INTEGRATING DEPRESSION CARE FOR ACS PATIENTS IN LOW-RESOURCE HOSPITALS IN CHINA

描述（由申请人提供）：心血管疾病作为世界头号杀手的沉重负担已不再是秘密。以前被认为主要是世界上最富裕国家的问题，低收入和中等收入国家已经超过了发达国家，现在这些慢性、致残和致命疾病的比例最大。精神疾病受到的重视略少一些，尽管它作为全球残疾调整生命年的主要原因正在增加，预计到2030年将成为第一大原因。心血管疾病和精神疾病结合起来，形成了一个不健康的循环：患有抑郁症的人患心血管疾病的风险更高，患有心血管疾病的人患抑郁症的可能性更大。独立管理这些疾病的有效干预措施是存在的，而且在美国等一些国家已经有证据表明，同时管理这两种疾病可以改善健康结果。然而，在中国，针对精神疾病和心血管疾病（如急性冠状动脉综合征（ACS））的医疗服务提供模式尚未形成。本研究的总体目标是开发、试点测试、实施和评估一种整合到ACS护理中的护士协调抑郁症护理模式，并通过一项大规模的随机对照试验，对其有效性和成本效益进行严格评估，该试验涉及中国15个省份的成熟的农村医院研究网络。本研究将培训中国资源匮乏医院心脏科病房的护士在ACS患者中使用有效的心理健康筛查和治疗工具。具体而言，该研究将确定该综合模型是否可以：减轻ACS后抑郁的症状和严重程度，通过减少主要心血管事件的发生率和再次住院来改善心血管健康，提高患者的生活质量，最后该模型是否可以改善与他们健康相关的其他问题，如增加身体活动和更好地坚持心血管药物治疗。这项研究的长期目标是找到一种方法，以一种可持续的、具有成本效益的方式为患有任何慢性疾病的患者提供心理健康服务，无论是ACS、糖尿病、中风还是癌症，这种方法可以在缺乏心理健康专家的资源有限的医院中实施。这项研究将填补在低资源条件下连接两个卫生领域的知识空白，并将为为低资源环境量身定制的综合服务模式铺平道路，该模式可在其他低资源环境中复制或测试。这项研究代表了来自世界各地的研究人员和学者的强有力的本地和国际合作，包括中国、澳大利亚和印度的乔治全球健康研究所、北京大学精神卫生研究所、中国卫生部和杜克大学。

DESCRIPTION (provided by applicant): The heavy burden of cardiovascular disease as the world's number one killer is no longer a secret. Formerly regarded as mainly a problem of the richest nations in the world, low- and middle-income countries have surpassed the developed world and now have the lion's share of these chronic, disabling, and deadly diseases. Mental illness is slightly more under-appreciated, even though it is increasing as a major cause of DALYs worldwide and is expected to become number one by 2030. Combined, cardiovascular disease and mental illness form a cycle of ill health: having depression makes one more at risk for a cardiovascular event, and having a cardiovascular event makes one more likely to suffer from depression. Effective interventions for managing these illnesses independently exist, and there is already evidence in some countries such as the US that managing both conditions together can improve health outcomes. However, a model of healthcare service delivery for both mental illness and cardiovascular conditions like acute coronary syndromes (ACS) in China has not been developed. The overall goal of this study is to develop, pilot test, implement, and evaluate a nurse-coordinated depression care model integrated into ACS care, with rigorous assessment of effectiveness and cost-effectiveness through a large scale, randomized controlled trial involving a well-established research network of rural hospitals in 15 provinces across China. This study will train nurses in cardiology wards in low-resource hospitals in China to use validated mental health screening and treatment tools among patients with ACS. Specifically, the study will determine if the integrated model can: reduce symptoms and severity of depression following ACS, improve cardiovascular health by reducing the incidence of major cardiovascular events and re-hospitalization, improve patients' quality of life, and finally whethe the model can improve other issues related to their health such as increasing physical activity and better adherence to cardiovascular medications. The long-term object of the study is to find a way to provide mental health services for patients with any chronic illness - whether it be ACS, diabetes, stroke, or cancer - in a sustainable and cost-effective manner that can be implemented in low-resource hospitals lacking in mental health specialists. This study will fill ina knowledge gap in bridging two health fields in low-resource conditions and will pave the way for an integrated service model customized to low-resource settings that can be replicated or tested in other low-resource environments. This study represents a strong local and international collaboration of researchers and academics from around the world, including The George Institute for Global Health in China, Australia and India, Peking University Institute of Mental Health, the Chinese Ministry of Health, and Duke University.