Motivational Antidepressant Therapy for Hispanics

描述（由申请人提供）：美国西班牙裔人未充分利用药物治疗重度抑郁症 (MOD)。西班牙裔人抗抑郁治疗（ADT）的保留率是大多数白人的一半。与大多数人群相比，抑郁的西班牙裔人还发现 ADT 不太可接受，不太可能服用抗抑郁药物，并且服药依从性较低，即使在调整了人口统计和临床协变量后也是如此。 ADT 未充分利用的三个主要原因——对治疗的不满、过度依赖早期治疗成果以及环境障碍——在西班牙裔的案例中被文化因素放大了。这些要素包括： 对潜在的污名化、依赖的担忧；以及 ADT 引起的副作用；预期使用与抗抑郁药不相容的药物；以及情绪疾病的治疗和病程的替代结构。标准 ADT 的文化一致性较低，导致许多西班牙裔人在相当不确定的情况下接受这种治疗形式。这放大了现有环境障碍的不利影响，导致保留率低和药物依从性差。公共卫生后果包括 MOD 发病率和复发率上升，以及医疗费用上升。在 NIMH 的支持下，我们的团队开发了一种适应文化的新颖干预措施，以提高西班牙裔人 ADT 的保留率，该干预措施可由精神科医生进行（干预开发的第一阶段）。这种手动药物治疗方法称为动机抗抑郁疗法 (MADT)，它基于动机访谈，这是一种患者参与的治疗方法，可减少参与治疗的矛盾心理。 MADT 在促进抑郁的西班牙裔人在 MOD 药物治疗急性期的保留和反应方面显示出强大的初步功效。拟议的 II 期研究将测试随机对照试验中 MADT 相对于标准 ADT 对在研究诊所寻求门诊精神科护理的抑郁西班牙裔患者的疗效。将在 9 个月的治疗过程中检查保留率、反应率、依从性和患者满意度。混合方法（定量-定性）将产生有关患者、干预措施和影响保留的护理特征过程的信息。如果在此 II 期试验中发现 MADT 比标准 ADT 更有效，混合方法数据将使我们能够进一步开发 MADT，用于社区环境中的 III 期有效性试验。

DESCRIPTION (provided by applicant): US Hispanics underutilize medication treatment for major depressive disorder (MOD). The retention rate in antidepressant therapy (ADT) among Hispanics is half that of majority whites. Depressed Hispanics also find ADT less acceptable, are less likely to fill antidepressant prescriptions, and have lower medication adherence than the majority population, even after adjusting for demographic and clinical covariates. Three main causes of ADT underutilization -dissatisfaction with treatment, over-reliance on early treatment gains, and environmental obstacles- are magnified by cultural elements in the case of Hispanics. These elements include: concerns about potential stigmatization, dependence; and side effects due to ADT; expectations of medication use incompatible with antidepressants; and alternative constructions of the treatment and course of emotional illness. The resulting low cultural congruence of standard ADT leads many Hispanics to enter into this form of treatment with considerable uncertainty. This magnifies the adverse effect of existing environmental barriers leading to low retention and poor medication adherence. The public health consequences include higher MOD morbidity and recurrence, and rising healthcare costs. With NIMH support, our team developed a culturally adapted, novel intervention for improving Hispanic retention in ADT that can be conducted by a psychiatrist (stage I of intervention development). Called Motivational Antidepressant Therapy (MADT), this manualized method of pharmacotherapy delivery is based on Motivational Interviewing, a therapeutic approach to patient engagement that reduces ambivalence about participating in treatment. MADT has shown strong preliminary efficacy in facilitating retention and response of depressed Hispanics in the acute phase of MOD pharmacotherapy. The proposed stage II study would test the efficacy of MADT in an RCT against standard ADT in depressed Hispanics seeking outpatient psychiatric care at a research clinic. Retention, response, adherence, and patient satisfaction will be examined over 9 months of treatment. A mixed-method approach (quantitative- qualitative) will yield information on patient, intervention, and process of care characteristics affecting retention. If MADT is found to be more efficacious than standard ADT in this stage II trial, the mixed- method data will allow us to further develop MADT for a stage III effectiveness trial in community settings.