Telephone-Based Depression Care for Rural Latino Primary Care Patients

描述（由申请人提供）：在拉丁美洲人中，抑郁症被低估和治疗不足。虽然特定的手动心理疗法，如认知行为疗法（CBT）已被证明对拉丁美洲人有效，许多拉丁美洲人更喜欢心理疗法作为抑郁症的一线治疗，但很少有拉丁美洲人接受这种治疗。农村地区的拉丁美洲人在心理治疗方面面临更多障碍，包括缺乏可用的心理健康提供者和地理隔离。为了解决这些障碍，这项拟议的试点将测试基于电话的CBT干预抑郁症低收入拉丁美洲初级保健患者在农村东部华盛顿州。一项在城市管理式护理环境中对讲英语的患者有效的手动电话CBT干预已被翻译成西班牙语，并将进行最低限度的调整，然后在80名患有抑郁症的低收入拉丁美洲女性和男性中进行测试，这些患者将通过系统筛选进行识别，并随机分配到研究干预与常规护理。将在基线、6周、3个月和6个月时测量结局。我们将检查干预对以下方面的影响：抑郁症状（主要结局）以及患者评定的改善、患者满意度、残疾和健康风险行为（次要结局）。我们还将估计干预的直接成本。通过对患者和医疗服务提供者的定性离职访谈，该研究将探讨这一人群中抑郁症护理的社会文化和实际障碍，以及进一步调整干预措施以解决这些障碍的必要性。一个由拉丁美洲患者的文化敏感的临床干预的概念模型指导的专家小组将使用研究结果，进一步调整和完善关于8个关键要素的干预：语言，人，隐喻，内容，概念，目标，方法和背景。该研究的最终目标是开发一种文化上合适的，可持续的和具有成本效益的抑郁症治疗计划，可以纳入为低收入农村拉丁美洲人服务的常规初级保健实践中，并可以在全面随机对照试验中进行测试。据我们所知，我们的研究是第一个研究CBT在农村拉丁裔人口中的有效性。性能现场（S）（组织，城市，州）亚基马谷农场工人诊所的家庭医疗中心，瓦拉瓦拉，华盛顿华盛顿大学，西雅图，华盛顿这项试点研究测试了基于电话的认知行为治疗干预抑郁症的低收入拉丁美洲初级保健患者在华盛顿东部农村。它最低限度地适应手动电话CBT显示有效的城市管理的护理环境。据我们所知，我们的研究是第一个研究CBT在农村拉丁裔人口中的有效性。

DESCRIPTION (provided by applicant): Among Latinos, depression is underdetected and undertreated. While specific manualized psychotherapies, such as cognitive behavioral therapy (CBT) have been shown effective for Latinos, and many Latinos prefer psychotherapy as first line treatment for depression, few Latinos receive such treatment. Latinos in rural areas face additional barriers to psychotherapy, including lack of available mental health providers and geographic isolation. In order to address these barriers, this proposed pilot will test a telephone-based CBT intervention for depressed low-income Latino primary care patients in rural Eastern Washington State. A manualized telephone CBT intervention shown effective in an urban managed care setting among English-speaking patients has been translated into Spanish and will be minimally adapted and then tested among 80 low-income Latino women and men with depressive disorder who will be identified through systematic screening and randomized to the study intervention vs. usual care. Outcomes will be measured at baseline, 6 weeks, and 3 and 6 months. We will examine the effect of the intervention on: depressive symptoms (the primary outcome) as well as patient-rated improvement, patient satisfaction, disability, and health risk behaviors (secondary outcomes). We will also estimate the direct costs of the intervention. Using qualitative exit interviews of patients and providers, the study will explore socio-cultural and practical barriers to depression care in this population and the need to further adapt the intervention to address these barriers. An expert panel guided by a conceptual model of culturally sensitive clinical interventions for Latino patients will use study results to further adapt and refine the intervention in regards to 8 key elements: language, persons, metaphors, content, concepts, goals, methods, and context. The study's ultimate objective is to develop a culturally appropriate, sustainable, and cost-effective depression treatment program that can be incorporated into routine primary care practices serving low-income rural Latinos and that can be tested in a full scale randomized controlled trial. To our knowledge, ours is the first study to examine the effectiveness of CBT in a rural Latino population. PERFORMANCE SITE(S) (organization, city, state) Yakima Valley Farmworkers Clinic's Family Medical Center, Walla Walla, Washington University of Washington, Seattle, Washington This pilot study tests a telephone-based cognitive behavioral therapy intervention for depressed low-income Latino primary care patients in rural Eastern Washington. It minimally adapts a manualized telephone CBT shown effective in an urban managed care setting. To our knowledge, ours is the first study to examine the effectiveness of CBT in a rural Latino population.