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

照亮心灵：减少晚年抑郁症中的差异

• 批准号: 7881317
• 负责人: Steven K. Rothschild
• 金额: $ 57.51万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7881317
• 关键词: Academic Medical Centers; Adherence; Adult; Age; Aging; Americas; Anxiety; Attention; Behavior; Behavior Control; Behavioral; Blood Glucose; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Chicago; Chronic Disease; Cities; Clinic; Clinical; Communities; Community Health Centers; Complex; Control Groups; Development; Diet; Diet Habits; Dyslipidemias; Elderly; Electronics; Emotional; Excess Mortality; Exposure to; Face; Fasting; Feeling hopeless; Food; Goals; Health; Health Personnel; Health Professional; Health Services; Health Services Accessibility; Health education; Healthcare; Healthcare Systems; Heart; Hemoglobin; High Density Lipoprotein Cholesterol; High Prevalence; Hispanics; Home environment; Hyperglycemia; Hypertension; Individual; Inflammation Mediators; Intervention; Learning; Life; Life Stress; Low income; Mails; Mediating; Medical; Menopause; Menstruation; Mental Depression; Mental Health Services; Metabolic syndrome; Methods; Minority; Morbidity - disease rate; Neighborhoods; Not Hispanic or Latino; Obesity; Outcome; Outcome Measure; Pathway interactions; Patients; Pharmaceutical Preparations; Physical activity; Physical environment; Population; Population Control; Poverty; Prevalence; Primary Health Care; Provider; Randomized; Recruitment Activity; Relative (related person); Research Personnel; Research Training; Resources; Risk; Risk Factors; Route; Services; Stress; Students; Symptoms; System; Telefacsimile; Telephone; Testing; Time; Trauma; Unemployment; Urban Health; Violence; Vision; Woman; Work; base; cardiovascular risk factor; care delivery; career; depressive symptoms; diet and exercise; evidence base; experience; factor A; fasting blood glucose level; fruits and vegetables; geriatric depression; health disparity; health equity; heart disease risk; improved; instrument; low socioeconomic status; medication compliance; mortality; multidisciplinary; patient oriented; primary care setting; programs; psychologic; psychosocial; racism; self esteem; stressor; success; virtual

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.

与白人相比，年长的黑人和西班牙裔成年人患心血管疾病的风险更高：缺乏运动、肥胖、空腹高血糖和血脂异常。黑人患高血压的比例也较高，而西班牙裔患代谢综合征的比例也较高。