Chronic or recurrent depression is responsible for much personal suffering and functional impairment. Psychotherapy has been shown to be an essential part of effective evidence-based treatment that could prevent much of this burden. Unfortunately, few people receive psychotherapy or support for the day-to-day tasks of leading a meaningful life. One reason is that symptoms of depression-such as hopelessness and low energy-interfere with both starting treatment and sticking with it. In this application, we propose testing an innovative, transportable intervention in a sample of patients with chronic or recurrent depression recruited from two health care clinics serving a diverse urban population. Key ingredients of the intervention include aggressive outreach, motivational enhancement, and transmission of hope and remoralization. We will randomly assign 300 patients with chronic or recurrent depression to either: a) continued usual care;or b) an 18-month organized treatment program including weekly group training in specific self-management skills that patients choose from a varied menu of potential strategies, monthly visits with a psychotherapist care manager (in person or by telephone), and monthly one-on-one in-person or telephone visits with a peer support specialist who will use "recovery dialogues" to help participants make choices and set and achieve goals. Blinded assessments will examine clinical outcomes (SCL depression score and patient-rated global improvement), functional outcomes (SF-36 Questionnaire and disability/lost productivity), and process variables (adequacy of pharmacotherapy, self-efficacy for managing depression, and use of coping strategies) over 24 months. The data collected will evaluate the program's effectiveness, i.e., the effects of the intervention on patient outcomes and processes of care, examine mediators of treatment outcome and moderators of treatment response, and estimate the program's costs and effect on the costs of treatment for depression.
Psychotherapy and support for the day-to-day tasks of leading a meaningful life are essential parts of care for people who suffer from longstanding depression. Unfortunately, few people receive such support, because symptoms of depression- such as hopelessness and low energy-interfere with both starting treatment and sticking with it. This project proposes testing a model of support for longstanding depression that involves outreach and care not only by psychotherapists but also by peer support specialists who have struggled with depression themselves, to provide people in need with hope as well as skills for leading more fulfilling lives.