Improving Hispanic Retention in Antidepressant Therapy

提高西班牙裔抗抑郁治疗的保留率

• 批准号: 6651019
• 负责人: ROBERTO LEWIS-FERNANDEZ
• 金额: $ 14.48万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-01 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6651019
• 关键词: Hispanic Americans; antidepressants; behavior therapy; behavioral /social science research tag; clinical research; combination therapy; handbook; human subject; human therapy evaluation; longitudinal human study; major depression; mental disorder chemotherapy; motivation; patient oriented research; psychotherapy; sertraline; technology /technique development; therapy compliance; venlafaxine; Hispanic Americans; antidepressants; behavior therapy; behavioral /social science research tag; clinical research; combination therapy; handbook; human subject; human therapy evaluation; longitudinal human study; major depression; mental disorder chemotherapy; motivation; patient oriented research; psychotherapy; sertraline; technology /technique development; therapy compliance; venlafaxine

DESCRIPTION (provided by applicant): The overall goal is to develop a culturally congruent intervention for use in outpatient pharmacological practice by a psychiatrist that will increase retention of Hispanics with major depressive disorder (MDD) in antidepressant therapy. Despite major advances in the treatment of psychiatric disorders, Hispanics continue to underutilize mental health services relative to non-Hispanic Whites and to their own mental health need, as evidenced by lower rates of treatment entry and retention. Hispanic dropout from medication therapy for MDD attains rates two to three times those of non-Hispanic Whites. Mental health utilization in general is lowest among less acculturated, migrant Hispanics, even after controlling for socio- economic factors and psychiatric diagnosis, suggesting that cultural factors are important causes of underutilization. Our pilot work with depressed, culturally traditional Hispanics entering antidepressant therapy suggests that cultural incongruence between patients' and psychiatrists' expectations and concerns about treatment produces ambivalence about taking medication or following physician instructions, which in turn interferes with retention. This association between ambivalence about treatment and dropout is predicted by the "transtheoretical model of change", a schematization of the stages individuals experience in the process of behavior change. However, the validity of this model for Hispanics has not been empirically tested. Motivational Interviewing (MI) is an effective brief psychotherapy that has improved retention among patients with dually diagnosed depression and substance abuse by targeting ambivalence about entering and remaining in treatment. However, MI has not been adapted for Hispanic patients in antidepressant therapy. The specific aims of this study are to: a) culturally adapt and manualize MI for depressed Hispanics in antidepressant therapy; b) explore the efficacy of 4 sessions of this manualized intervention for improving retention during a 12-week open- label trial with a 2nd generation antidepressant and at 6-month follow-up among 65 Hispanics seeking outpatient medication therapy for non-psychotic MDD; c) explore the predictive validity of the "transtheoretical model of change" for treatment retention by examining the relationship between the retention measures and baseline stage of change and stage progression during treatment; d) examine the efficacy of MI for helping patients progress through the stages of change. This study will yield pilot data on the efficacy of a manualized cultural adaptation of MI for enhancing retention of Hispanics in antidepressant therapy and on the predictive validity of the "transtheoretical model of change" in this population. This pilot data will allow us to apply for an R01 to further study this intervention and model in a controlled clinical trial.

描述（由申请人提供）：总体目标是为精神科医生在门诊的药理实践中使用文化一致的干预措施，以增加抗抑郁药治疗中具有重大抑郁症（MDD）的西班牙裔保留。 尽管在治疗精神疾病方面取得了重大进展，但与非西班牙裔白人相对于他们自己的心理健康需求，西班牙裔仍不足以使精神卫生服务不足，这证明了较低的治疗入境和保留率。 MDD药物疗法的西班牙裔辍学率达到了非西班牙裔白人的两到三倍。在控制社会经济因素和精神病诊断之后，通常在适应性的移民西班牙裔人士中，心理健康利用通常是最低的，这表明文化因素是未充分利用的重要原因。 我们的试点与抗抑郁药疗法的沮丧，文化传统的西班牙裔合作表明，患者和精神科医生的期望之间的文化不一致以及对治疗的担忧会导致对服用药物或遵循医师指导的矛盾性，这反过来又干扰了保留。 “变化的跨理论模型”预测了对治疗和辍学的矛盾性之间的这种关联，该阶段的示意图在行为变化过程中经历了经验。但是，该模型对西班牙裔的有效性尚未经过经验测试。动机访谈（MI）是一种有效的简短心理疗法，通过针对矛盾性进入和留在治疗中的矛盾性，改善了被诊断为抑郁症和药物滥用的患者的保留率。但是，MI尚未适用于西班牙裔患者进行抗抑郁治疗。 这项研究的具体目的是：a）在文化上适应和手动使MI抑制抗抑郁药治疗中的西班牙裔抑郁症； b）在为期12周的开放标签试验中，探索这项手动干预的4个会议的功效，以提高保留率，并在65种西班牙裔中进行了第二代抗抑郁药，并在65个西班牙裔中进行了6个月的随访，以寻求非精神药物MDD的门诊疗法； c）通过检查保留措施与治疗过程中的保留量与基线阶段和治疗过程中的基线阶段之间的关系，探索“变化的跨理论模型”的预测有效性； d）检查MI对帮助患者通过变化阶段进展的功效。 这项研究将产生有关MI的手动文化适应能力增强西班牙裔在抗抑郁治疗以及该人群中“变化的跨理论模型”的预测有效性方面的疗效的试验数据。该试点数据将使我们能够在对照临床试验中申请R01进一步研究此干预措施和模型。