Scaling Up Science-based Mental Health Interventions in Latin America (DIADA)

Dartmouth Health

Status: Completed

Conditions: Problematic Alcohol Use; Depression

Treatments: Behavioral: Laddr

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT03392883

1U19MH109988 (U.S. NIH Grant/Contract)

1U19MH109988 D18019

Details and patient eligibility

About

Conduct systematic, multi-site mental health implementation research in both rural and urban primary care settings with a broad group of stakeholders in the US and Latin America.

Full description

The investigators plan to launch and evaluate a new mental health service delivery model in Latin America. Specifically, in this new multi-component, mental health service delivery intervention, the investigators propose to: (1) harness mobile behavioral health technology for mental health (with a primary focus on depression and a secondary focus on problematic alcohol and other substance abuse), (2) launch new workforce training and service delivery models (including the integration of technology into service delivery), (3) launch and evolve an integrated data management system for systematic data tracking and outcomes assessment, and (4) launch and grow a learning collaborative of organizations integrating mental health into primary care. The investigators will launch this project at multiple primary care sites in various parts of Colombia, with a plan to inform subsequent adoption in several other Latin American countries, including Chile and Peru.

Enrollment: 1,348 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Provider and administrative staff Inclusion Criteria:

  • Aged > 18 years
  • Have worked for the study site for at least 3 months.

• Participant Inclusion Criteria:

  • Aged > 18 years
  • Patients at one of our collaborating primary care sites
  • Screen positive for minor (score of 5-9), moderate (score of 10-14), moderately severe (score of 15-19) or severe (score of 20-27) depression on Patient Health Questionnaire (PHQ-9)62 and/or screen positive for problematic alcohol use on Alcohol Use Disorder Identification Test (AUDIT) developed by the World Health Organization (a score of 8 or more on 10-item AUDIT)63 and have a confirmed diagnosis of depression and/or alcohol use disorder based on clinical consultation at the primary care site
  • Willing to provide informed consent to use mobile intervention and complete study assessments

Exclusion criteria

-Participant Exclusion Criteria

• Diagnosis with co-occurring severe mental illness (e.g., schizophrenia, bipolar disorder, depression with psychotic features)
• Alcohol withdrawal symptoms that require higher level of care (e.g., emergency medical or inpatient treatment)
• Express suicidal intention. This assessment will be based on a combination of a patient's response on the PHQ-9 assessment followed by further assessment by a primary care clinician. The PHQ-9 measure will not be used solely to determine eligibility on this criterion. Persons who express suicidal intention will immediately be provided immediate crisis management in accordance with the crisis management protocol at the collaborating primary care site.
• Intoxicated or otherwise impaired at the time of assessment (rendering the individual incapable of informed consent)

Trial design

Primary purpose: Health Services Research

Allocation: N/A

Interventional model: Single Group Assignment

Masking: None (Open label)

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1,348 participants in 1 patient group

Digital Health Assisted Mental Healthcare

Experimental group

Description:

This Digital Health Assisted Mental Healthcare intervention will be based on the novel mobile-based platform (Laddr® from Square2 Systems).

Treatment:

Behavioral: Laddr