Trial Outcomes & Findings for Evaluation of MoodRing on Improving the Quality of Depression Management in Adolescents (NCT NCT05376358)

NCT ID: NCT05376358

Last Updated: 2025-08-14

Results Overview

Adolescents will be asked the Partners in Health Scale The revised Partners in Health Scale (Smith 2016) assesses self-management with respect to a chronic condition, with regard to active involvement of a patient in managing their condition. Total scores range from 0 to 96 with higher scores indicating worse self-management. A larger negative change in self-management score means an improvement in self-management.

• Recruitment status: TERMINATED
• Study phase: NA
• Target enrollment: 73 participants
• Primary outcome timeframe: From baseline to 3 months
• Results posted on: 2025-08-14

Participant Flow

Recruitment sources: 81.4% from social media advertisement (591/726), 9.5% completing an electronic interest form in clinic at UPMC Children's Hospital of Pittsburgh Center for Adolescent and Young Adult Health (69/726), and from 9% completing the University of Pittsburgh online interest form (Pitt+Me) (66/726). Out of these, 12.5% (91/726) were able to be reached to complete screening. Prior to the study a plan was made to enroll healthcare providers. One provider was approached did not enroll.

Both the adolescent and the parent were required to complete the baseline survey to enter the study. Out of 73 adolescent and parent dyads consented for the study, 68 (93.1%) of adolescents completed the baseline survey while, despite multiple contacts, only 63 (86.3%) of parents completed the baseline. Therefore 63 adolescent parent dyads were able to start the study and were randomized.

Participant milestones

Measure	Usual Care Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
3 Month Timepoint Data Collection STARTED	31	32
3 Month Timepoint Data Collection COMPLETED	12	9
3 Month Timepoint Data Collection NOT COMPLETED	19	23
6 Month Timepoint Data Collection STARTED	31	32
6 Month Timepoint Data Collection COMPLETED	8	8
6 Month Timepoint Data Collection NOT COMPLETED	23	24

Reasons for withdrawal

Measure	Usual Care Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
3 Month Timepoint Data Collection Dyads who did not complete 3 month due to parent not completing (ONLY ADOLESCENT COMPLETED)	13	15
3 Month Timepoint Data Collection Dyads who did not complete 3 month due to adolescent not completing (ONLY PARENT COMPLETED)	3	3
3 Month Timepoint Data Collection Lost to Follow-up	3	5
6 Month Timepoint Data Collection Dyads who did not complete 6 month due to parent not completing (ONLY ADOLESCENT COMPLETED)	1	5
6 Month Timepoint Data Collection Lost to Follow-up	8	6

Baseline Characteristics

When calculating average adolescent age, 0 parent participants were analyzed. When calculating average parent age, 0 adolescent participants were analyzed.

