Motivational Antidepressant Therapy for Hispanics

西班牙裔动机抗抑郁疗法

基本信息

批准号：
7323482
负责人：
ROBERTO LEWIS-FERNANDEZ
金额：
$ 64.16万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-09-01 至 2012-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7323482
关键词：
Acute Adherence Adverse effects Affect Antidepressant adherence Antidepressive Agents Benchmarking Brief Psychotherapy Caring Characteristics Client satisfaction Clinic Clinical Communities Data Data Sources Dependence Depressed mood Early treatment Elements Emotional Facility Construction Funding Category Focus Groups Freedom Goals Health Care Costs Healthy People 2010 Hispanics Indium Individual Intervention Interview Lead Major Depressive Disorder Manuals Mediator of activation protein Mental Health Mental Health Services Mental disorders Methods Modality Morbidity - disease rate National Institute of Mental Health Outcome Outpatients Patients Pharmaceutical Preparations Pharmacotherapy Phase Physical Dependence Play Population Primary Health Care Process Psychiatric therapeutic procedure Psychiatrist Public Health Qualitative Research Randomized Controlled Trials Rate Recurrence Reliance Research Research Personnel Review Literature Role Sample Size Staging Standards of Weights and Measures Stigmata Stigmatization Targeted Research Testing Therapeutic Treatment outcome Uncertainty Week Writing base design dissemination trial effectiveness trial expectation improved medical specialties medication compliance motivational enhancement therapy novel prescription document prescription procedure programs psychosocial response satisfaction social stigma therapy development

Acute Adherence Adverse effects Affect Antidepressant adherence Antidepressive Agents Benchmarking Brief Psychotherapy Caring Characteristics Client satisfaction Clinic Clinical Communities Data Data Sources Dependence Depressed mood Early treatment Elements Emotional Facility Construction Funding Category Focus Groups Freedom Goals Health Care Costs Healthy People 2010 Hispanics Indium Individual Intervention Interview Lead Major Depressive Disorder Manuals Mediator of activation protein Mental Health Mental Health Services Mental disorders Methods Modality Morbidity - disease rate National Institute of Mental Health Outcome Outpatients Patients Pharmaceutical Preparations Pharmacotherapy Phase Physical Dependence Play Population Primary Health Care Process Psychiatric therapeutic procedure Psychiatrist Public Health Qualitative Research Randomized Controlled Trials Rate Recurrence Reliance Research Research Personnel Review Literature Role Sample Size Staging Standards of Weights and Measures Stigmata Stigmatization Targeted Research Testing Therapeutic Treatment outcome Uncertainty Week Writing base design dissemination trial effectiveness trial expectation improved medical specialties medication compliance motivational enhancement therapy novel prescription document prescription procedure programs psychosocial response satisfaction social stigma therapy development

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项目摘要

DESCRIPTION (provided by applicant): US Hispanics underutilize medication treatment for major depressive disorder (MOD). The retention rate in antidepressant therapy (ADT) among Hispanics is half that of majority whites. Depressed Hispanics also find ADT less acceptable, are less likely to fill antidepressant prescriptions, and have lower medication adherence than the majority population, even after adjusting for demographic and clinical covariates. Three main causes of ADT underutilization -dissatisfaction with treatment, over-reliance on early treatment gains, and environmental obstacles- are magnified by cultural elements in the case of Hispanics. These elements include: concerns about potential stigmatization, dependence; and side effects due to ADT; expectations of medication use incompatible with antidepressants; and alternative constructions of the treatment and course of emotional illness. The resulting low cultural congruence of standard ADT leads many Hispanics to enter into this form of treatment with considerable uncertainty. This magnifies the adverse effect of existing environmental barriers leading to low retention and poor medication adherence. The public health consequences include higher MOD morbidity and recurrence, and rising healthcare costs. With NIMH support, our team developed a culturally adapted, novel intervention for improving Hispanic retention in ADT that can be conducted by a psychiatrist (stage I of intervention development). Called Motivational Antidepressant Therapy (MADT), this manualized method of pharmacotherapy delivery is based on Motivational Interviewing, a therapeutic approach to patient engagement that reduces ambivalence about participating in treatment. MADT has shown strong preliminary efficacy in facilitating retention and response of depressed Hispanics in the acute phase of MOD pharmacotherapy. The proposed stage II study would test the efficacy of MADT in an RCT against standard ADT in depressed Hispanics seeking outpatient psychiatric care at a research clinic. Retention, response, adherence, and patient satisfaction will be examined over 9 months of treatment. A mixed-method approach (quantitative- qualitative) will yield information on patient, intervention, and process of care characteristics affecting retention. If MADT is found to be more efficacious than standard ADT in this stage II trial, the mixed- method data will allow us to further develop MADT for a stage III effectiveness trial in community settings.

描述（由申请人提供）：美国西班牙裔人不利于重度抑郁症的药物治疗（MOD）。西班牙裔抗抑郁治疗（ADT）的保留率是多数白人的一半。抑郁的西班牙裔人还发现，即使在调整了人口统计学和临床协变量后，ADT也不太可接受，并且填充抗抑郁药的可能性较小，并且与多数人群相比，药物依从性较低。在西班牙裔的情况下，文化因素将ADT缺乏利用的三个主要原因 - 对治疗，过度依赖的治疗，过度依赖对治疗的依赖以及环境障碍。这些要素包括：对潜在污名化，依赖性的担忧；和由于ADT引起的副作用；用药物使用与抗抑郁药不相容的期望；以及治疗和情绪疾病过程的替代结构。由此产生的标准ADT文化一致性低，导致许多西班牙裔人以极大的不确定性进入这种形式的治疗。这扩大了现有的环境障碍的不利影响，导致较低的保留率和药物依从性差。公共卫生的后果包括更高的MOD发病率和复发以及医疗保健费用上升。在NIMH的支持下，我们的团队开发了一种文化适应，新颖的干预措施，用于改善ADT中的西班牙裔保留，这可以由精神科医生（干预开发的I期）进行。这种手动药物疗法提供的手动化方法称为动机抗抑郁治疗（MADT），是基于动机访谈，一种治疗方法来减少参与治疗的矛盾情绪。 MADT在MOD药物疗法的急性阶段表现出强大的初步疗效和抑郁症西班牙裔的保留率和反应。拟议的第二阶段研究将在研究诊所对MADT在RCT中对抑郁症的西班牙裔ADT的功效，以寻求门诊精神病患者。在9个月的治疗中，将检查保留，反应，依从性和患者满意度。混合方法方法（定量定性）将产生有关影响保留率的患者，干预和护理特征过程的信息。如果发现MADT在此阶段II试验中比标准ADT更有效，那么混合方法数据将使我们能够进一步为社区环境中的III期有效性试验开发MADT。