Results from a cluster RCT testing DIALOG+ for people with chronic depression

Introduction: DIALOG+ is a technology-assisted and solution-focused intervention that comprises the collaborative completion of a standardised quality of life outcome measure followed by a 4 step solution focused discussion. It has been previously established to be a clinically-effective and cost-saving approach for the care planning of people with psychosis in community care. However, service users with chronic depression often have lower levels of quality of life yet have fewer targeted treatments compared to those with psychotic disorders.



Methods: After a period of feasibility testing to see how appropriate DIALOG+ was for a population with chronic depression, a multi-site cluster randomised controlled trial was conducted across 9 National Health Service (NHS) sites in the UK.



Results: The trial team recruited 366 eligible participants, and 128 clinicians delivered DIALOG+ for between 6 and 12 months as part of routine care.  Analysis showed that receiving DIALOG+ marginally improved individual’s quality of life compared to people in the active control group (DIALOG scale + treatment as usual). Further, the health costs for the intervention were minimal and economic analysis showed the added clinical benefits were worth the slightly increased costs. Process measures also indicated that the experiences of service users and clinicians using DIALOG+ were largely positive.



Discussion: Taken together this shows that DIALOG+ is a worthwhile approach to use for people with chronic depression in community care. Further its generic nature and low costs indicate the potential for it to be implemented widely across different mental health care contexts.