Baseline characteristics by cohort

Measure	MoodRing - Adolescents n=32 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. MoodRing App: Adolescents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood.	MoodRing - Parents n=32 Participants Parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. The MR app provides the parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9).	Usual Care - Adolescents n=31 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	Usual Care - Parents n=31 Participants Parents will not receive an intervention but only complete data collection.	Total n=126 Participants Total of all reporting groups
Age, Continuous Adolescents	16.25 years STANDARD_DEVIATION 1.41 • n=32 Participants • When calculating average adolescent age, 0 parent participants were analyzed. When calculating average parent age, 0 adolescent participants were analyzed.	—	15.65 years STANDARD_DEVIATION 1.45 • n=31 Participants • When calculating average adolescent age, 0 parent participants were analyzed. When calculating average parent age, 0 adolescent participants were analyzed.	—	15.95 years STANDARD_DEVIATION 1.43 • n=63 Participants • When calculating average adolescent age, 0 parent participants were analyzed. When calculating average parent age, 0 adolescent participants were analyzed.
Age, Continuous Parents	—	45.12 years STANDARD_DEVIATION 6.8 • n=32 Participants • When calculating average adolescent age, 0 parent participants were analyzed. When calculating average parent age, 0 adolescent participants were analyzed.	—	47.16 years STANDARD_DEVIATION 7.08 • n=31 Participants • When calculating average adolescent age, 0 parent participants were analyzed. When calculating average parent age, 0 adolescent participants were analyzed.	46.12 years STANDARD_DEVIATION 6.94 • n=63 Participants • When calculating average adolescent age, 0 parent participants were analyzed. When calculating average parent age, 0 adolescent participants were analyzed.
Sex/Gender, Customized Boy/Man	8 Participants n=32 Participants	2 Participants n=32 Participants	10 Participants n=31 Participants	0 Participants n=31 Participants	20 Participants n=126 Participants
Sex/Gender, Customized Girl/Woman	18 Participants n=32 Participants	30 Participants n=32 Participants	19 Participants n=31 Participants	31 Participants n=31 Participants	98 Participants n=126 Participants
Sex/Gender, Customized Not applicable	6 Participants n=32 Participants	0 Participants n=32 Participants	2 Participants n=31 Participants	0 Participants n=31 Participants	8 Participants n=126 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	2 Participants n=32 Participants	0 Participants n=32 Participants	4 Participants n=31 Participants	2 Participants n=31 Participants	8 Participants n=126 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	30 Participants n=32 Participants	32 Participants n=32 Participants	27 Participants n=31 Participants	29 Participants n=31 Participants	118 Participants n=126 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants n=32 Participants	0 Participants n=32 Participants	0 Participants n=31 Participants	0 Participants n=31 Participants	0 Participants n=126 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=32 Participants	0 Participants n=32 Participants	0 Participants n=31 Participants	0 Participants n=31 Participants	0 Participants n=126 Participants
Race (NIH/OMB) Asian	3 Participants n=32 Participants	3 Participants n=32 Participants	1 Participants n=31 Participants	0 Participants n=31 Participants	7 Participants n=126 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=32 Participants	0 Participants n=32 Participants	1 Participants n=31 Participants	0 Participants n=31 Participants	1 Participants n=126 Participants
Race (NIH/OMB) Black or African American	3 Participants n=32 Participants	3 Participants n=32 Participants	2 Participants n=31 Participants	3 Participants n=31 Participants	11 Participants n=126 Participants
Race (NIH/OMB) White	23 Participants n=32 Participants	26 Participants n=32 Participants	23 Participants n=31 Participants	26 Participants n=31 Participants	98 Participants n=126 Participants
Race (NIH/OMB) More than one race	3 Participants n=32 Participants	0 Participants n=32 Participants	4 Participants n=31 Participants	2 Participants n=31 Participants	9 Participants n=126 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=32 Participants	0 Participants n=32 Participants	0 Participants n=31 Participants	0 Participants n=31 Participants	0 Participants n=126 Participants
Self-Management	60.72 units on a scale STANDARD_DEVIATION 18.14 • n=32 Participants • parents were not asked this measure	—	59.74 units on a scale STANDARD_DEVIATION 13.51 • n=31 Participants • parents were not asked this measure	—	60.24 units on a scale STANDARD_DEVIATION 15.91 • n=63 Participants • parents were not asked this measure

PRIMARY outcome

Timeframe: From baseline to 3 months

Population: The pre-specified statistical analysis was not scientifically appropriate due to insufficient enrollment.

Adolescents will be asked the Partners in Health Scale The revised Partners in Health Scale (Smith 2016) assesses self-management with respect to a chronic condition, with regard to active involvement of a patient in managing their condition. Total scores range from 0 to 96 with higher scores indicating worse self-management.

A larger negative change in self-management score means an improvement in self-management.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Change From Baseline in Self-management at 3 Months	12 score on a scale Standard Deviation 14.3	-1.84 score on a scale Standard Deviation 16.04

SECONDARY outcome

Timeframe: 3 months

Population: Number participants include Adolescents who did not respond to the question on their baseline survey but their Parents did - total number of responses measured by adolescent or parent self-report even if one was missing.

Attendance at a healthcare provider visit for depression symptom reassessment within 3 months (yes/no) measured by adolescent or parent self-report (yes if any are yes, no if all are no). The metric reported will be percentage of individuals per study arm with a 'yes' result.

Outcome measures

Measure	Usual Care n=29 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=28 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Quality of Depression Management: Depression Symptom Reassessment	20 Participants	24 Participants

SECONDARY outcome

Timeframe: 3 months

Population: Number analyzed are adolescents who either themselves or their parent indicate taking/being prescribed an antidepressant.

Out of adolescents who are taking an antidepressant, receipt of at least 60 consecutive days (yes/no) measured by adolescent self-report. The metric reported will be percentage of individuals per study arm with a 'yes' result.

Outcome measures

Measure	Usual Care n=16 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=16 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Quality of Depression Management: Medication Adherence	16 Participants	12 Participants

SECONDARY outcome

Timeframe: 3 months

Population: Number analyzed were adolescents who either themselves or had their parent indicate that they were referred for psychotherapy.

Out of adolescents who report being referred for psychotherapy, receipt of at least 3 sessions within 3 months (yes/no) measured by adolescent and parent self-report (yes if any are yes, no if all are no). The metric reported will be percentage of individuals per study arm with a 'yes' result.

