Improving the Effectiveness of Treatment for Depression in Hispanics

提高西班牙裔抑郁症的治疗效果

基本信息

批准号：
8223303
负责人：
CARLOS BLANCO
金额：
$ 54.6万
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：
2008
资助国家：
美国
起止时间：
2008-02-01 至 2015-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8223303
关键词：
Acute Adult Affect Algorithms Antidepressive Agents Benchmarking Caring Characteristics Child Care Clinic Visits Clinical Combined Modality Therapy Control Groups Data Data Sources Depressed mood Development Disadvantaged Dropout Drops Evidence based treatment Face Focus Groups Foundations Freedom Future Goals Healthcare Systems Healthy People 2010 Hispanics Hour Individual Insurance Insurance Coverage Intervention Interview Literature Major Depressive Disorder Mediator of activation protein Medicaid Mental Depression Mental Health Mental Health Services Mental disorders Methods Modality Not Hispanic or Latino Occupations Outcome Outpatients Patient Participation Patient Preferences Patients Persons Pharmaceutical Preparations Pharmacotherapy Phase Population Primary Health Care Process Psychiatric therapeutic procedure Psychotherapy Public Health Publishing Randomized Regimen Research Sample Size Services Staging Stigmata System Targeted Research Telephone Testing Texas Time Treatment Effectiveness Treatment Efficacy Treatment outcome Visit alternative treatment arm base care delivery community setting design dissemination trial effectiveness trial efficacy testing flexibility follow-up help-seeking behavior improved medical specialties named group novel novel strategies patient oriented payment programs psychologic psychosocial randomized trial response satisfaction social stigma socioeconomics successful intervention therapy development treatment as usual

项目摘要

Despite the development of treatments of proven efficacy, treatment retention for Hispanics with major depressive disorder continues to be a major public health problem. Dropout rates from pharmacotherapy and psychotherapy in Hispanics are substantially higher than in non-Hispanic whites. Yet surprisingly little is known about clinical strategies to improve retention among Hispanics with major depressive disorder. Based on emerging literature and on promising pilot data derived from two small randomized trials of medication alone versus Interpersonal Psychotherapy (IPT) alone or combined with medication allowing for telephone session, we propose to compare treatment retention and outcome of depressed Hispanics patients who receive either: 1) antidepressant treatment following the Texas Medication Algorithm for Depression (TMA), or 2) an intervention based on patient treatment choice among the following options: a) TMA alone (i.e., medication alone), b) Brief IPT (IPT-B) alone with optional telephone sessions, or c) a combination of the TMA medication regimen and IPT-B. In order to maximize patient preference, satisfaction, and treatment retention, patients in the choice arm will be allowed to switch among the three treatments at any point during the study. To obtain preliminary data on the influence of insurance on choice, patients randomized to the choice arm will be further randomized to either a no co-payment for psychotherapy visit or $2 co-payment per visit (the median co-payment in the states in which Medicaid covers psychological services). Medication visits will have no co-payment on either study arm. All treatments will be delivered in Spanish or English depending on patient preference. In addition to quantitative data on retention and outcome, a mixed-method (quantitative-qualitative) approach will help to identify the mechanisms of action and key components of the proposed intervention. It will also characterize patient groups most responsive to the intervention and assess level of patient acceptance and satisfaction with treatment. We believe the proposed intervention holds promise for improving treatment retention for depressed Hispanics. The intervention is patient-centered, culturally sensitive, and honors patient preferences in the selection of evidence-based treatments. The findings from our intervention, if successful, would form an empirical foundation for the delivery of care to Hispanics and other socioeconomically disadvantaged populations that face logistical barriers to traditional mental health services.

尽管发展了可靠的疗效治疗方法，但对主要抑郁症的西班牙裔治疗保留率仍然是一个重大的公共卫生问题。西班牙裔药物治疗和心理治疗的辍学率大大高于非西班牙裔白人。然而，令人惊讶的是，关于改善严重抑郁症的西班牙裔保留率的临床策略知之甚少。基于新兴文献和有前途的试验数据，该数据由两项单独的药物与人际际心理治疗（IPT）单独进行，或与允许电话交往的药物结合使用，我们建议将接受治疗的抑郁症患者的治疗保留和抑郁症患者的结局进行比较：1接受抑郁症的抗抑郁药治疗（1）抑郁症的治疗方法，或者是根据抑郁症的抑郁症（TMA），或选项：a）单独使用TMA（即单独使用药物），b）单独使用可选的电话会话的简短IPT（IPT-B），或C）TMA药物治疗方案和IPT-B的组合。为了最大程度地提高患者的偏好，满意度和治疗保留率，在研究期间的任何时候，选择臂中的患者将被允许在三种治疗中切换。为了获得有关保险对选择影响的初步数据，将随机分配给选择部门的患者将进一步随机分配到无共付次心理治疗访问或每次访问2美元的共同支付（医疗补助涵盖心理服务的州的中位数共同付款）。在任何一个研究部门都没有药物访问。所有治疗方法将根据患者的偏爱以西班牙语或英语提供。除了有关保留和结果的定量数据外，混合方法（定量质量质量）方法将有助于确定所提出干预措施的作用机理和关键组成部分。它还将表征患者群体对干预和评估患者接受水平和对治疗满意度的水平最有反应的特征。我们认为，拟议的干预措施有望改善沮丧的西班牙裔治疗率。该干预措施以患者为中心，对文化敏感，并在选择基于证据的治疗方面尊重患者的偏好。如果成功的话，我们的干预措施的发现将构成向西班牙裔和其他社会经济处境不利的人群提供护理的经验基础，这些人群面临着传统心理健康服务的后勤障碍。

项目成果

期刊论文数量（9）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Health and wellness photovoice project: engaging consumers with serious mental illness in health care interventions.

DOI：
10.1177/1049732312470872
发表时间：
2013-05
期刊：
Qualitative health research
影响因子：
3.2
作者：
Cabassa LJ;Parcesepe A;Nicasio A;Baxter E;Tsemberis S;Lewis-Fernández R
通讯作者：
Lewis-Fernández R

Examining sex differences in DSM-IV-TR narcissistic personality disorder symptom expression using Item Response Theory (IRT).

DOI：
10.1016/j.psychres.2017.12.031
发表时间：
2018-03
期刊：
Psychiatry research
影响因子：
11.3
作者：
Hoertel N;Peyre H;Lavaud P;Blanco C;Guerin-Langlois C;René M;Schuster JP;Lemogne C;Delorme R;Limosin F
通讯作者：
Limosin F

Childhood maltreatment and impulsivity as predictors of interpersonal violence, self-injury and suicide attempts: A national study.

DOI：
10.1016/j.psychres.2018.08.059
发表时间：
2018-11
期刊：
Psychiatry research
影响因子：
11.3
作者：
McMahon K;Hoertel N;Olfson M;Wall M;Wang S;Blanco C
通讯作者：
Blanco C

Acculturation dimensions and 12-month mood and anxiety disorders across US Latino subgroups in the National Epidemiologic Survey of Alcohol and Related Conditions.

全国酒精及相关疾病流行病学调查中美国拉丁裔亚群体的文化适应维度以及 12 个月情绪和焦虑障碍。

DOI：
10.1017/s0033291716000763
发表时间：
2016
期刊：
Psychological medicine
影响因子：
6.9
作者：
Fernández,RLewis;Morcillo,C;Wang,S;Duarte,CS;Aggarwal,NK;Sánchez-Lacay,JA;Blanco,C
通讯作者：
Blanco,C