Developing an Abuse-Sensitive Depression Care Model

开发对虐待敏感的抑郁症护理模式

• 批准号: 7002316
• 负责人: Christina M Nicolaidis
• 金额: $ 18.13万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-01-01 至 2009-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7002316
• 关键词: behavioral /social science research tag; belief; clinical research; cognitive behavior therapy; depression; domestic violence; female; group therapy; human subject; human therapy evaluation; model design /development; patient oriented research; preference; primary care physician; psychological models; psychotherapy; spouse abuse; women' s health

DESCRIPTION (provided by applicant): Many studies have documented the value of multi-faceted interventions based on Wagner's Chronic Care Model for treating depression in primary care, but despite a well-known association between depression and intimate partner violence, (IPV) none have focused on the needs of depressed women with histories of IPV. Our long-range goal is to test the effectiveness of an abuse-sensitive chronic care model for depressed women seen in primary care settings. The objective of this proposal is to identify violence-related predictors of adherence and response to an existing multi-faceted depression care intervention, to adapt that model to be more responsive to the needs of abuse survivors, and to assess the feasibility and acceptability of the new abuse-sensitive model in preparation for a large randomized control trial. We hypothesize that women with a history of IPV are less likely to respond to traditional depression treatment models than non-abused women. We further hypothesize that the addition of special abuse-sensitive features such as abuse assessments, referrals to community resources, self-management tools about IPV, and group cognitive behavioral therapy focused on depression and abuse will improve the effectiveness of the chronic care model in treating depression. We propose 3 studies: 1) a prospective cohort study identifying violence related predictors of response to a traditional multi-faceted depression care intervention (care management, psychiatry support, provider education and a depression registry) being implemented by our collaborators; 2) a qualitative needs assessment of depressed IPV survivors to determine their beliefs, needs, treatment barriers and preferences; and 3) a pilot intervention assessing the acceptability and feasibility of an abuse sensitive depression care model. This work is significant, as it will improve our ability to provide mental health services to this challenging group of primary care patients. It is innovative as it applies concepts of chronic care management to an understudied and challenging population. This project will provide the necessary training, experience, and preliminary data for a R01 proposal to conduct a randomized controlled trial testing the effectiveness of an abuse-sensitive depression care model.

描述（由申请人提供）：许多研究已经证明了基于瓦格纳慢性护理模型的多方面干预在初级保健中治疗抑郁症的价值，但是尽管众所周知抑郁症与亲密伴侣暴力（IPV）之间存在关联，但没有一个研究关注有IPV史的抑郁症妇女的需求。我们的长期目标是测试一种对虐待敏感的慢性护理模式对初级保健机构中抑郁症妇女的有效性。本提案的目的是确定与暴力相关的预测因素对现有多方面抑郁症护理干预的依从性和反应，使该模型更能满足虐待幸存者的需求，并评估新的虐待敏感模型的可行性和可接受性，为大型随机对照试验做准备。我们假设有IPV病史的女性比没有受虐待的女性更不可能对传统的抑郁症治疗模式做出反应。我们进一步假设，增加特殊的虐待敏感特征，如虐待评估、转介到社区资源、关于IPV的自我管理工具，以及专注于抑郁和虐待的群体认知行为治疗，将提高慢性护理模式治疗抑郁症的有效性。我们提出了3项研究：1)一项前瞻性队列研究，确定对传统的多方面抑郁症护理干预（护理管理、精神病学支持、提供者教育和抑郁症登记）的反应的暴力相关预测因素；2)对抑郁症IPV幸存者进行定性需求评估，以确定他们的信念、需求、治疗障碍和偏好；3)评估虐待敏感型抑郁症护理模式的可接受性和可行性的试点干预。这项工作意义重大，因为它将提高我们为这一具有挑战性的初级保健患者群体提供精神卫生服务的能力。它是创新的，因为它将慢性护理管理的概念应用于研究不足和具有挑战性的人群。本项目将为R01提案提供必要的培训、经验和初步数据，以开展一项随机对照试验，测试虐待敏感抑郁症护理模型的有效性。