Outcome measures

Measure	Usual Care n=18 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=16 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Quality of Depression Management: Therapy Adherence	15 Participants	14 Participants

SECONDARY outcome

Timeframe: 3 month

Population: Number participants include Adolescents who did not respond to the question on their baseline survey but their Parents did - total number of responses measured by adolescent or parent self-report even if one was missing.

Average Number of visits for (greater number as reported by adolescent self-report and parent self-report):

1. urgent care;

2. emergency room;

3. inpatient hospitalization;

4. acute primary care provider visit for non-mental health related concern;

5. medical subspecialist visit

6. surgical subspecialist visit

Outcome measures

Measure	Usual Care n=29 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=27 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Urgent Care Visits	0.21 average number of visits Standard Deviation 0.53	0.20 average number of visits Standard Deviation 0.48
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Emergency Room	0.10 average number of visits Standard Deviation 0.31	0.22 average number of visits Standard Deviation 0.54
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Inpatient Hospitalization	0.10 average number of visits Standard Deviation 0.39	0 average number of visits Standard Deviation 0
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Acute PCP visit non mental health	0.52 average number of visits Standard Deviation 0.79	0.44 average number of visits Standard Deviation 0.95
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Medical Subspecialist Visit	0.62 average number of visits Standard Deviation 0.94	0.37 average number of visits Standard Deviation 0.71
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Surgical Subspecialist Visit	0.15 average number of visits Standard Deviation 0.46	0.15 average number of visits Standard Deviation 0.53

SECONDARY outcome

Timeframe: 3 months

Adolescents will be asked the PHQ-9 Patient Health Questionnaire-9 measures depression severity with a score ranging from 0 to 27, a higher score indicating greater severity.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Depression Severity at 3 Months	11.19 score on a scale Standard Deviation 3.56	11.17 score on a scale Standard Deviation 5.14

SECONDARY outcome

Timeframe: 3 months

Adolescents will respond to the PROMIS Pediatric Sleep-Related Impairment scale. This scale has four questions with response options of never, almost never, sometimes, almost always, and always, ranges from 4 to 19 with higher scores indicating higher levels of sleep-related impairment.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Sleep-Related Impairment at 3 Months	13.12 score on a scale Standard Deviation 3.85	13.17 score on a scale Standard Deviation 3.81

SECONDARY outcome

Timeframe: 3 months

Adolescents will respond to the PROMIS Pediatric Sleep Disturbance scale. This scale has four questions, the second (sleeping through the night) being reverse-scored, with response options of never, almost never, sometimes, almost always, and always, ranges from 4 to 20 with higher scores indicating higher levels of sleep disturbance.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Sleep Disturbance at 3 Months	13.48 score on a scale Standard Deviation 2.74	13.67 score on a scale Standard Deviation 3.67

SECONDARY outcome

Timeframe: 3 months

Adolescents will be asked the Mental Health Self-efficacy Scale (MHSES) The Mental Health Self-efficacy Scale (Clarke, 2014) measures one's belief in one's capability to perform mental health self-care behaviors. The score ranges from 6 to 60, with higher scores indicating higher confidence in mental health selfcare.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Self-Efficacy at 3 Months	33.62 score on a scale Standard Deviation 9.43	35.72 score on a scale Standard Deviation 9.77

SECONDARY outcome

Timeframe: 3 months

Adolescents will be asked based on Question 12 of Partners in Health Scale about self-management behavior. This question asks the average amount of time (options including Daily, More than once a week, Once a week, Once a month, Once a semester, Once a year, Less than once a year, Never) spent in potentially useful self-management activities. Each time category will be described by a percentage. Each of the following are asked individually: (1) created to-do lists to help me focus; (2) found strategies to create pleasurable distractions; (3) engaged in some physical activity (cycling, walking, etc.); (4) set realistic short-term goals; (5) made sure I had a good day/night routine with got enough sleep; (6) ensured enough rest to avoid getting exhausted; (7) left the house regularly; (8) ate healthy

