Barriers and Facilitators of Mental Health Services Utilization Among Latinos

描述(申请人提供)：使用基于社区的参与性研究(CBPR)模型，这项为期5年的纵向队列研究将在马萨诸塞州劳伦斯的加勒比拉美裔中实证评估个人、伴侣/家庭、社会背景和更大的社区应激源对临床抑郁症、抑郁症严重性和心血管疾病(CVD)风险的关联，并评估特定文化类型的社会支持和资源对这些关联的缓冲作用。参与这一合作的合作伙伴包括：劳伦斯的拉美裔居民个人、社区组织，包括大劳伦斯家庭健康中心、劳伦斯市市长健康特别工作组、劳伦斯老龄/老年中心理事会、大劳伦斯基督教女青年会、圣家医院、劳伦斯综合医院和UMMS。这项合作始于2003年，拟议的研究是在其先前的CBPR工作的基础上进行的。这项研究将在600名居住在马萨诸塞州劳伦斯的加勒比海拉丁裔成年人中进行，劳伦斯是一个被HRSA定义为医疗服务不足的社区。现有证据表明，抑郁症状和临床抑郁症在美国低收入拉丁裔中非常普遍。然而，在这一人群中缺乏对抑郁症的纵向研究，对这一人群中这些疾病的风险和保护因素知之甚少。有证据表明，抑郁症是残疾、超额死亡率和不良健康后果的独立风险因素，包括心血管疾病，而心血管疾病是拉美裔人的主要死亡原因。了解导致拉美裔人抑郁和心血管疾病风险的压力源，对于制定有针对性的干预措施至关重要。拟议研究的主要目的是：1)评估压力(在个人、伴侣/家庭、社会和更大的社区层面测量)与临床抑郁症和抑郁症严重程度的测量之间的横向联系；2)评估压力(在个人、伴侣/家庭、社会和更大的社区层面测量)与临床抑郁症和抑郁症严重程度测量之间的纵向联系；以及3)评估社会支持和资源(在个人、伴侣/家庭、社会和更大的社区层面测量)对压力与临床抑郁症和抑郁症严重程度的测量之间的关系的中介作用。第二个目标是：4)评估压力和抑郁指标与心血管疾病风险之间的纵向联系；5)调查与健康相关的行为，即饮食、体育活动、吸烟、饮酒和睡眠对压力和抑郁指标与心血管疾病风险之间的关系的中介作用。研究参与者将接受为期两年的跟踪调查，并每年采取措施。CBPR的目标是：1)通过持续的自我评估加强伙伴关系的参与性基础设施；2)评估传播和传播研究成果的外联进程；3)评估在实施新方案和开发新研究项目方面取得的成功，这些项目建立在拟议研究结果的基础上。 公共卫生相关性：劳伦斯大学与马萨诸塞州劳伦斯大学拉美裔健康伙伴关系(伙伴关系)，是一项为期7年的基于社区的参与性研究(CBPR)合作项目，旨在改善生活在马萨诸塞州劳伦斯的拉美裔人的健康，劳伦斯是一个由HRSA定义的医疗服务不足的社区。这一伙伴关系成立于2003年，包括大劳伦斯家庭健康中心、劳伦斯市市长健康特别工作组、劳伦斯老龄/老年中心理事会、大劳伦斯基督教青年会、圣家医院、劳伦斯综合医院和马萨诸塞大学医学院。该伙伴关系建议研究压力对劳伦斯拉丁裔精神健康和心血管风险的影响，以及可能影响这些联系的因素，特别是社会支持和资源。该伙伴关系还将寻求加强其进程，传播研究结果，并评估该项目对新的社区计划和研究项目的影响。

DESCRIPTION (provided by applicant): Using a community-based participatory research (CBPR) model, this 5-year longitudinal cohort study will empirically assess the association of individual, partner/family, social context and larger community stressors, on clinical depression, depression severity, and cardiovascular disease (CVD) risk among Caribbean Latinos in Lawrence, MA, and assess the buffering effects of culture-specific types of social support and resources on these associations. Partners in this collaboration are: individual Latino residents of Lawrence; community- based organizations including the Greater Lawrence Family Health Center, the City of Lawrence Mayor's Health Task Force, the Lawrence Council on Aging/Senior Center, the YWCA of Greater Lawrence, Holy Family Hospital, Lawrence General Hospital; and UMass Medical School (UMMS). This collaboration began in 2003 and the proposed study builds from its prior CBPR work. The study will be conducted among 600 Caribbean Latino adults living in Lawrence, MA, a HRSA defined medically underserved community. Available evidence suggests that depressive symptoms and clinical depression are highly prevalent among low-income Latinos in the US. However, there is a scarcity of longitudinal studies of depression in this population, and relatively little is known about the risk and protective factors for these conditions in this population. Evidence indicates that depression is an independent risk factor for disability, excess mortality and adverse health outcomes, including cardiovascular disease, a leading cause of death among Latinos. Understanding the stressors that contribute to depression and CVD risk among Latinos is crucial to developing targeted interventions. The primary aims of the proposed study are to: 1) assess cross-sectional associations between stress (measured at the individual, partner/family, social and larger community levels) and measures of clinical depression and depression severity; 2) assess longitudinal associations between stress (measured at the individual, partner/family, social and larger community levels) and measures of clinical depression and depression severity; and 3) assess the mediating effect of social support and resources (measured at the individual, partner/family, social and larger community levels) on the associations between stress and measures of clinical depression and depression severity. The secondary aims are to: 4) assess the longitudinal association between stress and measures of depression with CVD risk and 5) investigate the mediating effect of health-related behaviors, namely diet, physical activity, smoking, alcohol use and sleep on the association between stress and measures of depression with CVD risk. Study participants will be followed for two years with measures taken annually. CBPR aims are to: 1) enhance the participatory infrastructure of the Partnership through continuous self-assessment; 2) evaluate the outreach process for diffusion and dissemination of study results; and 3) evaluate the success in implementing new programs and developing new research projects that build from the results of the proposed study. PUBLIC HEALTH RELEVANCE: The Lawrence-UMass Latino Health Partnership (Partnership), is a 7-year community-based participatory research (CBPR) collaborative to improve the health of Latinos living in Lawrence, MA, a HRSA defined medically underserved community. Established in 2003, this Partnership includes the Greater Lawrence Family Health Center, the City of Lawrence Mayor's Health Task Force, the Lawrence Council on Aging/Senior Center, the YWCA of Greater Lawrence, Holy Family Hospital, Lawrence General Hospital and the University of Massachusetts Medical School. The Partnership proposes to study the influence of stress on mental health and cardiovascular risk among Lawrence Latinos as well as factors that may influence these associations, in particular social support and resources. The Partnership also will seek to enhance its process, disseminate the study results and evaluate the impact of the project on new community programs and research projects.