Community-Based Behavioral Activation for Latinos with Depression

描述(申请人提供)：美国拉丁裔人口的显著增长再也不能被忽视。这一群体面临许多挑战，并导致了高抑郁率，包括与移民经历有关的压力、低水平的文化适应、住房不足、经济负担、失业、低教育程度、歧视和语言障碍。最近，一种很有前途的抑郁症心理治疗方法，行为激活(BA)，在一项大型随机试验中表现良好，表明它对中到重度抑郁症与抗抑郁药物一样有效。BA是一种简单、务实的方法，可以激发患者实现环境变化，因此可能非常适合拉丁裔抑郁症。因此，这一探索性研究项目的主要目的是增加关于为抑郁的拉美裔人开发和提供文化和语言适应版本的BA的科学知识。关于BA-拉丁裔的一些初步工作已经完成，包括完成了一份初步手册和一项小规模试点研究。目前项目的具体目标是：1)通过重点小组和更多的试点病例继续开发BA-拉丁裔治疗手册的进程，以及2)在拉丁裔社区诊所进行随机临床试验，将BA-拉丁裔与照常治疗进行比较。该项目将继续开发一种得到经验支持的方法来治疗拉丁裔抑郁症，这种方法在留住患者进行治疗和针对影响这一人群中抑郁症的特定环境变量方面具有潜在的优势。该项目还将导致对BA-拉丁裔相对于CBT而不是TAU的进一步评估，进行更大规模的有效性研究，以便对复发和缓解进行更有力的分析，尝试研究将BA-拉丁裔培训方法传播到更多的社区诊所，并创建BA适应其他少数群体的模式，包括非裔美国人、土著美国人和亚裔美国人。

DESCRIPTION (provided by applicant): The remarkable growth of the Latino population in the United States can no longer be ignored. Many challenges face this group and contribute to high rates of depression, including the stress associated with the migration experience, low levels of acculturation, inadequate housing, financial burdens, unemployment, low educational attainment, discrimination, and the language barrier. Recently, a promising psychotherapeutic treatment for depression, Behavioral Activation (BA), has performed well in a large randomized trial, suggesting it is as effective as anti-depressant medication for moderate-to-severe depression. BA is a simple, pragmatic approach that activates patients to achieve environmental change and thus may be well suited to Latino depression. Thus, the primary purpose of this exploratory research project is to increase scientific knowledge on the development and delivery of a culturally and linguistically adapted version of BA for depressed Latinos. Some initial work on BA-Latino has already been completed including the completion of an initial manual and a small pilot study. The specific aims of the current project are to: 1) Continue the process of developing the treatment manual for BA-Latinos with focus groups and additional pilot cases, and 2) Compare BA-Latino to treatment-as-usual with a randomized clinical trial in a Latino community clinic. The project will continue the development of an empirically-supported approach to Latino depression that potentially has strengths at retaining patients in treatment and targeting the specific environmental variables that influence depression in this population. This project also will lead to further evaluations of BA-Latino compared to CBT rather than TAU, larger effectiveness studies that allow for more powerful analyses of relapse and remission, attempts to study the dissemination of the BA-Latino training methods to additional community clinics, and creation of a model for the adaptation of BA for other minority populations, including African Americans, Native Americans and Asian Americans.