Improving the Effectiveness of Treatment for Depression in Hispanics

尽管开发的治疗证明疗效，治疗保留西班牙裔严重抑郁症仍然是一个主要的公共卫生问题。西班牙裔的药物治疗和心理治疗的辍学率大大高于非西班牙裔白人。然而，令人惊讶的是，很少有人知道临床策略，以提高保留西班牙裔重性抑郁症。 基于新兴的文献和来自两个小型随机试验的有希望的试点数据，这些试验是单独使用药物与单独使用人际心理治疗（IPT）或与允许电话会议的药物联合使用，我们建议比较接受以下治疗的抑郁症西班牙裔患者的治疗保留和结果：1）根据德克萨斯抑郁症药物治疗算法（TMA）进行抗抑郁治疗，或2）基于患者在以下选项中的治疗选择进行干预：a）单独的TMA（即，单独的药物治疗），B）单独的简短IPT（IPT-B）与任选的电话会话，或c）TMA药物治疗方案和IPT-B的组合。为了最大化患者偏好、满意度和治疗保留，将允许选择组中的患者在研究期间的任何时间点在三种治疗之间切换。 为了获得保险对选择的影响的初步数据，随机分配到选择组的患者将进一步随机分配到心理治疗访视的无共付或每次访视2美元的共付（医疗补助涵盖心理服务的州的中位共付）。任何研究组的药物访视均无需共同支付。所有治疗将根据患者的偏好以西班牙语或英语进行。 除了关于保留和成果的定量数据外，混合方法（定量-定性）将有助于确定行动机制和拟议干预措施的关键组成部分。它还将描述对干预最有反应的患者群体，并评估患者接受程度和对治疗的满意度。 我们相信，拟议的干预措施有望改善抑郁症西班牙裔患者的治疗保留率。干预是以患者为中心的，文化敏感，并尊重患者在选择循证治疗方面的偏好。从我们的干预的结果，如果成功的话，将形成一个经验的基础，提供照顾西班牙裔和其他社会经济上处于不利地位的人口，面临后勤障碍，传统的精神卫生服务。

Despite the development of treatments of proven efficacy, treatment retention for Hispanics with major depressive disorder continues to be a major public health problem. Dropout rates from pharmacotherapy and psychotherapy in Hispanics are substantially higher than in non-Hispanic whites. Yet surprisingly little is known about clinical strategies to improve retention among Hispanics with major depressive disorder. Based on emerging literature and on promising pilot data derived from two small randomized trials of medication alone versus Interpersonal Psychotherapy (IPT) alone or combined with medication allowing for telephone session, we propose to compare treatment retention and outcome of depressed Hispanics patients who receive either: 1) antidepressant treatment following the Texas Medication Algorithm for Depression (TMA), or 2) an intervention based on patient treatment choice among the following options: a) TMA alone (i.e., medication alone), b) Brief IPT (IPT-B) alone with optional telephone sessions, or c) a combination of the TMA medication regimen and IPT-B. In order to maximize patient preference, satisfaction, and treatment retention, patients in the choice arm will be allowed to switch among the three treatments at any point during the study. To obtain preliminary data on the influence of insurance on choice, patients randomized to the choice arm will be further randomized to either a no co-payment for psychotherapy visit or $2 co-payment per visit (the median co-payment in the states in which Medicaid covers psychological services). Medication visits will have no co-payment on either study arm. All treatments will be delivered in Spanish or English depending on patient preference. In addition to quantitative data on retention and outcome, a mixed-method (quantitative-qualitative) approach will help to identify the mechanisms of action and key components of the proposed intervention. It will also characterize patient groups most responsive to the intervention and assess level of patient acceptance and satisfaction with treatment. We believe the proposed intervention holds promise for improving treatment retention for depressed Hispanics. The intervention is patient-centered, culturally sensitive, and honors patient preferences in the selection of evidence-based treatments. The findings from our intervention, if successful, would form an empirical foundation for the delivery of care to Hispanics and other socioeconomically disadvantaged populations that face logistical barriers to traditional mental health services.