Optimizing Veterans' Social Relationships to Enhance Depression Care

优化退伍军人的社会关系以加强抑郁症护理

• 批准号: 10176584
• 负责人: Alan Teo
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10176584
• 关键词: Address; Antidepressive Agents; Area; Attitude; Caring; Chronic; Clinical; Cross-Sectional Studies; Data; Depression and Suicide; Depressive disorder; Development; Diagnosis; Effectiveness; Evaluation; Family; Family member; Feeling suicidal; Focus Groups; Friends; Goals; Health Services; Health Services Research; Health behavior; Healthcare; Intervention; Interview; Link; Literature; Major Depressive Disorder; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Methods; Outcome; Patient Care; Patients; Perception; Physicians; Preparation; Primary Health Care; Process; Prospective cohort study; Randomized Controlled Trials; Reading; Research; Research Methodology; Research Personnel; Role; Self Efficacy; Self Management; Severities; Social Environment; Social Network; Social Processes; Social isolation; Social support; Source; Suicide; Suicide prevention; Testing; Training; Training Programs; Trust; Veterans; base; behavioral outcome; care preference; career; clinical practice; clinically significant; depressive symptoms; experience; help-seeking behavior; improved; interpersonal conflict; longitudinal analysis; loved ones; medication compliance; primary care setting; reducing suicide; satisfaction; skills; social cognitive theory; social norm; social relationships; suicidal behavior; suicidal risk; theories; therapy development

 DESCRIPTION (provided by applicant): Objective: This proposal is for a CDA-2 mentored training program that will transition Alan Teo, MD, MS into an independent VA mental health services researcher who has special expertise in the role of Veterans' social relationships in influencing mental health outcomes. The overarching objective of the research plan is to inform development of an intervention for primary care patients with major depression that harnesses the positive influences of close relationships on Veterans' depression care. Research Plan: Dr. Teo will conduct three sequential studies using mixed methods. The research approach will draw upon the literature on social support, social networks, and social cognitive theory. The Specific Aims of the proposed research are to: 1) Determine which features of VA patients' close relationships are associated with depression-related behaviors and outcomes; 2) Assess perceptions of key stakeholders in Veterans' depression treatment in primary care, including Veterans, their close relations, and clinicians involved in primary care-mental health integration; and 3) Develop and test a pilot intervention that promotes effective engagement of close relations in the care of VA primary care patients with major depressive disorder. Methods: The Aim 1 study will be a prospective cohort study of 200 primary care patients with depression to identify to what extent three social processes (social support, interpersonal conflict, and social norms) are associated with depression-related health behaviors, depression severity, and suicidal ideation and behaviors. A combination of cross-sectional and longitudinal analyses will be conducted, and results will support preparation of an IIR proposal. The Aim 2 study will be qualitative, employing interviews and focus groups. Results will provide a nuanced description of how close relations perceive Veterans' depression, existing ways that close relations are involved in Veterans' depression care, and preferences, barriers, and facilitators around engagement of close relations in Veterans' depression care. Finally, Aim 3 will be the development of a pilot intervention that will be tested locally in a non controlled trial. Intervention development will incorporate the most promising strategies identified by results from Aim 1 and Aim 2. Evaluation will focus on acceptability and feasibility. The expected outcome will be a manualized intervention and preliminary data to support a proposal for a larger randomized controlled trial. Participatory research methods involving Veterans and their close relations will be used in the Aims 2 and Aim 3 studies. Career Plan: Dr. Teo is a physician-investigator with training in health services research methods and expertise in social support and depression treatment in primary care settings. This proposal will substantially deepen his theoretical understanding, content expertise, and research skills. Specific areas for training are: 1) Qualitative and advanced quantitative skills that can be applied to mixed methods approaches in health services research; 2) Social relationship theory and applications to mental health; and 3) Intervention development for depression and suicide. The training plan will consist of formal coursework, seminars, and readings guided by the mentorship team. Ultimately, these efforts will assist in Dr. Teo reaching his goal of becoming a national leader in conducting research and implementing practice that integrates consideration of patients' social context into delivery of their mental health care.

 描述（由申请人提供）： 目的：该提案是一个CDA-2辅导培训计划，将过渡艾伦张，医学博士，MS成为一个独立的VA心理健康服务研究员谁拥有特殊的专业知识，退伍军人的社会关系在影响心理健康结果的作用。该研究计划的总体目标是为患有重度抑郁症的初级保健患者制定干预措施，利用密切关系对退伍军人抑郁症护理的积极影响。研究计划：Teo博士将使用混合方法进行三项连续研究。研究方法将借鉴社会支持，社交网络和社会认知理论的文献。拟议研究的具体目的是：1）确定退伍军人患者的密切关系的哪些特征与抑郁相关的行为和结果相关; 2）评估退伍军人抑郁症在初级保健中治疗的关键利益相关者的看法，包括退伍军人，他们的亲密关系，以及参与初级保健-心理健康整合的临床医生;和3）开发和测试一个试点干预措施，促进有效参与的密切关系，在照顾退伍军人事务部初级保健患者的严重抑郁症。研究方法：目标1研究将是一项前瞻性队列研究，纳入200例抑郁症初级保健患者，以确定三种社会过程（社会支持、人际冲突和社会规范）与抑郁症相关健康行为、抑郁症严重程度以及自杀意念和行为的相关程度。将结合进行横向和纵向分析，分析结果将支持编写一份综合影响报告提案。目标2的研究将是定性的，采用访谈和焦点小组。结果将提供一个细致入微的描述如何密切关系感知退伍军人的抑郁症，现有的方式，密切关系参与退伍军人的抑郁症护理，和偏好，障碍，和促进者周围的密切关系参与退伍军人的抑郁症护理。最后，目标3将是制定一项试点干预措施，在当地非政府组织中进行测试。 对照试验干预措施的制定将纳入目标1和目标2的结果所确定的最有希望的战略。评价将侧重于可接受性和可行性。 预期的结果将是一个手动干预和初步数据，以支持一个更大的随机对照试验的建议。目标2和目标3研究将采用涉及退伍军人及其密切关系的前瞻性研究方法。职业规划：Teo博士是一名医生调查员，接受过卫生服务研究方法的培训，并拥有初级保健环境中社会支持和抑郁症治疗的专业知识。这一建议将大大加深他的理论理解，内容专业知识和研究技能。培训的具体领域是：1）定性和高级定量技能，可应用于卫生服务研究的混合方法; 2）社会关系理论和应用于心理健康;和3）抑郁症和自杀的干预发展。培训计划将包括正式的课程，研讨会，并由导师团队指导阅读。最终，这些努力将有助于Teo博士实现他的目标，即成为开展研究和实施实践的国家领导者，将患者的社会背景考虑纳入其精神卫生保健的提供。