Changing Narratives of Depression in Rural Women of the South

南方农村妇女抑郁症的叙述发生变化

• 批准号: 8223301
• 负责人: EMILY Jean HAUENSTEIN
• 金额: $ 9万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8223301
• 关键词: Adolescent; Adopted; Affect; Age; Area; Behavior; Behavior Therapy; Brain; Case Study; Characteristics; Cognitive; Communities; Comorbidity; Computers; Distress; Education; Effectiveness; Emotional; Empiricism; Fostering; Future; Gender; Healthcare; Hospitalization; Hostility; Interpersonal Relations; Intervention; Learning; Link; Literature; Low income; Major Depressive Disorder; Manuals; Mediator of activation protein; Memory; Mental Depression; Mental Health; Methods; Movement; Music; Nurse Psychotherapist; Oral; Outcome; Participant; Play; Procedures; Process; Production; Psychiatric Nursing; Public Health; Race; Randomized Clinical Trials; Relative (related person); Research; Research Design; Research Personnel; Resources; Rural; Rural Community; Rural Health; Rural Population; Social Functioning; Social Interaction; Specialist; Speech; Staging; Structure; Symptoms; Target Populations; Testing; Therapeutic; United States National Institutes of Health; Visual; Withdrawal; Woman; alternative treatment; base; behavioral/social science; community setting; cost; depressive symptoms; digital; experience; improved; literacy; memory process; movie; public health relevance; research study; response; self help; skills; social; success; suicide rate

DESCRIPTION (provided by applicant): This 3-year, exploratory, Stage I behavioral treatment research study responding to NIH PAR-09-173 (replacing PAR-06-248), will establish digital story as a means of promoting therapeutic change among low- income rural women with major depressive disorder (MDD). Digital story is an autobiographical narrative that has been digitally audio recorded, augmented with still pictures, video, music, and other digitized media and converted to a movie that can be played on most computer platforms. When the autobiographical digital story is produced within the context of a therapeutic relationship and used to evoke adaptive change in the depression illness narrative, it can serve as a mechanism for improving women's view of themselves, for increasing their effectiveness in interpersonal interaction, and for promoting social engagement, ultimately reducing depressive symptoms. Narrative change occurs in interaction with the psychiatric nurse specialist, through the differential and additive effects of speech, audio, visual, and cognitive processes on narrative processing and memory in diverse areas of the brain, by women's experience of success in learning and applying new skills, and through supported engagement in new social interactions. As Stage I research, a theoretical framework is presented informed by a diverse and extensive social and behavioral science literature that links MDD with narrative disruption, interactional distress, and social withdrawal. A multi-method case study research design establishing those linkages is proposed. Using within and across case analyses that integrate qualitative and quantitative research approaches the investigative team will 1) Establish instructional, therapeutic, and technological procedures that foster adaptive change in illness narratives of rural, low-income women with MDD, 2) Determine a) how autobiographical illness narratives change during the process of creation and production of a digital story, b) what therapeutic and technological processes effect narrative change, and c) outcomes associated with completing digital story, and 3) Identify personal, intrapersonal, interpersonal, narrative and other characteristics associated with response and non-response to the creation and production of digital story. Outcomes of this intensive research study include a treatment procedure manual for digital story, methods for evaluating narrative change and its effect on outcomes, and hypotheses about potential change mechanisms associated with digital story that can be tested in a future, R01 level randomized clinical trial. PUBLIC HEALTH RELEVANCE: Depression affects as many as 40% of low-income rural women, yet they are less likely than urban women to obtain treatment. This unmet need, apparently due to limited rural health care resources, and reject of formal mental health treatments by rural populations, has led to excessive co-morbidity, frequent hospitalizations, and higher rates of suicide among rural populations. The proposed research tests a gender and culturally sensitive alternative treatment for depression that has the potential to be acceptable, affordable, and sustainable in resource poor rural health and community settings.

描述（由申请人提供）：这项为期3年的探索性，I期行为治疗研究研究对NIH PAR-09-173做出了反应（取代PAR-06-248），将建立数字故事，以此作为促进低收入的贫困障碍（MDD）低收入农村妇女（MDD）的治疗变化的一种手段。数字故事是一种自传叙事，已被数字录制，并通过静止图片，视频，音乐和其他数字化媒体进行增强，并转换为可以在大多数计算机平台上播放的电影。当自传数字故事是在治疗关系的背景下产生的，并用来唤起抑郁症疾病叙事的适应性变化时，它可以作为改善妇女对自己观点的机制，以提高人际关系互动的有效性，并促进社会参与，最终减轻抑郁症状。叙事变化是通过语音，音频，视觉，视觉和认知过程对大脑各个领域的叙事处理和记忆的差异和添加效应，通过女性在学习和应用新技能上的成功经验，以及通过支持新的社交互动的支持。作为I阶段的研究，理论框架是由多样化，广泛的社会和行为科学文献与叙事破坏，互动困扰和社会戒断联系起来的。提出了建立这些联系的多方法研究研究设计。在整合整合定性和定量研究方法的内部和跨案例分析中，调查团队将1）建立教学，治疗和技术程序，以促进农村，低收入妇女的疾病叙事的适应性变化，MDD的低收入妇女，2）确定a）自传疾病在创造的过程中的自传疾病叙事以及在数量的叙事过程中如何变化，以及在数量的范围内发生变化，b）与完成数字故事相关，以及3）确定与响应和对数字故事的创建和生产有关的响应和无反应相关的个人，人际，人际，叙事和其他特征。这项密集研究的结果包括用于数字故事的治疗程序手册，评估叙事变化及其对结果的影响的方法，以及关于与数字故事相关的潜在变化机制的假设，可以在未来的数字故事中进行测试，R01水平的随机临床试验。 公共卫生相关性：抑郁症影响着多达40％的低收入农村妇女，但与城市妇女获得治疗的可能性较小。这种未满足的需求显然是由于农村卫生保健资源有限以及拒绝农村人群的正式心理健康治疗，导致了农村人口中过度的合并症，频繁住院和更高的自杀率。拟议的研究测试了对抑郁症的性别和文化敏感的替代治疗方法，有可能在资源贫困的农村健康和社区环境中接受，负担得起和可持续性。