Assessing the critical parameters of eSMART-MH: a promising avatar-based digital therapeutic intervention to reduce depressive symptoms
Open accessAbstract
PURPOSE: To assess, from the young adults' (YAs') perspectives, the critical parameters (necessity, acceptability, feasibility, fidelity, and safety) of an avatar-based intervention, eSMART-MH, to reduce depressive symptoms. DESIGN AND METHODS: YAs (n = 60) were randomly assigned to eSMART-MH or control and observed for 12 weeks. Qualitative and quantitative data were collected. FINDINGS: Necessity, acceptability, fidelity, and safety of eSMART-MH were supported. Feasibility results were mixed. When benchmarked against usual care, eSMART-MH demonstrated greater feasibility. PRACTICE IMPLICATIONS: eSMART-MH is a promising digital therapeutic for depressive symptoms. Feasibility can be strengthened through "on the go" access via mobile devices and Internet delivery.
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Other features that participants reported liking included interactive activities and video components.
“Other features that participants reported liking included interactive activities (58, 62), and video components (62, 73).”
From What Works and What Doesn’t Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People (2019) · cites this paper as [58]
In “Acceptability of Intervention Content” (page unavailable), participants said they preferred interactive information, and one described eSMART-MH as more interactive than looking online. The same section does not establish that participants liked its video component: one participant explicitly said they disliked the video shown at the end of each session. (LLM, conf=0.88)
Experimental — accuracy not yet measuredParticipants reported that digital mental health interventions showed them things they did not know and helped them learn more about mental health.
“Participants reported that the DMHIs “showed me things I didn’t know” (56, p. 7), and helped them learn more about mental health (58).”
From What Works and What Doesn’t Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People (2019) · cites this paper as [58]
Some participants argued that it would be more convenient to be able to tailor modules to one's own needs.
“Some participants argued that it would be more convenient to be able to tailor modules to one’s own needs: “I didn’t like that you couldn’t skip out of something if you already understood the concept”(58, p. 163).”
From What Works and What Doesn’t Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People (2019) · cites this paper as [58]
In Pinto et al [30], chatbot was safe because no harm, distress, adverse events, or worsening of depressive symptoms were reported.
“The former study concluded that the chatbot was safe because users did not report any harm, distress, adverse events, or worsening of depressive symptoms resulting from using the chatbot during the study [30].”
From Effectiveness and safety of using chatbots to improve mental health: systematic review and meta-analysis (2020) · cites this paper as [30]
Participants reported being satisfied with the conversational agent interventions offered.
“Generally, from studies that reported user experience outcomes (n=11), participants reported being satisfied with the conversational agent interventions offered [22,23,25,26,29,30,32].”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [30]
The 2 uncontrolled studies and 2 studies that did not test for between-group effects reported reductions in depression and loneliness postintervention.
“Finally, the 2 uncontrolled studies included in the review [22,29] and 2 studies that did not test for between-group effects [28,30] reported reductions in depression [28-30] and loneliness [22] postintervention.”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [30]
Safety was only explicitly evaluated and reported in 1 study.
“Safety was only explicitly evaluated and reported in 1 study [30].”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [30]
Some participants in the study by Pinto et al reported that they would like more frequent, longer intervention sessions, and greater freedom to tailor content and responses to their needs.
“Some participants in the study by Pinto et al [30] reported that they would like more frequent, longer intervention sessions, and greater freedom to tailor content and responses to their needs.”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [30]
Participants reported that they found the agent empathic, liked the interactivity, the agent's personality, the agent's ability to form a relationship, and the agent's ability to learn from input.
“Participants reported that they found the agent empathic [26], that they liked the interactivity [30], the agent’s personality [22,25], the agent’s ability to form a relationship [28,33], and the agent’s ability to learn from input [26].”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [30]
The accessibility of the interventions was a key strength for many participants and where accessibility was limited, participants highlighted this and suggested ways to improve accessibility.
“The accessibility of the interventions was a key strength for many participants and where accessibility was limited, participants highlighted this and suggested ways to improve accessibility (eg, online access [30]).”
From Conversational agents in the treatment of mental health problems: mixed-method systematic review (2019) · cites this paper as [30]
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References 34 · Cited by 46
Research works printed but not linked: 3
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- Authors
- Pinto, M. D., Greenblatt, A. M., Hickman, R. L., Rice, H. M., Thomas, T. L., & Clochesy, J. M.
- Affiliations
- Emory University (US)
- University Hospitals of Cleveland (US)
- Case Western Reserve University (US)
- Florida International University (US)
- University of South Florida (US)
- Corresponding author
- Pinto, Melissa D.
- ORCID
- Venue
- Perspectives in Psychiatric Care
- Publisher
- Wiley
- Published
- 2015-03-19
- Volume
- 52
- Issue
- 3
- Pages
- 157-168
- ISSN
- 0031-5990 (ISSN-L)
- OpenAlex
- W1714874903
- Cited by
- 46
- References
- 34
- Citations by year
- 2025: 5 · 2024: 7 · 2023: 8 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 6 · 2018: 3 · 2017: 2 · 2016: 2 · 2015: 1
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Perspectives In Psychiatric Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Nurses Foundation
- National Institute for Health Research (KL2 TR000440)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- digital therapeutics, depressive symptoms, young adults, feasibility, acceptability, fidelity, safety, necessity, mobile health, online intervention
- MeSH terms
- Adolescent, Adult, Depression, Female, Humans, Male, Psychiatric Status Rating Scales, Self Care, United States, Cognitive Behavioral Therapy, Single-Blind Method, Telemedicine, Young Adult, Self Report, Mobile Applications
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