data were also analyzed. Results 60 eligible adolescents (female = 47) were enrolled in 2 months. 35.6% of those expressing interest were consented and all enrolled. Study retention was high (85%). Spark users rated the app as usable (System Usability Scalemean = 80.67) and engaging (User Engagement Scale-Short Formmean = 3.62). Median daily use was 29%, and 23% completed all levels. There was a significant negative relationship between behavioral activations completed and change in PHQ-8. Efficacy analyses revealed a significant main effect of time, F = 40.60, p < .001, associated with decreased PHQ-8 scores over time. There was no significant Group × Time interaction (F = 0.13, p = .72) though the numeric decrease in PHQ-8 was greater for Spark (4.69 vs. 3.56). No serious adverse events or adverse device effects were reported for Spark users. Two serious adverse events reported in the Active Control group were addressed per our safety protocol. Conclusion Recruitment, enrollment, and retention rates demonstrated study feasibility by being comparable or better than other mental health apps. Spark was highly acceptable relative to published norms. The study's novel safety protocol efficiently detected and managed adverse events. The lack of significant difference in depression symptom reduction between Spark and Active Control may be explained by study design and study design factors. Procedures established during this feasibility study will be leveraged for subsequent powered clinical trials evaluating app efficacy and safety. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04524598.
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Affiliation(s)
- Vera N. Kulikov
- Research Department, Limbix Health, San Francisco, CA, United States
| | | | - Shana A. Hall
- Research Department, Limbix Health, San Francisco, CA, United States
| | | | | | - Elise M. Vierra
- Content Department, Limbix Health, San Francisco, CA, United States
| | - Xin L. Koepsell
- Content Department, Limbix Health, San Francisco, CA, United States
| | - Jessica I. Lake
- Science Department, Limbix Health, San Francisco, CA, United States
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Blukacz A, Cabieses B, Obach A, Calderón AC, Álvarez MI, Madrid P, Rada I. Promoting the Participation of "Hard-to-Reach" Migrant Populations in Qualitative Public Health Research during the COVID-19 Pandemic in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1956. [PMID: 36767326 PMCID: PMC9916086 DOI: 10.3390/ijerph20031956] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 05/22/2023]
Abstract
The COVID-19 pandemic has further deepened socioeconomic and health inequities worldwide, especially among populations experiencing social vulnerability, such as international migrants. Sustained lockdowns and social distancing have raised challenges to conducting public health research with hard-to-reach populations. This study aims at exploring strategies to recruit "hard-to-reach" international migrants for qualitative public health research during the pandemic in Chile, based on the authors' experience. A retrospective qualitative evaluation process was carried out on the recruitment processes of three qualitative research projects focused on international migrants in Chile. All projects were implemented during the COVID-19 pandemic, demanding complementary and flexible strategies: (i) social media; (ii) snowball sampling; (iii) referrals from social workers and pro-migrant and migrant-led organizations; (iv) vaccination centers and healthcare centers; and (v) community-based recruitment. The strategies are qualitatively evaluated around seven emerging qualitative categories: (i) feasibility during lockdown periods; (ii) speed of recruitment; (iii) geographical coverage; (iv) sample diversity; (v) proportion of successful interviews; (vi) ethical considerations; and (vii) cost. Engaging hard-to-reach international migrants in public health research during the pandemic required constantly adapting recruitment strategies. Furthermore, relying on strategies that were not only Internet-based promoted the participation of populations with limited access to the Internet and low-digital literacy.
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Affiliation(s)
- Alice Blukacz
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Región Metropolitana, Santiago 7610658, Chile
| | - Báltica Cabieses
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Región Metropolitana, Santiago 7610658, Chile
- Department of Health Sciences, University of York, York YO10 5GH, UK
| | - Alexandra Obach
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Región Metropolitana, Santiago 7610658, Chile
| | - Alejandra Carreño Calderón
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Región Metropolitana, Santiago 7610658, Chile
| | - María Inés Álvarez
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Región Metropolitana, Santiago 7610658, Chile
| | - Paula Madrid
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Región Metropolitana, Santiago 7610658, Chile
| | - Isabel Rada
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Avenida Plaza 680, Las Condes, Región Metropolitana, Santiago 7610658, Chile
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Goldberg EM, Rosen RK, Dizon DS, Langdon KJ, Davoodi NM, Wray TB, Nugent NR, Dunsiger SI, Ranney ML. Using Social Media for Clinical Research: Recommendations and Examples From the Brown-Lifespan Center for Digital Health. J Med Internet Res 2022; 24:e35804. [PMID: 35700012 PMCID: PMC9237766 DOI: 10.2196/35804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022] Open
Abstract
Social media integration into research has increased, and 92% of American social media participants state they would share their data with researchers. Yet, the potential of these data to transform health outcomes has not been fully realized, and the way clinical research is performed has been held back. The use of these technologies in research is dependent on the investigators' awareness of their potential and their ability to innovate within regulatory and institutional guidelines. The Brown-Lifespan Center for Digital Health has launched an initiative to address these challenges and provide a helpful framework to expand social media use in clinical research.
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Affiliation(s)
- Elizabeth M Goldberg
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
| | - Rochelle K Rosen
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Don S Dizon
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Medical Oncology, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Lifespan Cancer Institute, Rhode Island Hospital, Providence, RI, United States
| | - Kirsten J Langdon
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, United States
| | | | - Tyler B Wray
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Nicole R Nugent
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Shira I Dunsiger
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Megan L Ranney
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
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Kutok ER, Dunsiger S, Patena JV, Nugent NR, Riese A, Rosen RK, Ranney ML. A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial. JMIR Ment Health 2021; 8:e26029. [PMID: 34524103 PMCID: PMC8482167 DOI: 10.2196/26029] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/10/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Between 15% and 70% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. OBJECTIVE This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. METHODS From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant-led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. RESULTS Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=-.66, SE 0.08, P=.04 at 8 weeks and β=-.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02). CONCLUSIONS This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. TRIAL REGISTRATION ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216.
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Affiliation(s)
- Emily R Kutok
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
| | - Shira Dunsiger
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States
| | - John V Patena
- Brown-Lifespan Center for Digital Health, Providence, RI, United States
| | - Nicole R Nugent
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, United States
| | - Alison Riese
- Department Pediatrics and Medial Science, Alpert Medical School of Brown University, Providence, RI, United States.,Hasbro Children's Hospital, Providence, RI, United States
| | - Rochelle K Rosen
- Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States.,Center for Behavioral and Preventive Medicine at The Miriam Hospital, Providence, RI, United States
| | - Megan L Ranney
- Brown-Lifespan Center for Digital Health, Providence, RI, United States.,Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, United States
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