Psychotherapy for Depressed Primary Care Patients

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DESCRIPTION (provided by candidate): This application is a resubmission of a request for a Mentored Patient-Oriented Research Career Development Award (K23) that will enable Dr. Uebelacker to develop her career as a clinical researcher with a programmatic line of research on treatments for depression that are accessible to a wide range of individuals and families. In particular, she will focus on the primary care setting. Primary care providers treat many individuals with major depressive disorder, usually with an antidepressant. However, at least half of these individuals do not respond fully to this treatment strategy. Thus, Dr. Uebelacker's initial goal is to develop an integrated problem-solving therapy for patients and families (IPST-PF) to augment "usual treatment" for primary care patients with persistent depression despite initial pharmacotherapy. Dr. Uebelacker's training goals are: 1) to develop expertise in clinical research in primary care settings; 2) to develop expertise in the design, execution, and analysis of clinical trials; 3) to improve knowledge of research ethics; 4) to develop increased competence in clinical work and research with multicultural populations; 5) to understand clinical and research issues in the use of psychotropic medications; and 6) to improve grant-writing and manuscript preparation skills. This training will be accomplished through 1) resources at Brown Medical School; 2) mentorship from Drs. Ivan Miller, Charles Eaton, and Lawrence Price, and consultants Drs. Wayne Katon and Debra Lobato; 3) coursework, seminars, and supervised clinical experiences; and 4) implementation of the proposed project. Dr. Uebelacker will implement a 5-year research project, during which she will develop and test IPST-PF for primary care patients with persistent depression. IPST-PF will be based on problem-solving therapy, and will include psychoeducation, problem-solving, and a focus on medication adherence. Family members will attend some therapy sessions. IPST-PF will augment treatment-as-usual. The first 18 months of the proposed award will be devoted to developing IPST-PF and piloting it in an open trial. Subsequently, Dr. Uebelacker will conduct a small randomized trial, comparing IPST-PF plus treatment-as-usual to treatment-as-usual. These data will be used to estimate an effect size, which in turn will be used to justify an R01 application for a full-scale clinical trial.