Effectiveness of an Internet-based Intervention for the Treatment of Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Depression is a highly prevalent disorder in Chile, generating important personal and social
      costs. This study aims to evaluate the effectiveness of the internet-based program ASCENSO as
      an adjunct intervention for the treatment of depression. ASCENSO provides information to
      promote patients' self-care, it monitors reported depression symptoms providing automatized
      feedback and provides the possibility of booking a counseling session via chat or by phone.
      To evaluate the effectiveness of ASCENSO, an open, evaluator-blind, prospective,
      parallel-group (one intervention group and one active control group) randomized controlled
      trial will be implemented in one mental health center in Santiago of Chile. The sample will
      be composed of adults initiating treatment for depression, and who have internet access.
      Participants will be randomly assigned to one of the two study arms. Randomization will be
      stratified by the number of patients´ previous episodes (dichotomized into none, 1 or more),
      following a permuted block randomization procedure. Patients in the experimental group
      (n=100) will receive the usual treatment plus access to the ASCENSO program. The control
      group (n=100) will only receive the usual treatment. At recruitment, months 6 and 9,
      patients' self-reported depression symptoms and quality of life will be assessed.
      Additionally, adherence to treatment in terms of patients' attendance to medical controls and
      psychotherapy sessions will be registered for both research groups.
    

Detailed description: 
      The public health system has established policies and priorities to provide access to
      depression treatment and to improve the quality of those services. The acknowledgment of the
      complexity and chronicity of the disorder has motivated the design and implementation of
      comprehensive disease management strategies for depression. There are experiences that show
      that information technologies can help to optimize the management of depression. If ASCENSO
      is effective, it could be a useful resource to include to the mental health services for
      depression in Chile.

      The components of the ASCENSO program are:

      Emergency. Standard Information on what to do and who to contact in a crisis situation.

      Online or phone counseling. Patients can schedule a 30-minute session with a psychologist,
      which is conducted in a private text chatroom or over the phone.

      Monitoring. Patients receive a bi-weekly email with a link to the monitoring questionnaire
      and automatized tailored feedback message. If a participant reports severe impairment, the
      ASCENSO administrator receives an alert notification and then contacts the patient.

      Self-care information and blog. Web pages with basic information about depression and
      self-care recommendations.
    

Intervention name(s): ASCENSO; Antidepressants or in combination with anxiolytics, neuroleptics or mood stabilizers.; Psychotherapy
Intervention type(s): Behavioral; Drug; Behavioral
Intervention description(s): Internet-based program: an adjunct support and monitoring system for the treatment of depression.; Usual psychiatric treatment which may include drugs: antidepressant monotherapy or antidepressants in combination with anxiolytics, neuroleptics or mood stabilizers as needed, according to the psychiatric evaluation. Monthly controls during 5 months in average.; Usual treatment: brief psychotherapy. One session per week, a total of 9 sessions in average.
Other intervention name(s): Internet-based program; Psychiatric treatment
Intervention MeSH terms: Anti-Anxiety Agents; Antipsychotic Agents; Antidepressive Agents
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Open randomized controlled trial in one mental health center.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Internet; Mental Health