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.

尽管开发了已证明有效的治疗方法，但患有重度抑郁症的西班牙裔患者的治疗保留仍然是一个主要的公共卫生问题。西班牙裔美国人接受药物治疗和心理治疗的退出率远高于非西班牙裔白人。然而令人惊讶的是，人们对改善患有重度抑郁症的西班牙裔人的记忆力的临床策略知之甚少。根据新兴文献以及两项小型随机试验（单独药物治疗与单独人际心理治疗 (IPT) 或与电话治疗相结合）得出的有希望的试点数据，我们建议比较接受以下任一治疗的抑郁西班牙裔患者的治疗保留率和结果： 1) 遵循德克萨斯抑郁症药物治疗算法 (TMA) 进行抗抑郁治疗，或 2) 根据患者在以下选项中选择的治疗选择进行干预：a) 单独 TMA（即单独药物治疗），b) 简短 IPT (IPT-B) 单独结合可选的电话会议，或 c) TMA 药物治疗方案和 IPT-B 的组合。为了最大限度地提高患者的偏好、满意度和治疗保留率，选择组中的患者将被允许在研究期间的任何时候在三种治疗之间切换。为了获得有关保险对选择影响的初步数据，随机分配到选择组的患者将进一步随机分配到心理治疗就诊无需自付费用或每次就诊 2 美元自付费用（接受治疗的州的自付费用中位数）。医疗补助涵盖心理服务）。任何一个研究组的药物就诊均无需支付自付费用。所有治疗都将根据患者的喜好以西班牙语或英语进行。除了有关保留和结果的定量数据外，混合方法（定量-定性）方法将有助于确定拟议干预措施的作用机制和关键组成部分。它还将描述对干预最敏感的患者群体的特征，并评估患者对治疗的接受程度和满意度。我们相信，拟议的干预措施有望改善抑郁的西班牙裔患者的治疗保留率。该干预措施以患者为中心，具有文化敏感性，并在选择基于证据的治疗方法时尊重患者的偏好。我们干预的结果如果成功，将为向西班牙裔和其他在传统心理健康服务方面面临后勤障碍的社会经济弱势群体提供护理奠定了经验基础。

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