Virtual primary care office lets young adults prep for doctor visits, manage depression

By Kerry Ludlam | Emory Nursing | Sept. 26, 2014

Watch as Melissa Pinto expalisn how young adults can use eSMART-MH to manage depression.

Wired. Connected. Always accessible. More than ever, these words embody the current world of teens and young adults. While the constant stream of information and input enable both generations to learn, create, and discover like never before, it also raises their risk of emotional harm.

"Kids today can't escape," says Melissa Pinto PhD RN, an assistant professor and mental health researcher at the Nell Hodgson Woodruff School of Nursing. "Gone are the days when teenagers had to drag the family phone into their rooms with their parents monitoring who's calling and how long they're talking. The boundaries between home, school, and their social lives are blurred. Young people today have a real peer audience all of the time, along with a worldwide platform."

Melissa Pinto

Melissa Pinto

With the pressures inherent for young people today, it comes as no surprise that depressive symptoms often begin during the teenage years and progress as teens reach their 20s, 30s, and 40s.

"Half of all people who develop a mental health disorder in their lifetime will have symptoms before age 15," notes Pinto, "and 75 percent of people who develop a mental health disorder in their lifetime will have symptoms by age 25."

To complicate matters, depression often goes unreported by teens and young adults, unscreened by health care providers, and unnoticed by parents.

"When young people go to get a checkup, they have their heart and lungs checked and maybe some lab work done, but unless the patients or their parents express a concern, they're likely not going to be screened for depression," Pinto says. "People, especially adolescents and young adults, have a hard time talking about it, even with their health care providers."

With this in mind, Pinto and a team of researchers from Case Western Reserve University and the University of South Florida pilot-tested an avatar-based program called eSMART-MH—short for Electronic Self-Management Resource Training for Mental Health—that immerses young adults into a virtual primary care environment. The self-management tool takes participants through the entire appointment process—from entering the waiting room and interacting with the front desk staff, to communicating with nurses and physicians about symptoms and concerns, to scheduling follow-up. eSMART-MH uses interactive technology familiar to its already tech-savvy participants.  

"We believe that we're meeting young people where they are with this technology," says Pinto. "We're able to give them assistance in a way that fits with their lifestyle and peer culture. We know that mental health has always been a sensitive topic. We're making progress on breaking the stigma that surrounds mental health. eSMART-MH is an effective dress rehearsal for talking to someone in an environment that is nonthreatening but still lifelike."

In Pinto's pilot project, 28 participants from ages 18 to 25 were randomly assigned to use eSMART-MH or a computer program on healthy living to manage their depressive symptoms. Study participants, primarily black females, lived in or near Cleveland, Ohio. After three months, eSMART-MH users showed a clinically significant reduction in their depressive symptoms. Those who used the healthy living program showed no change.

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