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一致的干预措施，用于精神科医生的门诊药理学实践，以增加西班牙裔重度抑郁症（MDD）患者在抗抑郁治疗中的保留。 尽管在精神疾病的治疗方面取得了重大进展，但西班牙裔人仍然没有充分利用相对于非西班牙裔白人和他们自己的心理健康需求的心理健康服务，这一点可以从治疗进入和保留率较低得到证明。西班牙裔MDD药物治疗的辍学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诊断之后，文化适应程度较低的西班牙裔移民的心理健康利用率也最低，这表明文化因素是利用不足的重要原因。 我们的试点工作与抑郁症，文化传统的西班牙裔进入抗抑郁药治疗表明，患者和精神科医生的期望和治疗的关注之间的文化不一致产生矛盾的服用药物或遵循医生的指示，这反过来又干扰保留。这种关于治疗和辍学的矛盾心理之间的联系是由“跨理论的变化模型”预测的，这是一种对个人在行为变化过程中所经历的阶段的图式化。然而，这种模式的西班牙裔的有效性还没有得到实证检验。动机性访谈（MI）是一种有效的简短心理治疗，通过针对进入和留在治疗中的矛盾心理，改善了双重诊断的抑郁症和药物滥用患者的保留。然而，MI尚未适应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，文化上适应和手动化MI用于抑郁的西班牙裔人; B）在65名寻求非精神病性MDD门诊药物治疗的西班牙裔人中，在为期12周的开放标签试验期间，在6个月的随访中，探索4次这种手动干预对改善记忆力的疗效。c）通过检查保留测量与基线变化阶段和治疗期间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展的功效。 这项研究将产生试点数据的有效性手动文化适应MI提高保留西班牙裔抗抑郁治疗和预测的有效性，在这一人群中的“transtheoretical模型的变化”。这些试点数据将使我们能够申请R 01，以便在对照临床试验中进一步研究这种干预措施和模型。

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.