Targeted and Tailored Messages to Enhance Depression Care

描述（由申请人提供）：对患者和医生的调查表明，处方药的直接面向消费者广告（DTCA）影响公众态度和患者行为。在最近的一项随机对照试验（RCT） MH64683中，我们发现患者对抗抑郁药的要求增加了抑郁相关的病史记录，询问自杀想法，并提供适当的初始治疗。但是，旨在鼓励患者参与的信息能否减少耻辱感，并克服在诊所内外实现最佳抑郁症护理的障碍？此外，基于目标与定制的传播策略的比较效果如何？在这个应用中，我们提出了一个两阶段的研究，以提高抑郁症的初始治疗的交付。首先，利用市场研究和心理学理论，我们将开发两种针对有抑郁风险的工作年龄成年人的沟通干预措施：(1)针对人口统计学的公共服务公告（psa）和(2)针对社会心理学的交互式多媒体计算机程序（IMCP）。其次，我们将在初级保健办公室进行随机对照试验，将两种干预措施相互比较，并与“注意力控制”（关于睡眠卫生的视频）进行比较。这个项目有两个具体目标。首先是开发和测试有针对性的psa和量身定制的IMCP，旨在减少耻辱感，促进有抑郁风险的工作年龄成年人有效参与护理。对护理的加强参与将通过以下可能性的增加来衡量：a)为抑郁症状寻求护理和b)明确要求抑郁症治疗。第二个目的是比较有针对性的psa、量身定制的IMCP和睡眠卫生视频（对照）对患者对抑郁症求医态度、患者的治疗请求、医生的病史记录和治疗建议以及患者临床结果的影响。作为探索性的子目标，我们还将研究对MD诊断准确性和治疗差异的影响。在这个项目中，形成性研究将用于开发和测试有针对性的公共服务公告（psa）和量身定制的交互式多媒体计算机程序（IMCP），旨在提高抑郁症护理寻求，鼓励适当的抑郁症治疗请求，并减少抑郁症相关的污名。然后，在初级保健办公室进行的一项随机对照试验中，将相互比较这两个项目对抑郁症护理和结果的影响，并与对照组进行比较。

DESCRIPTION (provided by applicant): Surveys of patients and physicians show that direct-to-consumer advertising (DTCA) of prescription drugs influences public attitudes and patient behaviors. In a recent randomized controlled trial (RCT), MH64683, we showed that patients' requests for antidepressants increase depression-related history-taking, inquiry about suicidal thoughts, and delivery of appropriate initial treatment. But can messages designed to encourage patient participation reduce stigma and overcome barriers to optimal depression care in the clinic and beyond? Furthermore, what is the comparative effectiveness of communication strategies based on targeting vs. tailoring? In this application, we propose a two-phase study to enhance delivery of initial treatment for depression. First, using approaches informed by market research and psychological theory, we will develop two communication interventions aimed at working age adults at risk for depression: (1) demographically targeted Public Service Announcements (PSAs) and (2) a social-psychologically tailored interactive multimedia computer program (IMCP). Second, we will conduct a RCT in primary care offices to compare the two interventions with each other and with an "attention control" (video on sleep hygiene). This project has two specific aims. The first is to develop and test targeted PSAs and a tailored IMCP designed to reduce stigma and promote effective participation in care among working- aged adults at risk for depression. Enhanced participation in care will be measured as an increase in the likelihood of: a) seeking care for depressive symptoms and b) making explicit requests for depression treatment. The second aim is to compare effects of targeted PSAs, a tailored IMCP, and a sleep hygiene video (control) on patients' attitudes towards depression care-seeking, patients' treatment requests, physicians' history-taking and treatment recommendations, and patients' clinical outcomes. As exploratory sub-aims, we will also examine effects on MD diagnostic accuracy and treatment disparities. In this project, formative research will be used to develop and test targeted public service announcements (PSAs) and a tailored interactive multimedia computer program (IMCP) designed to enhance depression care seeking, encourage appropriate depression treatment requests, and reduce depression-related stigma. Then, in a randomized controlled trial conducted in primary care offices, the effects of the two programs on depression care and outcomes will be compared with each other and with a control group.