Clinical Implications of Depression-Based Stigma

描述(由申请者提供)：这项资助调查了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治疗。少数民族和穷人尤其如此。在这项资助中，我们调查了与耻辱相关的担忧在多大程度上解释了未能得到适当的抑郁症护理。具体地说，我们考察了对抑郁症相关耻辱的担忧，如担心因他人意识到疾病或治疗而失去工作、保险或朋友，在多大程度上解释了对抑郁症护理的未得到满足的需求。我们还将调查提供治疗或提高治疗率的努力是否可以预测有和没有耻辱担忧的人的结果。我们使用两个现有的数据集：(1)护理伙伴，这是一个随机对照试验，旨在提高初级卫生保健环境中抑郁症的质量护理；(2)我们护理，是一个随机对照试验，为处于不利地位的年轻少数族裔妇女提供指南护理(CBT或帕罗西汀)。这些研究使我们能够检验与污名相关的担忧对抑郁症护理的接受和结果的影响，并包括贫困和少数民族的大样本。最后，我们将污名项目纳入由罗伯特·伍德·约翰逊基金会资助的具有全国代表性的社区研究--社区医疗保健中，该研究将使我们能够在具有全国代表性的样本中估计与抑郁症相关的污名率。这笔赠款的具体目的是：1)在具有全国代表性的社区样本中评估对抑郁症相关污名的担忧比率；2)确定对抑郁症相关污名的担忧对精神卫生服务使用的影响，控制已知的影响获得护理的需要、诱因和促成因素；3)检查干预措施是否有效，以增加对抑郁症的初级保健治疗的使用，使其更多地使用符合指南的初级保健疗法，从而提高对抑郁症相关污名的高、低担忧程度的人的护理质量；4)检查使用符合指南的抑郁症治疗(相对于促进获得这些治疗的质量改进计划)是否改善了对抑郁症相关耻辱的高度和低担忧的人的结果。在每个目标中，我们将探索不同种族的调查结果的不同程度。

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.