Peer Enhanced Depression Care: Using Peer Mentors to Provide Self-Care Support to Low-Income and Minority Older Adults

项目摘要 抑郁症是少数民族和低收入老年人的主要负担，他们不太可能使用精神药物。 卫生服务，需要开发新的服务提供模式，以提高生活质量 并解决这一群体在获得服务方面的差距。我们建议测试一个同伴的有效性- 提供抑郁症护理计划，该计划嵌入社区并与患者的 初级保健诊所。我们的第一个目标是进行一项随机对照试验， 抑郁症护理计划，其中有抑郁症个人经历的同伴导师会面 与在社区招募的老年人单独举行8次每周会议，重点是缓解 通过自我护理支持和与社区资源的联系来缓解抑郁症状。这群 干预措施中的低收入和少数老年人将与接受非 提供社交互动的同伴访问。同伴增强抑郁症护理计划需要一个长期的 疾病自我管理方法，并以社会支持、同伴 支持和社会学习。我们的第二个目标是了解调解人，如自我效能和 孤独感可能是造成干预效果的原因。我们的第三个目标是评估 通过与包括老年人在内的利益攸关方进行访谈，实施干预措施 接受干预的人，同伴导师，社会工作者，老年人的初级保健医生 和卫生系统管理员了解他们对障碍和促进因素的看法， 实施以及同行计划的影响。我们的目标是利用同伴传递的抑郁 护理，以降低有风险的低收入和少数民族成年人的心理健康发病率。的潜在 公共卫生影响很大，因为我们的项目旨在增加弱势群体获得抑郁症的机会。 一群老年人，他们经常得不到护理，并利用现有的同行工作人员 他们的服务在许多州都得到了补偿。

Project Summary Depression is a major burden for minority and low-income older adults who are less likely to use mental health services, and development of new service delivery models is needed to improve the quality of life and address disparities to access for this group. We propose to test the effectiveness of a peer- delivered depression care program that is embedded in the community and linked to the patient's primary care clinic. Our first aim will be to carry out a randomized controlled trial of the Peer Enhanced Depression Care program in which peer mentors who have personal experience of depression meet individually with older adults recruited in the community for 8 weekly meetings focused on relief of depressive symptoms through self-care support and linkages to community resources. This group of low-income and minority older adults in the intervention will be compared to a group that receives non- peer visits that provide social interaction. The Peer Enhanced Depression Care program takes a chronic disease self-management approach and is guided by the conceptual frameworks of social support, peer support, and social learning. Our second aim is to understand mediators such as self-efficacy and loneliness that may be responsible for the intervention effect. Our third aim is to evaluate the implementation of the intervention by conducting interviews with stakeholders, including older adults who received the intervention, peer mentors, social workers, the older adult's primary care physicians and health system administrators to obtain their perspectives on barriers and facilitators to implementation as well as the impact of the Peer Program. Our goal is to use peer-delivered depression care to decrease the mental health morbidity of at-risk low-income and minority adults. The potential public health impact is high because our project seeks to increase access to depression for a vulnerable group of older adults who often do not get care and leverages an existing workforce of peer workers whose services are reimbursed in many states.