Group Self-Management for Persons with Depression and Medical Illness

描述(由申请人提供)：由于高质量的抑郁症护理比率较低，拉美裔比白人遭受更大的抑郁症残疾负担。抑郁症在初级保健环境中的拉美裔人中很常见，也经常是慢性、反复发作的，并与慢性疾病共存。改善抑郁症和慢性疾病的结果需要患者成为受过教育的、积极的合作伙伴来管理他们的疾病。拉美裔人希望接受有关一般和心理健康的教育；对心理健康保健有与污名相关的担忧；比起药物治疗，他们更喜欢心理治疗。然而，安全网初级保健提供者和诊所往往将改善医疗结果放在首位，缺乏用于抑郁症护理的资源，特别是心理治疗。有一个重要的公共卫生需要开发一种与文化相关的、低成本的干预措施，其中包括教育和心理治疗元素，针对内科疾病和抑郁症，并使抑郁症护理去污名化。为了响应患者、提供者和临床对抑郁症护理的偏好和资源，在先前的工作中，我们开发了一种创新的、基于理论的团体干预，借鉴了两种提高自我效能的循证干预措施：针对抑郁症的团体认知行为疗法(CBT)和针对慢性内科疾病的团体自我管理。专业领导的小组CBT对初级保健中少数民族的抑郁症有效，但难以持续。在慢性病患者中，Lay领导的团体自我管理计划教育和授权患者从事健康的行为并参与他们的护理。这些团体改善了自我效能、与健康相关的行为和结果；适应了不同的条件；并得到了广泛的传播和持续。然而，标准的自我管理小组并不能改善抑郁症。因此，我们加强了西班牙语Tomando Control de su Salud慢性病自我管理计划，增加了CBT小组中与抑郁症相关的教育和技能建设内容。我们建议试行测试和完善Cuerpo Sano，Mente Sana，我们新增强的针对抑郁症和慢性病的西班牙语自我管理计划。按照成功实施干预措施的框架，我们1)评估干预背景，改进我们的干预和实施策略；2)对30名低收入西班牙语抑郁障碍和慢性内科疾病患者进行随机试验；3)与多利益攸关方小组一起审查可行性、可实施性和潜在可持续性的试点结果，并修订材料和程序；4)对另外30名患者进行后续试验；以及5)与临床利益攸关方一起审查其他研究结果(现在包括对自我效能、自我护理行为、抑郁和健康结果的3个月和6个月的干预效果)，并最终确定干预和实施策略。这项研究为今后对改善拉美裔人在安全网初级保健中的护理的战略的比较有效性研究奠定了基础。

DESCRIPTION (provided by applicant): Latinos suffer a greater disability burden from depression than whites due to low rates of quality depression care. Depression is common among Latinos in primary care settings and is also often chronic, recurring, and comorbid with chronic medical illness. Improving outcomes for both depression and chronic medical illness requires patients to become educated, active partners in managing their illnesses. Latinos desire education regarding general and mental health; have stigma-related concerns regarding mental health care; and prefer psychotherapy to medication. However, safety net primary care providers and clinics often prioritize improving medical outcomes and lack the resources for depression care, especially psychotherapy. There is an important public health need to develop a culturally relevant, low cost intervention that includes educational and psychotherapeutic elements, targets medical illness and depression, and destigmatizes depression care. In response to patient, provider, and clinic preferences and resources for depression care, in prior work, we developed but have not yet tested an innovative, theoretically-based group intervention, drawing upon two evidence-based interventions that improve self-efficacy: group cognitive behavioral therapy (CBT) for depression and group self-management for chronic medical illness. Professionally-led group CBT is effective for depression among ethnic minorities in primary care but is difficult to sustain. Among patients with chronic medical illness, lay-led group self-management programs educate and empower patients to engage in healthful behaviors and participate in their care. The groups improve self-efficacy, health-related behaviors, and outcomes; have been adapted for diverse conditions; and have been widely disseminated and sustained. However, standard self-management groups do not improve depression. We thus enhanced the Spanish- language Tomando Control de su Salud chronic disease self-management program by adding depression- related educational and skill-building content from group CBT. We propose to pilot test and refine Cuerpo Sano, Mente Sana, our newly enhanced Spanish-language self- management program for depression and chronic medical illness. Following a framework for successful implementation of interventions, we 1) evaluate intervention context and refine our intervention and implementation strategy; 2) conduct a randomized trial with 30 low-income Spanish-speaking patients with depressive disorder and chronic medical illness; 3) review pilot findings of feasibility, implementation, and potential sustainability with a multistakeholder panel and revise materials and procedures; 4) conduct a subsequent trial with 30 additional patients; and 5) review additional findings (now including 3- and 6-month intervention effects on self-efficacy, self-care behaviors, and depression and health outcomes) with clinic stakeholders and finalize the intervention and implementation strategy. This study lays the groundwork for future comparative effectiveness studies of strategies to improve care for Latinos in safety net primary care.