Reducing depressive symptoms among rural African Americans: REJOICE.

 描述(由申请人提供)：农村非裔美国人不成比例地暴露于贫困、种族主义和歧视等众多压力因素中，这些压力使他们面临经历更高水平的抑郁症状的风险。抑郁症状水平的升高可能会导致一系列负面后果，包括慢性疾病(如高血压、糖尿病等)的发展和管理不善、社会功能不佳、职业功能不佳以及临床抑郁症的发展。尽管存在减少抑郁症状的有效治疗方法，但非洲裔美国农村人往往得不到充分和及时的护理。非裔美国人教堂已被确定为为农村非裔美国人提供抑郁症教育和治疗的潜在场所。在非裔美国人农村社区内，教堂是一个关键门户，通过它可以接触到很大比例(高达85%)的非裔美国人社区。在这些社区中，教堂被用来解决身体健康问题，但很少有人主要关注精神健康问题。通过NIMHD资助的名为“改变三角洲健康(信仰)的信仰学术倡议”的项目，我们由信仰社区领袖和UAMS研究人员组成的合作伙伴关系，在文化上调整了一种基于证据的行为激活干预措施，用于非洲裔美国农村教堂。这种为期8个疗程的行为激活疗法被调整为包括基于信仰的主题、圣经和农村非裔美国人信仰文化的其他方面(例如，研究圣经，使用非信徒领袖来提供干预)。除了评估我们的干预措施的有效性外，确定如何以适当的保真度实施这种干预措施，以维持临床结果，对于提高将研究转化为实践的效率也至关重要。向“真实世界”环境传播基于证据的抑郁症干预措施的工作在解决抑郁症差距方面尤为突出，非洲裔农村美国人因此而背负着不成比例的负担。因此，本申请提出了一项旨在测试文化有效性的混合2语用有效性实施试验 这是一项经过调整的循证干预措施，并收集关于支持在非洲裔美国人农村教堂成功实施这一干预措施所需战略的初步数据。具体地说，这项研究的目的是：1)根据我们NIMHD资助的先导研究的结果，提炼出一种文化上合适的、基于证据的抑郁干预(REJEE)，2)确定REJEGE在治疗后和3个月的随访中是否优于常规护理对照组，3)收集关于在非裔美国农村教会接受和维持REJEGE的“真实世界”实施策略(即面对面培训和辅导电话)的试点数据。

 DESCRIPTION (provided by applicant): Rural African Americans are disproportionately exposed to numerous stressors such as poverty, racism, and discrimination that place them at risk for experiencing elevated levels of depressive symptoms. Elevated levels of depressive symptoms can lead to a host of negative outcomes including both the development of and poor management of chronic illnesses (i.e., hypertension, diabetes, etc.), poor social functioning, poor occupational functioning, and development of clinical depression. Though effective treatments for decreasing depressive symptoms exist, rural African Americans often fail to receive adequate and timely care. African American churches have been identified as potential venues for providing depression education and treatment for rural African Americans. Within the African American rural community, churches represent a key portal through which a large proportion (as much as 85%) of the African American community can be reached. Churches have been used to address physical health outcomes in those communities but few have focused primarily on addressing mental health outcomes. Through the NIMHD-funded project entitled, "Faith Academic Initiatives to Transform Health (FAITH) in the Delta", our partnership, consisting of faith community leaders and UAMS researchers, culturally adapted an evidence-based behavioral activation intervention for use with rural African American churches. This 8- session behavioral activation therapy was adapted to include faith-based themes, Scripture, and other aspects of the rural African American faith culture (e.g., Bible studies, use of lay leaders o deliver the intervention). In addition to assessing the effectiveness of our intervention, ascertaining ways to implement this intervention with proper fidelity to maintain clinical outcomes is also critically important to increase the efficiency of translating research into practice. Work towards disseminating evidence-based depression interventions to "real world" settings is particularly salient in addressing depression disparities, whereby rural African Americans bear a disproportionate burden. Thus, this application proposes a Hybrid-2 pragmatic-effectiveness implementation trial that seeks to test the effectiveness of the culturally adapted evidence-based intervention and gather preliminary data on the strategies necessary to support successful implementation of this intervention in rural African American churches. Specifically, this study aims to: 1) Refine a culturally appropriate, evidence-based depression intervention (REJOICE) based on results from our NIMHD-funded pilot study, 2) Determine whether REJOICE is superior to a usual-care control group at post treatment and a 3-month follow-up, 3) Collect pilot data regarding "real world" implementation strategies (i.e. face to fac training and coaching calls) on the uptake and maintenance of REJOICE in rural African American churches.