Technology-Facilitated Depression Self-Management Linked with Lay Supporters and Primary Care Clinics: Randomized Controlled Trial in a Low-Income Sample

Abstract

Purpose: To test whether technology-facilitated self-management support improves depression in primary care settings. Methods: We randomized 204 low-income primary care patients who had at least moderate depressive symptoms to intervention or control. Intervention participants received 12 months of weekly automated interactive voice response telephone calls that assessed their symptom severity and provided self-management strategies. Their patient-nominated supporter (CarePartner) received corresponding guidance on self-management support, and their primary care team received urgent notifications. Those randomized to enhanced usual care received printed generic self-management instructions. Results: One-year attrition rate was 14%. By month 6, symptom severity on the Patient Health Questionnaire-9 (PHQ-9) decreased 2.5 points more in the intervention arm than in the control arm (95% CI -4.2 to -0.8, p = 0.003). This benefit was similar at month 12 (p = 0.004). Intervention was also over twice as likely to lead to ≥50% reduction in symptom severity by month 6 (OR = 2.2 (1.1, 4.7)) and a decrease of ≥5 PHQ-9 points by month 12 (OR = 2.3 (1.2, 4.4)). Conclusions: Technology-facilitated self-management guidance with lay support and clinician notifications improves depression for primary care patients. Subsequent research should examine implementation and generalization to other chronic conditions. clinicaltrials.gov, identifier NCT01834534.

Keywords: behavioral health; psychology; telemedicine; telepsychiatry.

Conflict of interest statement

No competing financial interests exist.

Figures

Fig. 1.

CONSORT flow sheet for clinical trial. Notes: (1) includes 38 patients with a PHQ-9 total ≥10 at screening, who subsequently became ineligible because their PHQ-9 total dropped below 10 at baseline. (2) Includes three intervention arm patients, who actively self-withdrew and one who was withdrawn per protocol. (3) Includes all intervention participants, who either actively self-withdrew or were withdrawn per protocol. (4) Includes one control participant who was withdrawn per protocol. PHQ-9, Patient Health Questionnaire-9.

Fig. 2.

Predicted effects of intervention and time upon mean PHQ-9 total scores. Notes: (1) plotted values are group means ± standard errors predicted by the final model in which PHQ-9 total scores were regressed upon group and time, their two-way interactions, and the random intercept for patients across time. Note that the plotted means were not directly compared in the primary analysis, which focused upon changes' from baseline.