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

相对于白人，老年黑人和西班牙裔成年人心血管疾病的许多主要危险因素的发生率更高：缺乏运动，肥胖，空腹高血糖和血脂异常。黑人患高血压的比率也较高，而西班牙裔人患代谢综合征的比率也较高。 除了心血管疾病，这些人群还面临着严重和创伤性生活压力的高风险，导致抑郁和焦虑症状的高发生率。抑郁症和心血管疾病之间的联系是有据可查的。尽管如此，针对抑郁症的干预措施并没有显示出心血管死亡率的改善，针对单一风险因素的策略也未能减少健康差距，拉什城市健康公平中心的调查人员建议测试一种多层次的方法，该方法针对1）通过优先关注抑郁症的治疗来治疗个体心理和行为风险，通过在初级保健环境中建立一个多学科团队，将抑郁症的治疗和饮食、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，从而改善卫生保健系统。BRIGHTEN Heart（通过电子网络~ Heart连接老年健康团队的资源）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少数族裔老年人的抑郁症状。第二个目标是确定是否明亮 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心脏干预导致药物依从性改善的中介假设。一个探索性的目的是探讨创伤和主要的生活压力对干预结果的影响。方法：将从芝加哥的三个大型社区卫生中心招募250名黑人和西班牙裔成年人。受试者必须年龄超过65岁，BMI S25.0，并且通过PHQ-g仪器记录有抑郁症状。然后，受试者将被随机分配接受多水平BRIGHTEN心脏团队干预，或被邀请参加为老年人提供定期健康教育的会员计划。所有受试者将接受6个月的随访。 结果测量将包括PHQ-9抑郁量表和心脏代谢危险因素，包括空腹血糖、血红蛋白Ale、HDL胆固醇、血压和心脏CRP。该试验还将为少数民族学生和早期职业卫生专业人员提供差异研究培训。

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.