Barriers and Facilitators of Mental Health Services Utilization Among Latinos

描述（由申请人提供）：采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实证评估个人、伴侣/家庭、社会背景和更大的社区压力源对马萨诸塞州劳伦斯地区加勒比拉丁裔患者的临床抑郁、抑郁严重程度和心血管疾病（CVD）风险的关联，并评估文化特定类型的社会支持和资源对这些关联的缓冲作用。合作伙伴包括：劳伦斯的拉丁裔居民；以社区为基础的组织，包括大劳伦斯家庭健康中心、劳伦斯市市长健康工作组、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；和麻省大学医学院（UMMS）。这项合作始于2003年，拟议的研究建立在之前的CBPR工作的基础上。这项研究将在600名居住在马萨诸塞州劳伦斯的加勒比裔成年人中进行，这是一个HRSA定义的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人群中非常普遍。然而，对这一人群抑郁症的纵向研究很少，对这一人群中这些疾病的风险和保护因素的了解也相对较少。有证据表明，抑郁症是导致残疾、死亡率过高和不良健康后果（包括心血管疾病）的独立风险因素，心血管疾病是拉丁美洲人死亡的主要原因。了解导致拉丁美洲人抑郁和心血管疾病风险的压力因素对于制定有针对性的干预措施至关重要。本研究的主要目的是：1)评估压力（在个人、伴侣/家庭、社会和更大的社区层面测量）与临床抑郁和抑郁严重程度测量之间的横断面关联；2)评估压力（在个人、伴侣/家庭、社会和更大的社区层面测量）与临床抑郁和抑郁严重程度测量之间的纵向关联；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）在压力与临床抑郁测量和抑郁严重程度之间的关联中的中介作用。次要目的是：4)评估压力与抑郁测量与CVD风险之间的纵向关联；5)研究与健康相关的行为，即饮食、体育活动、吸烟、饮酒和睡眠在压力与抑郁测量与CVD风险之间的中介作用。研究参与者将被跟踪两年，每年进行一次测量。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)评估研究结果的传播和传播过程；3)评估在实施新计划和开发基于拟议研究结果的新研究项目方面的成功。

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.