Effectiveness and Implementation of a Mindfulness Intervention for Depressive Symptoms Among Low-income, Racial/Ethnic Minority Adults in a Federally Qualified Health Center

本R 01（PA-16-160）应用程序的目的是检查正念的临床有效性 减少社会经济弱势群体、种族/少数民族抑郁症状的干预措施 成年人，并探讨相关的实施因素，在联邦合格的健康中心（CIMHC）。这 研究将用于开发一种可推广的模式，以提供简化的心理健康干预措施， 以社区为基础的环境将广泛传播，并可扩展到其他人群。黑色和 西班牙裔成年人比白色人更有可能在初级保健中接受抑郁症治疗， 抗抑郁药是最常见的治疗方法。然而，黑人和西班牙裔成年人不太可能 比白人更容易接受抗抑郁药在小学内提供的正念抑郁干预 低收入、种族/少数民族的个人， 服务不足的人口。越来越多的研究表明，正念干预可以减少 炎症反应，可以由压力引发，并改善心理结果。我们建议 进行一项随机对照试验，以测试正念干预（M-Body）的临床效果， 与常规护理相比，在低收入种族/少数民族成年人中， 你好。在初步研究中，18-65岁有抑郁症状的妇女从一个健康中心招募， 参加为期8周，每次90分钟的M-Body干预。M-Body干预措施基于 基于正念的减压（MBSR），并已为CIMHC设置和患者人群量身定制。 来自PI（N=31）和CNOHC健康教育者（N=41）领导的四个试点小组的数据提供了以下证据： 可接受性、可行性以及随时间推移改善的抑郁症状和压力结果。成人（N=330）， 抑郁症状将从芝加哥，IL地区的一个社区健康中心招募，该地区为大多数种族/民族提供服务。 生活在贫困线或贫困线以下的少数民族（90%）（74%）。一半的患者将被随机分配至 M-Body干预臂，他们将接受由CIMHC工作人员领导的8周正念训练， 一半将随机接受常规治疗。与实施干预措施有关的因素的信息， 将通过召开一系列工作组会议和与联合国人权事务高级专员办事处工作人员、执行 领导和社区利益相关者。具体目标：1）确定正念的有效性 干预（M-Body）与针对种族/民族的增强常规护理相比， 少数民族成年人在联邦合格的健康中心（CIMHC）; 2）探索潜在的调解人（压力相关 生物标志物，正念）和干预措施的调节因素（年龄，个人，社会，环境压力） 3）对与准备工作有关的组织和个人机构因素进行广泛评估， 使用混合方法方法，在一个医疗保健中心实施M-Body干预措施。

The objective of this R01 (PA-16-160) application is to examine the clinical effectiveness of a mindfulness intervention on reducing depressive symptoms among socio-economically disadvantaged, racial/ethnic minority adults and explore factors related to implementation in a Federally Qualified Health Center (FQHC). This research will be used to develop a generalizable model for delivery of streamlined mental health interventions in community based settings that will be broadly disseminated and scalable to other populations. Black and Hispanic adults are more likely than those who are White to receive depression treatment in primary care, where antidepressants are the most commonly offered treatment. However, Black and Hispanic adults are less likely than Whites to find antidepressants acceptable. A mindfulness depression intervention provided within primary care may be more accessible and acceptable for low-income, racial/ethnic minority individuals, a severely underserved population. Accumulating research suggests that mindfulness interventions reduce the inflammatory response that can be triggered by stress and improves psychological outcomes. We propose to conduct a randomized controlled trial to test the clinical effectiveness of a mindfulness intervention (M-Body) on reducing depressive symptoms, compared to usual care, among low-income racial/ethnic minority adults in a FQHC. In preliminary studies, women ages 18-65 with depressive symptoms were recruited from a FQHC to participate in the 8-week, 90 minute per session M-Body intervention. The M-Body intervention is based on Mindfulness Based Stress Reduction (MBSR) and has been tailored for the FQHC setting and patient population. Data from four pilot groups led by the PI (N=31) and FQHC health educator (N=41) provide evidence of acceptability, feasibility and improved depressive symptom and stress outcomes over time. Adults (N=330) with depressive symptoms will be recruited from a FQHC in the Chicago, IL area that serves majority racial/ethnic minority individuals (90%) living at or below the poverty line (74%). Half of the patients will be randomized to the M-Body intervention arm where they will receive 8-weeks of mindfulness training led by FQHC staff and the other half will be randomized to usual care. Information on factors relevant to implementation of the intervention in the FQHC will be obtained by convening a series of workgroups and individual interviews with FQHC staff, executive leadership and community stakeholders. Specific Aims: 1) Determine the effectiveness of a mindfulness intervention (M-Body) on reducing depressive symptoms compared to enhanced usual care for racial/ethnic minority adults in a Federally Qualified Health Center (FQHC); 2) Explore potential mediators (stress related biomarkers, mindfulness) and moderators (age, personal, social, environmental stressors) of the intervention's effect; 3) Conduct a broad assessment of organizational and individual agency factors related to preparation and implementation of the M-Body intervention in a FQHC using a mixed methods approach.