Improving the Effectiveness of Treatment for Depression in Hispanics

提高西班牙裔抑郁症的治疗效果

• 批准号: 8015335
• 负责人: CARLOS BLANCO
• 金额: $ 56.1万
• 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: 2008
• 资助国家: 美国
• 起止时间: 2008-02-01 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8015335
• 关键词: Acute; Adult; Affect; Algorithms; Antidepressive Agents; Benchmarking; Caring; Characteristics; Child Care; Clinic Visits; Clinical; Combined Modality Therapy; Control Groups; Data; Data Sources; Depressed mood; Development; Disadvantaged; Dropout; Drops; Evidence based treatment; Face; Focus Groups; Foundations; Freedom; Future; Goals; Healthcare Systems; Healthy People 2010; Hispanics; Hour; Individual; Insurance; Insurance Coverage; Intervention; Interview; Literature; Major Depressive Disorder; Mediator of activation protein; Medicaid; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Modality; Not Hispanic or Latino; Occupations; Outcome; Outpatients; Patient Participation; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Pharmacotherapy; Phase; Population; Primary Health Care; Process; Psychiatric therapeutic procedure; Psychotherapy; Public Health; Publishing; Randomized; Regimen; Research; Sample Size; Services; Staging; Stigmata; System; Targeted Research; Telephone; Testing; Texas; Time; Treatment Effectiveness; Treatment Efficacy; Treatment outcome; Visit; alternative treatment; arm; base; care delivery; community setting; design; dissemination trial; effectiveness trial; efficacy testing; flexibility; follow-up; help-seeking behavior; improved; medical specialties; named group; novel; novel strategies; patient oriented; payment; programs; psychologic; psychosocial; randomized trial; response; satisfaction; social stigma; socioeconomics; successful intervention; therapy development; treatment as usual

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.

尽管已经开发出了被证明有效的治疗方法，但患有严重抑郁障碍的拉美裔人的治疗滞留仍然是一个主要的公共卫生问题。在拉美裔美国人中，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，人们对改善患有严重抑郁障碍的拉美裔美国人的保留率的临床策略知之甚少。 基于新出现的文献和来自两个小型随机试验的可喜的试点数据，我们建议比较接受以下任一种治疗的拉美裔抑郁症患者的治疗保留率和结果：1)遵循德克萨斯抑郁症药物算法(TMA)的抗抑郁治疗，或2)根据患者在以下选项中的治疗选择进行干预：a)单独使用TMA(即单独用药)，b)单独使用短暂IPT(IPT-B)并可选电话治疗，或c)TMA用药方案和IPT-B的组合。为了最大限度地提高患者的偏好、满意度和治疗保留率，CHOICE组的患者将被允许在研究期间的任何时候在三种治疗方法之间切换。 为了获得关于保险对选择的影响的初步数据，被随机分配到CHOICE ARM的患者将被进一步随机分配到不支付心理治疗就诊费用或每次就诊2美元自付费用(在医疗补助覆盖心理服务的州中，自付费用的中位数)。就诊就医将不会在任何一个研究部门共同支付费用。所有治疗将根据患者的喜好用西班牙语或英语提供。 除了关于保留率和结果的定量数据外，混合方法(定量-定性)将有助于确定拟议干预措施的行动机制和关键组成部分。它还将确定对干预最敏感的患者群体的特征，并评估患者对治疗的接受度和满意度。 我们相信，拟议的干预措施有望改善拉美裔抑郁症患者的治疗保留率。这种干预是以患者为中心的，对文化敏感，并尊重患者在选择循证治疗时的偏好。我们的干预结果如果成功，将为向拉美裔和其他面临传统精神卫生服务后勤障碍的社会经济弱势群体提供护理提供经验基础。