Developing Telephone CBT for HIV Related Depression

开发电话 CBT 治疗 HIV 相关抑郁症

• 批准号: 7587926
• 负责人: SETH S HIMELHOCH
• 金额: $ 22.97万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7587926
• 关键词: Adherence; Adult; Aftercare; Alcohols; Anti-Retroviral Agents; Behavior Therapy; Caring; Caucasians; Caucasoid Race; Climacteric; Clinic; DSM-IV; Data; Depressive disorder; Development; Disease; Disease Progression; Drug abuse; Effectiveness; Ensure; Evidence based practice; Feasibility Studies; Feedback; Future; Goals; HIV; Healthcare; Highly Active Antiretroviral Therapy; Improve Access; Individual; Intervention; Lead; Location; Manuals; Medical; Mental Health; Mental Health Services; Mental disorders; Modeling; Morbidity - disease rate; Outcome; Outpatients; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Provider; Psychotherapy; Published Comment; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Project Grants; Sample Size; Sampling; Services; Site; Staging; Telephone; Testing; Therapeutic Studies; Woman; base; cognitive behavior therapy; depressed; depression; depressive symptoms; effectiveness trial; health related quality of life; improved; innovation; low socioeconomic status; medical specialties; meetings; mortality; satisfaction; secondary outcome; therapy development; treatment as usual; treatment effect; treatment trial

DESCRIPTION (provided by applicant): Up to 40% of individuals receiving medical care for HIV meet DSM-IV criteria for co- occurring depressive disorder. Individuals with HIV and depressive disorders, compared to those with HIV alone, have been shown to have worse adherence to taking antiretroviral medication, increased HIV related morbidity and among woman a higher mortality. Previous research suggests that mental health interventions may lead to improved depressive and HIV related outcomes. However because many HIV infected depressed individuals may have trouble accessing mental health services, there is an urgent need for treatment trials to assess whether treatment of depression targeting patients in urban HIV care settings will result in both improved depressive and HIV related outcomes. The goal of this R-34 application is to use the stage model of behavioral therapy research to adapt, further develop and pilot test a telephone based cognitive behavioral therapy (CBT) intervention targeting HIV infected depressed individuals receiving care in adult outpatient HIV clinics. This application has two aims consistent with stage 1A and stage 1B of the stage of behavioral therapy research. First, we will adapt and further develop (Stage 1A) the telephone based CBT intervention using iterative feedback from multiple viewpoints --patients, providers and experts. Second, we will test the preliminary effectiveness (Stage 1B) of the adapted telephone psychotherapy. A total of 60 HIV infected, depressed individuals receiving care at an urban, outpatient HIV clinic will be randomly assigned to receive either the CBT telephone psychotherapy intervention or a non-directive telephone based therapy. The results will provide preliminary data on whether the telephone psychotherapy intervention for HIV infected depressed individuals is effective in reducing depression. The results will also be used to determine feasibility, accessibility, and generate a more accurate estimate of the needed sample size for future effectiveness trials and will serve as the basis for a R01 application to extend this research to larger samples, and multiple sites. If our hypothesis is correct and we find that a telephone based psychotherapy intervention leads to improved retention, better satisfaction and better depression outcomes, we will use these data to develop an R-01 application for a full-scale, randomized controlled trial of the telephone psychotherapy targeting depression in the HIV care setting. This larger trial will enable us to investigate not only whether improved treatment of depression leads to improved depressive outcomes but whether it leads to improved access to HIV related medical care leading to improved HIV related outcomes.

描述(由申请人提供)：接受艾滋病毒医疗护理的个人中，高达40%的人符合DSM-IV的共生抑郁障碍标准。与仅感染艾滋病毒的人相比，患有艾滋病毒和抑郁障碍的人对服用抗逆转录病毒药物的依从性更差，与艾滋病毒相关的发病率增加，妇女的死亡率更高。先前的研究表明，心理健康干预可能会改善抑郁和艾滋病毒相关的结果。然而，由于许多感染艾滋病毒的抑郁症患者可能难以获得精神卫生服务，因此迫切需要进行治疗试验，以评估在城市艾滋病毒护理环境中针对患者的抑郁症治疗是否会同时改善抑郁和艾滋病毒相关结果。这项R-34应用的目标是利用行为疗法研究的阶段模型来适应、进一步开发和试点测试一种基于电话的认知行为疗法(CBT)干预措施，该干预措施针对在成人门诊艾滋病毒诊所接受护理的艾滋病毒感染抑郁患者。这项应用有两个目标，与行为疗法研究阶段的阶段1A和阶段1B一致。首先，我们将适应和进一步发展(阶段1A)基于电话的CBT干预，使用来自多个观点--患者、提供者和专家--的迭代反馈。第二，我们将测试调整后的电话心理治疗的初步效果(阶段1B)。共有60名在城市艾滋病毒门诊诊所接受治疗的艾滋病毒感染者和抑郁症患者将被随机分配接受CBT电话心理治疗干预或非指导性电话治疗。这一结果将为对感染艾滋病毒的抑郁症患者进行电话心理治疗干预是否在减轻抑郁方面有效提供初步数据。结果还将用于确定可行性、可及性，并为未来的有效性试验产生更准确的样本量估计，并将作为R01应用程序的基础，将这项研究扩展到更大的样本和多个地点。如果我们的假设是正确的，并且我们发现基于电话的心理治疗干预导致了更好的保留、更好的满意度和更好的抑郁结果，我们将使用这些数据来开发R-01应用程序，以在HIV护理环境中针对抑郁症的电话心理治疗进行全面的随机对照试验。这项更大规模的试验将使我们不仅能够调查抑郁症治疗的改善是否导致抑郁结果的改善，而且还将调查它是否会改善获得艾滋病毒相关医疗护理的机会，从而改善艾滋病毒相关的结果。