A telephone-delivered mindfulness intervention for patients with comorbid depression and chronic disease

项目总结/摘要 抑郁症是全球残疾的第二大原因，经常与慢性病患者同时发生。与没有抑郁症的人相比，患有抑郁症和共病慢性病的人经历了更差的疾病结局和更高的死亡风险。高达38%的高血压患者（门诊护理实践中最常见的诊断）患有抑郁症，抑郁症与血压控制不良和这些患者死亡率增加14倍独立相关。虽然抑郁症是常见的，而且是可以治疗的，但50%的抑郁症患者在初级保健环境中仍未得到诊断或治疗。 该项目的主要重点是调查非常有希望的证据，即电话传递的正念干预（UPLIFT;使用实践和学习来增加有利的想法），减少癫痫患者的抑郁，可能有效地减少高血压患者的抑郁症状。与其他抑郁症心理治疗相比，UPLIFT具有成本，可访问性和可扩展性优势，因为它不需要有执照的临床医生进行交付，并且以基于组的格式通过电话交付。拟议的研究将：1）调整和建立UPLIFT在高血压患者中的可行性和可接受性; 2）在一项初步随机对照试验中建立UPLIFT与常规治疗的效应量估计值; 3）探索和测试UPLIFT效应的有希望的中介者和调节者。 该研究项目的目标不仅侧重于解决在初级保健环境中广泛使用和循证抑郁症治疗的需求，而且已经开发出关键能力的候选人，其长期职业目标是建立负担得起的证据基础，可访问的，可扩展的身心干预措施，为患者往往是抑郁症和慢性病的衰弱组合。研究培训的目标领域包括：1）基于实践的临床试验; 2）心理生物学评估（即，活动记录和生态瞬时评估）; 3）先进的研究设计和分析;以及4）保护人类受试者。对拟议项目和培训目标的支持将由纽约大学Langone医学中心提供的特殊资源以及候选人指导团队的专业知识提供，该团队由国家认可和NIH资助的行为（Ogedegbe博士和Spruill博士）和睡眠（Jean-Louis博士）科学家组成。该项目的顾问将在混合方法研究和生物统计领域提供更多的专门知识。

Project Summary/Abstract Depression is the second leading cause of disability worldwide and frequently co-occurs in patients with chronic diseases. Individuals with depression and comorbid chronic disease experience poorer disease outcomes and increased risk for mortality, compared to those without depression. Up to 38% of people with hypertension—the most common diagnosis in ambulatory care practices— have comorbid depressive disorders, and depression is independently associated with poor blood pressure control and an up to 14-fold increase in mortality in these patients. Although depression is common and eminently treatable, 50% of patients with depression remain undiagnosed or inadequately treated in primary care settings. The primary focus of this project is to investigate highly promising evidence that a telephone-delivered mindfulness intervention (UPLIFT; Using Practice and Learning to Increase Favorable Thoughts), which reduces depression in patients with epilepsy, may be effective for reducing depressive symptoms in hypertension patients. UPLIFT has cost, accessibility, and scalability advantages over other psychological treatments for depression because it does not require licensed clinicians for delivery and is delivered by phone in a group-based format. The proposed research will: 1) adapt and establish the feasibility and acceptability of UPLIFT in patients with hypertension; 2) establish effect size estimates of UPLIFT vs. usual care in a pilot randomized controlled trial; and 3) explore and test promising mediators and moderators of the effects of UPLIFT. The research project goals focus not only on addressing the need for widely accessible and evidence-based depression treatments in primary care settings, but have been developed to impart key competencies to the candidate whose long-term career goal is to establish an evidence base for affordable, accessible, and scalable mind-body interventions for patients with the often debilitating combination of depression and chronic disease. Targeted areas of research training include: 1) practice-based clinical trials; 2) psychobiological assessments (i.e., actigraphy and ecological momentary assessment); 3) advanced research design and analysis; and 4) protection of human subjects. Support for the proposed project and training goals will be provided by the exceptional resources available at the NYU Langone Medical Center and by the expertise of the candidate’s mentoring team comprised of nationally recognized and NIH-funded behavioral (Drs. Ogedegbe and Spruill) and sleep (Dr. Jean-Louis) scientists. Consultants on the project will provide additional expertise in the areas of mixed methods research and biostatistics.