A higher score indicates a better outcome.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Self-management Behavior at 3 Months Created to-do lists to help me focus · More than Once a Week	3 Participants	3 Participants
Self-management Behavior at 3 Months Created to-do lists to help me focus · Daily	4 Participants	5 Participants
Self-management Behavior at 3 Months Created to-do lists to help me focus · Once a Week	3 Participants	5 Participants
Self-management Behavior at 3 Months Created to-do lists to help me focus · Once a month	7 Participants	0 Participants
Self-management Behavior at 3 Months Created to-do lists to help me focus · Once a semester (3-4 months)	4 Participants	3 Participants
Self-management Behavior at 3 Months Created to-do lists to help me focus · Once a year	1 Participants	3 Participants
Self-management Behavior at 3 Months Created to-do lists to help me focus · Less than once a year	4 Participants	0 Participants
Self-management Behavior at 3 Months Created to-do lists to help me focus · Never	0 Participants	6 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · Daily	2 Participants	5 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · More than Once a Week	7 Participants	6 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · Once a Week	9 Participants	3 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · Once a month	3 Participants	7 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · Once a semester (3-4 months)	3 Participants	2 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · Once a year	1 Participants	1 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · Less than once a year	1 Participants	1 Participants
Self-management Behavior at 3 Months Found strategies to create pleasurable distractions · Never	0 Participants	0 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Daily	2 Participants	11 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · More than Once a Week	8 Participants	1 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a Week	9 Participants	10 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a month	4 Participants	2 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a semester (3-4 months)	2 Participants	1 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a year	0 Participants	0 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Less than once a year	1 Participants	0 Participants
Self-management Behavior at 3 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Never	0 Participants	0 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · Daily	2 Participants	4 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · More than Once a Week	5 Participants	3 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · Once a Week	1 Participants	7 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · Once a month	7 Participants	2 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · Once a semester (3-4 months)	9 Participants	2 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · Once a year	2 Participants	2 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · Less than once a year	0 Participants	2 Participants
Self-management Behavior at 3 Months Set realistic short-term goals · Never	0 Participants	3 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · Daily	1 Participants	4 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · More than Once a Week	10 Participants	8 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · Once a Week	5 Participants	6 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · Once a month	3 Participants	2 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · Once a semester (3-4 months)	4 Participants	3 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · Once a year	2 Participants	0 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · Less than once a year	0 Participants	2 Participants
Self-management Behavior at 3 Months Made sure I had a good day/night routine and got enough sleep · Never	1 Participants	0 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · Daily	2 Participants	2 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · More than Once a Week	7 Participants	8 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · Once a Week	9 Participants	6 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · Once a month	1 Participants	5 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · Once a semester (3-4 months)	4 Participants	1 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · Once a year	2 Participants	1 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · Less than once a year	0 Participants	1 Participants
Self-management Behavior at 3 Months Ensured enough rest to avoid getting exhausted · Never	1 Participants	1 Participants
Self-management Behavior at 3 Months Left the house regulary · Daily	5 Participants	9 Participants
Self-management Behavior at 3 Months Left the house regulary · More than Once a Week	12 Participants	10 Participants
Self-management Behavior at 3 Months Left the house regulary · Once a Week	5 Participants	2 Participants
Self-management Behavior at 3 Months Left the house regulary · Once a month	3 Participants	1 Participants
Self-management Behavior at 3 Months Left the house regulary · Once a semester (3-4 months)	0 Participants	0 Participants
Self-management Behavior at 3 Months Left the house regulary · Once a year	1 Participants	1 Participants
Self-management Behavior at 3 Months Left the house regulary · Less than once a year	0 Participants	1 Participants
Self-management Behavior at 3 Months Left the house regulary · Never	0 Participants	1 Participants
Self-management Behavior at 3 Months Ate healthy · Daily	4 Participants	3 Participants
Self-management Behavior at 3 Months Ate healthy · More than Once a Week	14 Participants	12 Participants
Self-management Behavior at 3 Months Ate healthy · Once a Week	5 Participants	4 Participants
Self-management Behavior at 3 Months Ate healthy · Once a month	1 Participants	2 Participants
Self-management Behavior at 3 Months Ate healthy · Once a semester (3-4 months)	0 Participants	2 Participants
Self-management Behavior at 3 Months Ate healthy · Once a year	1 Participants	0 Participants
Self-management Behavior at 3 Months Ate healthy · Less than once a year	0 Participants	1 Participants
Self-management Behavior at 3 Months Ate healthy · Never	1 Participants	1 Participants

SECONDARY outcome

Timeframe: 3 months

Adolescents will be asked the Medical Outcomes Study Social Support Survey The Medical Outcome Study Social Support Scale (Sherbourne, 1991) measures types of social support. Each item ranges from 1 to 5 and the total score is averaged and ranges from 1 to 5, with higher levels associated with greater support.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Social Support at 3 Months	3.66 score on a scale Standard Deviation 0.84	4.08 score on a scale Standard Deviation 0.72

SECONDARY outcome

Timeframe: From baseline to 6 months

Population: Only participants completing this measure were analyzed

Adolescents will be asked the Partners in Health Scale The revised Partners in Health Scale (Smith 2016) assesses self-management with respect to a chronic condition, with regard to active involvement of a patient in managing their condition. Total scores range from 0 to 96 with higher scores indicating worse self-management.

A larger negative change in self-management score means an improvement in self-management.

