Optimizing Veterans' Social Relationships to Enhance Depression Care

 描述(由申请人提供)： 目标：这项建议是关于CDA-2指导培训计划，该计划将把Alan Teo，医学博士，医学硕士转变为一名独立的退伍军人精神健康服务研究员，他在退伍军人社会关系在影响精神健康结果中的作用方面拥有特殊的专业知识。该研究计划的总体目标是为患有严重抑郁症的初级护理患者提供信息，以利用密切关系对退伍军人抑郁症护理的积极影响来制定干预措施。研究计划：张博士将使用混合方法进行三项顺序研究。研究方法将借鉴有关社会支持、社会网络和社会认知理论的文献。拟议研究的具体目的是：1)确定退伍军人患者密切关系的哪些特征与抑郁症相关的行为和结果；2)评估退伍军人在初级保健中抑郁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；以及3)开发和测试试点干预措施，促进密切关系有效参与退伍军人初级保健患有严重抑郁障碍的患者的护理。方法：研究1将对200名抑郁症患者进行前瞻性队列研究，以确定三种社会过程(社会支持、人际冲突和社会规范)在多大程度上与抑郁症相关的健康行为、抑郁严重程度以及自杀意念和行为有关。将进行横断面分析和纵向分析相结合，其结果将支持IIR提案的编写。目标2的研究将是定性的，采用访谈和焦点小组。结果将提供关于密切关系如何感知退伍军人抑郁症的细微差别描述，密切关系参与退伍军人抑郁症护理的现有方式，以及围绕密切关系参与退伍军人抑郁症护理的偏好、障碍和促进者。最后，目标3将是开发一项试点干预措施，该干预措施将在非 对照试验。干预措施的制定将纳入目标1和目标2的结果确定的最有希望的战略。评估将侧重于可接受性和可行性。 预期的结果将是一项人工干预和初步数据，以支持一项更大规模的随机对照试验的提议。目标2和目标3的研究将采用涉及退伍军人及其密切关系的参与性研究方法。职业规划：Teo博士是一名医生兼调查员，在初级保健环境中接受过卫生服务培训、研究方法以及社会支持和抑郁症治疗方面的专业知识。这一建议将大大加深他的理论理解、内容专长和研究技能。具体的培训领域是：1)可应用于卫生服务研究的混合方法方法的定性和高级定量技能；2)社会关系理论和对心理健康的应用；3)抑郁症和自杀的干预发展。培训计划将由指导小组指导的正式课程作业、研讨会和阅读材料组成。最终，这些努力将有助于张博士实现他的目标，即在进行研究和实施实践方面成为全国领先者，将患者的社会背景纳入精神健康护理的提供。

 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.