Motivational Antidepressant Therapy for Hispanics

描述（由申请人提供）：美国西班牙裔未充分利用药物治疗重度抑郁症（MOD）。在抗抑郁治疗（ADT）中，西班牙裔的留存率是大多数白人的一半。抑郁的西班牙裔也发现ADT不太可接受，不太可能填写抗抑郁药处方，并且即使在调整人口统计学和临床协变量后，药物依从性也低于大多数人群。ADT利用不足的三个主要原因-对治疗的不满，过度依赖早期治疗收益和环境障碍-在西班牙裔的情况下被文化因素放大。这些要素包括：关注潜在的污名化，依赖性;和副作用，由于ADT;药物使用与抗抑郁药不相容的预期;和替代结构的治疗和情绪疾病的过程。由此产生的标准ADT的低文化一致性导致许多西班牙裔进入这种形式的治疗相当不确定性。这放大了现有环境障碍的不利影响，导致低保留和药物依从性差。公共卫生后果包括更高的MOD发病率和复发率，以及不断上升的医疗费用。在NIMH的支持下，我们的团队开发了一种适应文化的新型干预措施，用于改善西班牙裔在ADT中的保留，可以由精神科医生进行（干预开发的第一阶段）。被称为动机抗抑郁治疗（MADT），这种药物治疗的手动方法是基于动机访谈，一种治疗方法，以减少患者参与治疗的矛盾心理。MADT在促进抑郁的西班牙裔美国人在MOD药物治疗的急性期的保留和反应方面显示出很强的初步疗效。拟议的第二阶段研究将在一项RCT中测试MADT对在研究诊所寻求门诊精神病治疗的西班牙裔抑郁症患者的标准ADT的疗效。将在9个月的治疗期间检查保留、反应、依从性和患者满意度。混合方法（定量-定性）将产生有关患者、干预和影响保留的护理特征过程的信息。如果在该II期试验中发现MADT比标准ADT更有效，则混合方法数据将允许我们进一步开发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.