TrueBlue Clinical Study - Investigating the Use of a Mobile Phone App TrueBlue for Monitoring Depression and Anxiety

This early-phase study of the TrueBlue App will recruit participants from Nottinghamshire Healthcare NHS Foundation Trust (NHFT), Nottingham University Hospitals NHS Trust (NUH) and a number of Primary Care sites in Nottinghamshire, UK. At study inclusion participants will be at least 18 years old, in the perinatal phase (between 12 weeks of pregnancy and 12 weeks post-partum), able to give capacious consent and satisfying the other detailed inclusion/exclusion criteria provided below. Initial recruitment will be to a 5-month, within-study pilot phase during which up to 12 participants will use the TrueBlue App for a 12-week period. Participants will be asked to complete two tasks on the App each week, involving reading or speaking to the App whilst it records the user's face and voice; and to complete each of the following four validated scales every two weeks: Patient Health Questionnaire 9-item scale (PHQ9), Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder 7-item scale (GAD7), Temporal Experience of Pleasure Scale (TEPS). Adverse Events (AEs) will be detected through structured surveillance at weeks 6 and 12, in addition to encouraging participants to report any new or recurrent health problems during their period of App use. AEs will be assessed for plausibility of relatedness to App use [Device-Related Adverse Events; (DRAEs)], seriousness and expectedness; with discussion at the Trial Management Committee (TMC) focusing on developing any necessary mitigations, including technological or informational changes. The Standard Operating Procedure (SOP) for investigation of AEs includes a break to recruitment if serious DRAEs are identified. During the 5-month within-study pilot phase, stakeholder focus groups will be convened, separately for clinicians and patients, with up to 6 participants in each group focusing on AEs, usability issues, integration into care, liaison with Perinatal Psychiatry services and study governance. These sessions will be conducted by the study team, with recorded, anonymised transcripts subjected to thematic or content analysis depending on the depth of data. Anonymised reports from these focus groups will inform the TMC and the later individual, semi-structured interviews.

Following the 5-month within-study pilot phase and any necessary adjustments to SOPs (notified appropriately to the REC), we will enter a 9-month study period to full recruitment (125 participants). In this later period, as in the pilot phase, participants will use the TrueBlue App for up to 12 weeks, as described above, with continued surveillance for AEs including the 6 and 12 week reviews. Throughout the total 14-month study metrics will be collected on usability, feasibility and acceptability, alongside the validated self-completion questionnaires assessing depression (PHQ9, EPDRS), anxiety (GAD-7) and anhedonia (TEPS). Audio-visual data recorded through the weekly tasks will be used to generate automated mood scores that will then be assessed for agreement with the validated scales.

Up to 30 study participants will also be invited to take part in individual, semi-structured interviews assessing their experience of the app, including barriers and facilitators to use. Recruitment will be to saturation of themes, or to a maximum of 30 interviews, using purposive sampling to encourage a representation of participants with high and low System Usability Scale (SUS) scores. Interview transcripts will be subjected to thematic analysis.

This study has received approval from the relevant UK ethics committee (NHS Rec reference 22/LO/0009, IRAS project reference: 295721) and regulatory authority (MHRA, CI/2023/0063/GB).

Inclusion criteria

• 18 years or older

• Fluent in spoken and written English
• Has capacity to provide consent
• At least 12 weeks pregnant or less than 12 weeks postpartum
• Access to internet connectivity
• Access to a compatible smart phone device (for up to 10 participants, where needed through not having a personal device, this access may be provided through the study team).
• Has a current GP within Nottinghamshire

Exclusion criteria

• ● Current clinically diagnosed psychiatric disorder other than depression

• Previous history of a clinically diagnosed psychiatric disorder, other than depression and generalised anxiety disorder (including previous Psychosis, Bipolar Disorder, Personality Disorder, Substance Abuse Disorders, Eating Disorders)
• Clinical diagnosis of an Autistic Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Parkinson's Disease or other current Neurological Disorder.