Depression Clinical Trial
— STEPS UPOfficial title:
Stepped Enhancement of PTSD Services Using Primary Care (STEPS UP): A Randomized Effectiveness Trial
Verified date | March 2017 |
Source | Henry M. Jackson Foundation for the Advancement of Military Medicine |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
The overall objective of this study is to test the effectiveness of a systems-level approach
to primary care recognition and management of PTSD and depression in the military health
system. More specifically, the investigators will test the effectiveness of a telephone care
management with preference-based stepped PTSD/depression care--STepped Enhancement of PTSD
Services Using Primary Care (STEPS UP)--as compared to Optimized Usual Care (OUC).
Primary Hypothesis 1: Active duty primary care patients with PTSD, depression, or both who
are randomly assigned to STEPS UP will report significantly greater reductions in PTSD and
depression symptom severity compared to participants assigned to OUC over 12-months of
follow-up.
Hypothesis 2: Active duty primary care patients with either PTSD, depression, or both who
are randomly assigned to STEPS UP will report significantly greater improvements in somatic
symptom severity, alcohol use, mental health functioning, and work functioning compared to
participants assigned to OUC over 12-months of follow-up.
Hypothesis 3: The STEPS UP program will be both more costly and more effective compared to
OUC over the 12-months of follow-up, and will have a favorable cost-effectiveness ratio in
terms of dollars per quality adjusted life years saved.
Hypothesis 4: Active duty primary care patients participating in STEPS UP, their clinicians,
care managers, and family members will report that STEPS UP is acceptable, effective,
satisfying, and appropriate PTSD and depression care.
Status | Completed |
Enrollment | 666 |
Est. completion date | February 2016 |
Est. primary completion date | October 2014 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 65 Years |
Eligibility |
Inclusion Criteria: - Active duty status at the time of enrollment - Positive PTSD screen (2 or more yes responses on PC-PTSD), per routine primary care screening. - DSM-IV-TR criteria for A) PTSD using the PCL-C (i.e.., a "moderate" or greater severity level on 1 re-experiencing, 3 avoidance, and 2 hyperarousal symptoms) and/or B) Depression, using the PHQ-9 (i.e., endorsement of at least 5 of the 9 symptoms experienced "more than half the days" and at least one of those symptoms must include either "little interest or pleasure in doing things" or "feeling down, depressed or hopeless") - Report of routine computer, Internet, and e-mail access - Capacity to consent to participation and provide research informed consent using local IRB-approved form Exclusion Criteria: - Treatment refractory PTSD or depression after participation in RESPECT-mil or specialty mental health treatment. - Acute psychosis, psychotic episode, or psychotic disorder diagnosis by history within the past 2 years - Bipolar I disorder by history or medical record review within last 2 years. - Active substance dependence disorder in the past year by history within the past 12 months. - Active suicidal ideation within the past 2 months by history. - Patients on psychoactive medication, unless that medication dosing and administration has been stable and regular for at least 1 month. - Acute or unstable physical illness. - Anticipated deployment, demobilization, or separation during the next six months. - Personnel who work in participating clinics. |
Country | Name | City | State |
---|---|---|---|
United States | William Beaumont Army Medical Center | Fort Bliss | Texas |
United States | Blanchfield Army Community Hospital | Fort Campbell | Kentucky |
United States | Winn Army Community Hospital | Fort Stewart | Georgia |
United States | Womack Army Medical Center | Ft. Bragg | North Carolina |
United States | Evans Army Community Hospital | Ft. Carson | Colorado |
United States | Madigan Army Medical Center | Tacoma | Washington |
Lead Sponsor | Collaborator |
---|---|
Henry M. Jackson Foundation for the Advancement of Military Medicine | RAND, RTI International, United States Department of Defense, University of Washington, VA Boston Healthcare System |
United States,
Batka C, Tanielian T, Woldetsadik MA, Farmer C, Jaycox LH. Stakeholder Experiences in a Stepped Collaborative Care Study Within U.S. Army Clinics. Psychosomatics. 2016 Nov - Dec;57(6):586-597. doi: 10.1016/j.psym.2016.05.008. — View Citation
Belsher BE, Jaycox LH, Freed MC, Evatt DP, Liu X, Novak LA, Zatzick D, Bray RM, Engel CC. Mental Health Utilization Patterns During a Stepped, Collaborative Care Effectiveness Trial for PTSD and Depression in the Military Health System. Med Care. 2016 Jul — View Citation
Bray RM, Engel CC, Williams J, Jaycox LH, Lane ME, Morgan JK, Unützer J. Posttraumatic Stress Disorder in U.S. Military Primary Care: Trajectories and Predictors of One-Year Prognosis. J Trauma Stress. 2016 Aug;29(4):340-8. doi: 10.1002/jts.22119. — View Citation
