Back to resultsScaling Up Science-based Mental Health Interventions in Latin America (DIADA)
Primary Purpose
Depression, Problematic Alcohol Use
Status
Completed
Phase
Not Applicable
Locations
Colombia
Study Type
Interventional
Intervention
Laddr
Sponsored by
About this trial
This is an interventional health services research trial for Depression focused on measuring Latin America, Depression, mHealth, Problematic Alcohol Use
Eligibility Criteria
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)
Sites / Locations
- Salud de Tundama
- Empresa Social del Estado Hospital Regional de Duitama- Santa Rosa de Viterbo Branch
- ESE Hospital San Antonio de Guatavita
- Hospital Mario Gaitán Yanguas
- Empresa Social del Estado Hospital Nelson Restrepo Martinez
- Javesalud
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Digital Health Assisted Mental Healthcare
Arm Description
This Digital Health Assisted Mental Healthcare intervention will be based on the novel mobile-based platform (Laddr® from Square2 Systems).
Outcomes
Primary Outcome Measures
The Integrated Measure of Implementation Context and Outcomes as a Change Over Time in Low and Middle Income Countries Consumer Instrument
This measure consists of 5 scales: Adoption, Appropriateness, Acceptability, Feasibility, and Reach/Access. All four scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot).
The Integrated Measure of Implementation Context and Outcomes as a Change Over Time in Low and Middle Income Countries Provider Instrument
This measure consists of 8 scales: Adoption, Appropriateness, Feasibility, Reach/Access, Organizational climate, Leadership in Implementing, and General Leadership Skills. All eight scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot).
The Integrated Measure of Implementation Context and Outcomes as a Change Over Time in Low and Middle Income Countries Organizational Staff Instrument
This measure consists of 9 scales: 1) Adoption, Appropriateness, Acceptability, Feasibility, Reach/Access, Organizational climate, Leadership in Implementing, General Leadership Skills, and Knowledge. All nine scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot).
The Program Sustainability Assessment Tool (PSAT) Providers
This instrument was developed from the Program Sustainability Assessment and consists of 7 scales: Environmental Support, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communication with Public, and Communications within the organization. All scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot). The seven sub-scales are combined to an overall score by averaging the sub-scale scores. The computed overall scales have a range of 1 to 4.
The Program Sustainability Assessment Tool (PSAT) Administrative Staff
This instrument was developed from the Program Sustainability Assessment and consists of 7 scales: Environmental Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communication with Public, Communications within the organization, and Communication with Government. All seven scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot). The seven sub-scales are combined to an overall score by averaging the sub-scale scores. The computed overall scales have a range of 1 to 4.
Secondary Outcome Measures
Patient Health Questionnaire (PHQ-8)
A measure with 8 items used to assess depression. The total score of the scale ranges from 0 to 24, with 0 representing no significant depressive symptoms and 24 representing the most severe depressive symptoms.
12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS)
The WHODAS 2.0 assesses health-related difficulties across six different domains of functioning (cognition, mobility, self-care, socializing, life activities, and participation) that are linked conceptually and operationally to the International Classification of Functioning, Disability and Health (ICF). The scores assigned to 12 items are - "none" (1), "mild" (2) "moderate" (3), "severe" (4) and "extreme" (5). The scores for the 12 items are summed into a total score ranging from 12 (least severe) to 50 (most severe). The last 3 items of the assessment collect the number of days the reported health-related difficulties impact the participants in the past 90 days.
General Anxiety Disorder Screener (GAD-7)
The GAD-7 is a 7-item self-reported screening questionnaire that has been validated to assess for generalized anxiety disorder (GAD) in outpatient and primary care settings. The measure is scored from 0 to 21, with 0 meaning minimal anxiety and 21 meaning most severe anxiety.
