Clinical Implications of Depression-Based Stigma

基于抑郁的耻辱的临床意义

• 批准号: 6923926
• 负责人: JEANNE MIRANDA
• 金额: $ 24.13万
• 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 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6923926
• 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）：这项拨款研究了与抑郁症相关的耻辱感。抑郁症是全球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。对于少数民族和穷人来说尤其如此。在这笔赠款中，我们研究了与耻辱相关的担忧在多大程度上解释了未能接受适当的抑郁症护理。具体来说，我们研究了对与抑郁症相关的耻辱感的担忧，例如由于其他人对疾病或治疗的认识而担心失去工作、保险或朋友，在多大程度上解释了抑郁症护理需求未得到满足的原因。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或没有耻辱感的人的结果。我们使用两个现有数据集：(1) Partners in Care，一项旨在提高初级卫生保健机构抑郁症护理质量的随机对照试验；(2) We Care，一项为弱势年轻少数族裔女性提供指南护理（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担忧对抑郁症护理接受度和结果的影响，并且包括大量贫困人口和少数族裔样本。最后，我们将耻辱项目纳入由罗伯特伍德约翰逊基金会资助的全国代表性社区研究“社区医疗保健”中，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。这笔赠款的具体目的是：1）评估全国代表性社区样本中对抑郁症相关耻辱的担忧率； 2) 确定对抑郁相关耻辱的担忧对使用精神卫生服务的影响，控制已知影响获得护理的需求、倾向和促成因素； 3) 检查增加使用符合指南的抑郁症初级保健治疗的干预措施是否能有效提高对抑郁相关耻辱关注程度高和低的人的护理质量； 4）检查使用符合指南的抑郁症治疗方法（而不是促进获得这些治疗的质量改进计划）是否可以改善对抑郁症相关耻辱高度关注和低度关注的人的结果。在每个目标中，我们将探讨研究结果因种族而异的程度。