Developing Telephone CBT for HIV Related Depression

开发电话 CBT 治疗 HIV 相关抑郁症

• 批准号: 7587926
• 负责人: SETH S HIMELHOCH
• 金额: $ 22.97万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7587926
• 关键词: Adherence; Adult; Aftercare; Alcohols; Anti-Retroviral Agents; Behavior Therapy; Caring; Caucasians; Caucasoid Race; Climacteric; Clinic; DSM-IV; Data; Depressive disorder; Development; Disease; Disease Progression; Drug abuse; Effectiveness; Ensure; Evidence based practice; Feasibility Studies; Feedback; Future; Goals; HIV; Healthcare; Highly Active Antiretroviral Therapy; Improve Access; Individual; Intervention; Lead; Location; Manuals; Medical; Mental Health; Mental Health Services; Mental disorders; Modeling; Morbidity - disease rate; Outcome; Outpatients; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Provider; Psychotherapy; Published Comment; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Project Grants; Sample Size; Sampling; Services; Site; Staging; Telephone; Testing; Therapeutic Studies; Woman; base; cognitive behavior therapy; depressed; depression; depressive symptoms; effectiveness trial; health related quality of life; improved; innovation; low socioeconomic status; medical specialties; meetings; mortality; satisfaction; secondary outcome; therapy development; treatment as usual; treatment effect; treatment trial

DESCRIPTION (provided by applicant): Up to 40% of individuals receiving medical care for HIV meet DSM-IV criteria for co- occurring depressive disorder. Individuals with HIV and depressive disorders, compared to those with HIV alone, have been shown to have worse adherence to taking antiretroviral medication, increased HIV related morbidity and among woman a higher mortality. Previous research suggests that mental health interventions may lead to improved depressive and HIV related outcomes. However because many HIV infected depressed individuals may have trouble accessing mental health services, there is an urgent need for treatment trials to assess whether treatment of depression targeting patients in urban HIV care settings will result in both improved depressive and HIV related outcomes. The goal of this R-34 application is to use the stage model of behavioral therapy research to adapt, further develop and pilot test a telephone based cognitive behavioral therapy (CBT) intervention targeting HIV infected depressed individuals receiving care in adult outpatient HIV clinics. This application has two aims consistent with stage 1A and stage 1B of the stage of behavioral therapy research. First, we will adapt and further develop (Stage 1A) the telephone based CBT intervention using iterative feedback from multiple viewpoints --patients, providers and experts. Second, we will test the preliminary effectiveness (Stage 1B) of the adapted telephone psychotherapy. A total of 60 HIV infected, depressed individuals receiving care at an urban, outpatient HIV clinic will be randomly assigned to receive either the CBT telephone psychotherapy intervention or a non-directive telephone based therapy. The results will provide preliminary data on whether the telephone psychotherapy intervention for HIV infected depressed individuals is effective in reducing depression. The results will also be used to determine feasibility, accessibility, and generate a more accurate estimate of the needed sample size for future effectiveness trials and will serve as the basis for a R01 application to extend this research to larger samples, and multiple sites. If our hypothesis is correct and we find that a telephone based psychotherapy intervention leads to improved retention, better satisfaction and better depression outcomes, we will use these data to develop an R-01 application for a full-scale, randomized controlled trial of the telephone psychotherapy targeting depression in the HIV care setting. This larger trial will enable us to investigate not only whether improved treatment of depression leads to improved depressive outcomes but whether it leads to improved access to HIV related medical care leading to improved HIV related outcomes.

描述（由申请人提供）：多达40％接受艾滋病毒医疗服务的人符合DSM-IV的抑郁症标准。与单独的艾滋病毒相比，患有艾滋病毒和抑郁症的个体已被证明对服用抗逆转录病毒药物的依从性较差，与艾滋病毒相关的发病率增加以及女性的死亡率更高。先前的研究表明，心理健康干预措施可能会改善抑郁症和HIV相关的结果。但是，由于许多受艾滋病毒感染的抑郁症患者可能难以获得精神卫生服务，因此迫切需要进行治疗试验来评估针对城市艾滋病毒护理环境中的抑郁症患者的治疗是否会导致改善抑郁症和与HIV相关的结果。该R-34应用的目的是使用行为疗法研究的阶段模型来适应，进一步开发和试点测试基于电话的认知行为疗法（CBT）干预措施，旨在针对HIV感染的受HIV感染的抑郁症患者在成人门诊HIV诊所接受护理。该应用具有两个与行为疗法研究阶段的1A期和1B期相一致的目标。首先，我们将使用来自多个观点的迭代反馈（患者，提供者和专家）来适应并进一步开发（第1A阶段）基于电话的CBT干预。其次，我们将测试适应性电话心理治疗的初步有效性（第1B期）。在城市，门诊艾滋病毒诊所接受护理的60名艾滋病毒感染的人将随机分配接受CBT电话心理治疗干预措施或非指导性电话治疗。结果将提供有关艾滋病毒感染抑郁症患者的电话心理治疗干预是否有效减少抑郁症的初步数据。结果还将用于确定可行性，可访问性，并为未来有效试验的所需样本量进行更准确的估计，并将作为R01应用程序的基础，以将该研究扩展到较大的样本和多个站点。如果我们的假设是正确的，并且我们发现基于电话的心理治疗干预措施会改善保留率，更好的满意度和更好的抑郁症结果，我们将使用这些数据来开发R-01应用程序，以针对HIV护理环境中靶向抑郁症的电话心理治疗的全面，随机对照试验。这项较大的试验将使我们不仅可以调查改善抑郁症的治疗方法是否会改善抑郁症的结果，还可以调查它是否会改善获得与HIV相关的医疗服务，从而改善HIV相关结果。