Effectiveness and Implementation of a Mindfulness Intervention for Depressive Symptoms Among Low-income, Racial/Ethnic Minority Adults in a Federally Qualified Health Center

此R01(PA-16-160)应用程序的目的是检查正念的临床效果 减少社会经济弱势、种族/族裔少数群体抑郁症状的干预措施 并探索与联邦合格健康中心(FQHC)实施相关的因素。这 将利用研究开发一个可推广的模式，在#年提供简化的心理健康干预措施 以社区为基础的环境，将广泛传播并可扩展到其他人群。黑色和 西班牙裔成年人比白人更有可能在初级保健中接受抑郁症治疗，在那里 抗抑郁药是最常见的治疗方法。然而，黑人和西班牙裔成年人不太可能 比白人更愿意接受抗抑郁药物。在小学阶段提供的正念抑郁干预 对于低收入、种族/少数民族个人来说，护理可能更容易获得和接受，严重的 服务不足的人口。越来越多的研究表明，正念干预可以减少 由压力引发的炎症反应，可改善心理结果。我们建议 进行随机对照试验，以测试正念干预(M-Body)对 与通常的护理相比，减少低收入种族/少数民族成年人的抑郁症状 FQHC。在初步研究中，18-65岁有抑郁症状的女性被从FQHC招募到 参加为期8周、每次90分钟的M-Body干预。M-Body干预基于 基于正念的压力减轻(MBSR)，并已为FQHC设置和患者群体量身定做。 由PI(N=31)和FQHC健康教育者(N=41)领导的四个试点小组的数据提供了证据 随着时间的推移，可接受性、可行性以及抑郁症状和压力结果的改善。成人(N=330) 抑郁症状将从伊利诺伊州芝加哥地区的FQHC招募，该地区服务于多数种族/民族 生活在贫困线或以下的少数群体(90%)(74%)。一半的患者将被随机分配到 M-Body干预臂，在那里他们将接受由FQHC工作人员和其他人员领导的为期8周的正念训练 一半的患者将随机接受常规护理。关于实施干预措施的相关因素的信息 FQHC将通过召集一系列工作组和与FQHC工作人员、高管和个人的面谈来获得 领导力和社区利益相关者。具体目标：1)决定正念的有效性 与加强对种族/民族的日常护理相比，在减少抑郁症状方面的干预(M-Body) 联邦合格健康中心(FQHC)的少数族裔成年人；2)探索潜在的媒介(与压力相关 生物标志物、专注力)和调节因素(年龄、个人、社会、环境应激源) 效果；3)广泛评估与筹备工作有关的组织和个人机构因素 使用混合方法在FQHC中实施M-Body干预。

The objective of this R01 (PA-16-160) application is to examine the clinical effectiveness of a mindfulness intervention on reducing depressive symptoms among socio-economically disadvantaged, racial/ethnic minority adults and explore factors related to implementation in a Federally Qualified Health Center (FQHC). This research will be used to develop a generalizable model for delivery of streamlined mental health interventions in community based settings that will be broadly disseminated and scalable to other populations. Black and Hispanic adults are more likely than those who are White to receive depression treatment in primary care, where antidepressants are the most commonly offered treatment. However, Black and Hispanic adults are less likely than Whites to find antidepressants acceptable. A mindfulness depression intervention provided within primary care may be more accessible and acceptable for low-income, racial/ethnic minority individuals, a severely underserved population. Accumulating research suggests that mindfulness interventions reduce the inflammatory response that can be triggered by stress and improves psychological outcomes. We propose to conduct a randomized controlled trial to test the clinical effectiveness of a mindfulness intervention (M-Body) on reducing depressive symptoms, compared to usual care, among low-income racial/ethnic minority adults in a FQHC. In preliminary studies, women ages 18-65 with depressive symptoms were recruited from a FQHC to participate in the 8-week, 90 minute per session M-Body intervention. The M-Body intervention is based on Mindfulness Based Stress Reduction (MBSR) and has been tailored for the FQHC setting and patient population. Data from four pilot groups led by the PI (N=31) and FQHC health educator (N=41) provide evidence of acceptability, feasibility and improved depressive symptom and stress outcomes over time. Adults (N=330) with depressive symptoms will be recruited from a FQHC in the Chicago, IL area that serves majority racial/ethnic minority individuals (90%) living at or below the poverty line (74%). Half of the patients will be randomized to the M-Body intervention arm where they will receive 8-weeks of mindfulness training led by FQHC staff and the other half will be randomized to usual care. Information on factors relevant to implementation of the intervention in the FQHC will be obtained by convening a series of workgroups and individual interviews with FQHC staff, executive leadership and community stakeholders. Specific Aims: 1) Determine the effectiveness of a mindfulness intervention (M-Body) on reducing depressive symptoms compared to enhanced usual care for racial/ethnic minority adults in a Federally Qualified Health Center (FQHC); 2) Explore potential mediators (stress related biomarkers, mindfulness) and moderators (age, personal, social, environmental stressors) of the intervention's effect; 3) Conduct a broad assessment of organizational and individual agency factors related to preparation and implementation of the M-Body intervention in a FQHC using a mixed methods approach.