The Quick Drinking Screen (QDS) (for Full Implementation Study Only)
The Quick Drinking Screen (QDS) is a 3-item questionnaire which asks about average drinking habits over the last ninety days. The responses are used to calculate the number of standard drinks consumed per week. In this measure, a standard drink is defined as 1-12 oz. regular can or glass of beer, or 1-5 oz. glass of regular wine, or 1 ½ oz. of regular proof hard liquor or spirits. Patients with alcohol use disorder will be asked to complete this measure as part of the baseline assessment and at every 3 months follow-up (a total of 5 assessment timepoints).
Full Information
NCT ID
NCT03392883
First Posted
October 30, 2017
Last Updated
October 14, 2022
Sponsor
Dartmouth-Hitchcock Medical Center
Collaborators
Pontificia Universidad Javeriana, National Institute of Mental Health (NIMH)
1. Study Identification
Unique Protocol Identification Number
NCT03392883
Brief Title
Scaling Up Science-based Mental Health Interventions in Latin America
Acronym
DIADA
Official Title
Scaling Up Science-based Mental Health Interventions in Latin America
Study Type
Interventional
2. Study Status
Record Verification Date
October 2022
Overall Recruitment Status
Completed
Study Start Date
February 13, 2018 (Actual)
Primary Completion Date
March 18, 2021 (Actual)
Study Completion Date
August 31, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Dartmouth-Hitchcock Medical Center
Collaborators
Pontificia Universidad Javeriana, National Institute of Mental Health (NIMH)
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
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.
Detailed 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.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Depression, Problematic Alcohol Use
Keywords
Latin America, Depression, mHealth, Problematic Alcohol Use
7. Study Design
Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
The investigators will initially pilot test this mental health service delivery model at a single primary care site and then refine the model based on pilot data. The investigators will then expand implementation across 6 Colombia-based healthcare sites in urban and rural communities (including approximately 2000 participants). Consistent with a modified stepped wedge design (multiple baseline design), the investigators will implement the model across sites on a staggered basis and expand the number of sites in which the investigators implement over time. By conducting this multi-site implementation research project, the investigators can assess the extent to which the implementation model and associated outcomes are replicable across sites and/or the extent to which the model needs to be modified for differing contexts.
Masking
None (Open Label)
Allocation
N/A
Enrollment
1348 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Digital Health Assisted Mental Healthcare
Arm Type
Experimental
Arm Description
This Digital Health Assisted Mental Healthcare intervention will be based on the novel mobile-based platform (Laddr® from Square2 Systems).
Intervention Type
Behavioral
Intervention Name(s)
Laddr
Intervention Description
Laddr is a mobile behavioral health technology that offers science-based self-regulation monitoring and health behavior change tools via an integrated platform to a wide array of populations. Specifically, the core functionality of Laddr (e.g., problem-solving therapy) will be structured to focus on an end user's management of depression and its impact on their functioning and quality of life. The program will secondarily focus on problematic alcohol use and its relationship to depression management.
Primary Outcome Measure Information:
Title
The Integrated Measure of Implementation Context and Outcomes as a Change Over Time in Low and Middle Income Countries Consumer Instrument
Description
This measure consists of 5 scales: Adoption, Appropriateness, Acceptability, Feasibility, and Reach/Access. All four scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot).
Time Frame
At 6- and 12-month follow-up visits with a sub-sample of participants
Title
The Integrated Measure of Implementation Context and Outcomes as a Change Over Time in Low and Middle Income Countries Provider Instrument
Description
This measure consists of 8 scales: Adoption, Appropriateness, Feasibility, Reach/Access, Organizational climate, Leadership in Implementing, and General Leadership Skills. All eight scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot).
Time Frame
At the time of the provider training, 6 months, 12 months, 18 months, and 24 months.
Title
The Integrated Measure of Implementation Context and Outcomes as a Change Over Time in Low and Middle Income Countries Organizational Staff Instrument
Description
This measure consists of 9 scales: 1) Adoption, Appropriateness, Acceptability, Feasibility, Reach/Access, Organizational climate, Leadership in Implementing, General Leadership Skills, and Knowledge. All nine scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot).
