TACKling chronic depression - adapting and testing a technology supported patient-centred and solution-focused intervention (DIALOG+) for people with chronic depression (TACK)

AIMS AND OBJECTIVES The overall aim is improve quality of life and clinical outcomes for people with chronic depression. We will adapt and comprehensively evaluate a person-centred solution-focused intervention (DIALOG+) for the treatment of chronic depression, and develop an online training package for use by different mental health professionals to aid implementation. BACKGROUND AND RATIONALE Depression affects one in four people during their lifetime. It is a leading cause of disability worldwide and a priority within the NHS. Despite a range of treatment options, between 20-30% of patients go on to develop a chronic disorder and are often termed "treatment resistant". Outcomes remain poor, with chronic depression associated with an increased suicide risk, poor quality of life, physical comorbidity and functional impairment. From a societal perspective, chronic depression is estimated to cost the UK economy over £7.5bn per year. There is a lack of evidence-based interventions and research specifically focused on chronic depression. Current treatment options lack effectiveness, or require referrals to specialist services. Consequently, there is need to develop interventions which are effective, cost-effective and can be routinely implemented within different clinical settings to improve patient outcomes. One potential solution is DIALOG+. It is based on quality of life research, patient-centred communication and solution-focused approaches. Unlike existing treatments, the intervention does not require additional referrals, but is instead implemented within routine appointments between patients and clinicians. The intervention has been shown to be effective in improving the quality of life and mental health outcomes of individuals with schizophrenia. If properly adapted and evaluated, it has the potential to improve outcomes for individuals with chronic depression. RESEARCH PLAN The research includes seven work packages (WPs) and will be led by a multidisciplinary team with expertise in the development of complex interventions and the treatment of chronic depression. To support the research, a Lived Experience Advisory Panel (LEAP) including eight individuals will be set up at the beginning of the study and provide expertise throughout. We will work with the LEAP to develop research materials, analyse qualitative findings, interpret results and ensure dissemination materials are accessible to patients and the public. In WP1 we will conduct a systematic review to identify recruitment and retention strategies used in previous psychosocial intervention trials with people with depression. This will help develop recruitment and retention strategies for the later stages of the programme. WP2 will iteratively adapt the intervention (DIALOG+) and online training materials for use with people with chronic depression. Initial adaptations will be based on two patient workshops and interviews with clinicians (n=10). Five clinicians and fifteen patients will then test the adapted intervention over a three-month period, with individual interviews used to help further modify the intervention. In WP3, a feasibility study will be conducted over 6 months, where nine clinicians and 45 patients will be randomised on a 2:1 basis to the intervention or an active control. This will inform the design of the full-randomised controlled trial (RCT) and will further refine the intervention and online training. In WP4, a multi-site cluster RCT with internal pilot will assess effectiveness and cost-effectiveness. Data will be collected from inner city, semi-urban and rural areas (East London, Sheffield, Oxford and Gloucestershire). A total of 448 patients and 112 clinicians will be recruited, with patients assessed at baseline, 6 and 12 months post-randomisation. A qualitative process evaluation (WP5) will explore the mechanisms of action and intervention processes. To maximise impact, twenty staff members from different professio