UNDERSTANDING THE CONTENT OF COUNSELING FOR DEPRESSION

咨询是治疗抑郁症的有效方法，但效果甚微 了解咨询和人际关系护理的内容 初级保健环境中的抑郁症患者。我们掌握的信息 来自于高度支持下的咨询的结构化方案研究 心理健康专科部门内的受控条件。它是 更好地了解初级保健临床医生通常是如何 在普通医疗环境中建议他们的抑郁症患者，因为 抑郁症在这一治疗部门很常见；仅在这种情况下 一半的抑郁症患者得到了适当的治疗，而且管理不善 许多抑郁症患者只会得到心理健康方面的护理 普通医疗部门内部的问题。系统的数据描述 常规护理咨询的内容也将有助于指导医生 报销政策，因为咨询正是那种 抑郁症患者在购买医疗保健时付费 保险公司。而且，正是这种护理会影响成本 以及抑郁症患者的护理结果。 第一项建议将建立在首席调查员之前的 临床医生的日常咨询和人际关系护理方式的工作 抑郁症。利用来自两个大型母体研究的数据 抑郁症(AHCPR Port-II，Kenneth B.Wells，Pi和NlMH合作社 协议，丽莎·V·鲁宾斯坦，PI)，拟议的项目将审查 为抑郁症患者提供的日常咨询和人际关怀的内容 患者由初级保健临床医生提供。第一项研究的PI是一个关键 这些家长研究的调查员，现在是他们的第一年 有计划的。两项家长研究的目的都是为了提高质量和 年预付费团体实践中抑郁症护理的成本效益 六个美国网站。在这篇文章中，我们首先将分析心理咨询的“黑匣子” 以及比以前更详细的人际关系风格 开展大规模的卫生服务研究。我们将进行新的 500名初级保健临床医师咨询资料分析 父母研究中的2500名抑郁症患者。新数据将是 通过录音内容分析收集到的言语咨询 225例抑郁症患者与非抑郁症患者的行为分析 和他们的供应商在一个网站上。分析将提供更丰富的 对咨询和人际关系风格的理解比以往更多 以前可用于初级保健中的抑郁症研究。

Counseling is an effective method for treating depression but little is known about the content of counseling and interpersonal care with depressed patients in primary care settings. The information we have comes from structured protocol studies of counseling under highly controlled conditions within the mental health specialty sector. It is important to better understand how primary care clinicians usually counsel their depressed patients in general medical settings because depression is common in this treatment sector; within this setting only half of depressed patients receive adequate treatment, and under managed care many depressed patients will only receive care for mental health problems within the general medical sector. Systematic data describing the content of usual care counseling will also help guide physician reimbursement policy because counseling is exactly the kind of care that depressed patients are paying for when they purchase healthcare insurance. Moreover, it is this kind of care that will affect the costs and outcomes of care among depressed patients. This FIRST proposal will build upon the Principal Investigator's previous work on clinician usual counseling and interpersonal style of care for depression. Utilizing the data from two large "parent" studies of depression (AHCPR PORT-II, Kenneth B. Wells, PI and NlMH Cooperative Agreement, Lisa V. Rubenstein, PI), the proposed project will examine the content of usual counseling and interpersonal care provided to depressed patients by primary care clinicians. The PI for this FIRST study is a key investigator in these parent studies which are now in their first year of planning. Both parent studies are designed to improve the quality and cost-effectiveness of care for depression in prepaid group practices in six US sites. In this FIRST we will analyze the "black box" of counseling and interpersonal style in more detail than has been possible in prior large-scale health services research studies. We will conduct new analyses of the counseling data from 500 primary care clinicians and 2,500 depressed patients in the parent studies. New data will be collected through audiotaped content analysis of verbal counseling behavior from 225 encounters with depressed and non-depressed patients and their providers in one site. Analyses will provide a richer understanding of counseling and interpersonal style than has been previously available for the study of depression in primary care.