DEPRESSION AND ANXIETY, MINORITY YOUTH, AND PRIMARY CARE

抑郁和焦虑、少数族裔青少年和初级保健

基本信息

批准号：
2890519
负责人：
Robert Edmund Roberts
金额：
$ 52.71万
依托单位：
UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
依托单位国家：
美国
项目类别：
财政年份：
1996
资助国家：
美国
起止时间：
1996-05-01 至 2002-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/2890519
关键词：
African American Hispanic Americans adolescence (12-20) caucasian American clinical anxiety clinical depression clinical research comorbidity culture disease /disorder proneness /risk epidemiology health care referral /consultation health care service utilization human subject mental disorder diagnosis mental health epidemiology primary care physician racial /ethnic difference

项目摘要

The overall goal is to investigate the relation between ethnicity, mental health, and medical care among adolescents. The major objective is to estimate incidence and prevalence of depression and anxiety among Anglo, African, and Hispanic American adolescents being seen in primary medical care clinics and to assess the impact of psychological dysfunction on the type and volume of services received. The descriptive aims are to: (1) Assess phenomenology of depression and anxiety across ethnic groups; (2) assess comorbidity of depression, anxiety, and somatic illness across ethnic groups; (3) estimate incidence and prevalence of depression and anxiety across ethnic groups; (4) determine whether adolescents with depression and anxiety are more frequent users of general medical services, and for what types of services; (5) determine the rate at which primary care providers recognize, label and treat mental health problems among adolescents; and (6) determine the rate at which primary care physicians refer adolescents with mental health problems to specialty mental health services. The methodologic aims are to: Assess concordance between physician diagnosis of depression and anxiety and diagnosis made independently using a structured diagnostic research interview, (2) assess the operating characteristics of screening scales for anxiety and depression across ethnic groups, and (3) assess concordance between parent and child reports of psychopathology using a structured psychiatric interview, and correlates of disagreement. In addition to examining the role of ethnic status, we also will assess the impact of ethnic identify, response styles, and selected psychosocial risk factors drawn from two main domains - stressors and resources. The analytic objective is to examine the efficacy of alternative models of stress and mental health, incorporating multiple dimensions of ethnicity into these models. A panel of youths 10-17 years of age will be sampled from Harris County Hospital District Health Centers over a 12 month period, and followed for 12 months. The T/1 sample will be 3,150, about 1,050 in each adolescent ethnic group. The parent sample will be about 1,380, also equally distributed across ethic groups, sampled on the basic of the diagnostic status of the adolescents. Data will be collected using self-report questionnaires, structured psychiatric interviews, physician report forms, and medical records. To examine the influence of risk factors, multivariate procedures such as logistic regression analysis, random regression, linear-models, GSK models, hierarchical discriminant function analysis, and linear structural equation models will be employed. Differential manifestation of symptoms will be examined using multivariate classification procedures (cluster analysis, factor analysis, latent trait analysis) to analyze symptom patterns within and across diagnostic groups as a function of ethnic status and selected psychosocial risk factors. Screening scales will be assessed for reliability, dimensionality, and efficacy in detecting cases of diagnosed disorder using, for example, Receiver Operating Characteristic (ROC) analyses, to estimate optimal screening scores in different subgroups.

总体目标是调查种族、心理之间的关系青少年的健康和医疗保健。主要目标是估计盎格鲁人抑郁和焦虑的发生率和患病率非洲裔和西班牙裔美国青少年在初级医疗机构就诊护理诊所并评估心理功能障碍对接受的服务类型和数量。描述性目标是：（1）评估不同种族群体抑郁和焦虑的现象学； (2) 评估抑郁、焦虑和躯体疾病的合并症族裔群体； (3) 估计抑郁症的发生率和患病率跨种族群体的焦虑； (4) 判断青少年是否患有抑郁症和焦虑症患者更频繁地使用普通医疗服务以及服务类型； (5) 确定速率初级保健提供者识别、标记和治疗心理健康问题在青少年中； (6) 确定初级保健的比率医生将有心理健康问题的青少年转诊至专科心理健康服务。方法的目标是：评估一致性医生对抑郁症和焦虑症的诊断与做出的诊断之间的关系独立使用结构化诊断研究访谈，(2) 评估焦虑筛查量表的操作特点跨种族群体的抑郁症，以及（3）评估父母之间的一致性和使用结构化精神病学的儿童精神病理学报告访谈，以及分歧的相关性。除了检查种族地位的作用，我们还将评估种族认同的影响，反应方式，以及从两种选择中提取的心理社会风险因素主要领域 - 压力源和资源。分析目标是检查压力和心理健康替代模型的功效，将种族的多个维度纳入这些模型中。一组 10-17 岁的青少年将从哈里斯县抽取样本医院区卫生中心 12 个月期间，并跟踪 12个月。 T/1样本为3,150个，每个青少年约1,050个民族。父样本约为 1,380，也同样分布于各个种族群体，根据诊断结果进行抽样青少年的状况。将通过自我报告收集数据问卷、结构化精神病学访谈、医生报告表、和医疗记录。为了检查风险因素的影响，多变量程序，例如逻辑回归分析、随机回归、线性模型、GSK 模型、分层判别函数分析，将采用线性结构方程模型。将使用多变量检查症状的差异表现分类程序（聚类分析、因子分析、潜在特征分析）来分析诊断组内和跨诊断组的症状模式作为种族地位和选定的社会心理危险因素的函数。将评估筛选量表的可靠性、维度和检测诊断疾病病例的功效，例如，接收者操作特性 (ROC) 分析，以估计最佳值不同亚组的筛选分数。