Time Frame
At the time of the staff training, 6 months, 12 months, 18 months, and 24 months.
Title
The Program Sustainability Assessment Tool (PSAT) Providers
Description
This instrument was developed from the Program Sustainability Assessment and consists of 7 scales: Environmental Support, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communication with Public, and Communications within the organization. All scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot). The seven sub-scales are combined to an overall score by averaging the sub-scale scores. The computed overall scales have a range of 1 to 4.
Time Frame
At the time of the provider training, 6 months, 12 months, 18 months, and 24 months.
Title
The Program Sustainability Assessment Tool (PSAT) Administrative Staff
Description
This instrument was developed from the Program Sustainability Assessment and consists of 7 scales: Environmental Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communication with Public, Communications within the organization, and Communication with Government. All seven scales have a range of 1 to 4 (1- Not at all, 2- A little bit, 3- A moderate amount, 4- A lot). The seven sub-scales are combined to an overall score by averaging the sub-scale scores. The computed overall scales have a range of 1 to 4.
Time Frame
At the time of the staff training, 6 months, 12 months, 18 months, and 24 months.
Secondary Outcome Measure Information:
Title
Patient Health Questionnaire (PHQ-8)
Description
A measure with 8 items used to assess depression. The total score of the scale ranges from 0 to 24, with 0 representing no significant depressive symptoms and 24 representing the most severe depressive symptoms.
Time Frame
This patient measure were assessed at baseline and every 3 months thereafter for a period of 12 months (for a total of 5 assessment timepoints per patient).
Title
12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS)
Description
The WHODAS 2.0 assesses health-related difficulties across six different domains of functioning (cognition, mobility, self-care, socializing, life activities, and participation) that are linked conceptually and operationally to the International Classification of Functioning, Disability and Health (ICF). The scores assigned to 12 items are - "none" (1), "mild" (2) "moderate" (3), "severe" (4) and "extreme" (5). The scores for the 12 items are summed into a total score ranging from 12 (least severe) to 50 (most severe). The last 3 items of the assessment collect the number of days the reported health-related difficulties impact the participants in the past 90 days.
Time Frame
This patient measure were assessed at baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints-level assessments per patient).
Title
General Anxiety Disorder Screener (GAD-7)
Description
The GAD-7 is a 7-item self-reported screening questionnaire that has been validated to assess for generalized anxiety disorder (GAD) in outpatient and primary care settings. The measure is scored from 0 to 21, with 0 meaning minimal anxiety and 21 meaning most severe anxiety.
Time Frame
This patient measure were assessed at baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints per patient).
Title
The Quick Drinking Screen (QDS) (for Full Implementation Study Only)
Description
The Quick Drinking Screen (QDS) is a 3-item questionnaire which asks about average drinking habits over the last ninety days. The responses are used to calculate the number of standard drinks consumed per week. In this measure, a standard drink is defined as 1-12 oz. regular can or glass of beer, or 1-5 oz. glass of regular wine, or 1 ½ oz. of regular proof hard liquor or spirits. Patients with alcohol use disorder will be asked to complete this measure as part of the baseline assessment and at every 3 months follow-up (a total of 5 assessment timepoints).
Time Frame
At baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints per patient with implementation study participants).
Other Pre-specified Outcome Measures:
Title
EuroQOL Five Dimensions Questionnaire (EQ-5D) (Only for Pilot Participants)
Description
The EQ-5D. The EQ-5D is a standardized instrument that has been widely used and validated within Spanish speaking populations from several countries in Latin America, and assesses 5 key dimensions of health.
Time Frame
This patient measure will be assessed at baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints per patient with pilot participants).
Title
EuroQol Visual Analogue Scale (EQ-VAS) (Only for Pilot Participants)
Description
The EQ-VAS assess health-related quality of life. The EQ-VAS asks "how good or bad your health is today?" The scale ranges from 0 (worst health imaginable) to 100 (best health imaginable). The participants marks their number with an "X" on the scale and writes it in a box.