Outcome measures

Measure	Usual Care n=20 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=20 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Change in Self-management at 6 Months	-1.55 score on a scale Standard Deviation 13.3	-4.6 score on a scale Standard Deviation 16.2

SECONDARY outcome

Timeframe: 6 months

Population: Number participants include Adolescents who did not respond to the question on their baseline survey but their Parents did - total number of responses measured by adolescent or parent self-report even if one was missing.

Attendance at a healthcare provider visit for depression symptom reassessment within the past 3 months (yes/no) measured by adolescent, parent self-report and electronic health record review (yes if any are yes, no if all are no). The metric reported will be percentage of individuals per study arm with a 'yes' result.

Outcome measures

Measure	Usual Care n=22 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=25 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Quality of Depression Management: Depression Symptom Reassessment	14 Participants	16 Participants

SECONDARY outcome

Timeframe: 6 months

Population: Number analyzed were adolescents who either themselves or had their parent indicate that they are taking/prescribed an antidepressant.

Out of adolescents who are taking an antidepressant, receipt of at least 60 consecutive days (yes/no) within the past 3 months, measured by adolescent, parent self-report and electronic health record review (yes if any are yes, no if all are no). The metric reported will be percentage of individuals per study arm with a 'yes' result.

Outcome measures

Measure	Usual Care n=12 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=12 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Quality of Depression Management: Medication Adherence	11 Participants	11 Participants

SECONDARY outcome

Timeframe: 6 months

Population: Number analyzed were adolescents who either themselves or had their parent indicate that they were referred for psychotherapy.

Out of adolescents who are referred for psychotherapy, receipt of at least 3 sessions within the past 3 months (yes/no) measured by adolescent, parent self-report and electronic health record review (yes if any are yes, no if all are no). The metric reported will be percentage of individuals per study arm with a 'yes' result.

Outcome measures

Measure	Usual Care n=12 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=18 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Quality of Depression Management: Therapy Adherence	11 Participants	17 Participants

SECONDARY outcome

Timeframe: 6 month

Population: Number participants include Adolescents who did not respond to the question on their baseline survey but their Parents did - total number of responses measured by adolescent or parent self-report even if one was missing.

Number of visits for (combined total between adolescent self-report, parent self-report, and electronic health-record review):

1. urgent care;

2. emergency room;

3. inpatient hospitalization;

4. acute primary care provider visit for non-mental health related concern;

5. medical or surgical subspecialist visit

Outcome measures

Measure	Usual Care n=23 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=26 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Urgent Care Visits	0.22 patient visits Standard Deviation 0.58	0.27 patient visits Standard Deviation 0.64
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Emergency Room	0 patient visits Standard Deviation 0	0.15 patient visits Standard Deviation 0.43
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Inpatient Hospitalization	0 patient visits Standard Deviation 0	0.04 patient visits Standard Deviation 0.20
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Acute PCP visit non mental health	0.30 patient visits Standard Deviation 0.52	0.27 patient visits Standard Deviation 0.56
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Medical Subspecialist Visit	0.61 patient visits Standard Deviation 1.19	0.94 patient visits Standard Deviation 1.58
Healthcare Utilization for Acute Care or Primary Care (for Non Mental-health Reason) Surgical Subspecialist Visit	0.13 patient visits Standard Deviation 0.43	0.15 patient visits Standard Deviation 0.54

SECONDARY outcome

Timeframe: 6 months

Population: Adolescents

Adolescents will be asked the PHQ-9 Patient Health Questionnaire-9 measures depression severity with a score ranging from 0 to 27, a higher score indicating greater severity.

Outcome measures

Measure	Usual Care n=26 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=24 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Depression Severity at 6 Months	11.1 score on a scale Standard Deviation 4.88	8.45 score on a scale Standard Deviation 3.75

SECONDARY outcome

Timeframe: 6 months

Population: Adolescents

Adolescents will be asked based on Question 12 of Partners in Health Scale about self-management behavior. This question asks the average amount of time (options including Daily, More than once a week, Once a week, Once a month, Once a semester, Once a year, Less than once a year, Never) spent in potentially useful self-management activities. Each of the following are asked individually: (1) created to-do lists to help me focus; (2) found strategies to create pleasurable distractions; (3) engaged in some physical activity (cycling, walking, etc.); (4) set realistic short-term goals; (5) made sure I had a good day/night routine with got enough sleep; (6) ensured enough rest to avoid getting exhausted; (7) left the house regularly; (8) ate healthy

