Clinical Implications of Depression-Based Stigma

描述（由申请人提供）：这项资助研究与抑郁症有关的耻辱。抑郁症是世界范围内导致残疾和生活质量下降的最重要因素之一，但大多数患者没有得到适当的治疗。少数民族和穷人尤其如此。在这项拨款中，我们研究了与病耻感相关的问题在多大程度上解释了抑郁症未能得到适当治疗的原因。具体来说，我们研究了对抑郁症相关的耻辱感的关注程度，例如由于其他人对疾病或治疗的认识而担心失去工作，保险或朋友，解释了未满足的抑郁症护理需求。我们还将调查提供治疗或提高治疗率的努力是否可以预测有和没有耻辱感问题的人的结果。我们使用了两个现有的数据集：(1)Partners in Care，一项随机对照试验，旨在改善初级卫生保健机构对抑郁症的护理质量；(2)We Care，一项随机对照试验，旨在为弱势的年轻少数族裔女性提供指导性护理（CBT或帕罗西汀）。这些研究使我们能够检查与耻辱感相关的担忧对抑郁症治疗的接受度和结果的影响，并包括大量贫困和少数民族样本。最后，我们在全国代表性的社区研究中纳入了病耻感项目，社区医疗保健，由罗伯特伍德约翰逊基金会资助，这将使我们能够估计全国代表性样本中与抑郁相关的病耻感率。这项拨款的具体目的是：1)评估一个具有全国代表性的社区样本中与抑郁症相关的耻辱感的关注率；2)确定对抑郁症相关污名化的关注对精神卫生服务使用的影响，控制已知影响获得护理的需求、易感因素和使能因素；3)研究增加使用与指南一致的初级保健治疗的干预措施是否能有效提高对抑郁相关病耻感的高度和低水平关注者的护理质量；4)研究使用与指南一致的抑郁症治疗（与促进获得这些治疗的质量改进计划相反）是否能改善对抑郁症相关污名的高度关注和低关注的人的结果。在每个目标中，我们将探讨研究结果在多大程度上因种族而异。

DESCRIPTION (provided by applicant): This grant examines stigma as it relates to depressive illness. Depressive disorders are among the most significant contributors to disability and reduced quality of life worldwide, but most patients don't receive appropriate care. This is particularly true of ethnic minorities and the poor. In this grant, we examine the extent to which stigma related concerns explain failure to receive appropriate care for depression. Specifically, we examine the extent to which concerns about depression-related stigma, such as fears about losing a job, insurance, or friends due to other people's awareness of illness or treatment, explain unmet need for depression care. We will also investigate if efforts to provide treatments or improve rates of treatment predict outcomes for both persons with and without stigma concerns. We use two existing data sets: (1) Partners in Care, a randomized, controlled trial of improving quality care for depression in primary health care settings and (2) We Care, a randomized controlled trial of providing access to guideline care (either CBT or paroxetine) for disadvantaged, young minority women. These studies allow us to examine the impact of stigma related concerns on acceptance and outcomes of depression care and include large samples of poor and ethnic minorities. Finally, we include stigma items in a nationally representative community study, Healthcare for Communities, funded by the Robert Wood Johnson Foundation that will allow us to estimate rates of depression-related stigma in a nationally representative sample. The specific aims of this grant are: 1) to assess rates of concerns about depression-related stigma in a nationally representative community sample; 2) to determine the impact of concerns about depression-related stigma on use of mental health services, controlling for need, predisposing, and enabling factors known to affect access to care; 3) to examine whether interventions to increase the use of guideline-concordant primary care treatments for depression are effective at improving the quality of care for both persons with high and low levels of concern about depression-related stigma; 4) to examine whether use of guideline-concordant treatments for depression (as opposed to quality improvement programs that promote access to those treatments) improve outcomes for both persons with high and low concerns about depression related stigma. Within each of the aims, we will explore the extent to which the findings vary by ethnicity.