Virtual Therapist Promising for MDD in Young Adults

Caroline Cassels

February 14, 2013

Computerized avatars — virtual 3D images of a healthcare provider — may help reduce depressive symptoms in young adults, preliminary research suggests.

A pilot study conducted by investigators at Case Western Reserve University in Cleveland, Ohio, showed that the use of an avatar healthcare provider in depressed patients aged 18 to 25 years was feasible and reduced depressive symptoms over time.

Known as the Electronic Self-Management Resource Training for Mental Health (eSMART-MH), this novel approach "demonstrated initial efficacy and is a promising developmentally appropriate depression self-management intervention for young adults," the authors, led by Melissa D. Pinto, PhD, RN, write.

The study is published in the February issue of Applied Nursing Research.

Delayed Treatment

According to investigators, major depression affects 9% of young adults in the United States, predisposing them to "serious impairments in psychological functioning" and placing them at "increased lifetime risk for disability, morbidity, mortality, and a decreased quality of life."

The researchers also point out that the onset of depression symptoms usually occurs in adolescence and young adulthood, yet many patients are not treated for as long as a decade after symptoms first present.

According to lead investigator Melissa D. Pinto, PhD, RN, the majority of young people with depression do not make contact with mental health providers until years after they first experience depressive symptoms.

Furthermore, she noted in a release that it is not uncommon for those who do seek professional help to go to their first few appointments but to stop going soon after.

The investigators also note that when it comes to using technology, young adults have a high comfort level and often prefer this form of interaction over face-to-face encounters.

The aim of the longitudinal, randomized controlled trial was to determine the efficacy of the eSMART-MH system in reducing depressive symptoms in a population of 28 young adults with depressive symptoms.

Participants were randomly assigned to receive either the eSMART-MH system or electronic screen-based health information.

Participants in the eSMART-MH group used the system to practice talking about depression, to ask avatar healthcare providers questions, to learn self-management skills to help manage depressive symptoms, and to receive tailored behavioral feedback.

Study participants received eSMART-MH or screen-based education at baseline, 4 weeks, and 8 weeks. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HAD-S) at 4-, 8- and 12-week follow-up.

The researchers found that participants who received eSMART-MH had a statistically significant reduction in depressive symptoms during a 3-month period, whereas those who received electronic screen-based health information had no change in symptoms.

At baseline, the intervention group's HAD-S score was greater than 8, consistent with a diagnosis of MDD; this score decreased over 3 months to less than 8, the authors report.

"This study established the feasibility of administering a depression self-management intervention using this novel avatar-based methodology, and the initial efficacy of using avatars as health providers and coaches in virtual primary care environments, to reduce depressive symptoms over time in a group of young adults," the investigators conclude.

The authors have disclosed no relevant financial relationships.

Appl Nurs Res. 2013; 26:45-48. Full article