Culturally Congruent Program of MDD Care for Hispanics

MDD 西班牙裔护理文化一致性计划

• 批准号: 7071109
• 负责人: ROBERTO LEWIS-FERNANDEZ
• 金额: $ 21.17万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-01 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7071109
• 关键词: Hispanic Americans; antidepressants; behavioral /social science research tag; clinical research; combination therapy; culture; focus groups; functional ability; health care model; health care policy; health care service utilization; human subject; human therapy evaluation; interview; major depression; mental disorder chemotherapy; outcomes research; outpatient care; patient care management; patient care planning; psychotherapy; questionnaires; social psychology

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.

描述（由申请人提供）：美国西班牙裔美国人相对于非西班牙裔白人及其自身的心理健康需求，使专业心理健康服务（SMHS）不足。相比之下，在调整了临床和社会经济协变量之后，西班牙裔在心理健康问题上利用初级保健几乎等同于多数白人。文化因素在这种选择性不足的情况下起着关键作用，因为调整后的使用率调整后的使用率最低，在较少的，移民的西班牙裔中最低。尽管文化能力取得了进步，但该领域仍缺乏经验测试，操作的护理计划来解决这些文化障碍。在缺席的情况下，基于初级保健的质量增强方法尚未缩小相对于白人的抑郁症治疗中的种族差距。需要具有文化上一致的方法来帮助弥合从一般健康到SMHS环境的西班牙裔患者的护理，因为基于初级保健的心理健康服务的适用性有限，超过了大型，资金良好的医疗保健系统。 该R34应用的目的是针对具有重大抑郁症（CCP-MDD）的西班牙裔人（CCP-MDD）制定一项运营的，文化上一致的护理计划，该计划可以促进他们的入境，保留和成功治疗，并在初级保健中转介。计划开发将通过文化配方（CF）的四个迭代修改（DSM-IV指南，涉及如何进行文化评估）进行。修改将基于以前的CF研究，从患有抑郁症患者及其亲戚的焦点小组获得的定性数据，以及在各种适应水平的MDD治疗中治疗MDD的结果。我们还将获得有关CCP-MDD在促进SMHS进入，保留率和阳性治疗结果中的有效性的初步数据，该数据在包括药物和/或人际关系心理治疗（IPT）的18周试验中。 研究小组在CF模型中拥有丰富的经验，用MDD进行药物治疗和IPT治疗，并为抑郁症开发手动治疗方法。我们与上曼哈顿上几位独立的西班牙裔初级保健医生正在进行的研究关系确保了这项研究的可行性。开发一项手动，文化一致的抑郁症护理计划的西班牙裔经验支持将构成文化能力研究中的重要一步。如果成功，则可以在更大的随机对照试验中对CCP-MDD进行通常的护理测试。