Depression Clinical Trial
Official title:
AniMovil mHealth Support for Depression Management in a Low-Income Country
Depression is a huge public health problem in low and middle-income countries (LMICs). Mental
health care systems in most LMICs are extremely limited, impeding the dissemination of
WHO-recommended models for improving care via "task-shifting" services to community health
workers (CHWs) who deliver evidence-based treatments such as cognitive behavioral therapy
(CBT). This comprehensive intervention will use IVR and text messaging (SMS) to support
effective depression care. Intervention patients will receive weekly automated (IVR) calls
and daily text messages (SMS) throughout the 12 week intervention. Patients with more severe
depression will receive up to 12 weekly CHW-delivered telephone CBT sessions, based on WHO
recommendations and a treatment model developed and tested in India. CHWs will use patients'
IVR contacts to enhance psychoeducation and they will use SMS plus web-based reports based on
patients' IVR calls to identify individuals needing additional follow-up. The CHWs' clinical
supervisor will use SMS messages to CHWs to reinforce best practices and monitor service
delivery.
Patients will be enrolled from Colombian clinics associated with the Universidad de Los Andes
in Bogota, Colombia. 114 patients will be randomized to either a usual enhanced care or
intervention group. Intervention group patients will receive weekly automated (IVR) calls and
daily text messages throughout the duration of the 12 week intervention. Patients with more
severe depression will receive up to 12 weekly CHW-delivered telephone CBT sessions, based on
WHO recommendations and a treatment model developed and tested in India. CHWs will use
patients' IVR contacts to enhance psychoeducation and they will use SMS plus web-based
reports based on patients' IVR calls to identify individuals needing additional follow-up.
The CHWs' clinical supervisor will use SMS messages to CHWs to reinforce best practices and
monitor service delivery. Program components will be modified to fit the local culture and
clinical environment via iterative engagement of health professionals and patients with
depression.
Those patients in usual enhanced care will receive the study manual and daily text messages
and feedback throughout the duration of the program. Patients in the enhanced usual care
group who present with more severe depression will be referred to the national program office
for depression services support - a free service available to all citizens diagnosed with
depression.
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