Young adults, in a period of transition, are often reluctant
to seek treatment for mental health problems because of the stigma, inadequate
insurance coverage and difficulty finding a mental health care provider.
But a new preliminary study by researchers at Case Western
Reserve University suggests that depression symptoms may be significantly
reduced when 18- to 25-year-olds interact with computerised avatars—virtual 3D
images of a healthcare provider like a nurse practitioner or physician —as a
way to rehearse office visits ahead of time and learn self-management skills.
Study results were published in the current Applied Nursing
Research journal article, “Avatar-based depression self-management technology:
promising approach to improve depression symptoms among young adults.”
Melissa Pinto, PhD, RN, a KL2 Clinical Research Scholar and
instructor at Case Western Reserve’s Frances Payne Bolton School of Nursing,
collaborated with developers of the Electronic Self-Management Resource
Training (eSMART) team: Ronald Hickman
Jr., PhD, ACNP-BC, and John Clochesy, PhD, RN, FAAN (now at University of
Southern Florida) from the nursing school, and Marc Buchner, PhD, from the
Virtual Gaming Lab at Case Western Reserve’s engineering school.
Pinto said the study was the first to her knowledge to use
an avatar-based intervention for this age group to improve depressive symptoms.
How the research was
The researcher used a Case Western Reserve-designed virtual
program, called eSMART-MH. eSMART-MH was adapted from a previous platform (eSMART-HD)
designed by the team to help adults with chronic health problems manage their
avatar program, eSMART-MH, was designed in Buchner’s Virtual Gaming Lab and
tailored for young adults with depressive symptoms. eSMART-MH walks young adults through
healthcare appointments with an avatar healthcare provider in virtual primary
care office setting. During these visits, young adults practise talking about
depression, ask avatar healthcare providers questions and learn self-management
skills to help manage depressive symptoms.
At this age, a majority of young people do not make contact
with mental health providers until years after they first experience depressive
symptoms. And those who do seek professional help may go to their first few
appointments, but stop going soon after, said Pinto, who has studied mental
health interventions in adolescents and young adults for six years.
The sample of 28 participants between 18 and 25 years old
was small—considered a preliminary study to gather data for something more
Pinto randomly divided the participants, recruited from
posters in city buses, into two groups: Half used e-SMART-MH, and the other
half used electronic screen-based health information.
Before each of four visits over three months, Pinto tested
participants for their depression levels to gauge whether they had incorporated
coping strategies from information learned at each session.
What the study found
Prior research reveals that, without some intervention,
depression may resolve temporarily, but usually becomes chronic and reoccurs
for many years and worsens over a person’s life. . In this small pilot study,
young adults who received eSMART-MH had a significant reduction in depressive
symptoms over the three-month study, and depressive symptoms dropped below
level for clinical significance.
The young adults who received electronic screen-based
information only had no significant change in depressive symptoms during the
study. Although the results of this
study are promising and exciting, this was the first test of eSMART-MH.
“We are very early in the science. We look forward to
assessing the eSMART-MH again in a larger study of young people,” Pinto said.