Psychotherapy for Depressed Primary Care Patients

描述(由候选人提供)：此申请是对以患者为导向的研究职业发展奖(K23)的申请的重新提交，该奖项将使Uebelacker博士能够以临床研究人员的身份发展她的职业生涯，她拥有一系列关于抑郁症治疗的方案研究，可供广泛的个人和家庭使用。特别是，她将专注于初级保健环境。初级保健提供者治疗许多患有严重抑郁障碍的人，通常使用抗抑郁药物。然而，这些人中至少有一半对这种治疗策略没有完全反应。因此，Uebelacker博士的最初目标是开发一种针对患者和家庭的综合问题解决疗法(IPST-PF)，以加强对尽管最初进行药物治疗但仍患有持续性抑郁症的初级保健患者的“常规治疗”。 Uebelacker博士的培训目标是：1)在初级保健环境中发展临床研究方面的专门知识；2)在临床试验的设计、执行和分析方面发展专门知识；3)提高研究伦理知识；4)提高临床工作和多文化人群的研究能力；5)了解精神药物使用方面的临床和研究问题；6)提高拨款撰写和手稿准备的技能。培训将通过1)布朗医学院的资源；2)伊万·米勒、查尔斯·伊顿和劳伦斯·普莱斯博士以及顾问韦恩·卡顿和黛布拉·洛巴托博士的指导；3)课程、研讨会和监督临床经验；以及4)拟议项目的实施。Uebelacker博士将实施一个为期5年的研究项目，在此期间，她将为患有持续性抑郁症的初级保健患者开发和测试IPST-PF。IPST-PF将以解决问题治疗为基础，将包括心理教育、解决问题和关注服药依从性。家庭成员将参加一些治疗课程。IPST-PF将加强照常治疗。拟议奖励的前18个月将专门用于开发IPST-PF并在公开试验中进行试点。随后，Uebelacker博士将进行一项小型随机试验，将IPST-PF加常规治疗与常规治疗进行比较。这些数据将被用来估计效应大小，这将被用来证明R01申请进行全面临床试验是合理的。

DESCRIPTION (provided by candidate): This application is a resubmission of a request for a Mentored Patient-Oriented Research Career Development Award (K23) that will enable Dr. Uebelacker to develop her career as a clinical researcher with a programmatic line of research on treatments for depression that are accessible to a wide range of individuals and families. In particular, she will focus on the primary care setting. Primary care providers treat many individuals with major depressive disorder, usually with an antidepressant. However, at least half of these individuals do not respond fully to this treatment strategy. Thus, Dr. Uebelacker's initial goal is to develop an integrated problem-solving therapy for patients and families (IPST-PF) to augment "usual treatment" for primary care patients with persistent depression despite initial pharmacotherapy. Dr. Uebelacker's training goals are: 1) to develop expertise in clinical research in primary care settings; 2) to develop expertise in the design, execution, and analysis of clinical trials; 3) to improve knowledge of research ethics; 4) to develop increased competence in clinical work and research with multicultural populations; 5) to understand clinical and research issues in the use of psychotropic medications; and 6) to improve grant-writing and manuscript preparation skills. This training will be accomplished through 1) resources at Brown Medical School; 2) mentorship from Drs. Ivan Miller, Charles Eaton, and Lawrence Price, and consultants Drs. Wayne Katon and Debra Lobato; 3) coursework, seminars, and supervised clinical experiences; and 4) implementation of the proposed project. Dr. Uebelacker will implement a 5-year research project, during which she will develop and test IPST-PF for primary care patients with persistent depression. IPST-PF will be based on problem-solving therapy, and will include psychoeducation, problem-solving, and a focus on medication adherence. Family members will attend some therapy sessions. IPST-PF will augment treatment-as-usual. The first 18 months of the proposed award will be devoted to developing IPST-PF and piloting it in an open trial. Subsequently, Dr. Uebelacker will conduct a small randomized trial, comparing IPST-PF plus treatment-as-usual to treatment-as-usual. These data will be used to estimate an effect size, which in turn will be used to justify an R01 application for a full-scale clinical trial.