Time Frame
This patient measure will be assessed at baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints per patient with pilot participants).
Title
Alcohol Timeline Follow-back (Alcohol TLFB) (Only for Pilot Participants)
Description
A measure used to assess problematic alcohol use. The Alcohol TLFB asks patients about their alcohol use in the past 30 days.
Time Frame
This patient measure will be assessed at baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints per patient with pilot participants).
Title
Behavioral Health Integration in Medical Care Index (BHIMC)
Description
The BHIMC is an organizational measure of the level of behavioral health integration in medical practice settings. It evaluates policy, clinical practice and workforce dimensions of integration using mixed methods, i.e. combination of document review and observation.
Time Frame
Approximately every year prior to the time of implementation launch at a given site (starting with baseline in late 2017); at the time of implementation launch; and approximately every year thereafter at each site until study completion (April 2021).
Title
The Time-driven Activity-based Costing (TDABC) Approach
Description
The TDABC method measures costs of implementing the proposed model of care for depression and alcohol use disorders.The TDABC method will be used to determine the costs of the specific human, equipment, and facility resources used for delivering mental health care to patients as part of the model of care.
Time Frame
Approximately every year prior to the time of implementation launch at a given site (starting with baseline in late 2017); at the time of implementation launch; and approximately every year thereafter at each site until study completion (April 2021).
Title
Non-Study Medical and Other Services (NSMOS)
Description
The NSOMS assesses patients' medical resource use that is not part of the intervention, including non-treatment therapy visits, physician visits, residential and/or hospital detoxification, hospital and emergency department visits, and medication use through patient self-report.
Time Frame
At baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints per patient).
Title
Non-Medical Expenses for Depression (NMED)
Description
The NMED assesses the non-medical costs of depression. This measure is in Spanish and has been used in Latin America and used by our team at Javeriana.
Time Frame
At baseline and every 3 months for a period of 12 months (for a total of 5 assessment timepoints per patient).
Title
Health and Work Performance Questionnaire (HPQ)
Description
The HPQ was developed by the World Health Organization, and assess the impact of depression on work performance (including sickness absence, presenteeism, and critical incidents).
Time Frame
At baseline, 6-month follow-ups, and 12-month follow-ups (for a total of 3 assessment timepoints per patient).
Title
Administrative Interviews
Description
Administrative interviews will assess implementation experiences, challenges to implementation and strategies used to facilitate implementation with different patient populations, changes made to workflow with use of the intervention, and salience of monitoring and feedback processes to inform providers and other stakeholders about the implementation success (approx. 5 at each site). The investigators will also assess the extent to which patients initiated use of the program via inquiry of their providers after learning of the program through patient channels.
Time Frame
At 3- and 6-months post-implementation (+/- a 2 week window around the targeted data collection date)
Title
Patient Utilization Interviews/Observations
Description
The investigators will recruit and follow a sample of patients (approx. 5 at each site) during the implementation project to explore feasibility issues regarding use, barriers and facilitating strategies for using the program, optimal dissemination strategies for promoting use of the program, and overall experiences using the program over time. These patient participants will be encouraged to document their experiences with the mental health service delivery model in an ongoing manner (e.g., note jotting, pictures, audio recording).
Time Frame
At 3- and 6-months post-implementation (+/- a 2 week window around the targeted data collection date)
Title
Provider Interviews
Description
Provider interviews will assess implementation experiences, challenges to implementation and strategies used to facilitate implementation with different patient populations, changes made to workflow with use of the intervention, and salience of monitoring and feedback processes to inform providers and other stakeholders about the implementation success (approx. 5 at each site). The investigators will also assess the extent to which patients initiated use of the program via inquiry of their providers after learning of the program through patient channels.
