Depression Treatment for Urban Low Income Minority Substance Users

城市低收入少数民族药物使用者的抑郁症治疗

基本信息

批准号：
8445363
负责人：
Stacey B Daughters
金额：
$ 35.42万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-15 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8445363
关键词：
AIDS clinical trial group AIDS prevention Abnormal coordination Abstinence Acquired Immunodeficiency Syndrome Address Adherence Adopted Adverse effects Affect Aftercare Alcohol or Other Drugs use Anti-Retroviral Agents Anus Area Behavior Behavioral Body Weight decreased California Chlamydia Chronic Clinical Clinical Trials Cognitive Complex Contracts Control Groups Data Daughter Depressed mood Development Distal District of Columbia Dose Dropout Drug usage Drug user Educational Background Equipment and supply inventories Event Exhibits Fever Chills Food Frequencies Gastric Emptying Gonorrhea Grant HIV HIV Seropositivity HIV risk Hand Health Personnel Hepatitis Home environment Impaired cognition Individual Injection of therapeutic agent Intervention Journals Knowledge Life Link Liquid substance Low income Major Depressive Disorder Manuals Measures Mediating Mediator of activation protein Medical Mental Depression Mental Health Minority Modeling Motivation Names Nausea Needle Sharing Needles Nondirective Therapy Numbness Oral Outcome Pain Participant Patient Self-Report Patients Pharmaceutical Preparations Positive Reinforcements Poverty Prevalence Psychiatry Psychological reinforcement Public Health Publishing Questionnaires Randomized Randomized Controlled Trials Recording of previous events Relapse Reporting Research Project Grants Residential Treatment Rewards Risk Risk Behaviors Risk-Taking Sample Size Sampling San Francisco Sex Behavior Sexual Partners Sexually Transmitted Diseases Staging Substance Abuse Treatment Centers Sweat Sweating Symptoms Syringes Testing Time Treatment Efficacy Treatment Protocols United States Substance Abuse and Mental Health Services Administration Universities Vagina Validity and Reliability Work condoms depressive symptoms effective therapy ethnic minority population experience follow-up foot forgetting high risk high risk sexual behavior inner city instrument medication compliance meetings pill primary outcome research and development seal sex sex risk sobriety substance abuse treatment therapy development treatment as usual treatment effect trial comparing urban area

项目摘要

Approximately 22% of substance users suffer from major depression, which is associated with higher rates of substance abuse treatment dropout, relapse to substance use, and HIV risk behavior. Further, in inner-city areas such as DC, rates of substance use and depression disproportionately affect ethnic minorities, as well as those living in poverty. Despite this link, few interventions targeting depression have been developed to meet the specific needs of depressed substance users. One approach that may be especially appropriate in this regard is behavioral activation (BA), which aims to increase individuals¿ engagement in pleasant events, thereby increasing contact with positive reinforcement and decreasing the frequency of aversive events. BA has been shown to be efficacious in the treatment of depression, and this uncomplicated and straightforward approach may be especially appropriate for the specific needs of an inner city low income substance abusing sample. Further, BA compliments standard substance abuse treatment in several key practical and theoretical ways as it is more easily adopted by staff in these settings, more time efficient (e.g., fewer and shorter sessions, group format), more easily understood by patients who suffer from cognitive limitations due to low education level and chronic drug use, and can incorporate aspects of sobriety into its treatment components. In an initial Stage 1 development project, a version of BA, the Life Enhancement Treatment for Substance Use (LETS ACT), was developed and specifically tailored for inner-city low income minority substance users with elevated depressive symptoms. Published in the Journal of Clinical Psychiatry, Daughters et al. (2008) demonstrated that LETS ACT led to a significantly greater reduction in self-reported depressive symptoms and a significant increase in enjoyment and reward value of activities as compared to the TAU control group. While preliminary findings prove promising, many questions remain unanswered and several extensions of this work are necessary, including an assessment of post treatment substance use and HIV risk behavior, a contact-matched control, and a larger sample size to allow for more complex analyses of the mechanisms underlying these outcomes. Thus, the objective of the present proposal is to follow-up on our previous Stage 1 treatment development efforts and small scale randomized control trial (RCT) with a fully-powered Stage 2 RCT comparing LETS ACT to nondirective therapy (NDT) among a sample of 243 low income depressed substance users currently receiving residential substance abuse treatment in inner-city Washington, DC.

大约22％的药物使用者患有严重抑郁症，这与滥用药物治疗率较高有关，继电器与药物使用和HIV风险行为有关。此外，在城市内部地区，例如DC，物质使用率和抑郁症的速度不成比例地影响少数民族以及生活在贫困中的族裔。尽管有这种联系，但很少有针对抑郁症的干预措施来满足抑郁症使用者的特定需求。在这方面尤其适合的一种方法是行为激活（BA），旨在增加个人参与宜人的事件，从而增加与积极强化的接触并降低厌恶事件的频率。 BA已被证明在抑郁症的治疗方面有效，这种简单明了的方法可能特别适合内城低收入药物滥用样本的特定需求。此外，BA以几种关键的实用和理论方式称赞标准药物滥用治疗，因为在这些情况下，员工更容易采用它，更加效率地采用了时间效率（例如，较少和较短的课程，小组格式），更容易被低教育水平和长期吸毒的认知限制而遭受认知限制的患者更容易理解。在最初的第1阶段开发项目（BA版本）中，开发了寿命增强的物质使用方法（Lets ACT），并专门针对城市中心低收入的少数族裔药物使用抑郁症状升高。 Daughters等人发表在《临床精神病学杂志》上。（2008年）表明，与TAU对照组相比，让我们的法案显着减少了自我报告的抑郁症状，并且活动的享受和奖励价值显着增加。尽管初步发现证明是有希望的，但许多问题仍未得到解决，这项工作需要进行几项扩展，包括评估治疗后药物使用和HIV风险行为，接触匹配的控制以及更大的样本量，以允许对这些成果的基本机制进行更复杂的分析。这是本提案的目的是在我们上一阶段的1治疗开发工作和小规模的随机对照试验（RCT）中进行跟进，并进行了完全动力的第2阶段RCT比较LET LES LES LES ACT与非辅导治疗（NDT）的243个低收入抑郁型药物的样本，目前正在接受内部城市中心的居民滥用治疗，该样本是华盛顿州内部城市中的住宅药物滥用治疗。