Optimizing Veterans' Social Relationships to Enhance Depression Care

优化退伍军人的社会关系以加强抑郁症护理

• 批准号: 9145534
• 负责人: Alan Teo
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9145534
• 关键词: Address; Address; Antidepressive Agents; Antidepressive Agents; Area; Area; Attitude; Attitude; Caring; Caring; Chronic; Chronic; Clinical; Clinical; Cohort Studies; Cross-Sectional Studies; Data; Data; Depression and Suicide; Depression and Suicide; Depressive disorder; Depressive disorder; Development; Development; Diagnosis; Diagnosis; Effectiveness; Effectiveness; Evaluation; Evaluation; Family; Family; Family member; Family member; Feeling suicidal; Feeling suicidal; Focus Groups; Focus Groups; Friends; Friends; Goals; Goals; Health Services; Health Services; Health Services Research; Health Services Research; Health behavior; Health behavior; Healthcare; Healthcare; Intervention; Intervention; Interview; Interview; Link; Link; Literature; Literature; Major Depressive Disorder; Major Depressive Disorder; Measures; Measures; Mental Depression; Mental Depression; Mental Health; Mental Health; Mental Health Services; Mental Health Services; Mental disorders; Mental disorders; Mentors; Mentors; Mentorship; Mentorship; Methods; Methods; Outcome; Outcome; Patient Care; Patients; Patients; Perception; Perception; Physicians; Physicians; Preparation; Preparation; Primary Health Care; Primary Health Care; Process; Process; Prospective cohort study; Randomized Controlled Trials; Randomized Controlled Trials; Reading; Reading; Research; Research; Research Methodology; Research Methodology; Research Personnel; Research Personnel; Role; Role; Self Efficacy; Self Efficacy; Self Management; Self Management; Severities; Severities; Social Environment; Social Environment; Social Network; Social Network; Social Processes; Social isolation; Social isolation; Social support; Social support; Source; Source; Suicide; Suicide; Suicide prevention; Suicide prevention; Testing; Testing; Training; Training; Training Programs; Training Programs; Trust; Trust; Veterans; Veterans; base; base; behavioral outcome; behavioral outcome; care preference; care preference; career; career; clinical practice; clinical practice; clinically significant; clinically significant; control trial; depressive symptoms; depressive symptoms; experience; experience; help-seeking behavior; help-seeking behavior; improved; improved; interpersonal conflict; interpersonal conflict; longitudinal analysis; loved ones; loved ones; medication compliance; medication compliance; primary care setting; primary care setting; prospective; reducing suicide; reducing suicide; satisfaction; satisfaction; skills; skills; social; social cognitive theory; social cognitive theory; social norm; social norm; social relationships; suicidal behavior; suicidal behavior; suicidal risk; suicidal risk; theories; theories; therapy development; therapy development

 DESCRIPTION (provided by applicant): Objective: This proposal is for a CDA-2 mentored training program that will transition Alan Teo, MD, MS into an independent VA mental health services researcher who has special expertise in the role of Veterans' social relationships in influencing mental health outcomes. The overarching objective of the research plan is to inform development of an intervention for primary care patients with major depression that harnesses the positive influences of close relationships on Veterans' depression care. Research Plan: Dr. Teo will conduct three sequential studies using mixed methods. The research approach will draw upon the literature on social support, social networks, and social cognitive theory. The Specific Aims of the proposed research are to: 1) Determine which features of VA patients' close relationships are associated with depression-related behaviors and outcomes; 2) Assess perceptions of key stakeholders in Veterans' depression treatment in primary care, including Veterans, their close relations, and clinicians involved in primary care-mental health integration; and 3) Develop and test a pilot intervention that promotes effective engagement of close relations in the care of VA primary care patients with major depressive disorder. Methods: The Aim 1 study will be a prospective cohort study of 200 primary care patients with depression to identify to what extent three social processes (social support, interpersonal conflict, and social norms) are associated with depression-related health behaviors, depression severity, and suicidal ideation and behaviors. A combination of cross-sectional and longitudinal analyses will be conducted, and results will support preparation of an IIR proposal. The Aim 2 study will be qualitative, employing interviews and focus groups. Results will provide a nuanced description of how close relations perceive Veterans' depression, existing ways that close relations are involved in Veterans' depression care, and preferences, barriers, and facilitators around engagement of close relations in Veterans' depression care. Finally, Aim 3 will be the development of a pilot intervention that will be tested locally in a non controlled trial. Intervention development will incorporate the most promising strategies identified by results from Aim 1 and Aim 2. Evaluation will focus on acceptability and feasibility. The expected outcome will be a manualized intervention and preliminary data to support a proposal for a larger randomized controlled trial. Participatory research methods involving Veterans and their close relations will be used in the Aims 2 and Aim 3 studies. Career Plan: Dr. Teo is a physician-investigator with training in health services research methods and expertise in social support and depression treatment in primary care settings. This proposal will substantially deepen his theoretical understanding, content expertise, and research skills. Specific areas for training are: 1) Qualitative and advanced quantitative skills that can be applied to mixed methods approaches in health services research; 2) Social relationship theory and applications to mental health; and 3) Intervention development for depression and suicide. The training plan will consist of formal coursework, seminars, and readings guided by the mentorship team. Ultimately, these efforts will assist in Dr. Teo reaching his goal of becoming a national leader in conducting research and implementing practice that integrates consideration of patients' social context into delivery of their mental health care.

