Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 26, 2023
Date Accepted: Oct 19, 2023
Secure Messaging Intervention in Patients Starting New Antidepressant to Promote Adherence: A Pilot Randomized Controlled Trial
ABSTRACT
Background:
There are a range of effective pharmacologic and behavioral treatments for depression. However, approximately one third of patients discontinue antidepressants within the first month of treatment and 44% discontinue them by the third month of treatment. The major reasons reported for discontinuation were side-effect burden, patients experiencing that the medications are not working, and patients wanting to resolve depression without using medication.
Objective:
This study tested the acceptability, feasibility, and preliminary effectiveness of an SMS Messaging intervention designed to improve antidepressant adherence and depression outcomes in Veterans by targeting the key reasons for antidepressant discontinuation, such as side-effect burden or prolonged delay (typically 6-weeks) of treatment effect.
Methods:
This pilot was a three-armed randomized controlled trial of 53 Veterans undergoing depression treatment at the Iowa City VA Health Care System (ICVAHCS). Veterans starting a new antidepressant were randomized to Secure Messaging Only (SM-Only), Secure Messaging with Coaching (SM+Coach), or an Attention Control (AC). The intervention lasted 6-weeks with 12-week follow-up on key antidepressant adherence, depressive symptom severity, and side-effect burden.
Results:
The interventions demonstrated small to moderate effect sizes in improving antidepressant adherence and reduced side-effect burden. They did not appear to benefit reduction in depressive symptom severity. Change from Baseline to 12-weeks on the Medication Adherence Rating Scale (MARS ) (increase=poor adherence) declined in the two intervention groups, SM-Only (Effect size 0.09) or SM+ Coach (Effect size = 0.85) whereas poor adherence increased for those in the AC group. These differences only reached statistical significance for the comparison between the SM+Coach intervention as compared with the AC. Depression scores on the 9-Item Patient Health Questionnaire (PHQ-9) decreased for all three treatment arms, though the decline was slightly larger for the SM-Only (ES=0.32) and the SM+Coach (ES=0.24) arms when compared with the AC group. None of these differences in depression changes between groups reached statistical significance. The two intervention arms indicated a decrease in side effects on the Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER) while the side effect assessment for the AC group increased. These differences were not statistically significant but indicated moderate effect sizes (SM-Only vs. AC ES=0.40, P=.07; SM+ Coach ES=0.54, P=.07). Consistent with prior research, the intervention that included brief synchronic meetings with a coach appeared to have greater benefit than the SMS messaging service alone.
Conclusions:
Veterans engaged in and accepted a targeted secure messaging intervention which aimed to improve adherence and overall depression outcomes. The intervention yielded small to moderate effect sizes on adherence and side-effect burden but not depressive symptom severity. Clinical Trial: ClinicalTrials.gov (NCT # 03930849)
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