Is There an App for That? Development and Evaluation of a Mobile App-Based Mental Health Intervention for Young People

The aim of this thesis was to develop and evaluate a mobile app-based mental health intervention for adolescents. This project took place across five phases. Phase 1 involved reviewing the youth mental health literature, which indicated that emotional self-awareness (ESA) and use of positive coping strategies were key protective factors in youth mental health that had potential to be targeted as part of youth mental health interventions. It also indicated that the existing evidence base pertaining to the use of mobile apps in youth mental health was poor. Phase 2 was a focus group study with young people aged 15-16 years (N=34, 40% female), assessing their needs from mental health mobile apps. Safety, engagement and functionality emerged as key factors that should be considered in the development of mobile app-based interventions for young people. Social interaction, awareness, accessibility, gender and young people in control were also identified as important. Findings from the focus groups informed Phase 3, which was the development of a mobile app-based intervention called ‘CopeSmart’, following established intervention development guidelines. Phase 4 was a small-scale feasibility study with 15-17 years olds (N=43, 88% female), who downloaded the CopeSmart app and used it over a one-week period and then completed self-report questionnaires pertaining to their experiences of using the app. Findings suggested that the app had potential as a feasible mental health intervention medium, with the majority of young people identifying it as at least somewhat useful and displaying a moderate level of engagement with it. Phase 5a was a large-scale effectiveness evaluation of the app using a cluster randomized controlled trial (RCT) methodology. Ten schools took part, randomized either to the intervention (N=6) or the control (N=4) condition. Participants were 15-18 year olds (Nintervention=385, Ncontrol=175; 62% female). Those in the intervention group downloaded the app and were encouraged to use it daily over a four-week period. The control group received no treatment. All participants completed questionnaires containing standardised measures of ESA, coping, distress, wellbeing and help-seeking at pre-test, post-test and 8-10 week follow up. Linear regressions confirmed that higher levels of ESA and use of positive coping strategies predicted more positive well-being outcomes. Multilevel modeling, conducted on both an intention to treat and a per protocol basis, revealed no significant changes in intervention group over time compared to the control group, indicating the intervention was not effective. The app itself captured data pertaining to user engagement and recorded users responses to questions about their daily experience of problems, coping and mood states. These data were captured for 208 participants (64% female) and were analysed as part of Phase 5b. Overall findings from across the five phases provide important insights into the role of mobile apps in youth mental health and are discussed in relation to their theoretical and practical implications for future research and practice in this area.