Developing an Abuse-Sensitive Depression Care Model

描述(由申请人提供)：许多研究证明了基于瓦格纳的慢性护理模式的多方面干预在初级保健中治疗抑郁症的价值，但尽管众所周知抑郁症与亲密伴侣暴力(IPV)之间的关联，但没有一项研究关注有IPV病史的抑郁症妇女的需求。我们的长期目标是测试初级保健环境中对虐待敏感的慢性护理模式对抑郁症妇女的有效性。这项提议的目的是确定与暴力有关的预测因素，以遵守和应对现有的多方面抑郁症护理干预措施，调整该模式，使其更适合虐待幸存者的需求，并评估新的虐待敏感模式的可行性和可接受性，为大型随机对照试验做准备。我们假设，有IPV病史的女性比未受虐待的女性更不可能对传统的抑郁症治疗模式产生反应。我们进一步假设，加入特殊的虐待敏感功能，如虐待评估、社区资源转介、关于IPV的自我管理工具，以及专注于抑郁和虐待的群体认知行为治疗，将提高慢性护理模式治疗抑郁症的有效性。我们提出了三项研究：1)一项前瞻性队列研究，确定与暴力相关的预测因素，以预测我们的合作者正在实施的传统多方面抑郁症护理干预措施(护理管理、精神病学支持、提供者教育和抑郁症登记)的反应；2)对抑郁IPV幸存者进行定性需求评估，以确定他们的信仰、需求、治疗障碍和偏好；以及3)试点干预，评估滥用敏感型抑郁症护理模式的可接受性和可行性。这项工作意义重大，因为它将提高我们向这一具有挑战性的初级保健患者群体提供精神卫生服务的能力。它是创新的，因为它将慢性护理管理的概念应用于研究不足和具有挑战性的人口。该项目将为R01提案提供必要的培训、经验和初步数据，以进行随机对照试验，测试滥用敏感型抑郁症护理模型的有效性。

DESCRIPTION (provided by applicant): Many studies have documented the value of multi-faceted interventions based on Wagner's Chronic Care Model for treating depression in primary care, but despite a well-known association between depression and intimate partner violence, (IPV) none have focused on the needs of depressed women with histories of IPV. Our long-range goal is to test the effectiveness of an abuse-sensitive chronic care model for depressed women seen in primary care settings. The objective of this proposal is to identify violence-related predictors of adherence and response to an existing multi-faceted depression care intervention, to adapt that model to be more responsive to the needs of abuse survivors, and to assess the feasibility and acceptability of the new abuse-sensitive model in preparation for a large randomized control trial. We hypothesize that women with a history of IPV are less likely to respond to traditional depression treatment models than non-abused women. We further hypothesize that the addition of special abuse-sensitive features such as abuse assessments, referrals to community resources, self-management tools about IPV, and group cognitive behavioral therapy focused on depression and abuse will improve the effectiveness of the chronic care model in treating depression. We propose 3 studies: 1) a prospective cohort study identifying violence related predictors of response to a traditional multi-faceted depression care intervention (care management, psychiatry support, provider education and a depression registry) being implemented by our collaborators; 2) a qualitative needs assessment of depressed IPV survivors to determine their beliefs, needs, treatment barriers and preferences; and 3) a pilot intervention assessing the acceptability and feasibility of an abuse sensitive depression care model. This work is significant, as it will improve our ability to provide mental health services to this challenging group of primary care patients. It is innovative as it applies concepts of chronic care management to an understudied and challenging population. This project will provide the necessary training, experience, and preliminary data for a R01 proposal to conduct a randomized controlled trial testing the effectiveness of an abuse-sensitive depression care model.