Group Self-Management for Persons with Depression and Medical Illness

描述（由申请人提供）：由于高质量的抑郁症护理率低，拉丁美洲人比白人遭受更大的抑郁症残疾负担。抑郁症在拉丁美洲人的初级保健环境中很常见，而且往往是慢性的，反复发作的，并与慢性疾病共病。改善抑郁症和慢性医学疾病的结果需要患者在管理他们的疾病方面成为受过教育的，积极的合作伙伴。拉丁美洲人希望获得关于一般和心理健康的教育;对心理健康护理有与耻辱相关的担忧;并且更喜欢心理治疗而不是药物治疗。然而，安全网初级保健提供者和诊所往往优先考虑改善医疗结果，缺乏抑郁症护理，特别是心理治疗的资源。有一个重要的公共卫生需要制定一个文化相关的，低成本的干预措施，包括教育和心理治疗元素，目标医学疾病和抑郁症，并消除抑郁症护理。 为了回应患者，提供者和诊所的偏好和资源，抑郁症护理，在以前的工作中，我们开发了但尚未测试一种创新的，以理论为基础的群体干预，借鉴两种循证干预措施，提高自我效能：群体认知行为疗法（CBT）抑郁症和慢性疾病的群体自我管理。社区领导的团体CBT对初级保健中少数民族的抑郁症有效，但难以持续。在患有慢性疾病的患者中，由外行领导的团体自我管理计划教育并赋予患者参与健康行为和参与护理的权力。这些团体提高自我效能、健康相关行为和结果;已适应各种条件;并已得到广泛传播和维持。然而，标准的自我管理小组并不能改善抑郁症。因此，我们加强了西班牙语Tomando Control de su Salud慢性病自我管理计划，增加了抑郁症相关的教育和技能建设的内容，从小组CBT。 我们建议试点测试和完善Cuerpo佐野，Mente Sana，我们新增强的西班牙语自我管理计划抑郁症和慢性医学疾病。在成功实施干预措施的框架之后，我们1）评估干预背景并改进我们的干预和实施策略; 2）对30名患有抑郁症和慢性医学疾病的低收入西班牙语患者进行随机试验; 3）与多利益相关者小组一起审查可行性，实施和潜在可持续性的试点结果，并修改材料和程序; 4）对另外30名患者进行后续试验; 5）与临床利益相关者一起审查其他结果（现在包括3个月和6个月对自我效能，自我护理行为以及抑郁和健康结果的干预效果），并最终确定干预和实施策略。这项研究奠定了基础，为未来的战略，以改善护理拉丁美洲人在安全网初级保健的比较有效性研究。 公共卫生相关性：该项目旨在通过试点测试和改进文化相关的低成本干预措施来减少抑郁症护理中的种族差异，以改善安全网初级保健环境中拉丁美洲人的抑郁症和一般医疗结果。群体自我管理干预承诺有显着的公共卫生影响，因为拉丁美洲人口的规模不断增长;抑郁症和慢性疾病的高患病率;其传播和可持续性的潜力，因为它对病人，供应商和系统的偏好和需求的响应。研究结果将奠定基础，为未来的比较有效性研究的替代战略，以改善护理抑郁症的安全网初级保健设置。

DESCRIPTION (provided by applicant): Latinos suffer a greater disability burden from depression than whites due to low rates of quality depression care. Depression is common among Latinos in primary care settings and is also often chronic, recurring, and comorbid with chronic medical illness. Improving outcomes for both depression and chronic medical illness requires patients to become educated, active partners in managing their illnesses. Latinos desire education regarding general and mental health; have stigma-related concerns regarding mental health care; and prefer psychotherapy to medication. However, safety net primary care providers and clinics often prioritize improving medical outcomes and lack the resources for depression care, especially psychotherapy. There is an important public health need to develop a culturally relevant, low cost intervention that includes educational and psychotherapeutic elements, targets medical illness and depression, and destigmatizes depression care. In response to patient, provider, and clinic preferences and resources for depression care, in prior work, we developed but have not yet tested an innovative, theoretically-based group intervention, drawing upon two evidence-based interventions that improve self-efficacy: group cognitive behavioral therapy (CBT) for depression and group self-management for chronic medical illness. Professionally-led group CBT is effective for depression among ethnic minorities in primary care but is difficult to sustain. Among patients with chronic medical illness, lay-led group self-management programs educate and empower patients to engage in healthful behaviors and participate in their care. The groups improve self-efficacy, health-related behaviors, and outcomes; have been adapted for diverse conditions; and have been widely disseminated and sustained. However, standard self-management groups do not improve depression. We thus enhanced the Spanish- language Tomando Control de su Salud chronic disease self-management program by adding depression- related educational and skill-building content from group CBT. We propose to pilot test and refine Cuerpo Sano, Mente Sana, our newly enhanced Spanish-language self- management program for depression and chronic medical illness. Following a framework for successful implementation of interventions, we 1) evaluate intervention context and refine our intervention and implementation strategy; 2) conduct a randomized trial with 30 low-income Spanish-speaking patients with depressive disorder and chronic medical illness; 3) review pilot findings of feasibility, implementation, and potential sustainability with a multistakeholder panel and revise materials and procedures; 4) conduct a subsequent trial with 30 additional patients; and 5) review additional findings (now including 3- and 6-month intervention effects on self-efficacy, self-care behaviors, and depression and health outcomes) with clinic stakeholders and finalize the intervention and implementation strategy. This study lays the groundwork for future comparative effectiveness studies of strategies to improve care for Latinos in safety net primary care. PUBLIC HEALTH RELEVANCE: This project aims to reduce ethnic disparities in depression care by pilot testing and refining a culturally relevant, low-cost intervention for improving both depression and general medical outcomes among Latinos in safety net primary care settings. The group self-management intervention promises to have significant public health impact given the growing size of the Latino population; the high prevalence of depression and chronic medical illness; and its potential for dissemination and sustainability given that its responsiveness to patient, provider, and system preferences and needs. Study findings will lay the groundwork for future comparative effectiveness studies of alternate strategies to improve care for depression in safety net primary care settings.