Two Stepped Care Models for PTSD among Cambodian Refugees in Primary Care

柬埔寨难民初级保健中创伤后应激障碍的两种阶梯式护理模式

• 批准号: 8460801
• 负责人: DEVON HINTON
• 金额: $ 37.58万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-19 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8460801
• 关键词: Acculturation; Acute; Adult; Advocate; Algorithms; Anger; Caring; Clinic; Communities; Education; Educational Background; Effectiveness; Ethnic Origin; Evaluation; Expectancy; Gender; Goals; Grant; Hybrids; Institutes; Intervention; K-Series Research Career Programs; Lead; Life; Literature; Long-Term Effects; Measures; Mental Depression; Mental Health; Mental disorders; Methods; Minority; Minority Groups; Modeling; National Institute of Mental Health; Participant; Patients; Pharmaceutical Preparations; Pharmacological Treatment; Pharmacology; Population; Post-Traumatic Stress Disorders; Prevalence; Primary Care Physician; Primary Health Care; Psychopathology; Public Health; Publishing; Race; Randomized; Refugees; Reporting; Research Personnel; Research Support; Resistance; Sampling; Selective Serotonin Reuptake Inhibitor; Severities; Strategic Planning; Surgeon; Symptoms; Testing; Therapeutic; Trauma; United States Dept. of Health and Human Services; caregiving; clinical decision-making; design; effective therapy; ethnic minority population; follow-up; low socioeconomic status; medication compliance; preference; primary care setting; response; stressor; therapy development

DESCRIPTION (provided by applicant): The NIMH has identified treatment development for non-English-speaking groups, particularly for posttraumatic stress disorder (PTSD), as a major Institute priority, as stated in the Surgeon General's report, Mental Health: Culture, Race, and Ethnicity (U.S. Department of Health and Human Services [USDHHS], 2001). The recently published NIMH Strategic Plan (USDHHS, 2008) has as one of its four strategic objectives to "Develop New and Better Interventions that Incorporate the Diverse Needs and Circumstances of People with Mental Illness" (USDHHS, 2008), and the plan emphasizes the need to personalize care so that it is appropriate for different cultural groups, for delivery in different contexts (primary care), and the report emphasizes the need to investigate the variables that influence who will benefit from which treatments (see too, USDHHS, 2010). Investigating these issues leads toward another of the NIMH Strategic Plan's strategic objectives: "Strengthen the Public Health Impact of NIMH-Supported Research." There is only one study examining an intervention for PTSD in a primary care clinic (Roy-Byrne et al., 2010), and there is no study of the treatment of PTSD among a refugee or ethnic minority group in primary care. This is a major gap in the literature. The current study is a hybrid effectiveness-efficacy study of Cambodian refugees, a group with an extremely high community rate of PTSD: a 62% community prevalence in one study (Marshall et al., 2005). The study utilizes several means to make the treatment more effective that can be utilized with other cultural groups, including the methods to increase the prescribing of adequate pharmacology by the primary care physician, the methods to increase medication adherence, the method of culturally appropriate evaluation, and the culturally sensitive CBT. The proposed grant would allow us to investigate whether effective treatment can be provided in primary care for Cambodian refugees with PTSD (with all the treatment adaptations, e.g., the hybrid culturally adapted CBT, applicable to all refugee and ethnic minority populations), and will compare two models of care. At step 1, all patients receive PTSD medication for 12 weeks. After step 1, patients who are still symptomatic will be randomized to one of two augmentation strategies. In the Pharmacology Augmentation Stepped Care Model, step 2 is pharmacologic augmentation (adding another PTSD pharmacological agent). In the CBT Augmentation Stepped Care Model, step 2 is a culturally adapted CBT (Hinton et al., 2004, 2005). We will investigate aspects of personalized care: in step 1, variables that moderate response to the initial pharmacological treatment (e.g., gender, education level, level of anger), and in step 2, variables that moderate the response to pharmacological and CBT augmentation (e.g., the moderators assessed for step 1, poor response to pharmacology in step 1, and treatment preference, viz., pharmacology or CBT).

描述（由申请人提供）：NIMH已确定了针对非英语的群体的治疗发展，特别是对创伤后应激障碍（PTSD）作为主要研究所的优先事项，如外科医生的报告，心理健康：文化，种族和种族（美国卫生与公众服务部[USDHHS]，2001年）。最近发表的NIMH战略计划（USDHHS，2008年）是其四个战略目标之一，它是“制定新的，更好的干预措施，结合了精神疾病的人的多样性和各种需求和环境”（USDHHS，2008年），该计划强调需要个性化的护理，以便在不同的文化群体中提供不同的文化群体，适用于不同的文化群体，以提供不同的文化群体，以提供不同的文化群体，以便提供不同的文化群体，以便在不同的文化群体中交付。 上下文（初级保健），该报告强调需要调查影响谁受益于哪些治疗方法的变量（也请参见USDHHS，2010年）。研究这些问题导致了NIMH战略计划的另一个战略目标：“加强了NIMH支持的研究的公共卫生影响”。 只有一项研究检查了初级保健诊所中PTSD的干预措施（Roy-Byrne等，2010），并且在初级保健中难民或少数民族群体中没有研究PTSD的研究。这是文献中的主要差距。当前的研究是对柬埔寨难民的一项混合有效性研究研究，该群体具有极高的PTSD率：在一项研究中，社区患病率为62％（Marshall等，2005）。该研究利用几种方法使治疗更有效，可以与其他文化群体一起使用，包括增加初级保健医生对适当药理学的处方的方法，提高药物依从性的方法，文化适当的评估方法以及文化敏感的CBT。 拟议的赠款将使我们能够调查是否可以在具有PTSD的柬埔寨难民的初级保健中提供有效的治疗（例如，所有治疗适应性的适应性，例如混合文化适应的CBT，适用于所有难民和所有少数民族），并将比较两种护理模型。在步骤1，所有患者接受PTSD药物12周。步骤1之后，仍然有症状的患者将被随机分为两种增强策略之一。在《药理学增强阶梯护理模型》中，第2步是药理学增强（增加另一种PTSD药理剂）。在CBT增强阶梯护理模型中，步骤2是一种文化适应的CBT（Hinton等，2004，2005）。我们将调查个性化护理的各个方面：在步骤1中，变量 对初始药理治疗的反应（例如性别，教育水平，愤怒水平），在步骤2中，变量对药理学和CBT增强的反应进行了缓解（例如，评估第1步评估的调节器，对第1步中的药理学反应不佳，以及第1步中的药理学反应，以及治疗偏好，VIZ，VIZ。

项目成果

Normal grief and complicated bereavement among traumatized Cambodian refugees: cultural context and the central role of dreams of the dead.

• DOI: 10.1007/s11013-013-9324-0
• 发表时间: 2013-09
• 期刊: CULTURE MEDICINE AND PSYCHIATRY
• 影响因子: 1.7
• 作者: Hinton, Devon E.;Peou, Sonith;Joshi, Siddharth;Nickerson, Angela;Simon, Naomi M.
• 通讯作者: Simon, Naomi M.