Interpersonal Psychotherapy--Depression in Heart Failure

人际心理治疗--心力衰竭的抑郁症

• 批准号: 7141366
• 负责人: Carolyn L Turvey
• 金额: $ 19.91万
• 依托单位: UNIVERSITY OF IOWA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7141366
• 关键词: behavioral /social science research tag; behavioral medicine; body physical activity; clinical depression; clinical research; clinical trials; comorbidity; congestive heart failure; coping; educational resource design /development; functional ability; geriatrics; human therapy evaluation; interpersonal relations; medical rehabilitation related tag; psychological aspect of aging; psychotherapy; quality of life; rehabilitation; social behavior; telemedicine; therapy design /development

DESCRIPTION (provided by applicant): This study aims to develop an intervention to treat depression in patients with congestive heart failure by addressing the emotional and behavioral sequelae of functional decline. Heart failure affects 4 to 5 million Americans and is the number one cause of hospitalization in people aged 65 and older, it leads to marked functional impairment and poor quality of life. People with heart failure also suffer significant depressive morbidity, with an estimated 11 to 36% meeting criteria for major or minor depression. In 1998, an estimated $5 billion of the $20 billion total cost for heart failure was associated with psychological distress and depression. The proposed treatment development entails integration of interpersonal psychotherapy (IPT) and behavioral activation (BA) techniques to reduce depression and improve functioning. Since many patients with advanced heart failure are homebound, we aim to develop the treatment so that it can be administered primarily by telephone. Access to care has been a major barrier to treatment in prior psychosocial studies in cardiac patients, particularly in rural settings. A manualized protocol developed specifically for telephone administration will greatly enhance actual dissemination of the intervention. The principal investigator's prior research showed how poor adjustment to impairment predicts chronicity of depressive symptoms even after controlling for baseline severity of depression. These factors represent a failure to accept functional loss and to develop new roles and activities consistent with the patient's current impaired functioning. IPT techniques will address issues of grief and loss and will help facilitate role transitions related to functional decline. BA techniques will be harnessed to increase engagement in meaningful activities and social interactions. The intervention targets depressive symptoms but also aims to improve role functioning and engagement in personal relationships. We will also examine whether reduction in depression corresponds to improved management of heart failure. Treatment development will include two phases. Phase I will entail a standardization of treatment based on pilot data with 15 heart failure patients. The main product of this phase will be a preliminary treatment manual. Phase II will include a pilot randomized clinical trial including 36 patients receiving the intervention and 36 patients in an attention control group. The main products of this phase are a finalized treatment manual and an estimate of treatment effect size. Treatment development will also determine optimal feasibility and recruitment strategies to yield adequate samples for a full-scale clinical trial. This study aims to develop an effective psychotherapy to treat depression in people with heart failure. Treatment development will focus on helping elders cope with functional decline. Although the focus of the treatment study is patients with heart failure, the long-term goal is to develop a treatment that reduces depression in elders suffering from irreversible loss in function.

描述（由申请人提供）：本研究旨在通过解决功能下降的情绪和行为后遗症来开发一种干预充血性心力衰竭患者的抑郁症。心力衰竭影响4至500万美国人，是65岁及65岁及以上的人住院的第一大原因，导致功能障碍和生活质量差。心力衰竭的人也患有明显的抑郁症发病率，估计有11％至36％的重度抑郁症标准。 1998年，心力衰竭的200亿美元总成本中有50亿美元与心理困扰和抑郁有关。 拟议的治疗发展需要整合人际心理治疗（IPT）和行为激活（BA）技术，以减少抑郁症并改善功能。由于许多患有晚期心力衰竭的患者是家里的，因此我们旨在开发治疗，以便主要通过电话进行治疗。在心脏病患者的先前心理社会研究中，特别是在农村环境中，获得护理一直是治疗的主要障碍。专门为电话管理开发的手动协议将大大增强对干预措施的实际传播。 首席研究者的先前研究表明，即使控制抑郁症的基线严重程度，对损害的调整差也能预测抑郁症状的慢性。这些因素代表了无法接受功能损失，并发展了与患者当前功能受损相一致的新作用和活动。 IPT技术将解决悲伤和损失的问题，并有助于促进与功能下降有关的角色转变。 BA技术将被利用，以增加参与有意义的活动和社交互动。干预措施针对抑郁症状，但旨在改善人际关系中的角色功能和参与。我们还将检查抑郁症的减少是否对应于改善心力衰竭的治疗。 治疗开发将包括两个阶段。第一阶段将需要基于15例心力衰竭患者的试验数据的标准化。此阶段的主要产品将是初步治疗手册。第二阶段将包括一项试验随机临床试验，其中包括36例接受干预的患者和注意对照组的36例患者。该阶段的主要产品是最终的治疗手册和治疗效果大小的估计。治疗开发还将确定最佳的可行性和招聘策略，以产生足够的样品进行全面临床试验。 这项研究旨在开发有效的心理治疗，以治疗心力衰竭患者的抑郁症。治疗开发将集中于帮助长者应对功能下降。尽管治疗研究的重点是心力衰竭的患者，但长期目标是开发一种减少功能不可逆损失的长者抑郁症的治疗方法。