Community-Based Behavioral Activation for Latinos with Depression

描述（由申请人提供）：拉丁裔人口在美国的显著增长不能再被忽视。这一群体面临许多挑战，并导致高抑郁率，包括与移民经历相关的压力、文化适应程度低、住房不足、经济负担、失业、受教育程度低、歧视和语言障碍。最近，一种很有前景的抑郁症心理治疗方法，行为激活（BA），在一项大型随机试验中表现良好，表明它与抗抑郁药物一样有效治疗中度至重度抑郁症。BA是一种简单，实用的方法，激活患者实现环境变化，因此可能非常适合拉丁裔抑郁症。因此，这个探索性研究项目的主要目的是增加科学知识的发展和提供一个文化和语言上适合抑郁的拉丁美洲人的BA版本。关于BA-Latino的一些初步工作已经完成，包括完成一份初步手册和一项小型试点研究。当前项目的具体目标是：1)通过焦点小组和额外的试点病例，继续开发BA-Latino治疗手册的过程；2)在拉丁裔社区诊所进行随机临床试验，将BA-Latino与常规治疗进行比较。该项目将继续开发一种经验支持的拉丁裔抑郁症治疗方法，这种方法在保留患者接受治疗和针对影响该人群抑郁症的特定环境变量方面具有潜在的优势。该项目还将进一步评估BA- latino与CBT而不是TAU的对比，进行更大规模的有效性研究，以便对复发和缓解进行更有力的分析，尝试研究将BA- latino培训方法传播到其他社区诊所，并创建BA适应其他少数民族人群的模型，包括非洲裔美国人、美洲原住民和亚裔美国人。

DESCRIPTION (provided by applicant): The remarkable growth of the Latino population in the United States can no longer be ignored. Many challenges face this group and contribute to high rates of depression, including the stress associated with the migration experience, low levels of acculturation, inadequate housing, financial burdens, unemployment, low educational attainment, discrimination, and the language barrier. Recently, a promising psychotherapeutic treatment for depression, Behavioral Activation (BA), has performed well in a large randomized trial, suggesting it is as effective as anti-depressant medication for moderate-to-severe depression. BA is a simple, pragmatic approach that activates patients to achieve environmental change and thus may be well suited to Latino depression. Thus, the primary purpose of this exploratory research project is to increase scientific knowledge on the development and delivery of a culturally and linguistically adapted version of BA for depressed Latinos. Some initial work on BA-Latino has already been completed including the completion of an initial manual and a small pilot study. The specific aims of the current project are to: 1) Continue the process of developing the treatment manual for BA-Latinos with focus groups and additional pilot cases, and 2) Compare BA-Latino to treatment-as-usual with a randomized clinical trial in a Latino community clinic. The project will continue the development of an empirically-supported approach to Latino depression that potentially has strengths at retaining patients in treatment and targeting the specific environmental variables that influence depression in this population. This project also will lead to further evaluations of BA-Latino compared to CBT rather than TAU, larger effectiveness studies that allow for more powerful analyses of relapse and remission, attempts to study the dissemination of the BA-Latino training methods to additional community clinics, and creation of a model for the adaptation of BA for other minority populations, including African Americans, Native Americans and Asian Americans. PUBLIC HEALTH RELEVANCE: This project will develop and evaluate a culturally and linguistically adapted version of Behavioral Activation (BA) for Latinos with depression. BA is a simple, pragmatic approach that activates patients to achieve environmental change and thus may be well suited to Latino depression, which often is characterized by seemingly overwhelming environmental obstacles. This project will lead to further evaluations of BA-Latino, larger effectiveness studies that explore depression relapse and remission, attempts to study the dissemination of the BA-Latino training methods to additional community clinics, and creation of a model for the adaptation of BA for other minority populations, including African Americans, Native Americans and Asian Americans.