Cognitive Behavioral Faith-based Depression Intervention For African American Adults (CB-FAITH): An Effectiveness And Implementation Trial

项目摘要 最近的一项研究表明，在美国，抑郁症状的患病率比 新冠肺炎与新冠肺炎大流行前相比。抑郁症在黑人中的患病率 冠状病毒感染占8.4%，流行期间占24.2%。尽管抑郁症的患病率与 在黑人和白人中，严重抑郁症的情况则截然相反。非洲 美国人/黑人在慢性病和残疾方面的症状水平更高，56.5%对38.6%的白人。这些 在威斯康星州麦迪逊拟议的研究网站上，非裔美国人的差异更加明显。 据报道，威斯康星州的黑人比白人经常遭受精神困扰的可能性要高出50%。尽管 患有抑郁症的生活负担，非裔美国人寻求心理健康服务的比率不能与 其他人口统计群体。国家精神卫生服务使用数据显示，白人使用23.0%，非洲人使用 在过去的12个月里，美国人的失业率为13.6%。为非裔美国成年人设计的文化适应疗法 有潜力解决并有可能消除这些健康差距；研究表明，文化适应 治疗的效果是标准化护理的四倍。尽管越来越多的文学作品表明非洲 美国人在经历精神疾病时更有可能使用宗教应对，这一经验得到了证实 文化适应的基于信仰的抑郁症干预措施不适用于这一群体。为了弥补这一差距，PI 与非裔美国人教会理事会建立变革性的伙伴关系，以制定以信仰为基础的 干预：认知行为信仰改善您的健康(CB-信仰)。CB信仰是精神上的- 基于此，精神/宗教主题、故事和经文被整合到核心认知行为中 内容。13个治疗单元侧重于增加对抑郁症和健康应对的知识 行为。它的设计是由非裔美国人有执照的精神健康临床医生和非洲人共同提供的 教堂里的美国牧师。我们建议进行一项混合类型1有效性-实施试验 采用以教会组为随机单位的阶梯形楔形簇随机设计， 同时测试干预措施和评估执行的障碍和促进者 干预的结果。样本将由10组组成，每组12个人(N=120) 作为患有临床抑郁症的非裔美国人男性和女性(25岁及以上)。临床结果将是 在基线、干预过程中6周和12周以及干预后3个月和6个月时测量。为 研究的实施臂，我们将使用RE-AIM概念框架来检查 实施。使用调查和半结构化访谈，重点关注个人和 组织层面将在干预实施期间和结束时进行。这样做的结果是 试验有可能推进AHRQ在医疗保健服务提供方面实现公平的目标。 。

PROJECT ABSTRACT Recent research shows the prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Prevalence of depression among Blacks pre- COVID was 8.4% and during-COVID pandemic 24.2%. Although the prevalence of depression is comparable among Blacks and Whites, the difference is dramatically reversed for severe depression. African Americans/Blacks have higher symptom levels for chronicity and disability, 56.5% vs. 38.6% for Whites. These disparities are even more stark for African Americans in the Madison, Wisconsin the proposed research site. Blacks in Wisconsin are 50% more likely than Whites to report having frequent mental distress. Despite the burden of living with depression, African Americans do not seek mental health services at comparable rates to other demographic groups. National mental health service use data show Whites use at 23.0% and African Americans at 13.6% in the past 12 months. Culturally adapted treatments designed for African American adults have the potential to address and potentially stop these health disparities; research shows culturally adapted treatments to be four times more effective than standardized care. Despite growing literature indicating African Americans are more likely to use religious coping when experiencing mental illness, empirically validated culturally adapted faith-based depression interventions do not exist for this group. To address this gap, the PI forged transformative partnerships with the African American Council of Churches to develop a faith-based intervention: Cognitive Behavioral Faith Fellowship to Improve Thy Health (CB-FAITH). CB FAITH is spiritually- based whereby spiritual/religious themes, stories, and scripture are integrated in the core cognitive behavioral content. The 13-treatment modules focus on increasing knowledge of depression and healthy coping behaviors. It is designed to be co-delivered by African American licensed mental health clinicians and African American pastors at churches. We propose conducting a hybrid type 1 effectiveness-implementation trial employing a stepped wedge cluster randomized design with church groups as the unit of randomization, providing simultaneous testing of the intervention and assessment of barriers and facilitators to implementation of the intervention. The sample will be comprised of 10 groups, each with 12 individuals (N=120) who identify as African American men and women (age 25 and older) with clinical depression. Clinical outcomes will be measured at baseline, weeks 6 and 12 during the intervention, and post-intervention at 3 and 6 months. For the implementation arm of the study, we will use the RE-AIM conceptual framework to examine implementation. Use of surveys and semi-structured interviews focusing on RE-AIM concepts at individual and organizational level will be conducted during and at the end of the intervention implementation. Results of this trial has the potential to advance the AHRQ’s goal of achieving equity in the delivery of healthcare services. .