E-mental Health Support for Rural Areas
E-mental Health Support for Rural Areas
In the treatment of depression, primary care team play an important role, but they are most
 effective when inserted into a collaborative model of disease management.

 Hypotheses:Depressed patients treated in rural primary care clinics participating in a
 e-mental heath collaborative programme to manage depression achieve at least 20% better
 recovery rates in comparison with the control group three months after the baseline
 assessment.

 Goal: to compare the effectiveness of a e-mental health collaborative programme with usual
 care in rural primary-care clinics.

 Methodology: a clinical trial with two arms will be conducted in 13 community rural hospitals
 in Chile. The active group will participate in a collaborative programme between primary care
 teams and specialized teams, with support from an electronic platform and a call center.The
 control group will receive usual care, according to the Ministry of Health's Guidelines to
 Depression.To evaluate inclusion criteria -depressive patients aged between 18 and 70 years-
 and exclusion criteria -current in treatment for depression- an interview will be used that
 will include the Mini-International Neuropsychiatric Interview (MINI) to evaluate depression
 .The principal outcome will be depressive symptoms measured with the Beck Depression
 Inventory (BDI-I), and secondary outcome quality of life measured with the Health Survey
 (SF-36) at three and six months after baseline assessment.To detect a difference of 20%, in a
 one-sided model, with an alpha of 5% and power of 80%, would require 152 depressed persons
 (76 to intervention and 76 to control group).A design effect of 1.35 based on an Intraclass
 Coefficient Correlation (ICC) of 0,03839 and 13 clinics were considered. After applying the
 design effect the sample needed increased to 206 depressed persons. Considering a retention
 rate of approximately 85% 237 depressed cases will be needed.

 A program of this kind may be useful to assist primary care teams in remote areas of the
 country, in order to improve treatment outcomes for depression that is currently addressed at
 the primary care level.
Inclusion Criteria:

 -  Subjects aged 18 or more with a current major depressive episode according to
 Diagnostic and Statistical Manual of Mental Disorders IV criteria (DSM-IV)

 Exclusion Criteria:

 -  Depressive treatment currently in process.