Tracking Depression Symptoms With a Health Chatbot

Study Overview
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Brief Summary
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The goal of this research is to bridge a significant effectiveness gap in the treatment of depression. The investigators have developed a chatbot which will assist in performing measurement-based care (MBC) via Facebook Messenger. Participants will be randomized to either Usual Care or Usual Care with additional Chatbot Care.

Detailed Description
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The goal of this research is to bridge a significant effectiveness gap in the treatment of depression. The investigators will be looking specifically at depressed women soon after they give birth, otherwise known as known as perinatal depression. Measurement-based care (MBC) which involves the use of quantitative assessments for depression screening, diagnosis, and symptom monitoring is recognized as one of the keys to depression management. MBC can be difficult to implement within the clinical setting due to the administrative overhead and close follow-up required. It is reasonable to hypothesize that low rates of MBC adoption are responsible for low rates of adequate depression care. The investigators have developed an automated conversational agent or chatbot (CB) for delivering MBC via Facebook Messenger. The investigators hypothesize that the use of CB-MBC, which combines a conversational interface with state-of-the-art quantitative assessments, will improve depression symptom severity for patients with perinatal depression. If successful, this project will provide primary care physicians with a new and inexpensive method for delivering better and safer care to their patients with depression. This study works to determine the impact of the chatbot in improving depression outcomes for patients under treatment for perinatal depression.

Official Title
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Automated Symptom Tracking for Measurement-Based Care of Depression

Conditions
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Depression, Postpartum, Depression, Unipolar

Intervention / Treatment
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* Device: Chatbot Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Provider Subject Cohort: residents and attendings from University of Chicago Medical Center OBGYN and NorthShore Hospital OBGYN clinics. Patient Subject Cohort: Age ≥ 18 years and able to and demonstrate English reading literacy of at least 8th-grade level (REALM-R ≥ 6) Postnatal women newly diagnosed or receiving treatment for non-psychotic unipolar depression with a severity-based entry criterion of moderate to severe (EPDS ≥ 12) Willing to participate and able to give written informed consent Must own a smart phone with a data plan Must have a Facebook account and Facebook Messaging app on phone (or willing to create account/download app today) Sufficient cognitive ability to provide self-report data on a computer touchscreen/ standard computer with minimal assistance Exclusion Criteria: Provider Subject Cohort: None Patient Subject Cohort: Subjects with documented dysthymia or Axis II diagnoses Subjects with self-reported or documented history of: anorexia or bulimia, obsessive compulsive disorder or prior hospitalization for suicidal ideation Active suicidality as determined by clinician Non-English speakers

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Usual Care Group<br>Subjects will undergo screening including Rapid Estimate of Adult Literacy in Medicine (REALM-R) and Edinburgh Postnatal Depression Scale (EPDS) and a few additional questions. Eligible subjects randomized to usual care will receive monthly reminder phone calls from a research coordinator. Subjects will receive an email with a link to surveys for the purpose of collecting information on depression severity, medication adherence, self-efficacy, side-effect burden, and maternal functioning. All participants will be asked to participate in a semi-structured debrief interview upon study completion. | |
| Experimental: Chabot Care Group<br>Subjects will undergo screening including REALM-R and EPDS and a few additional questions. Eligible subjects randomized to chatbot care will receive monthly reminder phone calls from a research coordinator. Subjects will receive an email with a link to surveys for the purpose of collecting information on depression severity, medication adherence, self-efficacy, side-effect burden, and maternal functioning. In addition to the above procedures, eligible subjects randomized to chatbot care will receive weekly messages from the chatbot asking them to complete a depression severity measure and side-effect burden assessments. Within week 1 subjects will receive a check-in call from a study coordinator to answer any questions regarding use of the chatbot. All participants will be asked to participate in a semi-structured debrief interview upon study completion. | Device: Chatbot Intervention<br>* a chatbot will be used to monitor depression severity<br>|
| No Intervention: Provider Subject Cohort<br>20 provider subjects from each study site will be enrolled to ensure they understand the study and consent to have their patients enrolled in the study | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Longitudinal Change in Depression Severity | Measured by the Edinburgh Postnatal Depression Scale (EPDS) Range 0-30 (dimensionless) Risk of depression goes up with an increasing score | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Depression Severity | Measured by the Computerized Adaptive Test-Depression Inventory (CAT-DI) and calculated change in Edinburgh Postnatal Depression Scale (EPDS) between Baseline and 3 months. Edinburgh Postnatal Depression Scale (EPDS) Range 0-30 (dimensionless) Risk of depression goes up with an increasing score | 3 months | 
| Change in Side-effect Burden | Measured by the Frequency, Intensity, and Burden of Side Effects Rating (FIBSER) questionnaire | 3 months | 
| Change in Maternal Function | Measured by the Barkin Index of Maternal Functioning | 3 months | 
| Change in Maternal Confidence | Measured by Maternal Confidence Questionnaire | 3 months | 
| Medication Adherence | Measured by 1-item medication adherence questionnaire | 3 months |