"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: 8828785
• 负责人: GEORGE S ALEXOPOULOS
• 金额: $ 38.97万
• 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 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8828785
• 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; Executive Dysfunction; Family; Female; Gender; Genotype; Goals; Hamilton Rating Scale for Depression; Home environment; Impaired cognition; Intervention; Language; Lead; Life; Major Depressive Disorder; Mediating; Mediation; Medical; Mental Depression; Mental disorders; Metabolic; Modeling; Motivation; National Institute of Mental Health; Participant; Patient Participation; Patients; Performance; Persons; Physical Medicine; Problem Solving; Quality of life; Randomized; Recommendation; Recovery; Recruitment Activity; Rehabilitation therapy; Reporting; Resources; Self Efficacy; Severities; Side; Social Workers; Stroke; Structure; Survivors; Time; Training; United States National Institutes of Health; Work; World Health Organization Disability Assessment Schedule; adverse outcome; base; compliance behavior; daily functioning; depressed patient; design; disability; experience; geriatric depression; indexing; mortality; novel; personalized intervention; personalized medicine; physical state; post stroke depression; preempt; psychosocial; repaired; serotonin transporter; skills; social rehabilitation; stem; targeted treatment; 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.

描述（由申请人提供）：我们建议研究“生态系统聚焦疗法”（EFT）对中风后抑郁症（PSD）的疗效，这种疾病困扰着大量中风患者，并增加死亡率、认知障碍和残疾中风后数年。 EFT 是一种基于我们的 PSD 综合模型的新型居家干预措施，该模型源自我们对晚年抑郁症的临床生物学和治疗研究。它假定了 PSD 的两条主要路径。首先，中风和中风修复机制有助于介导 PSD 的代谢变化。其次，由于患者突然残疾以及患者需求和家庭生活的变化而引发的“社会心理风暴”给这一系列抑郁事件增加了生物负担。 EFT 针对 PSD 的“社会心理风暴”，重点关注患者的能力与其“生态系统”（家庭、专业治疗师）挑战之间的相互作用。 EFT 遵循基于“适应性功能模型”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 不断根据 PSD 患者的能力水平“校准环境”，并通过五个集成组件针对 PSD“社会心理风暴”：1) 它提供了一个以行动为导向的关于患者康复的“新视角”。 2）它提供了“依从性增强结构”。 3）它为患者提供了一个“问题解决结构”，重点关注患者重视的问题，并与日常功能相关。 4) 它帮助家庭“重新设计其目标、参与和计划”以适应患者的残疾。 5）它“与专业治疗师协调护理” 目标是增加患者参与康复和社会活动。我们将招募160名 中风后 3 个月内的 PSD 患者，随机分配他们参加 10 周 EFT 课程和 4 次“加强”课程（超过 1 年）或比较条件（中风和抑郁教育；ESD），均由经过培训的社会工作者 (MSW) 管理。我们的主要假设指出： 在 12 周的时间内，EFT 将比 ESD 更大幅度地降低： H1) 抑郁症的严重程度； H2) 残疾。我们的次要假设假设： SH1) EFT 将导致比 ESD 更高的缓解 (HAM-Dd10) 率 12 周； SH2) 与 ESD 相比，EFT 参与者在 26 周和 52 周时的抑郁和残疾得分较低，生活质量得分较高。探索性分析将检查残疾和抑郁是否介导彼此的影响，以及“自我效能”、“行为激活”以及对康复建议和/或抗抑郁药的坚持是否介导抑郁和残疾的变化。我们还将探讨 PSD 和血清素转运蛋白基因型的临床特征是否会调节 ESD 的疗效。