Improving Hispanic Retention in Antidepressant Therapy

提高西班牙裔抗抑郁治疗的保留率

• 批准号: 6535497
• 负责人: ROBERTO LEWIS-FERNANDEZ
• 金额: $ 14.05万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-01 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6535497
• 关键词: Hispanic Americans; antidepressants; behavior therapy; behavioral /social science research tag; clinical research; combination therapy; handbook; human subject; human therapy evaluation; longitudinal human study; major depression; mental disorder chemotherapy; motivation; patient oriented research; psychotherapy; sertraline; technology /technique development; therapy compliance; venlafaxine

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.

描述(由申请人提供)：总体目标是开发一种文化契合的干预措施，供精神病学家在门诊药理实践中使用，这将增加患有严重抑郁障碍(MDD)的拉美裔患者在抗抑郁治疗中的留存率。尽管在精神疾病的治疗方面取得了重大进展，但与非拉美裔白人和他们自己的心理健康需求相比，拉美裔人仍然没有充分利用精神卫生服务，这一点从较低的入院率和保留率得到了证明。拉美裔MDD药物治疗的辍学率是非拉美裔白人的两到三倍。一般而言，即使在控制了社会经济因素和精神诊断之后，较不适应的拉美裔移民的心理健康利用率也是最低的，这表明文化因素是利用不足的重要原因。我们对接受抗抑郁药物治疗的抑郁、文化传统的拉美裔美国人进行的试点工作表明，患者和精神病学家对治疗的期望和担忧之间的文化不协调会产生服用药物或遵循医生指示的矛盾心理，这反过来又会干扰保持。这种关于治疗的矛盾心理和辍学之间的联系是由“跨理论改变模型”预测的，该模型是对个体在行为改变过程中经历的阶段的图解。然而，这一模型对拉美裔美国人的有效性尚未得到实证检验。动机访谈(MI)是一种有效的短期心理疗法，通过针对参加治疗和继续治疗的矛盾心理，改善了被诊断为抑郁症和药物滥用的患者的保留率。然而，MI并不适用于拉美裔患者的抗抑郁治疗。这项研究的具体目的是：a)在抗抑郁药物治疗中对抑郁的拉美裔患者进行文化适应和MI的手册制作；b)在一项为期12周的第二代抗抑郁药物开放试验期间，以及在65名寻求非精神病性MDD门诊药物治疗的拉美裔患者的6个月随访中，探索这种手册干预的4次会议对于改善保持能力的有效性；c)通过检查保留措施与治疗期间变化的基线阶段和阶段进展之间的关系，探索“跨理论变化模型”对治疗保留的预测有效性；d)检查MI帮助患者通过变化阶段进步的有效性。这项研究将提供关于MI的手工文化适应在抗抑郁治疗中增强拉美裔美国人保留率的有效性的初步数据，以及在这一人群中“跨理论变化模型”的预测有效性。这一试点数据将使我们能够申请R01来进一步研究这种干预措施，并在对照临床试验中建立模型。