Designing and Pilot Testing a Just-in-time Adaptive Intervention (JITAI) for Adolescent Depression Treatment in Primary Care

The PROMIS Sleep Disturbance 8a scale for adolescents is a self-report assessment of sleep difficulties over the past week. It includes 8 items related to sleep quality and disturbances rated on a 5-point scale. Raw scores (range: 8 - 40) are converted to normalized T-scores, with higher scores indicating greater sleep disturbance

The PROMIS Sleep-Related Impairment measure is a self-report assessment of the impact of sleep disturbances on daily functioning over the past week. It includes 8 items related to how sleep problems affect activities like school performance, mood, and social interactions, rated on a 5-point scale. Raw scores (range: 8-40) are converted to normalized T-scores, with higher scores indicating greater impairment in daily functioning due to sleep issues.

The Pittsburgh Sleep Quality Index (PSQI) is a self-report assessment of sleep quality over the past month. It includes 19 items covering sleep patterns, duration, disturbances, and daytime dysfunction. Response values are combined into components produce a global score (range: 0-21), with higher scores indicating poorer sleep quality and greater sleep-related difficulties.

The Physical Activity Questionnaire for Adolescents (PAQ-A) is a self-report assessment of physical activity levels in adolescents over the past 7 days. It includes 9 items related to the frequency and intensity of various physical activities, with responses on a 5-point scale. Scores are summed and averaged, with higher scores indicating greater physical activity levels.

The Patient Health Questionnaire-9 (PHQ-9) is a self-report tool used to assess the severity of depressive symptoms over the past two weeks. It includes 9 items related to mood, interest, and other depressive symptoms, rated on a 4-point scale. Total scores range from 0 to 27, with higher scores indicating more severe depressive symptoms and greater impairment.

The Generalized Anxiety Disorder-7 (GAD-7) is a self-report assessment of the severity of anxiety symptoms over the past two weeks. It includes 7 items related to anxiety-related feelings like worry, restlessness, and physical symptoms, rated on a 4-point scale. Total scores range from 0 to 21, with higher scores indicating more severe anxiety symptoms and greater impairment.

Step count will be collected via the Garmin smartwatch. The average daily step count over the 2-week baseline data collection period will be compared to the average daily step count in the last week of the intervention.

Activity intensity will be collected via the Garmin smartwatch, categorized into light, medium, and vigorous. The average daily minutes of moderate + vigorous activity during the 2-week baseline data collection period will be compared to the average daily minutes of moderate + vigorous activity in the last week of the intervention.

The Suicide Ideation Questionnaire-Junior (SIQ-Jr) measures the frequency of suicide ideations in the past month. The 15-item self-report assessment records frequency on a 7 point scale ranging from "Almost every day" (0) to "I never had this thought" (7). Scores range from 0 to 90 with higher scores indicating greater frequency of SI.

The Weiss Functional Impairment Rating Scale (WFIRS) is a self-report tool used to assess the functional impairment associated with ADHD symptoms across various domains, such as family, social, school/work, and emotional functioning. It includes 18 items rated on a 5-point scale. Total scores indicate the level of impairment, with higher scores reflecting greater functional difficulties and more significant impact on daily life.

Sleep duration will be collected via the Garmin smartwatch. The average daily sleep duration (in minutes) during the 2-week baseline data collection period will be compared to the average daily sleep duration (in minutes) in the last week of the intervention.

The midpoint of sleep (clock time halfway between bedtime and waketime) will be collected via the Garmin smartwatch. The standard deviation of the midpoint during the two week baseline period will compared to the standard deviation of the midpoint during the last two weeks of the intervention period.