Improving Hispanic Retention in Antidepressant Therapy

描述（由申请人提供）：总体目标是开发一种文化上一致的干预措施，供精神科医生在门诊药理学实践中使用，以增加患有重度抑郁症（MDD）的西班牙裔患者在抗抑郁治疗中的保留率。尽管在精神疾病治疗方面取得了重大进展，但与非西班牙裔白人和他们自己的心理健康需求相比，西班牙裔人对心理健康服务的利用仍然不足，接受治疗和保持治疗的比率较低就是证明。西班牙裔放弃重度抑郁症药物治疗的比率是非西班牙裔白人的两到三倍。即使在控制了社会经济因素和精神病学诊断后，总体而言，在文化适应程度较低的西班牙裔移民中，心理健康利用率最低，这表明文化因素是利用率不足的重要原因。我们对文化传统的西班牙裔抑郁症患者进行的试点工作表明，患者与精神科医生对治疗的期望和关注之间的文化不一致，导致患者在服药或遵循医生指示方面产生矛盾心理，这反过来又干扰了药物的保留。“改变的跨理论模型”预测了对治疗的矛盾心理与辍学之间的联系，这是一种个人在行为改变过程中经历的阶段的示意图。然而，这个模型对拉美裔的有效性还没有经过实证检验。动机性访谈（MI）是一种有效的简短心理治疗方法，通过针对双重诊断的抑郁症和药物滥用患者对进入和继续治疗的矛盾心理，提高了患者的保留率。然而，心肌梗死尚未适用于西班牙裔患者的抗抑郁治疗。本研究的具体目的是：a)在抗抑郁治疗中对西班牙裔抑郁症患者进行文化适应和手工化心肌梗死；b)对65名寻求非精神病性重度抑郁症门诊药物治疗的西班牙裔患者进行为期12周的第二代抗抑郁药开放标签试验和6个月的随访，探讨4次人工干预对改善保留率的疗效；C)通过检验保留措施与治疗期间基线变化阶段和阶段进展之间的关系，探索“跨理论变化模型”对治疗保留的预测效度；d)检查心肌梗死在帮助患者通过改变阶段的疗效。本研究将提供实验性数据，以证明人工文化适应心肌梗死对提高西班牙裔患者抗抑郁治疗的保留率的有效性，以及“跨理论变化模型”在该人群中的预测有效性。该试点数据将允许我们申请R01，以便在对照临床试验中进一步研究该干预措施和模型。

DESCRIPTION (provided by applicant): The overall goal is to develop a culturally congruent intervention for use in outpatient pharmacological practice by a psychiatrist that will increase retention of Hispanics with major depressive disorder (MDD) in antidepressant therapy. Despite major advances in the treatment of psychiatric disorders, Hispanics continue to underutilize mental health services relative to non-Hispanic Whites and to their own mental health need, as evidenced by lower rates of treatment entry and retention. Hispanic dropout from medication therapy for MDD attains rates two to three times those of non-Hispanic Whites. Mental health utilization in general is lowest among less acculturated, migrant Hispanics, even after controlling for socio- economic factors and psychiatric diagnosis, suggesting that cultural factors are important causes of underutilization. Our pilot work with depressed, culturally traditional Hispanics entering antidepressant therapy suggests that cultural incongruence between patients' and psychiatrists' expectations and concerns about treatment produces ambivalence about taking medication or following physician instructions, which in turn interferes with retention. This association between ambivalence about treatment and dropout is predicted by the "transtheoretical model of change", a schematization of the stages individuals experience in the process of behavior change. However, the validity of this model for Hispanics has not been empirically tested. Motivational Interviewing (MI) is an effective brief psychotherapy that has improved retention among patients with dually diagnosed depression and substance abuse by targeting ambivalence about entering and remaining in treatment. However, MI has not been adapted for Hispanic patients in antidepressant therapy. The specific aims of this study are to: a) culturally adapt and manualize MI for depressed Hispanics in antidepressant therapy; b) explore the efficacy of 4 sessions of this manualized intervention for improving retention during a 12-week open- label trial with a 2nd generation antidepressant and at 6-month follow-up among 65 Hispanics seeking outpatient medication therapy for non-psychotic MDD; c) explore the predictive validity of the "transtheoretical model of change" for treatment retention by examining the relationship between the retention measures and baseline stage of change and stage progression during treatment; d) examine the efficacy of MI for helping patients progress through the stages of change. This study will yield pilot data on the efficacy of a manualized cultural adaptation of MI for enhancing retention of Hispanics in antidepressant therapy and on the predictive validity of the "transtheoretical model of change" in this population. This pilot data will allow us to apply for an R01 to further study this intervention and model in a controlled clinical trial.