Engel CC, Bray RM, Jaycox LH, Freed MC, Zatzick D, Lane ME, Brambilla D, Rae Olmsted K, Vandermaas-Peeler R, Litz B, Tanielian T, Belsher BE, Evatt DP, Novak LA, Unützer J, Katon WJ. Implementing collaborative primary care for depression and posttraumatic — View Citation
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Engel CC, Jaycox LH, Freed MC, Bray RM, Brambilla D, Zatzick D, Litz B, Tanielian T, Novak LA, Lane ME, Belsher BE, Olmsted KL, Evatt DP, Vandermaas-Peeler R, Unützer J, Katon WJ. Centrally Assisted Collaborative Telecare for Posttraumatic Stress Disorder — View Citation
Engel CC, Oxman T, Yamamoto C, Gould D, Barry S, Stewart P, Kroenke K, Williams JW Jr, Dietrich AJ. RESPECT-Mil: feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care. Mil Med. 2008 Oct;173(10):935-40. — View Citation
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Lisa S. Meredith, Terri L. Tanielian, Michael D. Greenberg, Ana Suárez, Elizabeth Eiseman. "Expanding Access to Mental Health Counselors: Evaluation of the Tricare Demonstration" RAND/DRR-3458-1-OSD (available at www.rand.org)
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* Note: There are 19 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Posttraumatic Diagnostic Scale (PDS) | The PDS (Foa, 1996) is a 49-item self-report measure that assesses both severity of PTSD symptoms related to a single identified traumatic event and probable diagnosis of PTSD. | baseline - 3 months | |
Primary | Posttraumatic Diagnostic Scale (PDS) | The PDS (Foa, 1996) is a 49-item self-report measure that assesses both severity of PTSD symptoms related to a single identified traumatic event and probable diagnosis of PTSD. | baseline - 6 months | |
Primary | Posttraumatic Diagnostic Scale (PDS) | The PDS (Foa, 1996) is a 49-item self-report measure that assesses both severity of PTSD symptoms related to a single identified traumatic event and probable diagnosis of PTSD. | baseline - 12 months | |
Primary | Hopkins Symptom Checklist Depression Scale-20 Item Version (HSCL-20) | The HSCL-20 is a self-report scale comprising the 13 items of the Hopkins Symptom Checklist Depression Scale plus 7 additional items from the Hopkins Symptom Checklist-90-Revised. The HSCL-20 has been widely used as an outcome measure of depressive severity in large clinical trials (Boudreau, et al., 2002; Felker, et al., 2001; Fraser, et al., 2004; Hedrick, et al., 2003; Katon, et al., 1996; Kroenke, et al., 2001; Unutzer, et al., 2002; Williams, et al., 2000). | baseline - 3 months | |
Primary | Hopkins Symptom Checklist Depression Scale-20 Item Version (HSCL-20) | The HSCL-20 is a self-report scale comprising the 13 items of the Hopkins Symptom Checklist Depression Scale plus 7 additional items from the Hopkins Symptom Checklist-90-Revised. The HSCL-20 has been widely used as an outcome measure of depressive severity in large clinical trials (Boudreau, et al., 2002; Felker, et al., 2001; Fraser, et al., 2004; Hedrick, et al., 2003; Katon, et al., 1996; Kroenke, et al., 2001; Unutzer, et al., 2002; Williams, et al., 2000). | baseline - 6 months | |
Primary | Hopkins Symptom Checklist Depression Scale-20 Item Version (HSCL-20) | The HSCL-20 is a self-report scale comprising the 13 items of the Hopkins Symptom Checklist Depression Scale plus 7 additional items from the Hopkins Symptom Checklist-90-Revised. The HSCL-20 has been widely used as an outcome measure of depressive severity in large clinical trials (Boudreau, et al., 2002; Felker, et al., 2001; Fraser, et al., 2004; Hedrick, et al., 2003; Katon, et al., 1996; Kroenke, et al., 2001; Unutzer, et al., 2002; Williams, et al., 2000). | baseline - 12 months | |
Secondary | Somatic Symptom Severity - Patient Health Questionnaire - 15 (PHQ-15) | Somatic symptom severity will be measured with the widely used and validated 15 item Patient Health Questionnaire (PHQ-15; Kroenke, Spitzer, & Williams, 2002). A total sum of greater than or equal to 15 indicate a high somatic symptom severity based on data from primary care settings (Kroenke et al., 2002). | baseline - 3 months | |
Secondary | Somatic Symptom Severity - Patient Health Questionnaire - 15 (PHQ-15) | Somatic symptom severity will be measured with the widely used and validated 15 item Patient Health Questionnaire (PHQ-15; Kroenke, Spitzer, & Williams, 2002). A total sum of greater than or equal to 15 indicate a high somatic symptom severity based on data from primary care settings (Kroenke et al., 2002). | baseline - 6 months | |
Secondary | Somatic Symptom Severity - Patient Health Questionnaire - 15 (PHQ-15) | Somatic symptom severity will be measured with the widely used and validated 15 item Patient Health Questionnaire (PHQ-15; Kroenke, Spitzer, & Williams, 2002). A total sum of greater than or equal to 15 indicate a high somatic symptom severity based on data from primary care settings (Kroenke et al., 2002). | baseline - 12 months | |
Secondary | Alcohol Use Disorders Identification Test (AUDIT) | The AUDIT (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001) will be used to assess alcohol use, alcohol dependence symptoms, and alcohol-related problems, focused on the recent past. This 10-item scale is widely used and has been shown to be consistent with ICD-10 definitions for alcohol dependence and harmful alcohol use (Allen, Litten, Fertig, & Babor, 1997; Saunders, Aasland, Amundsen, & Grant, 1993; Saunders, Aasland, Babor, de, & Grant, 1993) | eligibility - 3 months | |
