A Multimedia Program to Improve Antidepressant Adherence and Prevent Relapse

描述（由申请人提供）：重度抑郁症是困扰成年人的最普遍的精神障碍之一。它严重影响角色功能，通常会反复发作。尽管抗抑郁药物已被证明有效，并且是治疗抑郁症最常见的方法，但高达70%的成年人没有完成推荐的治疗方案。也有证据表明，在预防抑郁症复发方面，认知行为疗法结合药物治疗比单独药物治疗更有效。该项目将开发和评估一种交互式多媒体干预，旨在改善治疗方案的依从性，防止接受抗抑郁药物的门诊患者抑郁症复发。经过经验验证的框架将适用于通过互联网或CD/DVD-ROM进行自我管理。干预将包括以知识和技能为基础的模块，包括：理解抑郁症、坚持治疗方案、情绪监测、行为激活、认知重构、人际关系、放松和未来规划。以能力为基础的教学设计将采用基于视频的教程、推荐和行为建模小片段来组织多个会议。其他浏览器模块将包括抑郁症自我筛查、学习放松、增强社交技能、改善沟通和解决问题的能力。在线支持系统将包括一个电子公告板，每周一次与干预教练的个人会议，以及一个专家提问论坛。将开发一种协作护理工具，使管理护理人员能够监测患者抗抑郁治疗的进展情况和参与IMM计划的情况，并提供持续支持。干预措施将包括六个目标人群：处于早期、中期和晚期的男性和女性。该计划的基本结构将对每个目标人群相同，但具体内容将针对每个用户群体进行定制。第一阶段的原型以18-39岁的女性为目标，提供理解抑郁症、坚持治疗、情绪监测和行为激活方面的培训。在受试者内设计可行性研究中对其进行了评估。结果显示，在抑郁症状、愉快活动参与、知识、感知耻辱、自我效能和使用所教技能的行为意图方面，前后和随访前都有显著的变化。研究对象发现该程序易于使用，并给予了很高的满意度。完全开发的II期产品将在一项大型随机试验（N = 270）中进行评估，随访6个月，比较干预和对照条件下抑郁症状的变化、抑郁缓解和复发率。受试者将是通过初级保健接受抗抑郁治疗的管理护理患者。由于重度抑郁症的高患病率和相关损伤，它已成为一个重要的公共卫生问题。虽然抗抑郁药物已被证明有效，并且是抑郁症最常见的治疗方法，但不坚持抗抑郁药物治疗是抑郁症复发和复发的关键变量。有证据表明，认知行为疗法与药物治疗相结合特别有效，因此迫切需要制定预防复发的方案，强调抗抑郁药物治疗方案的依从性，并结合易于实施和广泛传播的认知行为策略。

DESCRIPTION (provided by applicant): Major depression is one of the most prevalent mental disorders to afflict adults. It seriously impacts role functioning and typically takes a recurrent course. Although antidepressant medications have proven efficacy and are the most common treatment for depression, up to 70% of adults do not complete the recommended regimen. There is also evidence that cognitive-behavioral therapy in conjunction with medications is more effective than medications alone in preventing depression relapse. This project will develop and evaluate an interactive multimedia intervention aimed at improving regimen adherence and preventing depression relapse for outpatients receiving antidepressants. Empirically validated frameworks will be adapted for self-administration via the Internet or CD/DVD-ROM. The intervention will consist of knowledge- and skills-based modules including: understanding depression, regimen adherence, mood monitoring, behavioral activation, cognitive restructuring, interpersonal relations, relaxation, and planning for the future. The competency-based instructional design will be structured for multiple sessions using video- based tutorials, testimonials, and behavior modeling vignettes. Additional browser modules will include depression self-screening, learning to relax, enhancing social skills, and improving communication and problem solving. The online support system will include an electronic bulletin board, personal weekly conferences with an intervention coach, and an ask-an-expert forum. A collaborative care tool will be developed to allow managed care staff to monitor their patients' progress with antidepressant treatment and engagement in the IMM program, as well as provide ongoing support. The intervention will include six target populations: men and women in early, mid and late life. The basic structure of the program will be the same for each target population, but specific content will be customized to each user group. The Phase I prototype, targeted to 18-39 year-old women, provided training on understanding depression, regimen adherence, mood monitoring, and behavioral activation. It was evaluated in a within-subjects design feasibility study. The results showed significant pre to post and pre to follow-up changes in depressive symptomatology, pleasant activity engagement, knowledge, perceived stigma, self-efficacy, and behavioral intentions to use the skills taught. Subjects found the program easy to use and gave it high satisfaction ratings. The fully developed Phase II product will be evaluated in a large randomized trial (N = 270) with a six- month follow-up period to compare change in depressive symptoms as well as depression remission and relapse rates between intervention and control conditions. Subjects will be managed care patients who are undergoing antidepressant treatment via primary care. Major depression has become a critical public health issue given its high prevalence and associated impairments. Although antidepressant medications have proven efficacy and are the most common treatment for depression, nonadherence to antidepressant therapy is a key variable associated with depression relapse and recurrence. Given the evidence that combining cognitive-behavioral therapy with medications is especially efficacious, there is a critical need to develop relapse prevention programs that emphasize antidepressant medication regimen adherence combined with cognitive-behavioral strategies that can be easily implemented and widely disseminated.