Pathways to Reducing Disparities in Depression Outcomes

减少抑郁症结果差异的途径

• 批准号: 8890204
• 负责人: JEANNE MIRANDA
• 金额: $ 51.16万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-10 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8890204
• 关键词: Absenteeism at work; Action Research; Address; Administrator; Affect; African American; Awareness; Caring; Case Study; Chronic; Client; Collection; Color; Communities; Community Networks; Community Services; County; Data; Data Collection; Depressed mood; Discrimination; Enrollment; Evidence based intervention; Exercise; Family; Gender; Generations; Hair; Health; Health Care Costs; Health Services Accessibility; Healthcare; Homelessness; Housing; Income; Individual; Insurance; Intervention; Interview; Latino; Leadership; Length of Stay; Light; Location; Los Angeles; Mediator of activation protein; Medical; Mental Depression; Mental Health; Methods; Minority Groups; Modeling; National Institute of Mental Health; Neighborhoods; Outcome; Outpatients; Pathway interactions; Patient Self-Report; Phase; Physical activity; Policies; Policy Developments; Prevalence; Primary Health Care; Probability; Process; Provider; Psyche structure; Public Health; Quality of life; Randomized; Recreation; Recruitment Activity; Relative (related person); Research; Research Infrastructure; Research Personnel; Resources; Risk Factors; Science; Services; Social Justice; Social Work; Subgroup; Substance abuse problem; Surveys; Time; Training; Trust; Uninsured; Visit; Woman; Work; base; behavioral health; collaborative care; comparative effectiveness; compare effectiveness; cost; design; effectiveness trial; ethnic minority population; evidence base; follow-up; health disparity; health equity; improved; intervention effect; medical specialties; member; men; metropolitan; outreach; parent grant; physical conditioning; programs; racial/ethnic difference; racism; randomized trial; screening; social; social disparities; trial comparing

DESCRIPTION (provided by applicant): Depression for ethnic minorities is a common, disabling condition with documented disparities in access, quality and outcomes of care, particularly in primary care, which is a main treatment setting for ethnic minority groups. Quality improvement programs in primary care can reduce disparities in depression outcomes but are seldom available in vulnerable communities. The proposed project will use the data, partnership infrastructure, and research approach of "Community Partners in Care" (CPIC)-augmented by new collection of qualitative data-to shed light on the pathways by which health and social disparities can be reduced, as well as to illuminate how scientific research can inform policy development for neighborhood-focused health improvement. CPIC is a community-partnered randomized trial comparing the effectiveness of a community engagement and planning (CEP) intervention that activates multi-agency networks versus a technical assistance model for individual agencies, in implementing evidence-based interventions for depression in two under-resourced communities of color in Los Angeles. Analyses of 6-month client outcomes indicate that the CEP intervention, relative to technical assistance, led to improved mental wellness and physical health and reduced prevalence of poor mental health, risk factors for homelessness, and missed work days due to health. CPIC was implemented with community participatory co-leadership, including leaders' self-reflection on racism and social justice. The proposed investigators are original developers of CPIC. The proposed new secondary analyses and new qualitative data collection will clarify pathways for intervention effects on key subgroups (each community, African Americans and Latinos, men and women, homeless); develop explanatory models using mixed-methods; document intervention implementation for these groups; and explore the applicability and generalizability of the CPIC approach for a new Los Angeles County neighborhood-based health improvement initiative. The public health significance of the research is enhanced by the fact that it will be conducted entirely in partnership with leaders and members from the affected communities using a Community Partnered Participatory Research approach, which promotes equality and collaborative responsibility for all phases of work. Through that model's focus on equity and self-reflection among all leaders on the impact of racism, the proposed project will serve as an early example of a fourth-generation approach to addressing health disparities, which combines comprehensive intervention models and research strategy that incorporates the community context for racial and ethnic differences and the interactions in partnered leadership. .

描述（由申请人提供）：少数族裔的抑郁症是一种常见的致残性疾病，在护理的获取、质量和结果方面存在有记录的差异，特别是在初级保健中，这是少数族裔群体的主要治疗环境。质量 初级保健的改善计划可以减少抑郁症结果的差异，但在弱势社区很少有机会实施。拟议的项目将利用“护理社区合作伙伴”（CPIC）的数据、合作伙伴基础设施和研究方法（通过新收集的定性数据进行增强）来揭示减少健康和社会差距的途径，并阐明科学研究如何为以社区为中心的健康改善的政策制定提供信息。 CPIC 是一项社区合作的随机试验，比较了激活多机构网络的社区参与和规划 (CEP) 干预措施与针对单个机构的技术援助模式在洛杉矶两个资源贫乏的有色人种社区实施抑郁症循证干预措施时的有效性。对 6 个月客户结果的分析表明，相对于技术援助，CEP 干预改善了心理健康和身体健康，并减少了心理健康状况不佳、无家可归的风险因素以及因健康原因缺勤的发生率。 CPIC是在社区参与式共同领导下实施的，包括领导人对种族主义和社会正义的自我反思。拟议的调查人员是太保的原始开发人员。拟议的新的二次分析和新的定性数据收集将澄清对关键亚群体（每个社区、非裔美国人和拉丁裔、男性和女性、无家可归者）的干预效果的途径；使用混合方法开发解释模型；记录这些群体的干预实施情况；并探索 CPIC 方法对洛杉矶县社区健康改善新举措的适用性和普遍性。该研究将完全与领导人和专家合作进行，这一事实增强了该研究的公共卫生意义。 来自受影响社区的成员使用社区合作参与式研究方法，促进工作各个阶段的平等和协作责任。通过该模型关注所有领导人对种族主义影响的公平和自我反思，拟议的项目将成为解决健康差异的第四代方法的早期范例，该方法结合了全面的干预模型和研究策略，其中纳入了种族和民族差异的社区背景以及合作领导的互动。 。