Mental health problems are common in young people with 75% of disorders beginning in adolescence and adolescent onset posing a considerable risk factor for long term psychological problems [1
]. Adolescence is therefore likely to be an important phase for early intervention with primary care identified as the target setting in the World Health Organisation strategy for mental health [2
]. General Practitioners (GPs) are often the providers of first step interventions for mental health (i.e. screening, monitoring, and psychoeducation), initially managing mental health concerns within their own clinical practice, then becoming conduits or gatekeepers to second step and further mental health care services (i.e. psychotherapy, medication, hospitalisation) when necessary [3
]. Nevertheless, detection and management of mental health problems in primary care remains a challenge particularly with young people [5
]; it is estimated that GPs detect at best 50% of mental health disorders [6
]. Furthermore, 5.7% of adolescents are diagnosed with major depressive disorder [8
] and up to 30% of young people experience mild depressive symptoms [9
]. New methods are needed that focus on the early stages of mental health problems before clinically diagnosable mental health disorders are identified.
Poor recognition of symptoms by young people creates a significant barrier to communicating, detecting, and receiving help for mental health problems [11
]. Research suggests that most people do not recognise the symptoms of depression and are suspicious about effective treatments [12
]. Doctor related barriers to detection and management of mental health symptoms include insufficient time for assessments, a lack of confidence in managing and treating mental health symptoms, and a lack of systematic approaches to identify and provide evidence-based interventions for psychological disorders [13
]. Detection rates of psychological problems are not necessarily associated with GP level of training in mental health or adolescent health [7
], suggesting that further GP training in recognising mental health disorders may not be the most effective avenue for increasing detection rates.
There is some evidence that computerised screening, via portable computers such as Personal Digital Assistants or hand held touch pads (e.g. iPad) are both acceptable to patients and physicians, and can increase detection rates of health risk behaviours such as poor nutrition or exercise [14
]. Short duration self-monitoring programs involving the completion of homework diaries have had some success at reducing depressive symptoms [16
] and can be run on mobile phones [17
]. Mobile phones provide a unique avenue for early intervention of mental health problems as they are an ubiquitous accessory, with 100% market penetration in Australia and Britain, and 67% worldwide [19
]. Involving technology, such as computers, the internet or mobile phones in mental health programs can engage and foster young people's involvement [20
]. Daily monitoring of mental health symptoms across time (i.e. between appointments) via mobile phones may assist young people in reducing their symptoms of mental health problems before reaching clinically diagnosable disorders. Further, daily monitoring data in addition to clinical assessment may allow for greater matching of services to patient needs and enhance pathways to care when second step care is indicated. From the patient's perspective, there is evidence that self-monitoring, on its own, is a therapeutic activity via increasing self-awareness [23
], particularly of one's emotions, and leading to positive behaviour change [24
], and therefore in the context of first step mental health care in primary care settings may lead to therapeutic outcomes.
As the integration of "e-health" reforms into primary care are considered a top priority [27
], we have developed a novel mobile phone mental health assessment and management tool, the Mobile Tracking Young People's Experiences (mobiletype
) program [17
], designed for use in primary care and other clinical settings [28
]. The mobiletype
program monitors a young person's mood, stress, coping strategies and daily activities a number of times per day, and their eating, sleeping, exercise patterns, and alcohol and cannabis use once per day. This information is then uploaded to GPs, via a secure website and displayed in summary reports for review [17
]. Our pilot study suggests that young people will monitor their mental health symptoms for the purpose of reviewing this data with their doctor and that both doctor and young person find this a beneficial way of communicating information about mental health and that the mobiletype
program assisted the doctor to understand their patient better [28
The overall aim of this study was to investigate, via a randomised controlled trial, a number of suggested benefits found in our pilot studies of the mobiletype program. This RCT was conducted as an effectiveness trial, in which we were interested the utility of the mobiletype program in the real world primary care setting. This paper reports on the primary outcomes of the RCT, namely, the mental health outcomes. We hypothesised that the mental health outcomes of participants who complete the mobiletype program and review the data with their GP will be lower at post-test and 6 weeks post-test compared with those in the attention comparison group.