Improving Depression Management Through Peer Support (DIAL-UP)

US Department of Veterans Affairs (VA)

Status: Completed

Conditions: Depression

Treatments: Behavioral: Telephone-based peer support; Behavioral: Enhanced Usual Care

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT00777205

IIR 08-325

Details and patient eligibility

About

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.

Full 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.

Enrollment: 443 patients

Sex: All

Ages: 18+ years old

Volunteers: No 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.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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443 participants in 2 patient groups

Enhanced Usual Care

Active Comparator group

Description:

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.

Treatment:

Behavioral: Enhanced Usual Care

Telephone-based peer support

Experimental group

Description:

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.

Treatment:

Behavioral: Telephone-based peer support

Behavioral: Enhanced Usual Care