An eHealth Intervention to Increase Depression Treatment Initiation and Adherence Among Veterans Referred for Mental Health Services

Depression is the most prevalent mental health condition among VHA patients and is strongly associated with poor functioning, negative health outcomes, and suicide. Despite effective and available treatments, engagement in care is poor. This study will analyze VHA electronic medical record data, to identify patient characteristics associated with poor treatment engagement. The study will then develop and formatively evaluate an eHealth intervention to improve and sustain engagement in mental health care through self-monitoring. This is an important step in engaging Veterans who, in part, based on their military training, may have difficulty identifying or accepting depressed affect and the benefits of treatment. The information obtained will inform clinical strategies and operations policy to improve quality, coordination, and efficiency of mental health services.

Inclusion Criteria: * Veteran status * Recent referral to VA general mental health clinics providing psychotherapy for depression * No gender or minorities will be excluded from this study * 18-64 will be included Exclusion Criteria: * Current/Past Bipolar disorder and Current Psychotic disorder: to avoid potential exacerbation from treatment for depression * Alcohol Use disorder or Substance Use disorder: Depression treatments cannot reverse the adverse effects of substances on mood, and therefore impact on adherence and treatment characteristics may be confounded * Other current severe or unstable, psychiatric and medical disorders that necessitates clinical management that can confound results (e.g., cancer \[in chemotherapy\], suicidality, recent hospitalization \[medical/surgical\] for which recovery overlaps with study onset and duration, open skull/brain injury, moderate to severe TBI) * Moderate to severe cognitive impairment (SLUMS 20 and/or diagnosis in medical record) * Potentially temporary states/situations that may significantly impair mood/capability to engage in treatment: unstable environment that is not in one's control (e.g., homeless, temporary group home, extensive care taking duties)