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CONEMO application was tested in a clinical trial and published by the scientific journal JAMA, in May 2021

The application CONEMO - acronym for Emotional Control - which was developed and tested in a community trial in São Paulo, Brazil, and in a clinical trial in Peru by a multicenter research led by Professor Paulo Rossi Menezes, from Faculdade de Medicina da USP, and Professor Ricardo Araya, of King's College London, had its main results published in the scientific journal JAMA (The Journal of the American Medical Association), published by the American Medical Association, on May 11, 2021.

The application, used by users of the Unified Health System (SUS), in São Paulo, and the health systems of Peru, in Lima, proved to be effective in reducing depression three months after the beginning of treatment, in a statistically significant way, and had an impact on secondary variables such as quality of life, reduced perception of disabilities and behavioral activation.

“This technological innovation makes it possible to significantly expand access to mental health care for people who show symptoms of depression, especially in countries and communities where there is a shortage of specialized professionals. Expanding access to mental health treatment through digital interventions is even more relevant in this time of global pandemic”, said Prof. Paulo Menezes.

“This is the first digital intervention in mental health in low and middle income countries published in the scientific journal JAMA. We expect many more in the future, as more countries join this technological movement”, said Prof. Ricardo Araya.

Depression has a very high socioeconomic burden for all societies. In Brazil, about 80% of people with symptoms of depression do not receive any type of treatment. Digital interventions have great potential to expand access to mental health care, but so far there have been no clinical trials demonstrating their effectiveness in low- and middle-income countries. 880 participants were included in São Paulo and 432 in Lima, Peru, making this study the largest clinical trial in Latin American countries with digital intervention for depression.

The intervention, which lasts six weeks, in 18 sessions, is a low-intensity care and is based on principles of behavior activation. Nursing assistants and nurses were trained to verify if the participants were accessing the sessions and, in case they had any difficulty with the technology, they contacted them by phone.

“The support of the nursing team was essentially technological. Mental health care was performed by the user in interaction with the application. The nursing team is of great importance in adhering to and engaging the participants in the treatment. The team called the participant in scheduled interactions and whenever they noticed that there were delayed sessions to motivate them to continue accessing CONEMO”, says Heloísa Garcia Claro, a nurse who finished her postdoctoral work on the project under the supervision of Prof. Paulo Menezes.

In São Paulo, 40.7% of CONEMO participants had a reduction of at least 50% in the depression score, as measured by the Patient Health Questionnaire 9 - PHQ 9, three months after the beginning of the intervention, against 28.6% of people that were in the control group.In Lima, 52.7% of CONEMO participants were successful in their treatment, against 34.1% of participants in the control group.

“In the control group, we identified clinically significant depression and referred these patients for care in the health system itself. So, no one was left unattended and, therefore, it was expected that both groups would have an improvement. But, as we can see, this improvement was more significant in the group that, in addition to the care of the health system, also received CONEMO”, says nurse Heloísa Garcia Claro.

The application, which was developed between 2013 and 2016, needed to have its technology updated to work on current smartphones, and will be available for download in approximately three months, with the same content that was tested in clinical trials, in Brazilian Portuguese and Peruvian Spanish.

Araya R, Menezes PR, Claro HG, et al. Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials. JAMA. 2021; 325 (18): 1852–1862. doi: 10.1001/jama.2021.4348

Link to article: https://jamanetwork.com/journals/jama/fullarticle/2779828

Faculdade de Medicina da Universidade de São Paulo, King 's College London, State University of Campinas, Universidad Peruana Cayetano Heredia and Northwestern University. Funding: U.S. National Institute of Mental Health (NIMH) under grant number: MH 5U19MH098780-03.

Clinical supervisor preparing nursing assistant to use the tablet to accompany her participants
Nursing assistant explaining CONEMO technology to a SUS user