Culturally Congruent Program of MDD Care for Hispanics

描述（由申请人提供）：美国西班牙裔未充分利用专业心理健康服务（SMHS）相对于非西班牙裔白人和他们自己的心理健康需求。相比之下，在调整临床和社会经济协变量后，西班牙裔对心理健康问题的初级保健利用率几乎相当于大多数白人。文化因素在这种选择性利用不足中发挥了关键作用，因为调整后的SMHS使用率在文化适应程度较低的西班牙裔移民中最低。尽管在文化能力的进步，该领域缺乏经验检验，可操作的护理方案，以解决这些文化障碍。在他们的情况下，基于初级保健的质量提高方法并没有缩小抑郁症治疗相对于白人的种族差距。需要文化上一致的方法来帮助连接西班牙裔患者的护理从一般健康到SMHS设置，因为基于初级保健的心理健康服务在大型，资金充足的医疗保健系统之外的适用性有限。 该R34应用程序的目标是为患有重度抑郁症的西班牙裔美国人（CCP-MDD）制定一项可操作的文化一致的护理计划，该计划可以促进他们从初级保健转介时进入SMHS，保留和成功治疗。项目开发将通过文化表述（CF）的四次迭代修改进行，文化表述是DSM-IV指导如何进行文化评估的指南。修改将基于以前的CF研究，从抑郁症患者及其亲属的焦点小组获得的定性数据，以及在文化适应水平范围内治疗西班牙裔MDD初级保健患者的结果。我们还将在一项为期18周的MDD阶梯式护理试验（包括药物治疗和/或人际心理治疗（IPT））中获得关于CCP-MDD在促进SMHS进入、保留和积极治疗结局方面的有效性的初步数据。 该研究团队在CF模型方面拥有丰富的经验，对患有MDD的西班牙裔患者进行药物治疗和IPT治疗，并开发抑郁症的手动治疗。我们正在进行的研究与几个独立的西班牙裔初级保健医生在上曼哈顿确保研究的可行性。开发一个手动的，文化上一致的计划，抑郁症护理西班牙裔与初步的实证支持，将构成文化能力研究向前迈出的重要一步。如果成功，CCP-MDD可以在更大的随机对照试验中与常规治疗进行比较。

DESCRIPTION (provided by applicant): US Hispanics underutilize specialty mental health services (SMHS) relative to non-Hispanic Whites and to their own mental health need. By contrast, Hispanic utilization of primary care for mental health problems is nearly equivalent to that of majority Whites, after adjusting for clinical and socioeconomic covariates. Cultural factors play a key role in this selective underutilization, since adjusted rates of SMHS use are lowest among less acculturated, migrant Hispanics. Despite advances in cultural competence, the field lacks empirically tested, operationalized programs of care to address these cultural barriers. In their absence, quality enhancement approaches based in primary care have not closed the ethnic gap in depression treatment relative to Whites. Culturally congruent methods are needed to help bridge the care of Hispanic patients from general health to SMHS settings, since mental health services based in primary care have limited applicability beyond large, well-financed healthcare systems. The goal of this R34 application is to develop an operationalized, Culturally Congruent Program of care for Hispanics with Major Depressive Disorder (CCP-MDD) that can facilitate their entry, retention, and successful treatment in SMHS when referred from primary care. Program development will be conducted through four iterated modifications of the Cultural Formulation (CF), a DSM-IV Guideline for how to conduct a cultural assessment. Modifications will be based on previous CF research, qualitative data obtained from focus groups with depressed patients and their relatives, and results from the treatment of Hispanic primary care patients with MDD across a spectrum of acculturation levels. We will also obtain initial data on the effectiveness of CCP-MDD in facilitating SMHS entry, retention, and positive treatment outcome during an 18-week trial of stepped care for MDD that includes medication and/or interpersonal psychotherapy (IPT). The research team has extensive experience with the CF model, conducting medication and IPT treatment of Hispanics with MDD, and developing manualized treatments for depression. Our ongoing research relationship with several independent Hispanic primary care physicians in Upper Manhattan ensures the feasibility of the study. Development of a manualized, culturally congruent program of depression care for Hispanics with preliminary empirical support would constitute a significant step forward in cultural competence research. If successful, CCP-MDD could then be tested against usual care in a larger randomized, controlled trial.