Telepsychiatry & Culturally Sensitive Treatment of Depressed Asian Americans

描述(申请人提供)：与其他种族相比，亚裔美国人往往没有充分利用心理健康服务，治疗延迟，流失率更高(Kung，2003)。当出现精神疾病症状时，许多服务不足的华裔美国人会向他们的初级保健医生(PCP)寻求帮助(Yeung等人，2004年a)。2003年，申请人获得了职业发展奖，以研究文化敏感的协同治疗(CSCT)对初级保健中服务不足的患有严重抑郁障碍(MDD)的华裔美国人的有效性。CSCT的关键要素是积极筛查以增加对抑郁症患者的认识，由精神病学家进行对文化敏感的咨询，以及护理管理。初步研究结果表明，CSCT提高了MDD患者的病例识别率，促进了接触，并减少了缺乏服务的MDD华裔美国人的治疗差异(Yeung et al.，2006；Yeung，2007)。这项拟议的研究将探讨使用基于心灵感应的CSCT(T-CSCT)将CSCT模式扩展到偏远诊所服务不足的华裔美国人的可行性和有效性。这项研究的具体目的是：1)调查心理咨询是否可以被服务不足的MDD华裔美国人和他们的PCP接受；2)调查T-CSCT在改善偏远诊所中服务不足的MDD华裔美国人治疗结果方面的有效性。受试者将通过初级保健诊所的抑郁症筛查和宣传抑郁症自我筛查的广告来招募。200名MDD筛查呈阳性的未得到充分服务的华裔美国患者将随机接受T-CSCT或常规护理(UC)。比较两组患者的治疗结果。本研究将探讨以心灵感应为基础的文化敏感型精神病治疗对服务不足的患有严重抑郁障碍的华裔美国人的可接受性和有效性。其目标是增加获得精神卫生服务的机会，减少少数民族患者在治疗抑郁症方面的差距。

DESCRIPTION (provided by applicant): Asian Americans tend to underutilize mental health services compared to other ethnic groups, with delayed treatment and higher attrition rates (Kung, 2003). When suffering from symptoms of mental illnesses, many underserved Chinese Americans seek help from their primary care physicians (PCPs) (Yeung et al., 2004a). In 2003, the applicant received a Career Development Award to study the effectiveness of Culturally Sensitive Collaborative Treatment (CSCT) for the treatment of underserved Chinese Americans with major depressive disorder (MDD) in primary care. The key elements of CSCT are active screening to increase recognition of depressed patients, culturally sensitive consultation by a psychiatrist and care management. Preliminary findings show that CSCT improves case recognition, facilitates engagement, and decreases the disparities of treatment among underserved Chinese Americans with MDD (Yeung et al., 2006; Yeung, 2007). This proposed study will investigate the feasibility and effectiveness of using Telepsychiatry-based CSCT (T-CSCT) to extend the CSCT model to underserved Chinese Americans in remote clinics. The specific aims of this study are: 1) To investigate whether telepsychiatry consultation is acceptable to underserved Chinese Americans with MDD and to their PCPs, and 2) To investigate the effectiveness of T-CSCT on improving treatment outcomes of underserved Chinese Americans with MDD in remote clinics. Subjects will be recruited by depression screening in primary care clinics and by advertisements to promote depression self-screening. Two hundred underserved Chinese American patients who screen positive for MDD will be randomized to receive either T-CSCT or Usual Care (UC). Treatment outcomes of patients in these two groups will be compared. This study will examine the acceptability and effectiveness of telepsychiatry- based culturally sensitive psychiatric treatment for underserved Chinese Americans with major depressive disorder. The goal is to increase access to mental health services and to decrease disparities in the treatment of depression among ethnic minority patients.