MEMO is a depression prevention intervention for adolescents in New Zealand that uses multi-media text messages to deliver concepts from Cognitive Behavioral Therapy (CBT).
MEMO was iteratively developed with feedback from adolescents and expert advisors with expertise in adolescent psychiatry, CBT, marketing and media, and mobile health (mHealth) interventions. MEMO incorporates concepts from CBT into video clips delivered through text messages. Text messages link to videos on an intervention website that includes live action and animated clips that last up to 30 seconds each. Users receive 2 messages daily for 9 weeks and monthly messages directing them to the intervention website thereafter. Live action videos feature adolescents describing techniques for coping and celebrities challenging users to practice specific techniques. Animated clips featured 4 fictional adolescents explaining different intervention concepts. The intervention website includes summaries of intervention techniques, information for additional help, and downloads for relaxing audio recordings. MEMO content was designed to be appealing to Maori and Pasifika adolescents.
Cognitive Behavioral Therapy (CBT)
MEMO: An mHealth intervention to prevent the onset of depression in adolescents: A double-blind, randomised, placebo-controlled trial
Summary: Researchers recruited 855 students who were not depressed from 15 high schools in the Auckland, New Zealand and randomized them to receive MEMO (n=426) or a full attention control intervention (n=429) for 9 weeks. The control intervention focused on healthy eating, sustainability, and cyber safety and included equal numbers of text messages with similar content presentation (celebrities, adolescents, animated characters) to MEMO. Researchers and participants were blinded to who received MEMO versus the control intervention. Participants completed assessments of depression symptoms, quality of life, mood, and suicidal ideation at baseline, 9 weeks, and 12 months post-intervention. Participants in both groups experienced a non-significant decrease in depressive symptoms between baseline and 9 months, and a non-significant increase in depressive symptoms between 9 and 12 months. There were no significant between-group differences in depression symptom scores or changes in scores, nor in number of reported depressive episodes reported or time to first depressive episode. There were also no significant between-group differences in suicidal ideation, mood, or quality of life at any time point. Most participants (75%) reported viewing at least half of the messages, though website tracking indicated that 19% of participants viewed at least half of the video messages.
Take Away: MEMO had no effect on depression symptoms or other outcomes compared to a control intervention.
MEMO – A mobile phone depression prevention intervention for adolescents: Development process and postprogram findings on acceptability from a randomized controlled trial
Summary: Researchers evaluated the acceptability and perceived usefulness of MEMO compared to the control intervention. Participants completed assessments of intervention completion and perceived intervention usefulness at 9 weeks (post-intervention). Most participants liked the celebrity video messages (78%), the other-adolescent video messages (71.8%), the animated video messages (65.8%), and the text messages (60.3%). Most participants reported finding MEMO useful (84%). More female than male participants reported finding MEMO helpful. Significantly more MEMO participants reported that they would recommend the intervention to a friend than control participants. MEMO participants were more likely than control participants to report that the intervention helped them to be more positive, get rid of negative thoughts, relax, solve problems, have fun, and deal with school issues. MEMO and control participants were equally likely to know where to go for help. Participants who did not find MEMO helpful (n=67) most commonly reported that the intervention didn’t change as expected (n=15), that they didn’t have problems to address with MEMO (n=15), and that they had technical difficulties (n=15). Researchers noted that most technical difficulties arose because adolescents were using overseas mobile phones.
Take Away: MEMO was more acceptable to adolescents than a control intervention and adolescents reported finding MEMO useful.