Clinical Implications of Depression-Based Stigma

基于抑郁的耻辱的临床意义

• 批准号: 6794699
• 负责人: JEANNE MIRANDA
• 金额: $ 23.23万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-01 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6794699
• 关键词: behavioral /social science research tag; belief; clinical research; depression; health care quality; health care service utilization; health services research tag; human data; low socioeconomic status; mental health services; outcomes research; perception; psychosocial separation; racial /ethnic difference; social psychology

DESCRIPTION (provided by applicant): This grant examines stigma as it relates to depressive illness. Depressive disorders are among the most significant contributors to disability and reduced quality of life worldwide, but most patients don't receive appropriate care. This is particularly true of ethnic minorities and the poor. In this grant, we examine the extent to which stigma related concerns explain failure to receive appropriate care for depression. Specifically, we examine the extent to which concerns about depression-related stigma, such as fears about losing a job, insurance, or friends due to other people's awareness of illness or treatment, explain unmet need for depression care. We will also investigate if efforts to provide treatments or improve rates of treatment predict outcomes for both persons with and without stigma concerns. We use two existing data sets: (1) Partners in Care, a randomized, controlled trial of improving quality care for depression in primary health care settings and (2) We Care, a randomized controlled trial of providing access to guideline care (either CBT or paroxetine) for disadvantaged, young minority women. These studies allow us to examine the impact of stigma related concerns on acceptance and outcomes of depression care and include large samples of poor and ethnic minorities. Finally, we include stigma items in a nationally representative community study, Healthcare for Communities, funded by the Robert Wood Johnson Foundation that will allow us to estimate rates of depression-related stigma in a nationally representative sample. The specific aims of this grant are: 1) to assess rates of concerns about depression-related stigma in a nationally representative community sample; 2) to determine the impact of concerns about depression-related stigma on use of mental health services, controlling for need, predisposing, and enabling factors known to affect access to care; 3) to examine whether interventions to increase the use of guideline-concordant primary care treatments for depression are effective at improving the quality of care for both persons with high and low levels of concern about depression-related stigma; 4) to examine whether use of guideline-concordant treatments for depression (as opposed to quality improvement programs that promote access to those treatments) improve outcomes for both persons with high and low concerns about depression related stigma. Within each of the aims, we will explore the extent to which the findings vary by ethnicity.

描述（由申请人提供）：该补助金审查与抑郁症有关的耻辱。抑郁症是世界范围内导致残疾和生活质量下降的最重要因素之一，但大多数患者没有得到适当的护理。少数民族和穷人尤其如此。在这项研究中，我们研究了耻辱相关的问题在多大程度上解释未能得到适当的照顾抑郁症。具体来说，我们研究了对抑郁症相关污名的担忧，例如担心失去工作，保险或朋友，因为其他人对疾病或治疗的认识，解释了抑郁症护理未满足的需求。我们还将调查提供治疗或提高治疗率的努力是否能预测有和没有污名问题的人的结果。我们使用两个现有的数据集：（1）护理伙伴，一项在初级卫生保健环境中提高抑郁症护理质量的随机对照试验;（2）我们护理，一项为弱势年轻少数民族妇女提供指南护理（CBT或帕罗西汀）的随机对照试验。这些研究使我们能够研究与耻辱相关的问题对抑郁症护理的接受和结果的影响，并包括大量的贫困和少数民族样本。最后，我们在一项具有全国代表性的社区研究中纳入了耻辱项目，该研究由罗伯特·伍德约翰逊基金会资助，这将使我们能够估计全国代表性样本中与抑郁症相关的耻辱率。该补助金的具体目标是：1）评估全国代表性社区样本中对抑郁症相关污名的关注率; 2）确定对抑郁症相关污名的关注对使用心理健康服务的影响，控制已知影响获得护理的需求，诱发和促成因素; 3）检查增加使用与指南一致的抑郁症初级保健治疗的干预措施是否有效地提高了对抑郁症相关污名的高度和低度关注者的护理质量; 4）检查是否使用指南一致的抑郁症治疗方法（而不是促进获得这些治疗的质量改进计划）改善了对抑郁症相关耻辱感高度关注和低度关注的人的结果。在每一个目标中，我们将探讨研究结果因种族而异的程度。