Young adults, in a period of transition, are often reluctant to seek treatment for mental health problems because of the stigma, inadequate insurance coverage and difficulty finding a mental health care provider.

But a new preliminary study by researchers at Case Western Reserve University suggests that depression symptoms may be significantly reduced when 18- to 25-year-olds interact with computerized avatars—virtual 3D images of a healthcare provider like a nurse practitioner or physician —as a way to rehearse office visits ahead of time and learn self-management skills.

Study results were published in the current Applied Nursing Research journal article (http://www.appliednursingresearch.org/), "Avatar-based depression self-management technology: promising approach to improve depression symptoms among young adults."

Melissa Pinto, PhD, RN, a KL2 Clinical Research Scholar and instructor at Case Western Reserve's Frances Payne Bolton School of Nursing, collaborated with developers of the Electronic Self-Management Resource Training (eSMART) team: Ronald Hickman Jr., PhD, ACNP-BC, and John Clochesy, PhD, RN, FAAN (now at University of Southern Florida) from the nursing school, and Marc Buchner, PhD, from the Virtual Gaming Lab at Case Western Reserve's engineering school.

Pinto said the study was the first to her knowledge to use an avatar-based intervention for this age group to improve depressive symptoms.

The researcher used a Case Western Reserve-designed virtual program, called eSMART-MH. eSMART-MH was adapted from a previous platform (eSMART-HD) designed by the team to help adults with chronic health problems manage their health.

The interactive avatar program, eSMART-MH, was designed in Buchner's Virtual Gaming Lab and tailored for young adults with depressive symptoms. eSMART-MH walks young adults through healthcare appointments with an avatar healthcare provider in virtual primary care office setting. During these visits, young adults practice talking about depression, ask avatar healthcare providers questions and learn self-managements skills to help manage depressive symptoms.

At this age, a majority of young people do not make contact with mental health providers until years after they first experience depressive symptoms. And those who do seek professional help may go to their first few appointments, but stop going soon after, said Pinto, who has studied mental health interventions in adolescents and young adults for six years.

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Nuring offers something for everyone, but too few nurses gravitate to the mental health field. "We can always use more qualified psych nurses," said Benjamin Evans, RN, DD, DNP, APN, PMHCNS-BC, associate vice president of behavioral health services at Bergen Regional Medical Center in Paramus, N.J. "But not a lot of folks come out of nursing school with an interest in psych."

Robin Krajewski, RN, MSN, NPP, director of network development and management at PSCH in Flushing, N.Y., has found people fearful of working in behavioral health.

"There’s still a stigma about mental illness, and people are afraid," Krajewski said.

However, she adds, the field needs more people with the skill to understand what others are going through and the ability to coordinate all aspects of the patients’ care.

"Nurses look at the whole person and have an advantage in working with people," Krajewski said. "I’d say to nurses, give it a try."

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