Time Frame
At 3- and 6-months post-implementation (+/- a 2 week window around the targeted data collection date)
Title
COVID-19 Impact Survey
Description
The COVID-19 Impact Survey is a self-reported questionnaire developed by the NIMH U19 Scale-Up Hubs and will assess the impact of COVID-19 among patients, providers, and administrators enrolled in this study. Given the unknown and widespread implications of the COVID-19 pandemic in Colombia, it is critical to understand the context of COVID-19 for interpreting the study's findings.
Time Frame
Patients will be assessed once at a follow-up visit every 3 months or at a separately scheduled visit. Providers and administrators will be assessed once at a follow-up visit every 6 months or at a separate visit.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
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)
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Lisa A Marsch, PhD
Organizational Affiliation
Dartmouth College
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Carlos Gomez-Restrepo, MD
Organizational Affiliation
Pontificia Universidad Javeriana
Official's Role
Principal Investigator
Facility Information:
Facility Name
Salud de Tundama
City
Duitama
State/Province
Boyaca
Country
Colombia
Facility Name
Empresa Social del Estado Hospital Regional de Duitama- Santa Rosa de Viterbo Branch
City
Santa Rosa de Viterbo
State/Province
Boyaca
Country
Colombia
Facility Name
ESE Hospital San Antonio de Guatavita
City
Guatavita
State/Province
Cundinamarca
Country
Colombia
Facility Name
Hospital Mario Gaitán Yanguas
City
Soacha
State/Province
Cundinamarca
ZIP/Postal Code
Colombia
Country
Colombia
Facility Name
Empresa Social del Estado Hospital Nelson Restrepo Martinez
City
Guayabal
State/Province
Tolima
Country
Colombia
Facility Name
Javesalud
City
Bogotá
Country
Colombia
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Plan Description
The investigators agree to share all data in accordance with NIH's data sharing policy and in accordance with the specific data sharing requirements of this NIMH Cooperative Agreement funding mechanism. The investigators agree to cooperate with the NIMH program staff to provide timely, accurate, and complete data for purposes of monitoring the progress of research activities conducted within the proposed project. The investigators will also work with NIH program staff to promote broad availability of policies, practices, materials, tools and data generated by the proposed project activities. At the conclusion of this study, the investigators plan to make available a public use file of all related study data (stripped of all personal identifiers and suitable for use by other investigators). The investigators will make the dataset available in one or more several common formats (e.g., ascii tab delimited, SAS and SPSS).
IPD Sharing Time Frame
Data will become available at the conclusion of the study. The investigators agree to retain records for each completed study for a minimum of 3 years (or more if necessary) after study data lock. The investigators will also comply with all relevant Institutional Review Board(s) IRB(s) and other regulatory entities regarding data sharing and records retention.
IPD Sharing Access Criteria
Although the final dataset will be stripped of identifiers prior to release for sharing, the investigators will further assure participants' confidentiality with a data sharing agreement that stipulates that all data and associated documentation will only be available to users who declare: (1) a commitment to using the data only for research purposes and not to identify any individual participant; (2) a commitment to securing the data using appropriate computer technology; and (3) a commitment to destroying or returning the data after analyses are completed. The investigators understand that NIH has access to any and all data generated under the cooperative agreement and agree to provide a royalty-free, nonexclusive, and irrevocable license for the government to reproduce, publish, or otherwise use the material and data derived from research conducted under this cooperative agreement.
Citations:
PubMed Identifier
34347504
Citation
Marsch LA, Gomez-Restrepo C, Bartels SM, Bell K, Camblor PM, Castro S, Cardenas Charry MP, Cepeda M, Cubillos L, John D, Jassir MP, Lemley SM, Suarez-Obando F, Torrey WC, Uribe JM, Williams MJ. Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project. Psychiatr Serv. 2022 Feb 1;73(2):196-205. doi: 10.1176/appi.ps.202000041. Epub 2021 Aug 4.
Results Reference
derived
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Scaling Up Science-based Mental Health Interventions in Latin America
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