Reducing residual depressive symptoms with web-based Mindful Mood Balance

通过基于网络的正念情绪平衡减少残余抑郁症状

基本信息

批准号：
8758265
负责人：
Zindel Segal
金额：
$ 55.75万
依托单位：
UNIVERSITY OF TORONTO
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-16 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8758265
关键词：
Acute Address Adopted Adult Affective Aftercare American Antidepressive Agents Caring Chronic Clinical Clinical Practice Guideline Colorado Communities Controlled Study Data Data Collection Depressed mood Disease remission Educational process of instructing Effectiveness Electronic Mail Electronics Equilibrium Evaluation Funding Home environment Intervention Knowledge Maintenance Major Depressive Disorder Manuals Measures Mediating Mediation Medical Medical History Mental Depression Mental Health Methods Moods Online Systems Outcome Participant Pathway interactions Patient Self-Report Patients Persons Pharmacotherapy Phase Primary Health Care Prophylactic treatment Psyche structure Quality of life Randomized Randomized Clinical Trials Randomized Controlled Trials Recording of previous events Recovery Recurrence Relapse Relative (related person)Reliance Reporting Research Research Infrastructure Residual state Resolution Risk Self Management Services Severities Survival Analysis Symptoms System Telephone Testing Thinking Time Training Treatment Effectiveness aged base clinically significant cost depressive symptoms design dysphoria emotion regulation evidence base experience falls follow-up functional disability improved functioning innovation interest medical specialties meetings member mindfulness mindfulness based cognitive therapy peer programs prophylactic public health relevance satisfaction skills social success theories therapy design treatment as usual virtual

项目摘要

DESCRIPTION (provided by applicant): Residual depressive symptoms (RDS) following remission of major depressive disorder (MDD) are reported by 80-90% of adults receiving first-line antidepressant pharmacotherapy and carry an elevated risk for a chronic course of illness, rapid relapse and functional impairment (Nierenberg et al., 2010). Strategies for managing residual symptoms, however, have met with mixed success (Fava et al., 2007). Mindful Mood Balance (MMB; R34 MH0877223) is an individually tailored, web-based treatment designed to train remitted depressed patients to disengage from dysphoria-activated depressogenic thinking that perpetuates RDS and increases risk for relapse/recurrence. MMB was developed to increase access to Mindfulness-Based Cognitive Therapy (MBCT; R01 MH066992), an empirically supported prophylactic group treatment that can be easily sequenced with acute phase antidepressant pharmacotherapy. Results from our open trial of MMB (N=100) showed an effect size of d=1.09 for pre to post treatment reductions in depression scores among patients with RDS and d=1.54 in a quasi-experimental comparison to patients receiving usual care, with an on average reduction of 1.98 points on the PHQ-9 for MMB patients. We now propose a pragmatic randomized clinical trial of MMB to evaluate its effectiveness in reducing RDS in recurrently depressed patients. Patients will be members of Kaiser-Permanente Colorado (N = 460), aged 18 to 75, who score >5 and <9 on the PHQ-9, in remission from MDD and will be randomized 1:1 to either the usual depression care pathway (DepCare) or Mindful Mood Balance (MMB)+DepCare. We plan to test whether patients receiving MMB+DepCare will show greater reductions in RDS at both 8 week and 12 months follow up, than those receiving DepCare alone. We are also interested in examining whether fewer patients in MMB+DepCare will relapse over the follow up and will have higher end state functioning and quality of life. In order to examine the costs associated with adding this online treatment to the Depression Care Pathways at KPCO, we will calculate the marginal costs per additional number of depression free days (DFDs) for patients. Resolution of RDS can reduce the enormous personal and social costs experienced by Americans with this persistent symptom burden.

描述（由申请人提供）：80-90％接受一线抗抑郁药药物治疗的成年人报告了重大抑郁症（MDD）后的残留抑郁症状（RD）（MDD），并具有慢性疾病，快速复发和功能障碍的慢性风险（Nierenberg等人，2010年）。然而，管理残留症状的策略已经取得了不同的成功（Fava等，2007）。正念的情绪平衡（MMB； R34 MH0877223）是一种单独量身定制的基于网络的治疗方法，旨在训练寄生的抑郁症患者，从而使人脱离急躁激活的抑郁症思维，从而使RDS永久化并增加复发/复发的风险。 MMB的开发是为了增加获得基于正念的认知疗法的机会（MBCT； R01 MH066992），这是一种经验支持的预防群治疗，可以轻松地对急性相抗抑郁药物治疗进行测序。我们对MMB的开放试验（n = 100）的结果表明，在准实验性治疗的患者中，RDS患者的抑郁症患者的抑郁症患者的抑郁评分降低的效果大小为d = 1.09，与接受常规护理的患者进行了比较，MMB患者的PHQ-9平均降低1.98点。现在，我们建议对MMB进行务实的随机临床试验，以评估其在降低经常抑郁症患者中RDS方面的有效性。患者将是18至75岁的Kaiser-permanente Colorado（N = 460）的成员，在PHQ-9上得分> 5且<9，从MDD中恢复，并将随机1：1与通常的抑郁症护理途径（DEPCARE）或正念情绪平衡（MMB）+DEPCARE。我们计划测试接受MMB+DEPCARE的患者是否在8周和12个月的随访中表现出比单独接受DEPCARE的患者的降低。我们还有兴趣检查MMB+DEPCARE中较少的患者是否会因随访而复发，并具有更高的状态功能和生活质量。为了检查与KPCO的抑郁症护理途径中添加这种在线治疗相关的成本，我们将计算患者的每额外抑郁天数（DFD）的边际成本。 RDS解决可以减少承担这种持续症状负担的美国人所经历的巨大个人和社会成本。