Telepsychiatry & Culturally Sensitive Treatment of Depressed Asian Americans

描述（由申请人提供）：与其他族裔群体相比，亚裔美国人往往对精神卫生服务利用不足，治疗延迟，流失率较高（Kung，2003）。当患有精神疾病症状时，许多服务不足的华裔美国人向他们的初级保健医生（PCP）寻求帮助（Yeung等人，2004年a）。2003年，申请人获得了职业发展奖，以研究文化敏感性合作治疗（CSCT）在初级保健中治疗严重抑郁症（MDD）的有效性。CSCT的关键要素是积极筛查，以提高对抑郁症患者的认识，精神科医生的文化敏感咨询和护理管理。初步研究结果表明，CSCT提高了病例识别，促进了参与，并减少了患有MDD的服务不足的华裔美国人的治疗差异（Yeung等人，2006; Yeung，2007）。这项拟议的研究将调查使用远程精神病学CSCT（T-CSCT）的可行性和有效性，以扩大CSCT模式，在偏远诊所服务不足的华裔美国人。本研究的具体目的是：1）调查远程精神病学咨询是否可接受的服务不足的华裔美国人与MDD和他们的PCP，和2）调查T-CSCT的有效性，改善治疗结果的服务不足的华裔美国人与MDD在偏远的诊所。受试者将通过初级保健诊所的抑郁症筛查和促进抑郁症自我筛查的广告招募。200名MDD筛查阳性的未得到充分服务的美籍华人患者将随机接受T-CSCT或口腔护理（UC）。比较两组患者的治疗结局。本研究将探讨远程精神病学为基础的文化敏感的精神病治疗的可接受性和有效性的服务不足的美国华人与重性抑郁症。目标是增加获得精神卫生服务的机会，减少少数民族患者在治疗抑郁症方面的差距。

DESCRIPTION (provided by applicant): Asian Americans tend to underutilize mental health services compared to other ethnic groups, with delayed treatment and higher attrition rates (Kung, 2003). When suffering from symptoms of mental illnesses, many underserved Chinese Americans seek help from their primary care physicians (PCPs) (Yeung et al., 2004a). In 2003, the applicant received a Career Development Award to study the effectiveness of Culturally Sensitive Collaborative Treatment (CSCT) for the treatment of underserved Chinese Americans with major depressive disorder (MDD) in primary care. The key elements of CSCT are active screening to increase recognition of depressed patients, culturally sensitive consultation by a psychiatrist and care management. Preliminary findings show that CSCT improves case recognition, facilitates engagement, and decreases the disparities of treatment among underserved Chinese Americans with MDD (Yeung et al., 2006; Yeung, 2007). This proposed study will investigate the feasibility and effectiveness of using Telepsychiatry-based CSCT (T-CSCT) to extend the CSCT model to underserved Chinese Americans in remote clinics. The specific aims of this study are: 1) To investigate whether telepsychiatry consultation is acceptable to underserved Chinese Americans with MDD and to their PCPs, and 2) To investigate the effectiveness of T-CSCT on improving treatment outcomes of underserved Chinese Americans with MDD in remote clinics. Subjects will be recruited by depression screening in primary care clinics and by advertisements to promote depression self-screening. Two hundred underserved Chinese American patients who screen positive for MDD will be randomized to receive either T-CSCT or Usual Care (UC). Treatment outcomes of patients in these two groups will be compared. This study will examine the acceptability and effectiveness of telepsychiatry- based culturally sensitive psychiatric treatment for underserved Chinese Americans with major depressive disorder. The goal is to increase access to mental health services and to decrease disparities in the treatment of depression among ethnic minority patients.