Evaluation of an app to support emotional wellbeing of adolescents experiencing depression and/or anxiety

INTERVENTION: The intervention ("Quest ‐ Te Whitianga") is an app available to study participants for download on their personal Android or iOS smart phone, or Chromebook, for self‐directed use for the duration of the trial. For this evaluation trial, the treatment period will be approximately four weeks. The app has been co‐designed with Maori and Pasifika young people as part of the HABITs research group. The app consists of six modules, most of which contain at least three ‘levels’, which encourages the user to practise each skill at an increasing level of difficulty. The app is highly visual and requires minimum reading. The content is based on evidence‐based strategies derived from Cognitive Behavioural Therapy, Interpersonal Therapy (IPT) and positive psychology approaches. The app consists of six modules, most of which contain at least three ‘levels’, which encourages the user to practise each skill at an increasing level of difficulty. Each module contains interactive activities (e.g. relaxation activity, entries in a gratitude journal, selecting activities to try out, interactive conversations). Module levels generally take less than 5 minutes to complete. The app is highly visual and requires minimum reading. The content is based on evidence‐based strategies derived from Cognitive Behavioural Therapy, Interpersonal Therapy (IPT) and positive psychology approaches. The six modules cover the following core concepts: 1. Relaxation and mindfulness: brief slow and controlled breathing exercises 2. Structured problem solving: STEPS (Say what the problem is, Think of solutions, Examine each one, Pick one, See what happens) 3. Activity scheduling: an activity picker exercise designed to motivate the user to do fun, active and new activities to lift mood 4. Gratitude Journal: each time a user logs into the app s/he is asked to name three things they are grateful that day. 5. Interpersonal skills; Communication, assertiveness and staying in control o CONDITION: Anxiety;Depression; ; Anxiety ; Depression Mental Health ‐ Anxiety Mental Health ‐ Depression SECONDARY OUTCOME: Average duration of each app session (seconds)[This outcome is collected for the duration of the intervention period. When the app is connected to wifi the app connects to the HABITS IT platform using the HABITs API to send usage information, such as session duration. The raw data will subsequently be analysed to calculate average duration.] Changes in self‐reported wellbeing after completion of treatment compared with baseline using the Personal Wellbeing Measure (ONS4). [Baseline. ; Post‐intervention ‐ 4‐6 weeks after intervention commencement. ; Follow‐up ‐ 8‐10 weeks after intervention commencement. ; ] Changes in self‐reported wellbeing after completion of treatment compared with baseline using the WHO (Five) Wellbeing Index (WHO‐5).[Baseline. ; Post‐intervention ‐ 4‐6 weeks after intervention commencement. ; Follow‐up ‐ 8‐10 weeks after intervention commencement. ; ] Changes in the subscale components of the PHQ‐ADS (specifically, the GAD‐7) compared with baseline. [Baseline. ; Post‐intervention ‐ 4‐6 weeks after intervention commencement. ; Follow‐up ‐ 8‐10 weeks after intervention commencement. ; (NB. Only collected at Post‐intervention and Follow‐up in RCT arm of trial).] Changes in the subscale components of the PHQ‐ADS (specifically, the PHQ‐A) compared with baseline. [Baseline. ; Post‐intervention ‐ 4‐6 weeks after intervention commencement. ; Follow‐up ‐ 8‐10 weeks after intervention commencement. ; (NB. Only collected at Post‐intervention and Follow‐up in RCT arm of trial).] Estimate of changes in self‐reported life satisfaction using within‐app momentary assessments. ; ; INCLUSION CRITERIA: Participants will be eligible for inclusion if: PRIMARY OUTCOME: Acceptability: App ratings from young people using a brief app rating scale developed for this trial. Participants will also be asked to rate their preferred module within the app and provide a brief review.[Post‐intervention ‐ 4‐6 weeks after intervention commencement (primary timepoint).; Follow‐up ‐ 8‐10 weeks after intervention commencement.; (NB. Only collected at Follow‐up in ICON arm of RCT trial); ] Efficacy of app for adolescents with mild to moderate symptoms of depression and/or anxiety ‐ assessed using change in the composite Patient Health Questionnaire Anxiety‐Depression Scale (PHQ‐ADS).[Baseline.; Post‐intervention ‐ 4‐6 weeks after intervention commencement (primary timepoint).; Follow‐up ‐ 8‐10 weeks after intervention commencement. ; (NB. Only collected at Post‐intervention and Follow‐up in RCT arm of trial).] ; Momentary assessments are simple visual sliding scale assessments scheduled immediately before and after completion of the gratitude journal module activities. This within app likert scale (quantified on a scale from 0‐1) collects information on perceived satisfaction with life. Through the secure connection to our HABITS IT server, this information is passively collected from the app when connected to wifi. We will analyse these data to gauge whether there is an immediate improvement after using a module and/or a pattern of improvement over the course of the intervention period.[Evaluated every time participants start and finish the gratitude module.] Estimate of changes in self‐reported stress level using within‐app momentary assessments. ; Momentary assessments are simple visual sliding scale assessments scheduled immediately before and after completion of the gratitude journal activities. This within app likert scale (quantified on a scale from 0‐1) collects information on perceived stress. Through the secure connection to our HABITS IT server, this information is passively collected from the app when connected to wifi. We will analyse these data to gauge whether there is an immediate improvement after using a module and/or a pattern of improvement over the course of the intervention period.[Evaluated every time participants start and finish the relaxation module.] Number of levels of each module completed[This outcome is collected for the duration of the intervention period. When the app is connected to wifi the app connects to the HABITS IT platform using the HABITs API to send usage information, such as number of module levels completed.] Number of times the app is accessed during the intervention period[This outcome is collected for the duration of the intervention period. When the app is connected to wifi the app connects to the HABITS IT platform using the HABITs API to send usage information, such as number of times the app is accessed. ] Total time spent using app (seconds)[This outcome is collected for the duration of the intervention period. When the app is connected to wifi the app connects to the HABITS IT platform using the HABITs API to send usage information, such as total time spent. ] •They are aged 11‐16 years of age (on the day of consent); •They have approached, or been identified by, a school guidance counsellor, school nurse or primary healthcare provider as needing some support for their emotional wellbeing (‘feeling stressed, down, worried’ or having some symptoms of depression and/or anxiety); •They have access to a smart phone, tablet or Chromebook at home (Android, iOS or Chromebook);