Developing Telephone CBT for HIV Related Depression

开发电话 CBT 治疗 HIV 相关抑郁症

• 批准号: 7494359
• 负责人: SETH S HIMELHOCH
• 金额: $ 15.46万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7494359
• 关键词: Adherence; Adult; Alcohols; Anti-Retroviral Agents; Behavior Therapy; Caring; Caucasians; Caucasoid Race; Clinic; Cognitive Therapy; Condition; DSM-IV; Data; Depressed mood; Depressive disorder; Development; Disease; Disease Progression; Drug abuse; Effectiveness; Ensure; Evidence based practice; Feasibility Studies; Feedback; Future; Goals; HIV; Highly Active Antiretroviral Therapy; Improve Access; Individual; Intervention; Lead; Location; Manuals; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Morbidity - disease rate; Outcome; Outpatients; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Provider; Psychotherapy; Published Comment; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Project Grants; Sample Size; Sampling; Services; Site; Staging; Telephone; Testing; Therapeutic Studies; Woman; base; depressive symptoms; effectiveness trial; health related quality of life; improved; innovation; low socioeconomic status; medical specialties; mortality; satisfaction; therapy development; treatment effect; treatment trial

DESCRIPTION (provided by applicant): Up to 40% of individuals receiving medical care for HIV meet DSM-IV criteria for co- occurring depressive disorder. Individuals with HIV and depressive disorders, compared to those with HIV alone, have been shown to have worse adherence to taking antiretroviral medication, increased HIV related morbidity and among woman a higher mortality. Previous research suggests that mental health interventions may lead to improved depressive and HIV related outcomes. However because many HIV infected depressed individuals may have trouble accessing mental health services, there is an urgent need for treatment trials to assess whether treatment of depression targeting patients in urban HIV care settings will result in both improved depressive and HIV related outcomes. The goal of this R-34 application is to use the stage model of behavioral therapy research to adapt, further develop and pilot test a telephone based cognitive behavioral therapy (CBT) intervention targeting HIV infected depressed individuals receiving care in adult outpatient HIV clinics. This application has two aims consistent with stage 1A and stage 1B of the stage of behavioral therapy research. First, we will adapt and further develop (Stage 1A) the telephone based CBT intervention using iterative feedback from multiple viewpoints --patients, providers and experts. Second, we will test the preliminary effectiveness (Stage 1B) of the adapted telephone psychotherapy. A total of 60 HIV infected, depressed individuals receiving care at an urban, outpatient HIV clinic will be randomly assigned to receive either the CBT telephone psychotherapy intervention or a non-directive telephone based therapy. The results will provide preliminary data on whether the telephone psychotherapy intervention for HIV infected depressed individuals is effective in reducing depression. The results will also be used to determine feasibility, accessibility, and generate a more accurate estimate of the needed sample size for future effectiveness trials and will serve as the basis for a R01 application to extend this research to larger samples, and multiple sites. If our hypothesis is correct and we find that a telephone based psychotherapy intervention leads to improved retention, better satisfaction and better depression outcomes, we will use these data to develop an R-01 application for a full-scale, randomized controlled trial of the telephone psychotherapy targeting depression in the HIV care setting. This larger trial will enable us to investigate not only whether improved treatment of depression leads to improved depressive outcomes but whether it leads to improved access to HIV related medical care leading to improved HIV related outcomes.

描述（由申请人提供）：接受 HIV 医疗护理的个体中，高达 40% 的人符合 DSM-IV 针对共存抑郁症的标准。与单独感染艾滋病毒的人相比，患有艾滋病毒和抑郁症的人对服用抗逆转录病毒药物的依从性较差，艾滋病毒相关发病率增加，女性死亡率更高。先前的研究表明，心理健康干预措施可能会改善抑郁和艾滋病毒相关的结果。然而，由于许多感染艾滋病毒的抑郁症患者可能难以获得心理健康服务，因此迫切需要进行治疗试验来评估针对城市艾滋病毒护理机构中的患者的抑郁症治疗是否会改善抑郁症和艾滋病毒相关的结果。该 R-34 应用程序的目标是利用行为治疗研究的阶段模型来调整、进一步开发和试点测试基于电话的认知行为治疗 (CBT) 干预措施，该干预措施针对在成人 HIV 门诊诊所接受护理的 HIV 感染抑郁症患者。该应用程序具有与行为治疗研究阶段的1A阶段和1B阶段一致的两个目标。首先，我们将利用来自多个观点（患者、提供者和专家）的迭代反馈来调整和进一步开发（第 1A 阶段）基于电话的 CBT 干预。其次，我们将测试改编后的电话心理治疗的初步效果（第1B阶段）。总共 60 名艾滋病毒感染者、抑郁症患者在城市艾滋病毒门诊诊所接受护理，将被随机分配接受 CBT 电话心理治疗干预或非指导性电话治疗。研究结果将为艾滋病毒感染者抑郁症患者的电话心理治疗干预是否能有效减少抑郁症提供初步数据。结果还将用于确定可行性、可访问性，并对未来有效性试验所需的样本量进行更准确的估计，并将作为 R01 应用程序的基础，将该研究扩展到更大的样本和多个地点。如果我们的假设是正确的，并且我们发现基于电话的心理治疗干预可以提高记忆力、满意度和抑郁结果，我们将使用这些数据开发 R-01 应用程序，用于电话的全面、随机对照试验针对艾滋病毒护理环境中抑郁症的心理治疗。这项更大规模的试验将使我们不仅能够调查改善抑郁症的治疗是否会改善抑郁症的结果，而且能够调查是否可以改善获得艾滋病毒相关医疗服务的机会，从而改善艾滋病毒相关的结果。