Culturally Congruent Program of MDD Care for Hispanics

描述（由申请人提供）：相对于非西班牙裔白人及其自身的心理健康需求，美国西班牙裔美国人未充分利用专业心理健康服务 (SMHS)。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的利用几乎与大多数白人相当。文化因素在这种选择性利用不足中发挥着关键作用，因为调整后的 SMHS 使用率在文化程度较低的西班牙裔移民中最低。尽管文化能力取得了进步，但该领域缺乏经过实证检验、可操作的护理计划来解决这些文化障碍。在他们缺席的情况下，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拉美裔患者的护理从一般健康到 SMHS 环境，因为基于初级保健的精神卫生服务在大型、资金充足的医疗保健系统之外的适用性有限。 此 R34 申请的目标是为患有重度抑郁症 (CCP-MDD) 的西班牙裔患者开发一个可操作的、文化上一致的护理计划，以促进他们在从初级保健转诊时进入、保留并在 SMHS 中成功接受治疗。计划开发将通过对文化制定 (CF) 的四次迭代修改来进行，文化制定是一项关于如何进行文化评估的 DSM-IV 指南。修改将基于之前的 CF 研究、从抑郁症患者及其亲属焦点小组获得的定性数据，以及不同文化适应水平的西班牙裔初级保健 MDD 患者的治疗结果。我们还将在为期 18 周的 MDD 分级护理试验（包括药物和/或人际心理治疗 (IPT)）期间获得有关 CCP-MDD 在促进 SMHS 进入、保留和积极治疗结果方面有效性的初步数据。 研究团队在 CF 模型、对患有 MDD 的西班牙裔患者进行药物和 IPT 治疗以及开发抑郁症的手动治疗方面拥有丰富的经验。我们与曼哈顿上城几位独立的西班牙裔初级保健医生的持续研究关系确保了该研究的可行性。为西班牙裔人制定一个手动的、文化上一致的抑郁症护理计划并提供初步的实证支持，将构成文化能力研究的重要一步。如果成功，CCP-MDD 就可以在一项更大规模的随机对照试验中与常规护理进行比较。

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.