Culturally Congruent Program of MDD Care for Hispanics

描述(由申请者提供)：相对于非西班牙裔白人和他们自己的心理健康需求，美国拉美裔美国人没有充分利用专门的精神健康服务(SMHS)。相比之下，在对临床和社会经济变量进行调整后，拉美裔对精神健康问题的初级保健的利用程度几乎与多数白人相当。文化因素在这种选择性的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。尽管在文化能力方面取得了进展，但该领域缺乏经过经验检验的、可操作的护理计划来解决这些文化障碍。在缺乏他们的情况下，基于初级保健的质量提高方法并没有缩小抑郁症治疗中相对于白人的种族差距。需要文化上一致的方法来帮助将拉美裔患者的护理从普通卫生保健环境过渡到SMHS环境，因为基于初级保健的精神卫生服务的适用性有限，超出了大型、资金充足的医疗保健系统。 此R34应用程序的目标是为患有严重抑郁障碍的拉美裔患者开发一个可操作的、文化上一致的护理计划(CCP-MDD)，以促进他们从初级保健转诊到SMHS时的进入、保留和成功治疗。计划的制定将通过对文化表述(CF)的四次迭代修改来进行，CF是DSM-IV关于如何进行文化评估的指南。修改将基于先前的CF研究、从抑郁症患者及其亲属的焦点群体获得的定性数据，以及对不同文化适应水平的患有MDD的西班牙裔初级保健患者的治疗结果。我们还将在包括药物和/或人际心理治疗(IPT)在内的为期18周的MDD分级护理试验中，获得CCP-MDD在促进SMHS进入、保留和积极治疗结果方面的有效性的初步数据。 该研究团队在CF模式方面拥有丰富的经验，对患有MDD的拉美裔美国人进行药物治疗和IPT治疗，并开发抑郁症的机械化治疗。我们与曼哈顿上城的几位独立拉美裔初级保健医生的持续研究关系确保了这项研究的可行性。在初步的实证支持下，为拉美裔美国人开发一个手工化的、文化上一致的抑郁症护理计划，将构成文化能力研究的重要一步。如果成功，CCP-MDD随后可以在一项更大的随机对照试验中与常规护理进行测试。

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.