Telepsychiatry to Improve the Management of Adolescent Depression in Primary Care

Telepsychiatry-Based Collaborative Program to Improve the Management of Adolescent Depression in Primary Care Clinics in the Araucanía Region, Chile: A Randomized Controlled Trial

Background: Depression is common in adolescents and it is associated with serious consequences. In Chile, primary care team has a leading role in the management of depression in adolescents. Nevertheless, the majority of primary care professionals report not feeling adequately prepared to take on this responsibility and having difficulties referring patients to specialists. This situation is particularity complex in regions far away from the central zone. Telepsychiatry is a potential solution to an equitable access to specialized clinical expertise. Purpose: The purpose of this study is to determine whether a telepsychiatry-based collaborative program is effective to improve the management of depression in adolescents between 13 and 19 years of age in 16 primary care clinics in the Araucanía Region, Chile. Study design: A cluster-randomized clinical trial will be carried out with 237 adolescents. The efficacy, adherence, and acceptability of the telepsychiatry-based collaborative program will be evaluated.

General aim To carry out a randomized controlled trial to compare the efficacy of telepsychiatry intervention versus usual care to treat depression in adolescents in primary care clinics in the Araucanía Region, Chile. Specific aims To compare the level of depressive symptoms of adolescents suffering depression participating in a telepsychiatry program versus usual care in primary care clinics. To compare the level of health-related quality of life (HRQoL) of adolescents suffering depression participating in a telepsychiatry program versus usual care in primary care clinics. To compare adolescents' adherence with a telepsychiatry program versus usual care in primary care clinics. To evaluate adolescents' satisfaction with a telepsychiatry program. To evaluate health staff's satisfaction with a telepsychiatry program.

Online training on the diagnosis and management of adolescent depression for health professionals from primary care clinics participating in active branch. Clinical management of depression by primary care professionals, according to algorithms based on the Clinical Guidelines of the Chilean Ministry of Health (MINSAL). Supervision of primary care professionals through an internet site run by a team of specialists. Telephone monitoring of patients by personnel trained on clinical progress, treatment adherence, and side effects (applicable for patients taking drugs).

Online training on the diagnosis and management of adolescent depression for health professionals from primary care centers participating in active branch. Clinical management of depression by primary care professionals, according to algorithms based on the Clinical Guidelines of the Chilean Ministry of Health (MINSAL).

The intervention includes: Online training for the health staff Medical and psychological treatment, as described in the AUGE Clinical Guidelines for Depression Online supervision in a web platform by specialists Telephone monitoring

Online training for the health staff Medical and psychological treatment, as described in the AUGE Clinical Guidelines for Depression

Inclusion Criteria: Meets diagnostic criteria of a depressive disorder according a structured interview (MINI-KID) Exclusion Criteria: Psychotic symptoms Bipolar disorder Current substance and/or alcohol dependence Suicide risk that requires specialized treatment Current treatment with antidepressant and/or psychotherapy Low intellectual abilities

CESFAM Amanecer, CESFAM Labranza, CESFAM Pedro de Valdivia, CESFAM Pueblo Nuevo, CESFAM Santa Rosa, CESFAM Villa Alegre, Consultorio Miraflores

Martinez V, Rojas G, Martinez P, Zitko P, Irarrazaval M, Luttges C, Araya R. Remote Collaborative Depression Care Program for Adolescents in Araucania Region, Chile: Randomized Controlled Trial. J Med Internet Res. 2018 Jan 31;20(1):e38. doi: 10.2196/jmir.8021.