Targeted and Tailored Messages to Enhance Depression Care

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DESCRIPTION (provided by applicant): Surveys of patients and physicians show that direct-to-consumer advertising (DTCA) of prescription drugs influences public attitudes and patient behaviors. In a recent randomized controlled trial (RCT), MH64683, we showed that patients' requests for antidepressants increase depression-related history-taking, inquiry about suicidal thoughts, and delivery of appropriate initial treatment. But can messages designed to encourage patient participation reduce stigma and overcome barriers to optimal depression care in the clinic and beyond? Furthermore, what is the comparative effectiveness of communication strategies based on targeting vs. tailoring? In this application, we propose a two-phase study to enhance delivery of initial treatment for depression. First, using approaches informed by market research and psychological theory, we will develop two communication interventions aimed at working age adults at risk for depression: (1) demographically targeted Public Service Announcements (PSAs) and (2) a social-psychologically tailored interactive multimedia computer program (IMCP). Second, we will conduct a RCT in primary care offices to compare the two interventions with each other and with an "attention control" (video on sleep hygiene). This project has two specific aims. The first is to develop and test targeted PSAs and a tailored IMCP designed to reduce stigma and promote effective participation in care among working- aged adults at risk for depression. Enhanced participation in care will be measured as an increase in the likelihood of: a) seeking care for depressive symptoms and b) making explicit requests for depression treatment. The second aim is to compare effects of targeted PSAs, a tailored IMCP, and a sleep hygiene video (control) on patients' attitudes towards depression care-seeking, patients' treatment requests, physicians' history-taking and treatment recommendations, and patients' clinical outcomes. As exploratory sub-aims, we will also examine effects on MD diagnostic accuracy and treatment disparities. In this project, formative research will be used to develop and test targeted public service announcements (PSAs) and a tailored interactive multimedia computer program (IMCP) designed to enhance depression care seeking, encourage appropriate depression treatment requests, and reduce depression-related stigma. Then, in a randomized controlled trial conducted in primary care offices, the effects of the two programs on depression care and outcomes will be compared with each other and with a control group.