Outcome measures

Measure	Usual Care n=20 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=20 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Self-management Behavior at 6 Months to help me focus · Daily	3 Participants	5 Participants
Self-management Behavior at 6 Months to help me focus · More than Once a Week	2 Participants	3 Participants
Self-management Behavior at 6 Months to help me focus · Once a Week	6 Participants	1 Participants
Self-management Behavior at 6 Months to help me focus · Once a month	3 Participants	3 Participants
Self-management Behavior at 6 Months to help me focus · Once a semester (3-4 months)	3 Participants	2 Participants
Self-management Behavior at 6 Months to help me focus · Once a year	0 Participants	3 Participants
Self-management Behavior at 6 Months to help me focus · Less than once a year	2 Participants	2 Participants
Self-management Behavior at 6 Months to help me focus · Never	1 Participants	1 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · Daily	3 Participants	7 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · More than Once a Week	4 Participants	5 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · Once a Week	7 Participants	3 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · Once a month	3 Participants	4 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · Once a semester (3-4 months)	2 Participants	0 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · Once a year	0 Participants	1 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · Less than once a year	1 Participants	0 Participants
Self-management Behavior at 6 Months Found strategies to create pleasurable distractions · Never	0 Participants	0 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Daily	6 Participants	6 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · More than Once a Week	5 Participants	4 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a Week	3 Participants	7 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a month	5 Participants	1 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a semester (3-4 months)	1 Participants	1 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Once a year	0 Participants	1 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Less than once a year	0 Participants	0 Participants
Self-management Behavior at 6 Months Engaged in some moderate physical activity (cycling, walking, etc.) · Never	0 Participants	0 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · Daily	2 Participants	5 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · More than Once a Week	4 Participants	4 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · Once a Week	2 Participants	6 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · Once a month	4 Participants	2 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · Once a semester (3-4 months)	5 Participants	2 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · Once a year	2 Participants	1 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · Less than once a year	0 Participants	0 Participants
Self-management Behavior at 6 Months Set realistic short-term goals · Never	1 Participants	0 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · Daily	2 Participants	3 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · More than Once a Week	3 Participants	7 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · Once a Week	5 Participants	6 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · Once a month	6 Participants	2 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · Once a semester (3-4 months)	3 Participants	1 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · Once a year	0 Participants	0 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · Less than once a year	0 Participants	0 Participants
Self-management Behavior at 6 Months Made sure I had a good day/night routine and got enough sleep · Never	1 Participants	1 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · Daily	3 Participants	1 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · More than Once a Week	5 Participants	7 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · Once a Week	2 Participants	8 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · Once a month	7 Participants	2 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · Once a semester (3-4 months)	2 Participants	0 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · Once a year	0 Participants	1 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · Less than once a year	1 Participants	0 Participants
Self-management Behavior at 6 Months Ensured enough rest to avoid getting exhausted · Never	0 Participants	1 Participants
Self-management Behavior at 6 Months Left the house regularly · Daily	4 Participants	10 Participants
Self-management Behavior at 6 Months Left the house regularly · More than Once a Week	11 Participants	6 Participants
Self-management Behavior at 6 Months Left the house regularly · Once a Week	5 Participants	2 Participants
Self-management Behavior at 6 Months Left the house regularly · Once a month	0 Participants	1 Participants
Self-management Behavior at 6 Months Left the house regularly · Once a semester (3-4 months)	0 Participants	1 Participants
Self-management Behavior at 6 Months Left the house regularly · Once a year	0 Participants	0 Participants
Self-management Behavior at 6 Months Left the house regularly · Less than once a year	0 Participants	0 Participants
Self-management Behavior at 6 Months Left the house regularly · Never	0 Participants	0 Participants
Self-management Behavior at 6 Months Ate healthy · Daily	5 Participants	3 Participants
Self-management Behavior at 6 Months Ate healthy · More than Once a Week	6 Participants	9 Participants
Self-management Behavior at 6 Months Ate healthy · Once a Week	6 Participants	4 Participants
Self-management Behavior at 6 Months Ate healthy · Once a month	2 Participants	1 Participants
Self-management Behavior at 6 Months Ate healthy · Once a semester (3-4 months)	0 Participants	2 Participants
Self-management Behavior at 6 Months Ate healthy · Once a year	1 Participants	1 Participants
Self-management Behavior at 6 Months Ate healthy · Less than once a year	0 Participants	0 Participants
Self-management Behavior at 6 Months Ate healthy · Never	0 Participants	0 Participants

SECONDARY outcome

Timeframe: 6 months

Population: Adolescents

Adolescents will be asked the Mental Health Self-efficacy Scale (MHSES) The Mental Health Self-efficacy Scale (Clarke, 2014) measures one's belief in one's capability to perform mental health self-care behaviors. The score ranges from 6 to 60, with higher scores indicating higher confidence in mental health selfcare.

