Activating Messages for Enhancing Primary Care Practice (AMEP2): Effectiveness Study

• Process of Care [ Time Frame: Within 24 hours of intervention delivery (physician post-visit assessment) ] [ Designated as safety issue: No ]
  Minimally acceptable initial care, meaning 1) antidepressant prescription, 2) referral to a mental health specialist, or 3) follow up within 14 days if PHQ >= 15 or within 30 days otherwise
  
  
• Patient Outcomes [ Time Frame: Stigma: Within 24 hours of intervention delivery (patient post-visit assessment); depression symptoms: 12 weeks ] [ Designated as safety issue: No ]
  1) Stigma as measured by a scale adapted from Kanter JW, Rusch LC, Brondino MJ. Depression self-stigma: a new measure and preliminary findings. J Nervous Mental Dis 1008; 196(9):663-70, and 2) depression symptoms measured via PHQ-8 scores.
  
  
• Toxicity [ Time Frame: Within 24 hours of intervention delivery (patient and physician post-visit assessment, audio-recording of doctor-patient interaction at index visit) ] [ Designated as safety issue: No ]
  1) Stigma as measured by a scale adapted from Kanter (see above) and 2) antidepressant prescribing by physician
  
  

• Direct or indirect patient requests for depression treatment [ Time Frame: Within 24 hours of intervention delivery (physician post-visit assessment, audio-recording of doctor-patient interaction at index visit) ] [ Designated as safety issue: No ]
  Patient request for medicine for depression or referral to a mental health professional
  
  

This project is an investigator-initiated study involving two sequential phases and is funded by the National Institute of Mental Health. Phase I included the use of marketing research (i.e. focus groups, adaptive conjoint analysis, and other survey methods) to produce two clinic-based interventions: a public service announcement (PSA) and interactive multimedia computer program (IMCP). The two clinic-based interventions are intended to include messages that will activate patients to talk with their physicians about specific health concerns (depression) and/or any depressive symptoms they've been experiencing. In Phase II (as described in this registration protocol), those interventions will undergo assessment in a randomized controlled effectiveness trial (RCT) in primary care settings in Sacramento and San Francisco.