Collaborative Care for Depression and Diabetic Retinopathy in African Americans

描述（由申请人提供）：抑郁症发生在20-25%患有糖尿病视网膜病变（DR）的老年非裔美国人中，并通过损害糖尿病自我管理实践和提高血红蛋白A1 C水平（HbA 1C）加速DR的进展。治疗抑郁症可以改善糖尿病自我管理，降低HbA 1C，从而防止DR的进展。然而，AA比白人更不可能接受抑郁症治疗。与白人相比，AA的血糖控制较差，DR（39% vs. 26%）、威胁视力的DR（9.3% vs. 3.2%）和法律的失明（7.3% vs. 5.4%）的发生率较高，抑郁是原因之一。这些差异需要新的干预措施来治疗抑郁症，改善血糖控制，并防止老年AA的DR进展。我们寻求一个规划补助金的支持，以完善的方法，进行可行性研究，并制定了一个计划的随机对照临床试验（RCT）的程序手册，题为“抑郁症和糖尿病视网膜病变的合作护理”（CC-DDR）。CC-DDR是一种新型的心理健康/眼科干预，我们正在设计用于治疗轻度至中度DR和共病抑郁的老年AA患者的抑郁和降低HbA 1C水平。社区卫生工作者，谁匹配参与者的种族和文化背景，将与眼科医生在视网膜诊所，教育参与者之间的联系抑郁症，糖化血红蛋白，和DR，并将护理扩展到家庭，他们将使用行为激活治疗抑郁症和提高糖尿病自我管理技能。在进行全面的CC-DDR RCT之前，我们提出了一个3阶段的规划补助金。在第一阶段，我们将：1）制定CC-DDR治疗方案; 2）开发一种工具来评估治疗师的依从性和能力; 3）寻求专家小组的意见来完善这些材料。在第二阶段，我们会进行公开试验，以评估CC-DDR的可行性。在第三阶段，我们将为计划中的CC-DDR随机对照试验制定程序手册。随着人口老龄化和DR的患病率在老年AA中迅速增加，如果我们要保护这一人群的视力，那么治疗抑郁症、降低HbA 1C和预防DR进展的文化相关干预措施是重要的。

DESCRIPTION (provided by applicant): Depression occurs in 20-25% of older African Americans with diabetic retinopathy (DR) and accelerates progression of DR by compromising diabetes self-management practices and raising hemoglobin A1C levels (HbA1C). Treating depression improves diabetes self-management and lowers HbA1C and may thereby prevent progression of DR. AAs, however, are less likely to be treated for depression than whites. Depression contributes to why AAs have worse glycemic control and higher rates of DR (39% vs. 26%), vision-threatening DR (9.3% vs. 3.2%), and legal blindness (7.3 vs. 5.4%) than whites. These disparities necessitate new interventions to treat depression, improve glycemic control, and prevent progression of DR in older AAs. We seek support for a planning grant to refine the methods, conduct a Feasibility Study, and develop a Manual of Procedures for a planned randomized controlled clinical trial (RCT) entitled, "Collaborative Care for Depression and Diabetic Retinopathy" (CC-DDR). CC-DDR is a novel mental health/ophthalmologic intervention that we are designing to treat depression and lower HbA1C levels in older AAs with mild-to-moderate DR and comorbid depression. Community Health Workers, who match participants in race and cultural background, will work with ophthalmologists in the retina clinic to educate participants on the links between depression, HbA1C, and DR, and will extend care into the home where they will use Behavior Activation to treat depression and improve diabetes self-management skills. Before moving to a full-scale RCT of CC-DDR, we propose a 3- stage planning grant. In Stage I we will: 1) develop the CC-DDR treatment protocol; 2) develop a tool to assess therapists' adherence and competency; and 3) seek input from a panel of experts to refine these materials. In Stage II we will conduct an open trial of CC-DDR to evaluate its feasibility. In Stage III we will develop the Manual of Procedures for the planned RCT of CC-DDR. As the population ages and the prevalence of DR rapidly increases in older AAs, a culturally relevant intervention that treats depression, lowers HbA1C, and prevents progression of DR is significant if we are to preserve vision in this population.