Group Self-Management for Persons with Depression and Medical Illness

描述（由申请人提供）：由于低质量的抑郁症治疗率，拉丁美洲人比白人遭受更大的抑郁症残疾负担。抑郁症在初级保健机构的拉丁美洲人中很常见，而且往往是慢性的、反复发作的，并与慢性医学疾病共病。改善抑郁症和慢性医学疾病的结果需要患者成为管理疾病的受过教育、积极的合作伙伴。拉丁美洲人希望接受关于一般健康和心理健康的教育；对精神卫生保健有与耻辱有关的关切；他们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，缺乏抑郁症护理的资源，特别是心理治疗。发展一种与文化相关的低成本干预措施，包括教育和心理治疗因素，针对医疗疾病和抑郁症，并消除对抑郁症护理的污名化，这是公共卫生的重要需要。为了回应患者、提供者和诊所对抑郁症护理的偏好和资源，在之前的工作中，我们开发了一种创新的、基于理论的群体干预，但尚未测试，它借鉴了两种改善自我效能的循证干预：针对抑郁症的群体认知行为疗法（CBT）和针对慢性医学疾病的群体自我管理。在初级保健中，专业领导的团体CBT对少数民族抑郁症有效，但难以维持。在慢性疾病患者中，外行领导的团体自我管理项目教育和授权患者从事健康的行为并参与他们的护理。这些小组提高了自我效能感、健康相关行为和结果；已经适应了不同的条件；并得到了广泛传播和持续。然而，标准的自我管理小组并没有改善抑郁症。因此，我们通过增加与抑郁相关的教育和技能建设内容，增强了西班牙语的Tomando Control de su Salud慢性疾病自我管理项目。我们建议试点测试和完善Cuerpo Sano， Mente Sana，这是我们新增强的针对抑郁症和慢性疾病的西班牙语自我管理程序。根据成功实施干预措施的框架，我们1)评估干预措施的背景并完善我们的干预和实施战略；2)对30例低收入西班牙语抑郁症合并慢性内科疾病患者进行随机试验；3)与多利益相关方小组一起审查可行性、实施和潜在可持续性的试点结果，并修订材料和程序；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回顾其他研究结果（目前包括3个月和6个月干预对自我效能感、自我护理行为、抑郁和健康结果的影响），并确定干预和实施策略。本研究为未来在安全网初级保健中改善拉丁裔护理策略的比较有效性研究奠定了基础。

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.