Improving Depression Management Through Peer Support

Status

Completed

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT00777205

Acronym

DIAL-UP

Enrollment

443

Registered

2008-10-22

Start date

2010-02-28

Completion date

2013-09-30

Last updated

2015-04-27

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Depression

Keywords

Peer Support, Quality of Life, Telephone

Brief summary

We conducted a randomized controlled trial (RCT) that compared the effectiveness of a telephone delivered, recovery focused, peer-support intervention to enhanced usual care for VA patients with depression.

Detailed description

Peer-support interventions have been recommended by prestigious national task forces and incorporated into the VA Comprehensive Mental Health Strategic Plan. Patients who cope with longer term depressive symptoms may benefit from these interventions.This study examines the effectiveness of a feasible, scalable mutual peer-support intervention for VA patients in depression treatment and will inform leaders who are considering implementing peer-support initiatives. In this study, each study participant (a veteran in treatment for depression) was matched with another participating veteran and the pairs were randomized to enhanced usual care or to the telephone based peer-support intervention (DIAL-UP). All study participants received usual care plus written materials outlining depression self-management strategies, behavioral activation, and recovery. DIAL-UP participants also received: a) a peer-support manual that outlined peer support principles and provided peer discussion topics and b) access to a specialized telephone platform that permited free calls to their partners, ready access to mental health staff for back-up and advice, and recorded tips on depression management. Patients were encouraged to call their partners at least once per week during the 6-month intervention period. Patient outcomes were assessed at 3, 6, and 12 months following enrollment.

Interventions

BEHAVIORALTelephone-based peer support

Patients received a) a peer-support manual that outlines self-management and recovery principles and provides peer discussion topics and b) access to a specialized telephone platform that permits free calls to their partners, ready access to mental health staff for back-up and advice on being effective partners, and recorded tips on depression management. They were asked to call their peer partner at least once a week for 24 weeks.

BEHAVIORALEnhanced Usual Care

Patients received their usual mental health care plus a copy of the Depression Helpbook by Wayne Katon and bi-weekly study mailings with depression management tips.

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

* currently in treatment at Ann Arbor, Detroit, Battle Creek, or Saginaw VA or their associated community based outpatient clinics * not receiving formal mental health services or regularly attending mutual self-help programs outside of the VA * diagnosis of a depressive disorder in the last 24 months that is confirmed by the relevant clinician * being seen less than bi-weekly by clinicians for psychiatric or substance use disorders * past trial of psychotherapy and/or antidepressant trial * have a current PHQ-9 scores \> 10 or WSAS scores \> 10 * have stable access to and ability to communicate by telephone

Exclusion criteria

* diagnosis of schizophrenia, schizoaffective disorder, MDD with psychotic features, or Bipolar I in the past 24 months. Diagnosis of active substance dependence in the past 12 months or substance abuse in the last 6 months * an immediate risk of suicide, requiring hospitalization or urgent evaluation * clinician assessment that participation in the study could have an adverse impact on the patient or his/her partner.

Design outcomes

Primary

Measure	Time frame	Description
Change in Functional Status-Mental Health (MCS) Over 12 Month Period	Change over study period	The Veterans Rand 36 Item Health Survey (VR-36) mental health component score (MCS) and physical health component score (PCS) were used as measures of functional status. The MCS and PCS have a mean of 50 and standard deviation of 10, with higher scores indicating better health.
Change in Functional Status-Physical Health (PCS) Over 12 Month Period	Change over study period	The Veterans Rand 36 Item Health Survey (VR-36) mental health component score (MCS) and physical health component score (PCS) were used as measures of functional status. The MCS and PCS have a mean of 50 and standard deviation of 10, with higher scores indicating better health.
Quality of Life	Change over study period	The 14-item Quality of Life Enjoyment and Satisfaction Questionnaire Short Form (Q-LES-Q-SF), which has good reliability and has been used in multiple depression studies, was used to assess quality of life. Responses are scored on a 5-point scale ('not at all or never' to 'frequently or all the time'), where higher scores indicate better enjoyment and satisfaction with life (possible range 14-70).
Depression Symptoms	Change over study period	The 21-item Beck Depression Inventory-2nd Edition (BDI-II) was used to assess depressive symptoms. Total score of 0-13 is considered minimal range, 14-19 is mild, 20-28 is moderate, and 29-63 is severe.
Recovery Orientation	Change over study period	The 30-item Mental Health Recovery Measure (MHRM) was used to assess recovery orientation. The MHRM has been fielded among diverse populations and has a high level of internal consistency (Cronbach's α =.93) and shows change following engagement in recovery oriented treatments. The MHRM is scored using a 5 point Likert Scale (0 to 4) for each item, yielding a theoretical range from 0 - 120 for Total Score. Higher scores correspond to a higher self-reported level of mental health recovery.

Countries

United States

Participant flow

Recruitment details

Participants were recruited from a total of 15 VA mental health clinics, located within four VA Healthcare Systems and their affiliated Community Based Outpatient Centers.

Participants by arm

Arm	Count
Enhanced Usual Care Patients in the enhanced usual care arm received their usual mental health care, a copy of the Depression Helpbook by Wayne Katon and bi-weekly study mailings with depression management tips. Enhanced Usual Care: Patients received a copy of the Depression Helpbook by Wayne Katon and bi-weekly study mailings with depression management tips.	243
Telephone-based Peer Support Participants used an IVR telephone system for mutual peer support over a 6-month period of time. Additionally, participants will received a copy of the Depression Helpbook by Wayne Katon and bi-weekly study mailings with depression management tips. Telephone-based peer support: Patients received a) a peer-support manual that outlines self-management and recovery principles and provides peer discussion topics and b) access to a specialized telephone platform that permits free calls to their partners, ready access to mental health staff for back-up and advice on being effective partners, and recorded tips on depression management. They were asked to call their peer partner at least once a week for 24 weeks. Enhanced Usual Care: Patients received a copy of the Depression Helpbook by Wayne Katon and bi-weekly study mailings with depression management tips.	144
Total	387

Withdrawals & dropouts

Period	Reason	FG000	FG001
Overall Study	Death	0	2
Overall Study	Lost to Follow-up	25	9
Overall Study	Protocol Violation	0	56
Overall Study	Withdrawal by Subject	6	4

Baseline characteristics

Characteristic	Enhanced Usual Care	Telephone-based Peer Support	Total
Age, Customized 18-44 years	48 participants	25 participants	73 participants
Age, Customized 45-64 years	161 participants	91 participants	252 participants
Age, Customized > 65 years	34 participants	28 participants	62 participants
Sex: Female, Male Female	47 Participants	27 Participants	74 Participants
Sex: Female, Male Male	196 Participants	117 Participants	313 Participants

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	— / —	— / —
other Total, other adverse events	0 / 243	0 / 144
serious Total, serious adverse events	5 / 243	2 / 144

Outcome results

Primary

Change in Functional Status-Mental Health (MCS) Over 12 Month Period

The Veterans Rand 36 Item Health Survey (VR-36) mental health component score (MCS) and physical health component score (PCS) were used as measures of functional status. The MCS and PCS have a mean of 50 and standard deviation of 10, with higher scores indicating better health.