Incentives + Reminders for Depression

Overseen By Steven C Marcus, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Must be taking: Antidepressants

Disqualifiers: Substance use disorder, Bipolar, Schizophrenia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

Duration: 12 weeks

525 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify whether you need to stop taking your current medications. However, you must not have been treated with antidepressants in the past 90 days to participate.

What data supports the effectiveness of the treatment Personalized Daily Text Messages with Financial Incentives for depression?

Research shows that financial incentives can improve engagement in digital mental health interventions, which are effective in reducing symptoms of depression and anxiety. However, a study found no difference in engagement or mental health outcomes when financial incentives were added to a digital mental health app, suggesting that while incentives may help engagement, they might not enhance treatment outcomes. ^{1 2 3 4 5}

How does the treatment of personalized daily text messages with or without financial incentives for depression differ from other treatments?

This treatment is unique because it uses personalized daily text messages to support individuals with depression, with the option of adding financial incentives to increase engagement. Unlike traditional therapies, this approach leverages digital communication and behavioral economics principles to encourage positive behavior changes and maintain social connections, which are risk factors for depression. ^{1 2 3 6 7}

What is the purpose of this trial?

The goal of this randomized controlled trial study is to compare different adherence support strategies for primary care patients with depression who have been newly prescribed antidepressant medications. We will examine whether personalized daily text messages with and without financial incentives improves anti-depressant adherence and depression symptoms as compared to treatment as usual (no messages or incentives for taking medications). We will measure adherence with a wireless pill bottle and by assessment of electronic health prescription records. Participants in the study will be asked to complete assessments of depression symptoms via telephone at 6 and 12 weeks.

Eligibility Criteria

This trial is for adults aged 21-64 with a clinical diagnosis of major depressive disorder, who score at least 10 on the PHQ-9, have been prescribed antidepressants by their primary care doctor, are interested in medication adherence, own a cell phone and can use an electronic pill bottle. They must be Penn Medicine primary care outpatients.

Inclusion Criteria

I am a primary care outpatient at Penn Medicine.

My depression score is at least 10 on the PHQ-9.

I own a cell phone.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive personalized daily text reminders with or without financial incentives to improve antidepressant adherence

12 weeks

Assessments via telephone at 6 and 12 weeks

Follow-up

Participants are monitored for antidepressant adherence and depression symptoms after treatment

4 weeks

Treatment Details

Interventions

• Personalized Daily Text Messages with Financial Incentives
• Personalized Daily Text Messages without Financial Incentives

Trial Overview The study tests if personalized daily text messages alone or combined with financial incentives improve adherence to antidepressant medications and reduce depression symptoms compared to usual treatment (no reminders or incentives). Adherence is tracked using a wireless pill bottle and health records.

Participant Groups

Group I: Reminders and Incentives Experimental Treatment 2 Interventions

This group will receive 12 weeks of personalized daily text reminders paired with 6 weeks of financial incentives.

Group II: Reminders Alone Experimental Treatment 1 Intervention

This group will receive 12 weeks of personalized daily text reminders without financial incentives.

Group III: Usual Care Active Control 1 Intervention

The usual care group will receive no text reminders or financial incentives.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Findings from Research

Nudges are simple and cost-effective interventions that can help reduce behavioral risk factors for depression, such as low physical activity, poor coping strategies, and weak social connections.

By leveraging cognitive biases, nudges can encourage healthier behaviors, making them a practical alternative to more expensive preventive therapies like problem-solving therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Nudges" to Prevent Behavioral Risk Factors Associated With Major Depressive Disorder. Woodend, A., Schölmerich, V., Denktaş, S.[2018]

Digital mental health apps have been shown to effectively reduce symptoms of anxiety and depression, with a small-to-medium overall effect size based on a meta-analysis of 25 studies involving 4159 participants.

Apps that included more engagement features tended to have larger effects on clinical outcomes, but surprisingly, there was a negative correlation between the use of persuasive system design features and user engagement, suggesting that simply adding features may not guarantee higher completion rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement. Wu, A., Scult, MA., Barnes, ED., et al.[2023]

A study involving 1,217 participants found that personalized feedback significantly improved smoking cessation rates, with continuous abstinence at 3 and 12 months being twice as high in the feedback group compared to others.

In contrast, while a financial incentive increased the use of self-help materials, it did not improve cessation rates and was linked to higher relapse rates among those who quit.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program. Curry, SJ., Wagner, EH., Grothaus, LC.[2019]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Engagement in Digital Mental Health Interventions: Can Monetary Incentives Help? [2021]

2. United States pubmed.ncbi.nlm.nih.gov

"Nudges" to Prevent Behavioral Risk Factors Associated With Major Depressive Disorder. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Money can't buy happiness: A randomized controlled trial of a digital mental health app with versus without financial incentives. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Increasing the Impact of Interventions Incentivizing Psychiatric Treatment Engagement: Challenges and Opportunities. [2023]

5. England pubmed.ncbi.nlm.nih.gov

Smartphone apps for depression and anxiety: a systematic review and meta-analysis of techniques to increase engagement. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program. [2019]

7. Switzerland pubmed.ncbi.nlm.nih.gov

Personalized digital intervention for depression based on social rhythm principles adds significantly to outpatient treatment. [2023]