STAY-FINE: a personalized monitoring and intervention app to prevent relapse of anxiety and mood disorders in youth and young adults

BACKGROUND Anxiety and mood disorders are the most common mental health problems in youth and are associated with large impairment in current and lifelong functioning and increased suicide risk. Many youths with anxiety or mood disorders continue to experience new episodes into adulthood, resulting in high personal and societal costs both in adolescence and adulthood. As an estimate, 60% of adolescents, relapse within three years after an episode of depression or anxiety. If this relapse can be prevented, the chronic course of these disorders into later adolescence and adulthood may be broken. However, relapse prevention is hardly studied in youths, and, to date, there is no intervention available for adolescents in the Netherlands. OBJECTIVES The current study aims to prevent relapse of anxiety and depression in youth and young adults, with STAY-FINE, a low-threshold, personalized monitoring and intervention app. By using the format of an app with a strong focus on self-management, the participants may experience the intervention as less stigmatizing, as has been suggested by our patient focus group. STUDY POPULATION Adolescents aged 13–21 years, remitted from a depression or anxiety disorder after successful treatment or no treatment. Youths and young adults will be recruited via mental health care organisations, general practitioners, websites, (social) media, high schools, vocational schools, and universities. There are no regional barriers to participation. DESIGN a randomized controlled trial comparing STAY-FINE monitoring + intervention to monitoring only. Monitoring takes place during three-week baseline period, and is continued once every three months. Moreover, semi-structured interviews will be conducted along with self-report questionnaires at 0, 3, 6, 12, 24 and 36 months. This long-term follow-up is crucial for the current study. First, a pilot study on the feasibility of STAY-FINE monitoring and intervention app will be conducted. SAMPLE SIZE The RCT will include in total 212 youths, providing 80% power to demonstrate a significant in relative risk reduction of relapse (hazard ratio= 0.60) of 40% between the treatment conditions in the cumulative incidence of depressive and anxiety relapse over 36 months. The pilot study will include ten youths receiving the STAY-FINE monitoring app or STAY-FINE monitoring plus intervention app. INTERVENTION The app intervention is supported by a expert patient counsellor. After a three-week monitoring phase, a personalized case conceptualization is made collaboratively with the participant and the expert patient counsellor, based on the assessments, monitoring data, and information given on onset of the disorder and current dysfunctional beliefs. Based on this case conceptualisation, the participant gets a personalized advise for which modules to follow in the modular intervention app. The intervention is based on the well-established Preventive Cognitive Therapy for relapse prevention, that has been developed and studied on adults by a member of our project group. For the current study, it is enriched with self-management modules on preventing anxiety relapse and modules focussing on behavioural activation and exposure, resilience and personal meaning. A chat group with peers, guided by the expert patient counsellor, is added to support adolescents to get and keep their lives on track, and to stay fine. OUTCOME MEASURES Primary outcome is time to relapse in terms of a depressive episode/anxiety disorder, based on a semi-structured clinical interview. Secondary outcomes include symptom reduction of anxiety, depression, and comorbid disorders, self-efficacy and quality of life PROJECT GROUP: Our project group includes experts on depression and anxiety, on conducting RCTs in youths and (young) adults, on e-health and app development, and on relapse prevention. Our project group consists of researchers, clinicians, and expert patients, and we had the opportunity to use input from a patient focus group. Co-funding has been obtained from our collaborators (mental health institutions, university, institution for post-master education). With this app-based approach, we aim to ameliorate quality of life by breaking the continuing cycle of depression and anxiety disorders in a highly feasible manner in difficult to reach groups.