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许多压力源，如贫困，种族主义和歧视，使他们处于经历抑郁症状水平升高的风险之中。抑郁症状水平的升高会导致一系列负面结果，包括慢性疾病的发展和管理不善（即，高血压、糖尿病等），不良的社会功能，不良的职业功能和临床抑郁症的发展。虽然存在减少抑郁症状的有效治疗方法，但农村非裔美国人往往无法得到充分和及时的护理。非裔美国人教堂已被确定为为提供抑郁症教育和治疗的农村非裔美国人的潜在场所。在非洲裔美国人的农村社区，教堂是一个关键的门户网站，通过它可以达到很大一部分（高达85%）的非洲裔美国人社区。教会已被用来解决这些社区的身体健康结果，但很少有主要侧重于解决心理健康的结果。通过NIMHD资助的项目，题为“信仰学术倡议，以改变健康（信仰）在三角洲”，我们的伙伴关系，由信仰社区领袖和UAMS研究人员，文化适应了基于证据的行为激活干预与农村非洲裔美国人教会使用。这8个疗程的行为激活疗法被改编为包括基于信仰的主题，圣经和农村非洲裔美国人信仰文化的其他方面（例如，圣经研究，利用外行领导人进行干预）。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“真实的世界”传播循证抑郁干预措施的工作在解决抑郁症差异方面尤为突出，农村非洲裔美国人承担了不成比例的负担。因此，本申请提出了一个混合-2语用有效性实施试验，旨在测试文化的有效性， 适应基于证据的干预措施，并收集必要的战略，以支持在农村非洲裔美国人教会成功实施这一干预措施的初步数据。具体而言，本研究旨在：1）根据我们NIMHD资助的试点研究的结果，完善一种文化上适当的、以证据为基础的抑郁干预（REJOICE），2）确定REJOICE在治疗后和3个月随访时是否上级常规护理对照组，3）收集关于“真实的世界”执行战略的试点数据（即面对面的培训和辅导电话）在农村非洲裔美国人教会的吸收和维持喜乐。

 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.