eCare for Moods: An Internet-based Management Program

The study aim is to explore the effect of a comprehensive Internet-based disease management program for bipolar disorder and recurrent or chronic major depression on clinical outcomes and satisfaction with care.

This study is a randomized controlled trial that includes 404 subjects, 300 subjects with bipolar disorder and 104 subjects with recurrent or chronic major depressive disorder. The study subject diagnostic groups (bipolar and depressive) are separately randomized to either usual care or to eCare and the data collected from the two diagnostic groups are analyzed separately.

All subjects randomized to the eCare intervention are assigned an eCare nurse care manager in addition to one year of access to an Internet-delivered care management and patient self-management program. While both diagnostic groups receive similar Internet-delivered services for depression, the subjects with bipolar disorder receive special services for bipolar disorder. All subjects randomized to usual care will receive their normal psychiatric care and do not have access to the website.

Study subjects are followed for 24 months and outcome measurements are taken every six months by telephone interviewers blinded to treatment assignment. Specific measures include depression and mania symptoms, severity, adherence with medication, general health, functioning at work and at home, satisfaction with care, and confidence in coping with their disorder. The primary outcomes for patients with bipolar disorder are the severity of depression and the severity of mania over time. The primary outcome for patients with recurrent or chronic depression is the severity of depression over time. The hypothesis is that Internet-based care management will have a favorable effect on the burden of bipolar disorder and/or on recurrent/chronic depression over time.

• Major Depressive Disorder
• Bipolar Disorder

• Active Comparator: Usual Care
  Member with recurrent or chronic depression receives usual specialty mental health care
  Intervention: Other: Internet based disease management program
• Experimental: Internet-based disease managment program
  Usual care is augmented with internet based education, self monitoring and clinical monitoring
  Intervention: Other: Internet based disease management program

Inclusion Criteria:

• Diagnosis of bipolar or recurrent major depressive disorder and access to a computer

Exclusion Criteria:

• No diagnosis of bipolar or recurrent major depressive disorder, no computer access