Clinical Trial of Enhanced Measurement-Based Care (eMBC)

Major Depressive Disorder (MDD) is increasingly recognized as the most common psychiatric disorder and as one of the most common medical diagnoses worldwide.

This research study investigates the feasibility of using an Internet-based application that incorporates a technology-enhanced platform of measurement-based care (eMBC) in routine clinical care for MDD within an outpatient psychiatric setting.

Measurement-based care (MBC) is an evidence-based approach for providing effective clinical care to patients with MDD. MBC utilizes validated rating scales to assess symptom severity, functional impairments, treatment adherence, and side-effect burden to personalize clinical decision-making based on measured outcomes and clinical algorithms. However, despite evidence demonstrating improved outcomes, MBC is still not routinely used by physicians. Barriers to the use of MBC include lack of knowledge of which scales to use, how to incorporate measurements into clinical charting systems, and the extra time needed for repeated assessments.

Our research team developed a web-based application (app) optimized for mobile devices to address the treatment gap in MBC for people with depression, especially those who are working while depressed. This user-friendly app encourages patients to actively participate in MBC by using their smartphones, tablets, or computers to screen, monitor, and manage depressive symptoms and functional outcomes. Results can be easily displayed and printed to share with clinicians, thereby affording health professionals a simple and cost-effective means to integrate eMBC into standard practices and to optimize treatment for MDD at the point of care, without needing additional materials, equipment, or staffing.

To determine both the clinical and practical utility of eMBC, this study will enroll "real-world" patients with few exclusion criteria and undergoing naturalistic treatments so that findings will be generalizable to other clinical settings and practices.

• Enhanced Measurement-Based Care (eMBC)
  Participants randomized to this group will use a personally-owned smartphone, tablet, or laptop computer to access the online eMBC platform.
  Intervention: Other: Enhanced Measurement-Based Care (eMBC)
• Information website (control)
  Participants randomized to this group will receive information about online resources for mental health

Inclusion Criteria:

1. age 19-65 and capable of informed consent;
2. diagnosis of MDD by the Diagnostic and Statistical Manual, Fifth Edition (DSM-5) criteria as determined by the clinic psychiatrist (and if needed confirmed through the Mini International Neuropsychiatric Interview);
3. at least moderate depression as defined by QIDS-SR score of 10 or higher on the Quick Inventory for Depressive Symptomatology, Self-Rated (QIDS-SR);
4. access to an Internet-enabled computer or mobile device; and
5. able to read and understand English sufficiently to use the eMBC platform

Exclusion Criteria:

1. active psychotic or substance use disorder; or
2. severe suicidality as judged by the psychiatrist.

• Vancouver Coastal Health Research Institute
• Healthy Minds Canada
• Pfizer