Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial

Abstract

BackgroundDespite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services.ObjectiveThe objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile.MethodsA cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up.ResultsMore than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3).ConclusionsThis is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions.Trial RegistrationClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY)

Improving Mental Health Care in Developing Countries Through Digital Technologies: A Mini Narrative Review of the Chilean Case

“…Both Martínez et al (under review) and Espinosa et al (32) suggested enabling peer communication. ASCENSO and CTA studies showed that email does not seem to be a good way to contact and monitor participants (27,29). A possible way to improve the usability and effectiveness of e-mental health interventions is to facilitate access to the content of programs using mobile devices like smartphones (8,9).…”

“…Martínez et al (29) tested the feasibility, acceptability, and effectiveness of a RCDC intervention for adolescents with depression. The intervention group received periodic remote supervision by psychiatrists located in Santiago, through SEHR and phone patient monitoring.…”

“…(28)(29)(30), three acceptability and/or feasibility studies [(31,32); Martínez et al under review], and three on-going studies without published results [(33, 34); Irarrázaval et al under review]. The responsible researcher from three studies (Gaete et al, under review; Martínez et al, under review; Irarrázaval et al, under review) provided details of it and its preliminary results.…”

Distant mood monitoring for depressive and bipolar disorders: a systematic review

“…Nine articles [5,28,[33][34][35][36][37][38][39] met the inclusion criteria for this systematic review. Mood monitoring studies were conducted in Chile [35], Denmark [33,34], South Africa [5,28], and the United States of America [36][37][38][39]. Details regarding study designs and monitoring procedures are presented in Table 1.…”

“…Details regarding study designs and monitoring procedures are presented in Table 1. Most studies used quantitative methods [5,[35][36][37][38][39][40], with only two studies [28,34] including a qualitative component (semi-structured interviews). Details regarding outcome measures, effectiveness, adverse events, and completion rates are presented in Table 2.…”