Effects of Depression and Its Treatment on the Impact of ART on Health Outcomes

抑郁症及其治疗对 ART 对健康结果的影响

• 批准号: 7621280
• 负责人: GLENN John WAGNER
• 金额: $ 38.07万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-12-11 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7621280
• 关键词: Adherence; Administrator; Africa; Africa South of the Sahara; American; Antidepressive Agents; Area; Attitude; Behavioral; CD4 Lymphocyte Count; Caring; Characteristics; Child; Chronic; Clinic; Cohort Studies; Communities; Data; Developed Countries; Developing Countries; Diagnosis; Dimensions; Disclosure; Disease Progression; Disinhibition; Distress; Economics; Effectiveness; Endogenous depression; Epidemic; Expenditure; Family; Funding; Goals; HIV; Health; Health Policy; Health Services Accessibility; Home environment; Household; Individual; Intervention; Interview; Left; Life; Link; Measures; Mental Health; Modeling; Occupations; Outcome; Output; Pathway interactions; Patients; Phase; Play; Prevalence; Productivity; Provider; Psyche structure; Public Health; Public Policy; Research; Research Personnel; Resources; Risk Behaviors; Role; Rural; Safe Sex; Schools; Self Care; Self Efficacy; Services; Severity of illness; Sexual Dysfunction; Sexual Health; Social isolation; Staging; Stigmata; Structure; Subgroup; Travel; Uganda; Weight; Work; antiretroviral therapy; comparative; cost effectiveness; demographics; depressed; depression; functional status; health economics; improved; interest; member; mortality; optimism; physical conditioning; prospective; public health relevance; response; scale up; sex risk; social; social cognitive theory; social stigma; socioeconomics; therapy development; therapy outcome; transmission process

DESCRIPTION (provided by applicant): The expansion of access to ART has the potential to greatly benefit the physical, social and economic well being of individuals and households, as well as produce unintended negative consequences with regard to increased risk behavior and social disruption which can compromise its effectiveness. Drawing on Social Cognitive Theory, the proposed 4-year study will examine (1) how depression influences multiple health outcomes of patients and their households including economic output, household constellation, children's school attendance, and sexual risk behaviors, both directly and as a moderator of impact of ART; and (2) the impact of antidepressant treatment in mitigating the negative consequences of depression on these health outcomes in the context of ART scale-up in Uganda. The study will consist of two phases. In Phase 1, semi- structured qualitative interviews with ART patients, clinic providers, administrators, and support service organizations will be used to explore (1) the impact of HIV and ART on patients' physical, mental, social, economic and sexual health; (2) how mental health and depression influence these ART outcomes; and (3) attitudes towards and acceptability of depression treatment and antidepressants. Findings will help develop and refine hypotheses and measures for use in Phase 2. In Phase 2, patients entering HIV care and starting ART will be followed for 12 months in a longitudinal prospective cohort study. Those diagnosed with depression will be offered antidepressant treatment. Data from our two other just-funded observational cohort studies of ART and non-ART patients in Uganda, which include a subgroup of patients who are depressed but not receiving depression treatment, will provide important additional comparative data for evaluating the effects of depression and antidepressant therapy. These findings could provide critical information for the development of interventions and public health policy aimed at maximizing the benefits of ART in limiting HIV transmission and the social and economic consequences of the epidemic in the developing world, including the prioritization of improved diagnosis and treatment of depression. PUBLIC HEALTH RELEVANCE: This study is important to public health as its findings could provide critical information for the development of interventions and public health policy aimed at maximizing the benefits of ART in limiting HIV transmission and the social and economic consequences of the epidemic in the developing world, including the prioritization of improved diagnosis and treatment of depression.

描述（由申请人提供）：扩大获得抗逆转录病毒治疗的机会有可能极大地有利于个人和家庭的身体、社会和经济福祉，并产生意外的负面后果，即增加风险行为和社会破坏，从而影响其有效性。根据社会认知理论，这项为期4年的研究将探讨（1）抑郁症如何直接影响患者及其家庭的多种健康结果，包括经济产出，家庭布局，儿童入学率和性风险行为，以及作为ART影响的调节剂;以及（2）在乌干达ART规模扩大的背景下，抗抑郁治疗对减轻抑郁症对这些健康结果的负面影响的影响。研究将分两个阶段进行。在第一阶段，将对ART患者、诊所提供者、管理者和支持服务组织进行半结构化定性访谈，以探讨（1）HIV和ART对患者生理、心理、社会、经济和性健康的影响;（2）心理健康和抑郁如何影响这些ART结果;（3）对抑郁症治疗和抗抑郁药的态度和可接受性。研究结果将有助于开发和完善用于第2阶段的假设和措施。在第2阶段，进入艾滋病毒护理并开始ART的患者将在纵向前瞻性队列研究中随访12个月。那些被诊断患有抑郁症的人将被提供抗抑郁治疗。来自我们另外两项刚刚资助的观察性队列研究的乌干达ART和非ART患者的数据，其中包括一个抑郁但未接受抑郁治疗的患者亚组，将为评估抑郁症和抗抑郁治疗的效果提供重要的额外比较数据。这些发现可以为制定干预措施和公共卫生政策提供关键信息，这些政策旨在最大限度地发挥抗逆转录病毒疗法在限制艾滋病毒传播方面的益处，以及该流行病在发展中国家的社会和经济后果，包括优先改善抑郁症的诊断和治疗。公共卫生关系：这项研究对公共卫生很重要，因为它的发现可以为制定干预措施和公共卫生政策提供关键信息，这些干预措施和公共卫生政策旨在最大限度地发挥ART在限制艾滋病毒传播方面的益处以及发展中国家流行病的社会和经济后果，包括优先改善抑郁症的诊断和治疗。