The Role of Social Networks in Treatment Engagement for Minorities

申请者描述(申请人提供)：本申请是应NOT-MH-10-021‘S关于心理健康差异定向研究的竞争性修订申请。我们请求修改加州大学洛杉矶分校/兰德NIMH合作的质量护理研究中心。我们计划对一个独特的数据库进行二次分析，以了解社交网络在支持有抑郁症风险或需要治疗的人，特别是那些服务不足的少数族裔的人参与治疗和药物使用方面所发挥的作用。这一分析的目的是为今后以社区为基础的干预措施的发展提供信息，其中包括将重点放在干预接受者的社会网络上，以此作为改善结果的机制。该数据库包括未得到充分服务的少数族裔的大量样本和白人的匹配样本，这使得能够分析社交网络成员支持少数族裔和白人参与的潜力。它还将允许探讨提高质量干预措施对寻求治疗和坚持治疗相关网络的活跃程度的影响，以及按族裔群体进行比较。该项目将建立在网络分析理论和方法的基础上，调查经历过抑郁症的人如何利用个人网络来应对症状、生活事件、寻求帮助和使用治疗。我们的具体目标是：分析来自关怀伙伴少数族裔和匹配的白人受访者的次要数据，以确定他们的社会互动有何不同，以及用于处理抑郁症状和压力事件的主动应对策略的类型。将使用扎根的理论方法来确定定性数据中的主题，检查来自社会网络访谈的网络可视化，并确定社会网络在提高治疗参与度和结果方面所发挥的作用。我们建议使用混合方法分析方法来开发理论，基于对来自护理伙伴的数据的实证分析，这是一项针对抑郁症的实践发起的质量改进计划的小组级别随机对照试验，其资助截止于2009年3月。数据包括对所有少数族裔和白人的一系列780次深入定性采访，受访者提供了涉及压力、抑郁和治疗的具体事件以及他们如何应对这些情况的详细信息。它还包括来自社交网络访谈的数据，受访者在访谈中提供了关于他们的个人网络的详细信息，网络成员对受访者的压力、抑郁和治疗的积极和消极影响，以及这些网络成员之间的关系结构。这些数据将与9年来的纵向调查数据挂钩。我们的分析结果将为包括少数民族在内的不同群体未来有效的心理健康干预增加证据基础。我们将使用一个社区工作小组来审查数据，帮助生成假设和解释，并在分析中提供文化能力。

DESCRIPTION (provided by applicant): This application is in response to NOT-MH-10-021 's request for competitive revision applications for targeted research on mental health disparities. We request a revision to the UCLA/RAND NIMH Partnered Research Center for Quality Care. We plan secondary analysis of a unique data base to understand the roles that social networks play in supporting the engagement in treatment and medication use of persons who are at risk of or in need of treatment for depression, in particular those who are underserved minorities. The objective of this analysis is to inform the development of future community-based interventions that include a focus on the social networks of intervention recipients as a mechanism for improving outcomes. The data base includes a large sample of underserved minorities and a matched sample of whites which allows for the analyses of the potential of social network members to support engagement for minorities as well as whites. It will also allow for exploration of the effect of a Quality Improvement intervention on the activation level of networks related to treatment seeking and adherence to treatments as well as comparisons by ethnic group. The project will build on network analysis theory and methods to investigate how personal networks are used in coping with symptoms, life events, help-seeking and use of treatments by those who have experienced depression. Our specific aim is: To analyze secondary data from Partners in Care minority and matched white respondents to determine how their social interactions differ and the types of proactive coping strategies used to deal with depressive symptoms and stressful events. A grounded theory approach will be used to identify themes in the qualitative data, examine network visualizations derived from the social network interviews, and identify the roles social networks play in enhancing treatment engagement and outcome. We propose to use a mixed-methods analytic approach to develop theory, based on empirical analysis of data from Partners in Care, a group-level randomized controlled trial of practice-initiated Quality Improvement programs for depression for which funding ended March 2009. Data include a series of 780 in-depth qualitative interviews with all minorities and a sub-sample of whites in which respondents provided detailed information about specific events involving stress, depression, and treatment and how they coped with those situations. It also includes data from a social network interview in which respondents provided detailed information about their personal networks, the positive and negative influence of network members on the respondent's stress, depression and treatment and the structure of relationships among these network members. These data will be linked to 9 years of longitudinal survey data. The findings from our analyses will add to the evidence base for future effective mental health interventions for diverse groups, including ethnic minorities. We will use a community work group to review the data and help generate hypotheses and explanations as well as provide cultural competence in the analysis.