Developing an Abuse-Sensitive Depression Care Model

描述（由申请人提供）：许多研究都记录了基于瓦格纳的慢性护理模式的多方面干预措施在初级保健中治疗抑郁症的价值，但尽管抑郁症和亲密伴侣暴力之间存在众所周知的关联，但没有一项研究关注有IPV病史的抑郁症女性的需求。我们的长期目标是测试滥用敏感的慢性护理模式的有效性抑郁症妇女在初级保健设置。本提案的目的是确定与暴力相关的预测因素，以遵守和响应现有的多方面抑郁症护理干预措施，以适应该模型，以更好地满足虐待幸存者的需求，并评估新的滥用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病史的女性对传统抑郁症治疗模式的反应比非受虐女性要少。我们进一步假设，增加特殊的虐待敏感的功能，如滥用评估，转介社区资源，自我管理工具IPV，和小组认知行为治疗抑郁症和虐待的重点将提高慢性护理模式在治疗抑郁症的有效性。我们提出3项研究：1）一项前瞻性队列研究，确定对传统多方面抑郁症护理干预反应的暴力相关预测因素（护理管理，精神病学支持，提供者教育和抑郁症登记）由我们的合作者实施; 2）抑郁症IPV幸存者的定性需求评估，以确定他们的信仰，需求，治疗障碍和偏好;以及3）评估虐待敏感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心理健康服务的能力。它是创新的，因为它适用于慢性病护理管理的概念，以研究不足和具有挑战性的人口。该项目将提供必要的培训，经验和初步数据的R 01建议进行随机对照试验测试的有效性滥用敏感的抑郁症护理模式。

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.