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O’Connor KE, Shanholtz CE, Espeleta HC, Ridings LE, Gavrilova Y, Hink A, Ruggiero KJ, Davidson TM. Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury. J Trauma Acute Care Surg 2024; 96:650-657. [PMID: 37339343 PMCID: PMC10733549 DOI: 10.1097/ta.0000000000004078] [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] [Indexed: 06/22/2023]
Abstract
BACKGROUND Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service. METHODS This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up. RESULTS Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals. CONCLUSION Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Kelly E. O’Connor
- Department of Surgery, Virginia Commonwealth University, PO Box 980141, Richmond, VA 23298 USA
| | - Caroline E. Shanholtz
- Department of Psychology, University of California, Los Angeles, 1285 Psychology Building BOX 951563, Los Angeles, CA 90095 USA
| | - Hannah C. Espeleta
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Leigh E. Ridings
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Yulia Gavrilova
- Department of Surgery, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425
| | - Ashley Hink
- Department of Surgery, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Tatiana M. Davidson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
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Kumar H, Li T, Shi J, Musabirov I, Kornfield R, Meyerhoff J, Bhattacharjee A, Karr C, Nguyen T, Mohr D, Rafferty A, Villar S, Deliu N, Williams JJ. Using Adaptive Bandit Experiments to Increase and Investigate Engagement in Mental Health. PROCEEDINGS OF THE ... AAAI CONFERENCE ON ARTIFICIAL INTELLIGENCE. AAAI CONFERENCE ON ARTIFICIAL INTELLIGENCE 2024; 38:22906-22912. [PMID: 38666291 PMCID: PMC11044947 DOI: 10.1609/aaai.v38i21.30328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Digital mental health (DMH) interventions, such as text-message-based lessons and activities, offer immense potential for accessible mental health support. While these interventions can be effective, real-world experimental testing can further enhance their design and impact. Adaptive experimentation, utilizing algorithms like Thompson Sampling for (contextual) multi-armed bandit (MAB) problems, can lead to continuous improvement and personalization. However, it remains unclear when these algorithms can simultaneously increase user experience rewards and facilitate appropriate data collection for social-behavioral scientists to analyze with sufficient statistical confidence. Although a growing body of research addresses the practical and statistical aspects of MAB and other adaptive algorithms, further exploration is needed to assess their impact across diverse real-world contexts. This paper presents a software system developed over two years that allows text-messaging intervention components to be adapted using bandit and other algorithms while collecting data for side-by-side comparison with traditional uniform random non-adaptive experiments. We evaluate the system by deploying a text-message-based DMH intervention to 1100 users, recruited through a large mental health non-profit organization, and share the path forward for deploying this system at scale. This system not only enables applications in mental health but could also serve as a model testbed for adaptive experimentation algorithms in other domains.
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Affiliation(s)
- Harsh Kumar
- Department of Computer Science, University of Toronto
| | - Tong Li
- Department of Statistics, University of Toronto
| | - Jiakai Shi
- Department of Computer Science, University of Toronto
| | | | - Rachel Kornfield
- Center for Behavioral Intervention Technologies, Northwestern University
| | - Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Northwestern University
| | | | | | | | - David Mohr
- Center for Behavioral Intervention Technologies, Northwestern University
| | | | - Sofia Villar
- MRC - Biostatistics Unit, University of Cambridge
| | - Nina Deliu
- MRC - Biostatistics Unit, University of Cambridge
- MEMOTEF Department, Sapienza University of Rome
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Kornfield R, Stamatis CA, Bhattacharjee A, Pang B, Nguyen T, Williams JJ, Kumar H, Popowski S, Beltzer M, Karr CJ, Reddy M, Mohr DC, Meyerhoff J. A text messaging intervention to support the mental health of young adults: User engagement and feedback from a field trial of an intervention prototype. Internet Interv 2023; 34:100667. [PMID: 37746639 PMCID: PMC10511778 DOI: 10.1016/j.invent.2023.100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/08/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023] Open
Abstract
Background Young adults have high rates of mental health conditions, but most do not want or cannot access treatment. By leveraging a medium that young adults routinely use, text messaging programs have potential to keep young adults engaged with content supporting self-management of mental health issues and can be delivered inexpensively at scale. We designed an intervention that imparts strategies for self-managing mental health symptoms through interactive text messaging dialogues and engages users through novelty and variety in strategies (from cognitive behavioral therapy, acceptance and commitment therapy, and positive psychology) and styles of interaction (e.g., prompts, peer stories, writing tasks). Methods The aim of this mixed-methods study was to pilot 1- and 2-week versions of an interactive text messaging intervention among young adults (ages 18-25), and to obtain feedback to guide intervention refinements. Young adults were recruited via a mental health advocacy website and snowball sampling at a North American University. We used Wizard-of-Oz methods in which study staff sent messages based on a detailed script. Transcripts of interviews were subject to qualitative analysis to identify aspects of the program that need improvements, and to gather participant perspectives on possible solutions. Results Forty-eight individuals ages 18-25 participated in the study (mean age: 22.0). 85 % responded to the program at least once. Among those who ever responded, they replied to messages on 85 % of days, and with engagement sustained over the study period. Participants endorsed the convenience of text messaging, the types of interactive dialogues, and the variety of content. They also identified needed improvements to message volume, scheduling, and content. Conclusions Young adults showed high levels of engagement and satisfaction with a texting program supporting mental health self-management. The program may be improved through refining personalization, timing, and message volume, and extending content to support use over a longer timeframe. If shown to be effective in randomized trials, this program has potential to help address a substantial treatment gap in young adults' mental health.
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Affiliation(s)
- Rachel Kornfield
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Caitlin A. Stamatis
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Ananya Bhattacharjee
- Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON M5S 2E4, Canada
| | - Bei Pang
- Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON M5S 2E4, Canada
| | - Theresa Nguyen
- Mental Health America, 500 Montgomery St #820, Alexandria, VA 22314, United States of America
| | - Joseph J. Williams
- Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON M5S 2E4, Canada
| | - Harsh Kumar
- Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON M5S 2E4, Canada
| | - Sarah Popowski
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Miranda Beltzer
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Christopher J. Karr
- Audacious Software, 3900 N. Fremont St. Unit B, Chicago, IL 60613, United States of America
| | - Madhu Reddy
- Department of Informatics, University of California-Irvine, Donald Bren Hall #5019, Irvine, CA 92617, United States of America
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
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