"Ecosystem Focused Therapy" in Post Stroke Depression

中风后抑郁症的“生态系统聚焦疗法”

• 批准号: 8269430
• 负责人: GEORGE S ALEXOPOULOS
• 金额: $ 40.91万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-03 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8269430
• 关键词: Adaptive Behaviors; Adherence; Age; Antidepressive Agents; Aphasia; Behavior; Behavioral; Biological; Biology; Caring; Characteristics; Clinical; Cognitive; Color; Communities; Competence; Depressed mood; Development; Disease; Disease remission; Ecosystem; Education; Environment; Event; Family; Female; Functional disorder; Gender; Genotype; Goals; Hamilton Rating Scale for Depression; Home environment; Impaired cognition; Intervention; Language; Lead; Life; Major Depressive Disorder; Mediating; Mediation; Medical; Medicine; Mental Depression; Mental disorders; Metabolic; Modeling; Motivation; National Institute of Mental Health; Participant; Patient Participation; Patients; Performance; Persons; Problem Solving; Quality of life; Randomized; Recommendation; Recovery; Recruitment Activity; Rehabilitation therapy; Reporting; Resources; Schedule; Self Efficacy; Severities; Side; Social Workers; Stroke; Structure; Survivors; Time; Training; United States National Institutes of Health; Work; World Health Organization; adverse outcome; base; compliance behavior; daily functioning; design; disability; experience; geriatric depression; indexing; mortality; novel; physical state; post stroke depression; preempt; psychosocial; repaired; serotonin transporter; skills; social rehabilitation; stem; therapy development; treatment adherence; working group

DESCRIPTION (provided by applicant): We propose to study the efficacy of "Ecosystem Focused Therapy" (EFT) in post-stroke depression (PSD), a disorder that afflicts a large number of stroke victims and increases mortality, cognitive impairment, and disability for years after stroke. EFT is a new, home-delivered intervention based on our integrative model of PSD, which originated from our clinical biology and treatment studies in late-life depression. It postulates two main paths to PSD. First, stroke and stroke-repair mechanisms contribute to metabolic changes mediating PSD. Second, a "psychosocial storm" stemming both from the patient's sudden disability and the change in the patient's needs and family life add a biological burden to this cascade of depressogenic events. EFT targets the "psychosocial storm" of PSD and focuses on the reciprocal interaction between the patient's abilities and the challenges of his/her "ecosystem" (family, specialized therapists). EFT follows a structured personalization approach based on the "model of adaptive functioning", in which behavior is a function of the person's competence and the demands of the environment. Thus, EFT continuously "calibrates the environment" to the PSD patient's competence level and targets the PSD "psychosocial storm" through five integrated components: 1) It offers an action-oriented, "new perspective" about the patient's recovery. 2) It provides an "adherence enhancement structure". 3) It offers a "problem solving structure" to the patient focusing on problems, valued by the patient, and pertinent to daily function. 4) It helps the family "reengineer its goals, involvement, and plans" o accommodate the patient's disability. 5) It "coordinates care with specialized therapists" with the goal to increase patient participation in rehabilitation and social activities. We will recruit 160 PSD patients within 3 months after stroke and randomly assign them to 10 weekly sessions and 4 "booster" sessions (over 1 year) of EFT or a comparison condition (Education on Stroke and Depression; ESD) both administered by trained social workers (MSW). Our Primary Hypotheses state that: Over a period of 12 weeks, EFT will lead to greater reduction than ESD in: H1) severity of depression; and H2) disability. Our Secondary Hypotheses postulate that: SH1) EFT will lead to higher remission (HAM-Dd10) rates than ESD by 12 weeks; and SH2) EFT participants will have lower scores of depression and disability and higher scores in quality of life than ESD at 26 and 52 weeks. Exploratory Analyses will examine whether disability and depression mediate the effect of each other and whether "self-efficacy", "behavioral activation", and adherence to rehabilitation recommendations and/or antidepressants mediate change in depression and disability. We will also explore whether clinical features of PSD and serotonin transporter genotypes moderate the efficacy of ESD. PUBLIC HEALTH RELEVANCE: This study proposes to investigate the efficacy of a novel, home-delivered, psychosocial intervention in reducing depression and disability in depressed stroke survivors. The intervention is designed to enable patients to develop a new perspective and adaptation skills and to change their "ecosystem" (family, specialized therapists) so as to accommodate the patients' new state. This way, the new intervention can offer an optimal chance at adaptation, by promoting the patients' adherence to rehabilitation and by increasing their sense of competence and their engagement in valued activities.

描述（由申请人提供）：我们建议研究“生态系统浓缩疗法”（EFT）在中风后抑郁症（PSD）中的疗效，该疾病会困扰着大量的中风受害者，并增加了死亡率，认知障碍和中风后的残疾。 EFT是一种基于我们的PSD综合模型的新型，提供家庭提供的干预措施，该模型源自我们在晚期抑郁症中的临床生物学和治疗研究。它假设通往PSD的两个主要途径。首先，中风和中风修复机制有助于代谢变化介导PSD。其次，既源于患者的突然残疾，又是患者需求和家庭生活的变化造成的“心理风暴”，这为这一层次的抑郁症事件增加了生物负担。 EFT针对PSD的“心理风暴”，重点关注患者能力与其“生态系统”（家庭，专业治疗师）的挑战之间的相互互动。 EFT遵循一种基于“自适应功能模型”的结构化个性化方法，其中行为是人的能力和环境需求的函数。因此，EFT连续地“校准环境”到PSD患者的能力水平，并通过五个综合组件瞄准PSD“心理风暴”：1）它提供了针对动作的，有关患者康复的动作，“新观点”。 2）它提供了“依从性增强结构”。 3）它为专注于患者的问题的患者提供了一种“解决问题结构”，并与患者有价值，并且与日常功能有关。 4）它可以帮助家庭“重新设计其目标，参与和计划” o适应患者的残疾。 5）它“与专业治疗师协调护理” 旨在增加患者参与康复和社交活动的目标。我们将招募160 PSD患者中风后3个月内，将他们随机分配到10个每周的课程和4个“助推器”会议（超过1年）的EFT或比较状况（中风和抑郁症的教育； ESD的教育； ESD）。我们的主要假设指出：在12周的时间内，EFT将导致比ESD更大的减少：H1）抑郁症的严重程度；和H2）残疾。我们的次要假设假设：SH1）EFT在12周之前会导致比ESD更高的缓解率（HAM-DD10）； SH2）EFT参与者的抑郁和残疾分数将比26和52周的ESD得分较低。探索性分析将检查残疾和抑郁症是否介导彼此的影响以及“自我效能感”，“行为激活”以及遵守康复建议和/或抗抑郁药的遵守介导抑郁症和残疾的变化。我们还将探讨PSD和5-羟色胺转运蛋白基因型的临床特征是否会适应ESD的功效。 公共卫生相关性：这项研究建议研究一种新颖的，家庭送达的社会心理干预措施在减轻抑郁症幸存者中抑郁和残疾方面的功效。该干预措施旨在使患者能够发展出新的观点和适应能力，并改变其“生态系统”（家庭，专业治疗师），从而适应患者的新状态。这样，新的干预措施可以通过促进患者遵守康复并增加他们的能力感和参与有价值的活动来提供最佳的适应机会。