 描述（由申请人提供）： 目标：本提案针对 CDA-2 指导培训计划，该计划将医学博士、理学硕士 Alan Teo 转变为一名独立的 VA 心理健康服务研究员，他在退伍军人的社会关系在影响心理健康结果方面的作用具有特殊的专业知识。该研究计划的总体目标是为患有严重抑郁症的初级保健患者制定一项干预措施提供信息，该干预措施利用亲密关系对退伍军人抑郁症护理的积极影响。研究计划：Teo 博士将使用混合方法进行三项连续研究。研究方法将借鉴有关社会支持、社交网络和社会认知理论的文献。拟议研究的具体目标是： 1) 确定 VA 患者亲密关系的哪些特征与抑郁相关行为和结果相关； 2) 评估主要利益相关者对初级保健退伍军人抑郁症治疗的看法，包括退伍军人、他们的密切关系以及参与初级保健-心理健康整合的临床医生； 3) 制定并测试一项试点干预措施，促进密切关系有效参与对患有重度抑郁症的 VA 初级保健患者的护理。方法：Aim 1 研究将是一项针对 200 名初级保健抑郁症患者的前瞻性队列研究，旨在确定三种社会过程（社会支持、人际冲突和社会规范）与抑郁相关健康行为、抑郁严重程度以及自杀意念和行为的关联程度。将进行横截面和纵向分析相结合，结果将支持 IIR 提案的准备。 Aim 2 研究将采用访谈和焦点小组的方式进行定性研究。结果将细致入微地描述亲密关系如何看待退伍军人抑郁症、亲密关系参与退伍军人抑郁症护理的现有方式，以及亲密关系参与退伍军人抑郁症护理的偏好、障碍和促进因素。最后，目标 3 将是开发一项试点干预措施，并在非本地环境中进行测试。 对照试验。干预措施的制定将纳入根据目标 1 和目标 2 的结果确定的最有前途的策略。评估将侧重于可接受性和可行性。 预期结果将是手动干预和初步数据，以支持更大规模随机对照试验的提议。目标 2 和目标 3 研究将采用涉及退伍军人及其密切关系的参与式研究方法。职业规划：Teo 博士是一名医师研究员，接受过卫生服务研究方法方面的培训，并拥有初级保健机构中社会支持和抑郁症治疗方面的专业知识。该提案将大大加深他的理论理解、内容专业知识和研究技能。培训的具体领域包括： 1) 可应用于卫生服务研究混合方法的定性和高级定量技能； 2）社会关系理论及其在心理健康中的应用； 3) 针对抑郁症和自杀的干预措施的制定。培训计划将包括由导师团队指导的正式课程、研讨会和阅读材料。最终，这些努力将帮助张博士实现成为国家领导者的目标，进行研究和实施实践，将患者的社会背景融入到他们的心理保健服务中。