PROJECT SUMMARY
Over 3 million adolescents are diagnosed annually with major depressive disorder (MDD). Adolescent MDD
predicts lifelong risk of chronic medical conditions, psychosocial disability, and death by suicide. Current
evidence-based practices for adolescent MDD, such as standard cognitive behavioral therapy, are time and
resource intensive while still leaving some adolescent MDD symptoms, including sleep disturbance and fatigue,
unresolved. Capitalizing on adolescents’ near ubiquitous use of technologies, including smartphones and
wearable devices, this proposal aims to develop an innovative and scalable digital tool (i.e., Sidekick) that will
deliver a just-in-time adaptive intervention for adolescent MDD treatment within outpatient primary care. This
R61/R33 will test whether Sidekick engages core target mechanisms of sleep and physical activity for improving
adolescent MDD and functioning. The R61 phase will expand an existing digital platform by developing and
optimizing Sidekick’s intervention algorithms, conducting user testing, and testing whether Sidekick engages
core treatment mechanisms (i.e., sleep duration and physical activity levels). Smartphones and smartwatches
will collect passive data and ecological momentary assessments on sleep and physical activity. Sidekick will
process these streams of data to identify periods where adolescents need just-in-time support to increase
physical activity and improve sleep. Aim 1 will focus on developing and refining the algorithm that individually
tailors intervention type and delivery timing. Aim 2 will consist of a micro-randomized trial with 30 adolescents
receiving collaborative care for MDD to test whether youth demonstrate improved sleep (e.g., more sleep for
insomnia, less sleep for hypersomnia) and increased physical activity when they receive (vs. do not receive) a
Sidekick tailored intervention. Once we satisfy our “go” criteria of engaging sleep and physical activity targets,
the R33 phase will conduct a moderately sized randomized control trial of 70 youth receiving collaborative care
for MDD. Aim 3 will examine whether youth who receive Sidekick in combination with collaborative care vs.
collaborative care alone demonstrate greater improvements in sleep, physical activity, MDD symptoms, and
psychosocial functioning. To better prepare for a larger clinical trial, Aim 4 will assess whether Sidekick is
feasible, acceptable, appropriate, usable, and engaging across all phases of the study. If successful, this project
will have a significant, lasting impact on the field of adolescent mental health by creating a digitally delivered,
just-in-time adaptive intervention that can overcome substantial barriers in accessing evidence-based
interventions and assisting adolescents in their daily contexts where support is most needed. This research will
set the stage for a series of R01s testing Sidekick in expanded settings and as an evidence-based therapy
enhancement tool for other mental health problems that may benefit from in-the-moment physical activity and
sleep support, like suicidality, inattention, and executive functioning difficulties.