Comparing Differing Financial Incentive Structures for Increasing Antidepressant Adherence Among Adults

Study Overview
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Brief Summary
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The investigators will test using financial incentives by leveraging decision-making biases to improve adherence to antidepressants among adults newly prescribed antidepressants. This study will compare the effects of usual care, increasing financial incentives, and decreasing financial incentives on daily antidepressant medication adherence and depression symptom control of non-elderly adults with Major Depressive Disorder.

Detailed Description
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A three arm randomized controlled trial will compare interventions to promote antidepressant adherence. One hundred twenty adults with major depressive disorder (MDD) who are initiating antidepressant treatment will be randomized in equal proportion to 1) usual care, 2) usual care and an escalating daily financial incentive for 6 weeks, or 3) usual care and a de-escalating financial incentive for daily antidepressant adherence for 6 weeks. Study patients will participate in three assessments over a 12 week period as well as passive monitoring of antidepressant daily adherence through a wireless electronic pill bottle over the same 12 week period. The primary outcome will be the number of antidepressant daily doses taken during the initial six weeks of treatment. The secondary outcome will be daily adherence during the next six weeks following the discontinuation of the intervention.

Official Title
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Antidepressant Medication Adherence in Adults With Depression

Conditions
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Depression

Intervention / Treatment
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* Other: Financial incentives


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Prescribed antidepressant Plan to take antidepressant as prescribed Working cell phone that allows texting Score on PHQ-9 ≥ 10 Exclusion Criteria: No antidepressant use in last 90 days Never been diagnosed with bipolar disorder, schizophrenia, or schizoaffective disorder Not currently pregnant or breastfeeding No other serious medical condition

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Escalating Incentives<br>Participants assigned to the escalating financial incentives will receive an increasing financial incentive for taking their antidepressant medication for the initial 6 weeks of treatment. | Other: Financial incentives<br>* Providing money for taking antidepressant medication<br>|
| Experimental: De-escalating Incentives<br>Participants assigned to the de-escalating financial incentives will receive a decreasing financial incentive for taking their antidepressant medication for the initial 6 weeks of treatment. | Other: Financial incentives<br>* Providing money for taking antidepressant medication<br>|
| No Intervention: Control<br>Participants in this condition will receive usual care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Antidepressant adherence | The number of antidepressant daily doses taken during the initial six weeks of treatment | Daily for first 6 weeks of study | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Antidepressant adherence post-intervention | The number of antidepressant daily doses taken between 6 and 12 weeks | Daily between 6 and 12 weeks | 
| Depression symptoms | Severity of depressive symptoms as assessed by the Patient Health Questionnaire (PHQ-9). The PHQ-9 measures depressive symptoms, with scores ranging from 0-27 (higher scores meaning more depressive symptoms). | At baseline, 6 week follow-up, and 12 week follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Medication Adherence