Improving Depression Management Through Peer Support

Not Applicable

Completed

Conditions: Depression

Interventions: Behavioral: Telephone-based peer support
Behavioral: Enhanced Usual Care

Registration Number: NCT00777205

Lead Sponsor: US Department of Veterans Affairs

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.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 443

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.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Telephone-based peer support	Telephone-based peer support	Participants in the intervention arm received usual mental health care and biweekly study mailings. In addition, they had access to a telephone platform over which they could make free calls to their peer partner for mutual peer support over a 6-month period of time.
Enhanced Usual Care	Enhanced Usual Care	Patients in the enhanced usual care arm received their usual mental health care, a copy of the Depression Helpbook, and bi-weekly study mailings with depression management tips.
Telephone-based peer support	Enhanced Usual Care	Participants in the intervention arm received usual mental health care and biweekly study mailings. In addition, they had access to a telephone platform over which they could make free calls to their peer partner for mutual peer support over a 6-month period of time.

Primary Outcome Measures

Name	Time	Method
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.
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).
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.

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (4): VA Ann Arbor Healthcare System, Ann Arbor, MI
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Ann Arbor, Michigan, United States
VA Medical Center, Battle Creek
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Battle Creek, Michigan, United States
John D. Dingell VA Medical Center, Detroit, MI
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Detroit, Michigan, United States
Aleda E. Lutz VA Medical Center
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Saginaw, Michigan, United States