Population-Based Psychiatric Intervention in Primary Care

描述（由申请人提供）：这是一个NIMH中期职业研究者奖在以患者为导向的研究（NIMH工作人员已告知博士Katon，他可以提交他的K-24奖作为一个完整的教授竞争续期的请求）。Katon博士先前的研究：1）开发创新的“协作护理”干预措施，以改善初级保健环境中抑郁症和焦虑症患者的护理质量和结果; 2）提高对焦虑症和抑郁症对常见医学疾病患者的不良影响的理解;以及3）开发干预措施以改善患有慢性内科疾病和共病抑郁症和焦虑症的患者的精神病学结果。该提案的具体目标包括：1）继续提高Katon博士的流行病学，生物统计学和卫生经济学技能，以便在基于人群的研究中证明抑郁症和慢性医学疾病之间的双向不良相互作用。这些以人群为基础的研究的证据将通过以下方式得到：a）在横断面和纵向研究中显示抑郁症对医学症状负担、功能损害、对药物治疗方案的依从性、医学并发症和死亡率的不利影响;和B）通过纵向研究表明，残留的抑郁症状和医疗疾病的并发症与发生重大疾病的风险较高有关，抑郁症和新的功能缺陷。其他目标包括：2）开发和测试抑郁症和慢性疾病患者的协作护理模式的适应性，旨在改善医疗疾病控制，行为风险因素，以及提高抑郁症护理质量; 3）继续调整协作护理干预措施，并在精神卫生保健质量存在差异的新人群（如患有抑郁症的青少年人群）中测试其有效性，注意力缺陷多动障碍（ADHD）的年轻人生活在农村环境中，和妇女抑郁症治疗的Ob-Gyn设置;和4）继续扩大博士Katon的指导初级研究人员在心理健康服务研究。将通过继续和扩大研究活动、流行病学、生物统计学和卫生经济学课程以及外部顾问的指导来实现这些目标。这些课程，与导师的互动，以及指导阅读将提高博士. Katon的能力作为一个导师，以及加强他的卫生服务部门的前沿研究。相关性：将在该奖项的过程中完成的研究将增加有关筛查和治疗慢性疾病患者抑郁症的重要性的知识;测试抑郁症和慢性疾病患者的护理新模式，旨在提高抑郁症和医疗护理的质量;并调整协作护理模式，以适应新的人群（患有多动症和抑郁症的青年以及在妇产科治疗的妇女），这些人群在精神卫生保健质量方面存在差异。

DESCRIPTION (provided by applicant): This is a request for a competing renewal of an NIMH Midcareer Investigator Award in Patient-Oriented Research (NIMH staff has advised Dr. Katon that he could submit a competing renewal of his K-24 award as a full professor). This K-24 will build on Dr. Katon's prior research in: 1) developing innovative "collaborative care" interventions to improve the quality of care and outcomes of patients with depressive and anxiety disorders within primary care settings; 2) improving understanding about the adverse impact of anxiety and depressive disorders in patients with common medical disorders; and 3) developing interventions to improve psychiatric outcomes in patients with chronic medical illness and comorbid depressive and anxiety disorders. The specific aims of this proposal include: 1) to continue to enhance Dr. Katon's epidemiologic, biostatistical and health economic skills in order to demonstrate in population-based studies the bidirectional adverse interactions between depression and chronic medical illness. The evidence from these population- based studies will be developed by a) showing in cross-sectional and longitudinal studies the adverse impact of depression on medical symptom burden, functional impairment, adherence to medical regimens, medical complications and mortality; and b) by demonstrating in longitudinal studies that residual depressive symptoms and incident complications of medical illness are associated with a higher risk of developing major depression and new deficits in functioning. Additional aims include: 2) to develop and test adaptations of collaborative care models in patients with depression and chronic medical illness that are targeted at improving medical disease control, behavioral risk factors, as well as improving quality of depression care; 3) to continue to adapt collaborative care interventions and test their effectiveness in new populations experiencing disparities in quality of mental health care such as adolescent populations with depression, youth with attention-deficit hyperactivity disorder (ADHD) living in rural settings, and women with depression treated in Ob-Gyn settings; and 4) To continue to expand Dr. Katon's mentorship of junior investigators in mental health services research. These goals will be met through continued and expanded research activities, coursework in epidemiology, biostatistics and health economics and mentorship from external consultants. These courses, interactions with mentors, and mentored readings will improve Dr. Katon's ability as a mentor as well as enhancing the cutting edge research of his Health Services Division. RELEVANCE: The research that will be completed during the course of this award will increase knowledge about the importance of screening for and treating depression in patients with chronic medical illnesses; test new models of care in patients with depression and chronic medical illnesses aimed at improving quality of quality of depression and medical care; and adapt the collaborative care model to new populations (youth with ADHD and depression and women treated in Ob-Gyn settings) that experience disparities in quality of mental health care.