Outcome measures

Measure	Usual Care n=20 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=20 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Self-Efficacy at 6 Months	37.5 score on a scale Standard Deviation 9.32	39.95 score on a scale Standard Deviation 10.56

SECONDARY outcome

Timeframe: 6 months

Population: Adolescents

Adolescents will be asked the Medical Outcomes Study Social Support Survey The Medical Outcome Study Social Support Scale (Sherbourne, 1991) measures types of social support. Each item ranges from 1 to 5 and the total score is averaged and ranges from 1 to 5, with higher levels associated with greater support.

Outcome measures

Measure	Usual Care n=20 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=20 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Social Support at 6 Months	4.03 score on a scale Standard Deviation 0.76	4.04 score on a scale Standard Deviation 0.83

SECONDARY outcome

Timeframe: 6 months

Population: Adolescents

Adolescents will respond to the PROMIS Pediatric Sleep-Related Impairment scale. This scale has four questions with response options of never, almost never, sometimes, almost always, and always, ranges from 4 to 19 with higher scores indicating higher levels of sleep-related impairment.

Outcome measures

Measure	Usual Care n=20 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=20 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Sleep-Related Impairment at 6 Months	12.9 score on a scale Standard Deviation 4.79	13.05 score on a scale Standard Deviation 3.02

SECONDARY outcome

Timeframe: 6 months

Population: Adolescent

Adolescents will respond to the PROMIS Pediatric Sleep Disturbance scale. This scale has four questions, the second (sleeping through the night) being reverse-scored, with response options of never, almost never, sometimes, almost always, and always, ranges from 4 to 20 with higher scores indicating higher levels of sleep disturbance.

Outcome measures

Measure	Usual Care n=20 Participants Participants in this arm will receive no intervention and access treatment as usual per their mental health services provider. A mobile application (AWARE) which is not interactive and is only for purposes of data collection will be downloaded on the adolescents' smartphone. Usual Care: Adolescents and parents in the usual care arm will receive instructions to download the AWARE app. This app will only track data and will not be interactive. Otherwise they will receive care as per routine by their healthcare provider team.	MoodRing n=20 Participants Adolescent participants in this arm will download two mobile applications - a data collection non-interactive app to collect passive sensing data (AWARE) and the MoodRing (MR) mobile application with which they can visualize their data about their mood, sleep, activity, enter their own mood score, and access psychoeducational resources including links to a research-based website, SOVA. Their parents will download a parent MoodRing application which provides them with parenting resources and articles and a weekly report of their adolescents' mood as predicted by passive sensing. Clinical providers will receive access to a web portal where they can view their adolescent patients' data who are enrolled in the study. MoodRing App: Adolescents and parents in the MR arm will receive instructions to download the MR app and AWARE app, customize the app, utilize an app-based self-guided onboarding, and review questions with the research team. The MR app provides the adolescent and their parent a notification to view a weekly report predicting their mood score (i.e. depression severity level similar to the Patient health questionnaire-9). The MR app will provide a library of coping strategies for adolescents and opportunities to self-track their mood. Clinicians in the MR Arm will get access to a MR portal online. They will be able to view patients they are a provider for. The clinician will receive in-person and/or video-based training to use the portal.
Sleep Disturbance at 6 Months	13.1 score on a scale Standard Deviation 2.63	13.65 score on a scale Standard Deviation 2.28

OTHER_PRE_SPECIFIED outcome

Timeframe: 3 months

Adolescents will respond to the School Based Sleep Habits Survey-Child Form which asks 43 questions about weekday and weeknight sleep patterns, sleep awakenings, and sleep time preferences.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 3 months

The General-practice Users Perceived-need Inventory (GUPI) The General-Practice Users Perceived-Need Inventory (McNab, 2004) will be used to measure perceived need for treatment. There is no scoring. Adolescents will be asked this and parents about their perception of their adolescent's need for mental health services. The response will be evaluated by the total number of individuals who agree that they would like to or are already getting help with a) medication and b) counseling as comapred to those who respond they do not need this kind of help.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 3 months

Rating scale of General Mental Health A rating scale of General Mental Health (Cadigan, 2018) will be used with two questions each ranging from 1 to 5 with regard to a self-rating of general mental health. Adolescents will be asked this and parents about their perception of their adolescent's mental health.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 3 months

Adolescents will be asked the GAD-7 Generalized Anxiety Disorders 7-item Questionnaire measures extent of anxiety symptoms. The total score ranges from 0 to 21 with a higher score indicating greater severity.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 3 months

M-PACS (The Parent-Adolescent Communication Scale (Olson, 1985) modified for mental health) asks 20 questions with regards to communication between parents and adolescents, with responses 1-5 from strongly disagree to strongly agree. Some items are reverse scored with a higher scale score indicating better communication. Both adolescents and parents will be asked these questions.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 3 months

