Step Up Wellness Program for Depression Physical Inactivity and Smoking

描述（由申请人提供）：与NIMH R34机制的目标相一致，本补助金申请的主要目标是开发和评估抑郁症患者身心健康干预的可行性和可接受性，这些患者也不活动和吸烟。该计划旨在作为常规初级保健服务的辅助手段。虽然标准的护理干预措施通常单独解决这些问题，但这些行为经常聚集在一起。这种聚集不仅加剧了每种行为的有害影响，而且可能使单独治疗每种行为更加困难，而且可能更加昂贵。将对每一种行为的干预结合到一个单一的计划中更有效，可能会产生协同的有益效果，而一种行为的改变会增强其他行为的改变。此外，人们可能更有可能参与抑郁症，尼古丁依赖或身体活动的正式治疗，当它是在一个全面的健康计划的背景下，而不是作为一个精神健康或药物滥用计划的污名。因此，综合干预可能比标准的常规护理更能提供服务。尽管在单一干预中解决抑郁症和共病行为风险因素的合理性，但这还没有做到。目前的研究是我们在抑郁症护理和开发健康行为改变的单一行为干预方面工作的自然延伸。该试验的目的是开发一种干预措施，重点是同时改善抑郁症状，加强体力活动，促进戒烟。我们将进行一系列试点测试，以评估干预的可行性，耐受性和可接受性，包括随机试点试验。我们假设，与常规护理对照组相比，干预参与者在3个月和6个月随访时报告抑郁症状改善，体力活动增加，戒烟尝试增加。还将探讨次要行为结果。此外，我们将分析健康计划数据，以描述在一个大型医疗机构中，抑郁症患者吸烟和低体力活动的共病发生率。在此资助期间收集的数据将使我们能够评估干预的可接受性和可行性，完善计划材料和概念模型，并收集数据，为未来的有效性试验提供样本和功效计算。抑郁症和危险的健康行为（例如，缺乏体育活动、吸烟）往往是共病的，但标准干预措施的目的是分别治疗每一种行为。单独处理每种行为的效率较低，而且可能比同时处理每种行为的效率更低。目前的研究将设计和评估一个治疗方案，同时解决抑郁症，身体活动水平和吸烟问题。这项工作将提供有价值的信息，这种综合治疗方法的可行性，可接受性和影响，并将奠定基础，为今后在这方面的研究工作。

DESCRIPTION (provided by applicant): Consistent with the goals of the NIMH R34 mechanism, the main objectives of this grant application are to develop and evaluate the feasibility and acceptability of a mental and physical wellness intervention for persons with depression who are also physically inactive and smoke cigarettes. This program is designed as an adjunct to usual primary care services. While standard care interventions typically address each of these issues individually, these behaviors frequently cluster. This clustering not only compounds the deleterious impact of each behavior, but can make treating each in isolation more difficult and, potentially, more costly. Combining intervention for each of these into a single program is more efficient and may have a synergistic beneficial effect, whereas change in one behavior enhances change in the others. Furthermore, people may be more likely to engage in formal treatment for depression, nicotine dependence, or physical activity when it is framed in the context of a comprehensive wellness program and not stigmatized as a mental health or substance abuse program. As a result, the combined intervention may allow a greater reach of services than does standard usual care. Despite the sound rationale for addressing depression and co-morbid behavioral risk factors in a single intervention, this is not yet being done. The current study is a natural extension of our work in depression care and developing single-behavior interventions for health behavior change. The aims of the trial are to develop an intervention focused on concurrently improving depressive symptoms, enhancing physical activity, and promoting smoking cessation. We will conduct a series of pilot tests to assess the feasibility, tolerability, and acceptability of the intervention, including a randomized pilot trial. We hypothesize that, compared to usual care controls, intervention participants will report improved depressive symptoms, increased physical activity, and increased attempts to quit smoking at 3 and 6 month follow-up. Secondary behavioral outcomes will also be explored. In addition, we will analyze health plan data to describe the co-morbid incidence of smoking and low physical activity among persons with depression in a large health care organization. Data collected during this grant will allow us to evaluate the acceptability and feasibility of the intervention, refine the program materials and conceptual model, and collect data to inform sample and power calculations for a future effectiveness trial. Depression and risky health behaviors (e.g., physical inactivity, smoking) tend to be co-morbid, but standard interventions are designed to treat each behavior separately. Treating each behavior individually is less efficient, and potentially less effective, than treating each concurrently. The current study will design and evaluate a treatment program which addresses depression, physical activity level, and smoking simultaneously. This work will provide valuable information about the feasibility, acceptability, and impact of this comprehensive treatment approach and will lay the ground work for future research in this area.