Remotely-Delivered Programs Targeting COVID-19 Stress-Related Depression and Substance Use

针对 COVID-19 压力相关抑郁症和药物滥用的远程交付计划

• 批准号: 10200231
• 负责人: Carl Fulwiler
• 金额: $ 69.67万
• 依托单位: CAMBRIDGE HEALTH ALLIANCE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-20 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10200231
• 关键词: Address; Affect; Affective; Alcohol consumption; Alcohol or Other Drugs use; Anxiety; Back; COVID-19; COVID-19 pandemic; Caring; Cognitive Therapy; Data; Drug usage; Early Intervention; Electronic Mail; Enrollment; Equipment and supply inventories; Future; General Population; Health Alliance; Health Insurance; Health Services; Health system; Healthcare; Healthcare Systems; Heavy Drinking; Hurricane; Inflammation; Inflammatory; Interleukin-6; Internet; Intervention; Liquid substance; Low income; Measures; Mediating; Mental Depression; Mental Health; Mental Tests; Mental disorders; Methods; Modern 1601-history; Monitor; Oral; Participant; Patients; Persons; Population; Primary Health Care; Psyche structure; Public Health; Randomized; Randomized Controlled Trials; Recurrence; Relapse; Rewards; Risk; Risk Factors; Saliva; Salivary; Sampling; Severities; Stress; Symptoms; System; TNF gene; Testing; TimeLine; Toxicology; Underserved Population; arm; behavioral health; comparative effectiveness; comparative efficacy; compare effectiveness; computerized; cytokine; depressive symptoms; diaries; disadvantaged population; effective therapy; innovation; mindfulness based cognitive therapy; mindfulness intervention; negative affect; patient stratification; pragmatic trial; prevent; primary outcome; programs; psychoeducational; public health relevance; recurrent depression; resilience; safety net; screening; secondary outcome; socioeconomic disadvantage; stress symptom; substance use prevention

Project Summary/Abstract: Remotely Delivered Programs Targeting COVID-19 Stress-Related Depression and Substance Use The COVID-19 pandemic presents an unparalleled level of everyday stress and is likely to increase rates of depression and substance use, potentially overwhelming behavioral health treatment capacity. We have developed a new program (CHA MindWell; CHA-MW) to address the anticipated surge in demand for behavioral health services for our safety-net health system’s health system’s diverse and socioeconomically disadvantaged population. It has both a screening/monitoring/referral and an early intervention component: First, we implemented remote computerized adaptive testing (CAT-MH®) to stratify patients at risk of stress- related mental illness into 3 tiers: Minimal symptoms or low-risk (Tier 1), mild-to-moderate symptoms or at-risk but not meeting criteria for in-person treatment (Tier 2), and moderate-to-severe symptoms requiring treatment (Tier 3). In standard CHA-MW, CAT-MH is delivered online by email to participants monthly to determine if they are Tier 3 and referral to mental health treatment is needed. Second, Tier 2 patients are referred to a live, online psychoeducational program - Mindfulness-Based Cognitive Therapy for Resilience (MBCT-R), which is an 8-week group adapted from MBCT, which is effective for treatment of stress, anxiety, and depression (known risk factors for substance use), and preventing relapse among patients with recurrent depression. MBCT-R will therefore have impact both during and after COVID-19. When participants enroll in MBCT-R they receive enhanced CHA-MW (i.e., weekly in addition to monthly CAT-MH monitoring), allowing us to closely determine if a higher level of care becomes necessary. We will randomize Tier 2 patients who have mild-to- moderate symptoms of depression (CAT-Depression Inventory 50-75, PHQ-9 equivalency 10-20) in a 3-arm comparative effectiveness RCT to compare MBCT-R + enhanced CHA-MW weekly monitoring to either: a) enhanced CHA-MW weekly monitoring alone (with rapid referral to mental health treatment if needed), or b) an asynchronous internet CBT (iCBT) application + CHA-MW weekly monitoring. We expect MBCT-R to reduce depression symptoms (primary outcome), stress, and indirectly prevent substance use (secondary outcome). For a sub-study within the RCT, we will collect preliminary data using daily diaries to measure stress-related affective reactivity data (upticks in negative affect and/or reductions in positive affect during stress days) and adaptively sample salivary inflammatory cytokines (IL-6, TNF-a, IL-1b) remotely on 2 high and 2 low stress days before and after the interventions. Because this pragmatic effectiveness trial of a live, online mindfulness- based intervention with naturalistic remote monitoring is already embedded in our safety-net health system, it can be implemented immediately and disseminated rapidly if effective at reducing depression symptoms, and could impact behavioral health systems nationally during and after COVID-19 and future public health crises.

项目摘要/摘要：针对COVID-19与压力相关的抑郁症和物质使用的远程交付的程序Covid-19大流行呈现出每天压力的无与伦比的水平，并且很可能会增加抑郁症和药物使用率，并有可能压倒性的行为健康治疗能力。我们已经开发了一项新计划（Cha Mindwell; CHA-MW），以解决对我们安全网卫生系统的卫生系统多样性和社会经济上弱势群体的行为卫生服务需求的预期激增。它既有筛查/监测/推荐和早期干预组成部分：首先，我们实施了远程计算机化的自适应测试（CAT-MH®），以将有压力相关的精神疾病风险分为3层的患者：最小风险或低风险（Tier 1）症状，轻度到中度的症状，不需要症状，但需要治疗的症状，以治疗（tiere toer-toertore）（TIER 2），tiere 2），tiere tiers-2），且症状，并适用于2），症状和症状（tierse），症状和症状，并不满意。 3）。在标准CHA-MW中，CAT-MH通过电子邮件在线交付以每月参与，以确定它们是否为第3层，并且需要转介到心理健康治疗。其次，将2级患者转诊为现场，在线心理教育计划 - 基于正念的弹性认知疗法（MBCT-R），这是一个由MBCT改编的为期8周的组，MBCT-R将在COVID-19期间和之后产生影响。当参与者参加MBCT-R时，他们会收到增强的CHA-MW（即除每月的CAT-MH监测外，每周一次），从而使我们能够密切确定是否需要更高的护理水平。我们将在3臂比较有效性RCT中随机对2例患有轻度至中度抑郁症状的患者（CAT抑郁量表50-75，PHQ-9等效性10-20），以比较MBCT-R + CHA-MW每周的CHA-MW每周监测到： （ICBT）应用 + CHA-MW每周监视。我们预计MBCT-R可以减轻抑郁症状（主要结果），压力并间接防止使用底物（次要结果）。对于RCT中的子研究，我们将使用每日日记收集初步数据，以测量与压力相关的情感反应性数据（在压力日期间负面影响和/或减少积极影响的上升和/或减少唾液炎性细胞因子（IL-6，TNF-A，TNF-A，IL-1B，IL-1B）在2天和2天之后和之后的压力低下。因为这项实用的实用有效性试验已经将基于自然主义远程监测的基于在线正念的干预措施嵌入了我们的安全网卫生系统中，因此，如果有效地减少抑郁症状，可以立即实施并迅速进行传播，并可能在2019年和未来的公共卫生危机和未来的公共卫生危机期间和未来的公共卫生危机中对行为卫生系统产生影响。