Evaluation of a Mental Health Physician Support Program in Nova Scotia

NCT01975948 | Completed Results DMC

• 1 other identifier: CDHA-RS/2014-150
• Study Type: interventional
• Target: 285
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of this study is to test the program's effectiveness in a primary care setting in reducing stigma among medical personnel, increasing the comfort level of physicians and staff in providing care to those living with mental illness, and in improving client well-being and mental health.

Conditions

Major Depressive Disorder

Keywords

Mental Health; Education and Practice Support Program; Depression; Primary Care; Skill-based training; Patient centered outcomes

Outcome Measures

Primary Outcomes (2)

• Depression Severity (Change in Patient Health Questionnaire-9 (PHQ-9) Score From Baseline

  The Patient Health Questionnaire-9 (PHQ-9) covers nine symptom-based Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for major depressive disorder. Scores range from 0-27, with higher scores indicating more severe depression severity. We compared between-group mean differences of PHQ-9 scores during follow-up, assessed as a group-by-time interaction. We used a multi-level mixed model analysis: physicians clustered within practices, patients clustered within their corresponding physicians, and longitudinal PHQ-9 ratings clustered within patients. The four follow-up time points were represented by indicator variables. The effect of the intervention was measured as an intervention by time interaction, and the time-by-group interaction was assessed using a likelihood ratio test.

  Baseline, 1, 2, 3, and 6 months

• Between Group Changes in Total Score on the Opening Minds Scale for Health Care Providers (OMS-HC)

  The Opening Minds Scale for Health Care Providers (OMS-HC) is a 15 item validated scale that also captures three main dimensions of stigma; negative attitudes, health professionals' own willingness to disclose/seek help for a mental illness, and preference for greater social distance. Items are rated on a 5-point scale: from strongly agree to strongly disagree. Total scores can range from 15 to 75 for the overall total score, 6 to 30, 4-29, 5-25 for sub-scales respectively. Total scores are averaged to result in mean scores range from 1 to 5 with lower scores indicating less stigma. This scale has been widely validated and used in evaluations of anti-stigma interventions in Canada. The analysis was conducted using a multi-level mixed model in which physicians were clustered within practices and stigma ratings were clustered within physicians (one or two observations per physician). The effect of the intervention was measured in this analysis as an intervention by time interaction.

  Baseline and at 6 months

Secondary Outcomes (1)

• Between Group Changes in Occupational Functioning From Baseline to 6 Months

  Baseline, 1, 2, 3, and 6 months

Other Outcomes (7)

• Between Group Change at 6 Months From Baseline in Physician Confidence and Comfort in Managing Mental Illness

  Baseline and 6 months

• Between Group Change in Physician Confidence and Comfort With Non-program Specific Tools and Skills

  Baseline and 6 months

• Between Group Change in Physician Confidence and Comfort With Program Specific Tools and Skills

  Baseline and 6 months

Study Arms (4)

Mental Health PSP: Physicians

EXPERIMENTAL

Physicians training in Adult Mental Health Practice Support Program

Other: Mental Health Practice Support Program

Treatment as Usual: Physicians

ACTIVE COMPARATOR

Those administering treatment as usual for depression

Other: Treatment as Usual

Mental Health PSP: Patients

EXPERIMENTAL

Those belonging to a physician who has completed the Adult Mental Health Practice Support Program training.

Other: Mental Health Practice Support Program

Treatment as Usual: Patients

ACTIVE COMPARATOR

Those receiving treatment as usual for depression

Other: Treatment as Usual

Interventions

Mental Health Practice Support Program OTHER

1. training and (2) practice support. * Three half day workshop sessions over a 24 week period. * Practice support: 3 evidence based Supported Self Management tools (Cognitive Behavioral Interpersonal Skills Manual,Bounceback program, Antidepressant Skills Workbook), and Practice support coordinator provides guidance to incorporate newly acquired tools, skills, and processes

Mental Health PSP: Patients; Mental Health PSP: Physicians

Treatment as Usual OTHER

Physicians manage patients with depression as usual

Treatment as Usual: Patients; Treatment as Usual: Physicians

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Depression defined by PHQ-9 score of \> 10.
• \> 18 years old.
• Able to read and speak English.
• Sufficiently intact cognitive functioning (physician judgement).
• Free of urgent or emergent medical or psychiatric issues e.g. unstable cardiovascular disease, suicidal ideation.

You may not qualify if:

• Not currently under treatment for depression either with an antidepressant medication or psychotherapy.

Sponsors & Collaborators

• Nova Scotia Health Authority: lead

Study Sites (1)

Dalhousie University Department of Psychiatry

Halifax, Nova Scotia, B3H2E2, Canada

Location

Related Publications (1)

• Lauria-Horner B, Beaulieu T, Knaak S, Weinerman R, Campbell H, Patten S. Controlled trial of the impact of a BC adult mental health practice support program (AMHPSP) on primary health care professionals' management of depression. BMC Fam Pract. 2018 Nov 28;19(1):183. doi: 10.1186/s12875-018-0862-y.

  PMID: 30486799 DERIVED

MeSH Terms

Conditions

Depressive Disorder, Major; Psychological Well-Being; Depression

Interventions

Therapeutics

Condition Hierarchy (Ancestors)

Depressive Disorder; Mood Disorders; Mental Disorders; Personal Satisfaction; Behavior; Behavioral Symptoms

Limitations and Caveats

Challenges in physician sample: 75% completed pre-post OMS-HC scale Physicians experienced challenges identifying study patients leading to small number of patients.

Results Point of Contact

• Title: Dr. Bianca Lauria-Horner
• Organization: Dalhousie University, Department of Psychiatry

bianca.horner@dal.ca

902-473-5633

Study Officials

• Bianca A Lauria-Horner, MD

  Associate Professor Dalhousie University Department of Psychiatry

  PRINCIPAL INVESTIGATOR

• Scott Patten, FRCP(C), PhD

  Professor, Departments of Community Health Sciences and Psychiatry, Calgary, Alberta

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Primary Mental Healthcare Education Leader

Study Record Dates

• First Submitted: October 21, 2013
• First Posted: November 5, 2013
• Study Start: November 1, 2013
• Primary Completion: December 1, 2015
• Study Completion: December 1, 2015
• Last Updated: October 14, 2021
• Results First Posted: June 26, 2017

Record last verified: 2021-09

Data Sharing

• IPD Sharing: Will share
• Shared Documents: STUDY PROTOCOL, ICF
• Time Frame: Available as of August 21/2017 till December 31/2017
• Access Criteria: Contact: Bianca Lauria-Horner hornerb@dal.ca

Locations

CA (1)