CONEMO study: A randomized controlled trial to evaluate the effectiveness of a mobile technology intervention in the treatment of depressive symptoms in people with diabetes or hypertension in Peru

Depression is one of the most common mental disorders (CMDs), accounting for a large amount of the burden of disease. People with non-communicable chronic diseases, such as diabetes or hypertension, are at higher risk of also having depressive symptoms. This co-morbidity leads to negative consequences for the progression of the disease and treatment adherence. However, most people with CMDs do not access treatment, due to a shortage of human and economic resources, as well as an inadequate distribution of the funds and health providers. Innovative and effective interventions are needed to address the treatment gap for depression in Latin America, expanding the coverage of mental health for the general population. The use of technology can be an efficient approach to deliver effective treatments and promote the access to care in underserved populations. Another strategy is task-shifting of certain lower-level functions from a specialist to a health provider non-specialized in mental health. The CONEMO study takes from these two approaches to test the effectiveness of an intervention delivered through mobile technology and involving nurses to monitor the study participants (instead of psychologists or psychiatrists).

Objective

The CONEMO study has several objectives: 1) To assess the effectiveness of CONEMO in reducing depressive symptoms compared to usual care among people with hypertension and/or diabetes at 3 months after inclusion. 2) To assess the effectiveness of CONEMO in reducing depressive symptoms compared to usual care among people with hypertension and/or diabetes at 6 months after inclusion. 3) To assess the effectiveness of CONEMO in improving (a) social functioning, (b) quality of life, (c) adherence to diabetes and hypertension medication, and (d) level of daily activities, compared to usual care among people with hypertension and/or diabetes at 3 and 6 months after inclusion.

Design:

Individually randomized controlled trial. Participants assigned to the control group receive the current standard of care for any of their ongoing health conditions, and additionally, their depressive symptomatology is monitored via telephone by the research team.
The intervention group receives the CONEMO (Control Emocional) mobile application installed on a smartphone. CONEMO is low-intensity psycho-educational 6-week intervention, aiming at reducing depressive symptoms in people with diabetes and/or hypertension. The contents of CONEMO are based on the behavioral activation theory (BA), and its use is assisted by a nurse. In addition, their depressive symptomatology is also monitored via telephone by the research team.

Results

Currently being implemented.

Contact

Francisco Diez Canseco BA, MPH
fdiezcanseco@upch.pe

Location

Perú

Funding

National Institute of Mental Health (NIMH), EEUU.

Duration

2013 – 2018

Research team

Jaime Miranda, MD, MSc, PhD. CRONICAS, Universidad Peruana Cayetano Heredia.
Paulo Rossi Menezes, MD, MSc, PhD. Universidad de Sao Paulo.
Ricardo Araya, MD, PhD. Kings College London .
David Mohr, PhD. Northwestern University.

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