Motivational Antidepressant Therapy for Hispanics

描述(由申请人提供)：美国拉美裔人对严重抑郁障碍(MOD)的药物治疗不足。拉美裔美国人在抗抑郁治疗(ADT)中的保留率是多数白人的一半。抑郁的拉美裔人也发现ADT不太容易被接受，不太可能满足抗抑郁药物的处方，即使在调整了人口统计学和临床协变量后，他们的服药依从性也低于大多数人。在拉美裔美国人中，ADT利用不足的三个主要原因--对治疗的不满、对早期治疗成果的过度依赖和环境障碍--被文化因素放大。这些因素包括：对ADT可能造成的污名、依赖和副作用的担忧；对与抗抑郁药不相容的药物使用的预期；以及情绪疾病的治疗和病程的替代结构。由此产生的标准ADT的低文化一致性导致许多拉美裔人进入这种形式的治疗，具有相当大的不确定性。这放大了现有环境壁垒的不利影响，导致保留率低和服药依从性差。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成本。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中的滞留，可以由精神病学家进行(干预开发的第一阶段)。这种被称为动机抗抑郁治疗(MADT)的药物治疗方法是基于动机访谈的，这是一种减少患者参与治疗的矛盾心理的治疗方法。MADT在促进抑郁的拉美裔人在MOD药物治疗的急性期的保留和反应方面显示出强大的初步疗效。拟议的第二阶段研究将在研究诊所寻求门诊精神治疗的抑郁症拉美裔患者中，测试随机对照试验中MADT与标准ADT的疗效。保留、反应、依从性和患者满意度将在9个月的治疗中进行检查。混合方法(定量-定性)将产生关于患者、干预和影响保留的护理特征的过程的信息。如果MADT在第二阶段试验中被发现比标准ADT更有效，混合方法的数据将使我们能够进一步开发MADT，以便在社区环境中进行第三阶段有效性试验。

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.