BRIGHTEN HEART: REDUCING DISPARITIES IN LATE LIFE DEPRESSION & METABOLIC SYNDROME

照亮心灵：减少晚年抑郁症中的差异

• 批准号: 8458604
• 负责人: Steven K. Rothschild
• 金额: $ 66.38万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8458604
• 关键词: Academic Medical Centers; Adherence; Adult; African American; Age; Aging; Americas; Anxiety; Attention; Behavior; Behavior Control; Behavioral; Blood Glucose; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Chicago; Chronic Disease; Cities; Clinic; Clinical; Communities; Community Health Centers; Complex; Control Groups; Development; Diet; Diet Habits; Dyslipidemias; Elderly; Electronics; Emotional; Excess Mortality; Exposure to; Face; Fasting; Feeling hopeless; Food; Goals; Health; Health Personnel; Health Professional; Health Services; Health Services Accessibility; Health education; Healthcare; Healthcare Systems; Heart; Hemoglobin; High Density Lipoprotein Cholesterol; High Prevalence; Hispanics; Home environment; Hyperglycemia; Hypertension; Individual; Inflammation Mediators; Intervention; Learning; Life; Life Stress; Low income; Mails; Mediating; Medical; Menopause; Menstruation; Mental Depression; Mental Health Services; Metabolic syndrome; Methods; Minority; Morbidity - disease rate; Neighborhoods; Not Hispanic or Latino; Obesity; Outcome; Outcome Measure; Pathway interactions; Patients; Pharmaceutical Preparations; Physical activity; Physical environment; Population; Population Control; Poverty; Prevalence; Primary Health Care; Provider; Randomized; Recruitment Activity; Relative (related person); Research Personnel; Research Training; Resources; Risk; Risk Factors; Route; Services; Stress; Students; Symptoms; System; Telefacsimile; Telephone; Testing; Time; Trauma; Unemployment; Urban Health; Violence; Vision; Woman; Work; base; cardiovascular risk factor; care delivery; career; depressive symptoms; diet and exercise; evidence base; experience; fasting blood glucose level; fruits and vegetables; geriatric depression; health disparity; health equity; heart disease risk; improved; instrument; low socioeconomic status; medication compliance; mortality; multidisciplinary; patient oriented; primary care setting; programs; psychologic; psychosocial; racism; self esteem; stressor; success; virtual

Relative to whites, older black and Hispanic adults experience higher rates of many major risk factors for cardiovascular disease: physical inactivity, obesity, fasting hyperglycemia, and dyslipidemia. Blacks also have elevated rates of hypertension, while Hispanlcs have elevated rates of the metabolic syndrome. Beyond cardiovascular disease, these populations also face high exposures to major and traumatic life stressors, contributing to high rates of depression and anxiety symptoms. Linkages between depression and cardiovascular disease are well documented. Despite this, interventions targeting depression have not shown improvements in cardiovascular mortality, and strategies targeting single risk factors have also failed to reduce health disparities, investigators from the Rush Center for Urban Health Equity propose to test a multi-level approach that targets 1) individual psychological and behavioral risk by providing preferential attention to the treatment of depression and 2) the health care system by building a multi-disciplinary team in a primary care setting, in which treatment of depression and behavioral risk factors of diet, activity, and medication adherence are integrated in the service of reducing the metabolic syndrome. The primary aim of the BRIGHTEN Heart (Bridging Resources of a Geriatric Health Team via Electronic Networking ~ Heart) trial is to determine whether BRIGHTEN Heart can reduce depression symptoms in older minority adults with comorbid depression and metabolic syndrome. Secondary aims are to determine whether the BRIGHTEN Heart intervention can result in reduced prevalence of metabolic syndrome as compared to an attention control and to test the mediating hypothesis that the BRIGHTEN Heart intervention results in improvements in adherence with medications. An exploratory aim is to explore the impact of trauma and major life stressors on the results of the intervention. Methods: 250 black and Hispanic adults will be recruited from three large community health centers in Chicago. Subjects must be over age 65, have a BMI S25.0, and have symptoms of depression documented via the PHQ-g instrument. Subjects will then be randomized to either receive the multi-level BRIGHTEN Heart team intervention or be invited to participate in a membership program providing regular health education to older adults. All subjects will be followed for six months. Outcome measures will include the PHQ-9 depression instrument, and cardiometabolic risk factors including fasting blood glucose, hemoglobin Ale, HDL cholesterol, blood pressure, and cardiac CRP. The trial will also provide disparities research training for minority students and early career health professionals.

与白人相比，老年黑人和西班牙裔成年人罹患心血管疾病的许多主要危险因素的比例更高：缺乏运动、肥胖、空腹高血糖和血脂异常。黑人的高血压发病率也较高，而西班牙裔的代谢综合征发病率也较高。 除了心血管疾病之外，这些人群还面临着大量的重大和创伤性生活压力源，导致抑郁和焦虑症状的发生率很高。抑郁症和心血管疾病之间的联系已有充分记录。尽管如此，针对抑郁症的干预措施并未显示出心血管死亡率的改善，针对单一危险因素的策略也未能减少健康差异，拉什城市健康公平中心的研究人员建议测试 多层次方法，针对 1) 个人心理和行为风险，优先关注抑郁症的治疗；2) 医疗保健系统，在初级保健环境中建立多学科团队，将抑郁症治疗和饮食、活动和药物依从性等行为风险因素整合到减少代谢综合征的服务中。 BRIGHTEN Heart（通过电子网络桥接老年健康团队的资源〜心脏）试验的主要目的是确定 BRIGHTEN Heart 是否可以减轻患有抑郁症和代谢综合征共病的老年人的抑郁症状。次要目标是确定 BRIGHTEN 是否 与注意力控制相比，心脏干预可以降低代谢综合征的患病率，并检验 BRIGHTEN Heart 干预可以改善药物依从性的中介假设。探索性目的是探讨创伤和主要生活压力源对干预结果的影响。方法：将从芝加哥三个大型社区卫生中心招募 250 名黑人和西班牙裔成年人。受试者必须年满 65 岁，BMI S25.0，并且有通过 PHQ-g 仪器记录的抑郁症状。然后，受试者将被随机分配接受多层次的 BRIGHTEN Heart 团队干预，或被邀请参加为老年人提供定期健康教育的会员计划。所有科目都将被跟踪六个月。 结果测量将包括 PHQ-9 抑郁症测试仪和心脏代谢危险因素，包括空腹血糖、血红蛋白麦芽酒、HDL 胆固醇、血压和心脏 CRP。该试验还将为少数族裔学生和早期职业卫生专业人员提供差异研究培训。