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有国家的问题，低收入和中等收入国家已经超过发达国家，现在这些慢性，致残和致命疾病的最大份额。精神疾病被稍微低估了，尽管它正在成为全球抑郁症的主要原因，预计到2030年将成为第一位。心血管疾病和精神疾病结合在一起，形成了一个健康不良的循环：抑郁症使人更容易患上心血管疾病，而心血管疾病使人更容易患上抑郁症。独立管理这些疾病的有效干预措施已经存在，并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））的医疗保健服务提供模式尚未开发。本研究的总体目标是通过一项涉及中国15个省农村医院的大型随机对照研究网络，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，并对有效性和成本效益进行严格评估。本研究将培训中国低资源医院心脏科病房的护士在ACS患者中使用经验证的心理健康筛查和治疗工具。具体而言，该研究将确定整合模型是否可以：减少ACS后抑郁的症状和严重程度，通过减少主要心血管事件和再住院的发生率来改善心血管健康，改善患者的生活质量，以及最终该模型是否可以改善与其健康相关的其他问题，例如增加体力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，为任何慢性疾病患者提供心理健康服务-无论是ACS，糖尿病，中风还是癌症-以可持续和具有成本效益的方式，可以在缺乏心理健康专家的低资源医院实施。这项研究将填补知识空白，在低资源条件下，弥合两个健康领域，并将铺平道路，为低资源环境定制的综合服务模式，可以复制或测试在其他低资源环境。这项研究代表了来自世界各地的研究人员和学者的强大本地和国际合作，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.