The CPCS (Child Parent Connectedness Scale) asks 5 questions from a scale of 1-5 from strongly disagree to strongly agree with regards to connectedness and relationship satisfaction with each other. A higher score indicates higher child-parent connectedness. Both adolescents and parents will be asked these questions.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 3 months

Adolescents who respond with anything besides "none" to the 9th question of the PHQ-9 will be asked to complete the brief CSSR-S scale. This scale asks two questions, have you (the participant) wished you (the participant) were dead or wished you (the participant) could go to sleep and not wake up? (yes/no) and have you (the participant) actually had any thoughts of killing yourself? (yes/no). Positive answers indicate suicidal thinking. These will be asked on an online survey. Those adolescents responding positively will complete a full CSSR-S interview.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 6 months

Adolescents will respond to the School Based Sleep Habits Survey-Child Form which asks 43 questions about weekday and weeknight sleep patterns, sleep awakenings, and sleep time preferences.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 6 months

Rating scale of General Mental Health A rating scale of General Mental Health (Cadigan, 2018) will be used with two questions each ranging from 1 to 5 with regard to a self-rating of general mental health. Adolescents will be asked this and parents about their perception of their adolescent's mental health.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 6 months

The General-practice Users Perceived-need Inventory (GUPI) The General-Practice Users Perceived-Need Inventory (McNab, 2004) will be used to measure perceived need for treatment. There is no scoring. Adolescents will be asked this and parents about their perception of their adolescent's need for mental health services. The response will be evaluated by the total number of individuals who agree that they would like to or are already getting help with a) medication and b) counseling as comapred to those who respond they do not need this kind of help.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: at 6 months

System Usability Questionnaire (Bangor, 2008) asks 11 questions about the usability of a technological intervention. SUS scores range from 0-100. Higher scores indicate better usability.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: at 6 months

Acceptability of Intervention Measure (AIM) (Weiner, 2017) asks 4 questions on a 1-5 Likert scale with completely disagree to completely agree with regards to acceptability of an intervention and 3 questions were added including with regards to efficiency, help taking care of patients, patient benefit from the intervention. Higher scores indicate higher acceptability. Also an open-ended question will be asked about feedback using MoodRing.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: at 6 months

System Usability Questionnaire (Bangor, 2008) asks 11 questions about the usability of a technological intervention. SUS scores 0-100. Higher scores indicate better usability. Adolescents and Parents - only those randomized to the MoodRing arm - will be asked these questions.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: at 6 months

Acceptability of Intervention Measure (AIM) (Weiner, 2017) asks 4 questions on a 1-5 Likert scale with completely disagree to completely agree with regards to acceptability of an intervention. Additional questions will be asked about perceived benefit, taking care of mental health, and confidence in mental health management. Higher scores indicate higher acceptability. Also an open-ended question will be asked about feedback using MoodRing. Adolescents and Parents - only those randomized to the MoodRing arm - will be asked these questions.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 6 months

Adolescents will be asked the GAD-7 Generalized Anxiety Disorders 7-item Questionnaire measures extent of anxiety symptoms. The total score ranges from 0 to 21 with a higher score indicating greater severity.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 6 months

M-PACS (The Parent-Adolescent Communication Scale (Olson, 1985) modified for mental health) asks 20 questions with regards to communication between parents and adolescents, with responses 1-5 from strongly disagree to strongly agree. Some items are reverse scored with a higher scale score indicating better communication. Both adolescents and parents will be asked these questions.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 6 months

The CPCS (Child Parent Connectedness Scale) asks 5 questions from a scale of 1-5 from strongly disagree to strongly agree with regards to connectedness and relationship satisfaction with each other. A higher score indicates higher child-parent connectedness. Both adolescents and parents will be asked these questions.

Outcome measures

Outcome data not reported

OTHER_PRE_SPECIFIED outcome

Timeframe: 6 months

Adolescents who respond with anything besides "none" to the 9th question of the PHQ-9 will be asked to complete the brief CSSR-S scale. This scale asks two questions, have you (the participant) wished you (the participant) were dead or wished you (the participant) could go to sleep and not wake up? (yes/no) and have you (the participant) actually had any thoughts of killing yourself? (yes/no). Positive answers indicate suicidal thinking. These will be asked on an online survey. Those adolescents responding positively will complete a full CSSR-S interview.

Outcome measures

Outcome data not reported

Adverse Events

Usual Care

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

MoodRing

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Ana Radovic

University of Pittsburgh

Phone: 4126927227

Email: anr94@pitt.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place