Culturally Sensitive Treatment for Depressed Asians

描述（由申请人提供）：这是重新提交的一项以患者为导向的K-23奖申请，旨在加强亚裔美国人抑郁症治疗领域的临床培训和研究专业知识。此应用程序与原来的应用程序不同之处在于：在基层医疗诊所进行的抑郁症筛查将采用面对面访谈，而不是使用电话访谈;增加了假设，以评估文化适应程度和疾病信念是否可以预测治疗结果;以及在必要时，患者家属将参与心理教育和家庭咨询。候选人和马萨诸塞州总医院抑郁症临床和研究项目的初步研究表明，抑郁症在亚裔美国人中很普遍，其中许多患者不熟悉抑郁症的概念。抑郁的亚裔美国人经常不抱怨他们的情绪症状，导致对他们的疾病认识不足。仅在初级保健中识别抑郁的亚裔美国人并不能导致初级保健医生的充分治疗。我们提出了一个全面的方法：文化敏感的合作治疗（CSCT）治疗抑郁症的亚裔美国人在初级保健。CSCT包括由受过文化敏感性培训的精神病医生向抑郁症患者提供文化咨询，介绍抑郁症的概念，由初级保健医生根据既定准则治疗抑郁症，以及由双语和双文化护理经理在精神病医生的监督下进行护理管理。该项目的目标是评估这种创新方法与常规护理相比的有效性。拟议的研究将在马萨诸塞州总医院的抑郁症临床和研究项目中进行，由Maurizio Fava博士指导，并将包括该研究领域专家的咨询。该项目还将包括一个教学部分，包括精神疾病文化方面的课程、卫生服务研究方法、成本效益分析和伦理学。在奖励期的最后2年，将开始开发涉及不同地点和不同亚裔群体的更大规模的R 01项目。

DESCRIPTION (provided by applicant): This is a resubmission of an application for a mentored patient-oriented K-23 award, designed to enhance clinical training and research expertise in the area of treatment of depression among Asian Americans. This application differs from the original one in that face to face interviews will be used for screening of depression in primary care clinic instead of using telephone interviewers; hypotheses are added to assess if degree of acculturation and illness beliefs predict treatment outcomes; and involvement of patients' family members for psychoeducation and family counseling will be provided if necessary. Preliminary studies from the candidate and the Depression Clinical and Research Program at the Massachusetts General Hospital have shown that depression is prevalent among Asian Americans and many of these patients are unfamiliar with the concept of depression. Depressed Asian Americans frequently do not complain about their mood symptoms leading to under-recognition of their illness. Recognition of depressed Asian Americans in primary care alone does not result in adequate treatment by primary care physicians. We are proposing a comprehensive approach: Culturally Sensitive Collaborative Treatment (CSCT) for treating depressed Asian Americans in primary care. CSCT includes Cultural Consultation to depressed patients by a psychiatrist trained in cultural sensitivity to introduce the concept of depression, treatment of depression by primary care physicians based on established guidelines, and Care Management by a bilingual and bicultural Care Manager under the supervision of a psychiatrist. The goal of this project is to evaluate the effectiveness of this innovative approach compared to usual care. The proposed study will be based at the Massachusetts General Hospital in the Depression Clinical and Research Program, under the mentorship of Dr. Maurizio Fava, MD, and will include consultation from experts in this research area. There will also be a didactic component to the project, include coursework in the cultural aspects of mental illness, methodology of health service research, cost-effectiveness analysis, and ethics. The development of a larger scale R01 project involving different sites and different groups of Asian Americans will be started during the last 2 years of the award period.