Secondary | Alcohol Use Disorders Identification Test (AUDIT) | The AUDIT (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001) will be used to assess alcohol use, alcohol dependence symptoms, and alcohol-related problems, focused on the recent past. This 10-item scale is widely used and has been shown to be consistent with ICD-10 definitions for alcohol dependence and harmful alcohol use (Allen, Litten, Fertig, & Babor, 1997; Saunders, Aasland, Amundsen, & Grant, 1993; Saunders, Aasland, Babor, de, & Grant, 1993) | eligibility - 6 months | |
Secondary | Alcohol Use Disorders Identification Test (AUDIT) | The AUDIT (Babor, Higgins-Biddle, Saunders, & Monteiro, 2001) will be used to assess alcohol use, alcohol dependence symptoms, and alcohol-related problems, focused on the recent past. This 10-item scale is widely used and has been shown to be consistent with ICD-10 definitions for alcohol dependence and harmful alcohol use (Allen, Litten, Fertig, & Babor, 1997; Saunders, Aasland, Amundsen, & Grant, 1993; Saunders, Aasland, Babor, de, & Grant, 1993) | eligibility - 12 months | |
Secondary | Health-Related Quality of Life and Functional Status - Medical Outcomes Study Short Form-12 (SF-12) | Limitations in role functioning will be assessed using the SF-12 (Ware et al., 1996). The SF-12 is a widely used measure of health-related quality of life and functioning with established reliability and validity. This measure will be used for the economic analysis as well as to measure functioning as an outcome. | baseline - 3 months | |
Secondary | Health-Related Quality of Life and Functional Status - Medical Outcomes Study Short Form-12 (SF-12) | Limitations in role functioning will be assessed using the SF-12 (Ware et al., 1996). The SF-12 is a widely used measure of health-related quality of life and functioning with established reliability and validity. This measure will be used for the economic analysis as well as to measure functioning as an outcome. | baseline - 6 months | |
Secondary | Health-Related Quality of Life and Functional Status - Medical Outcomes Study Short Form-12 (SF-12) | Limitations in role functioning will be assessed using the SF-12 (Ware et al., 1996). The SF-12 is a widely used measure of health-related quality of life and functioning with established reliability and validity. This measure will be used for the economic analysis as well as to measure functioning as an outcome. | baseline - 12 months | |
Secondary | WHO Health and Work Performance Questionnaire—Short Form (HPQ-SF) | The HPQ-SF (Kessler, et al., 2004; Kessler, et al., 2003) will be used to assess work presenteeism and absenteeism. The self-report survey contains 11 items and assesses work in the prior 4 weeks. These items will be used both to assess work functioning and to estimate costs related to PTSD and associated conditions. | baseline - 3 months | |
Secondary | WHO Health and Work Performance Questionnaire—Short Form (HPQ-SF) | The HPQ-SF (Kessler, et al., 2004; Kessler, et al., 2003) will be used to assess work presenteeism and absenteeism. The self-report survey contains 11 items and assesses work in the prior 4 weeks. These items will be used both to assess work functioning and to estimate costs related to PTSD and associated conditions. | baseline - 6 months | |
Secondary | WHO Health and Work Performance Questionnaire—Short Form (HPQ-SF) | The HPQ-SF (Kessler, et al., 2004; Kessler, et al., 2003) will be used to assess work presenteeism and absenteeism. The self-report survey contains 11 items and assesses work in the prior 4 weeks. These items will be used both to assess work functioning and to estimate costs related to PTSD and associated conditions. | baseline - 12 months | |
Secondary | Numeric Rating Scale for Pain | This trial will use a two-item numeric rating scale for pain, adapted from the NRS (Cleeland and Ryan, 1994) and the University of Washington's IMPACT studies. The items ask patients to rate pain intensity on average and how much the pain interferes with their daily activities on 11-point numeric rating scales. | baseline - 3 months | |
Secondary | Numeric Rating Scale for Pain | This trial will use a two-item numeric rating scale for pain, adapted from the NRS (Cleeland and Ryan, 1994) and the University of Washington's IMPACT studies. The items ask patients to rate pain intensity on average and how much the pain interferes with their daily activities on 11-point numeric rating scales. | baseline - 6 months | |
Secondary | Numeric Rating Scale for Pain | This trial will use a two-item numeric rating scale for pain, adapted from the NRS (Cleeland and Ryan, 1994) and the University of Washington's IMPACT studies. The items ask patients to rate pain intensity on average and how much the pain interferes with their daily activities on 11-point numeric rating scales. | baseline - 12 months |
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