Development and testing of a behavioral activation mobile therapy for elevated depressive symptoms

 描述(由申请人提供)：大约20%-40%的人口经历了抑郁症状的加重(Kubik等人，2003年)。尽管最近的研究表明，如果阈值以下抑郁的影响能够被完全阻断，总体人口死亡率将降低6.5%，但大多数抑郁症状升高的个体从未接受过循证治疗(Cuijpers等人，2013年)。抑郁症状增加最常报告给初级保健医生(PCPS；Mitchell等人，2009年)，他们缺乏治疗阈值下抑郁的循证资源。这种循证资源的缺乏导致了患者的一些负面结果，包括：1)大多数人没有得到适当的治疗(Kessler等人，2005年)，2)未来再次报告抑郁症状的可能性降低(Bell等人，2011年)，以及3)死亡风险增加(Cuijpers等人，2004年)。作为抑郁症状升高患者最有可能的首次接触，初级保健医生在提供循证干预方面具有独特的地位(McDowell等人，2011年)。考虑到阻碍初级保健医生使用循证战略的因素，包括需要额外培训以支持实施和/或患者成本过高，移动应用程序等移动技术提供了满足广泛治疗需求的理想战略。然而，目前还没有针对抑郁症状的移动应用程序可供PCP使用，这些应用程序既有证据又足够直接，可以推荐给他们的患者。一种特别适用于移动平台并容易被PCP推荐的升高抑郁症状的治疗方法是短暂行为激活(Brief Behaviative Activation)(Brief BA；Lejuez等人，2011年)。通过研究，Brief BA证明了在抑郁症状升高的个人中减轻抑郁症状的有效性(Gawrysiak等人，2009年；Hopko等人，2003年；雷诺兹等人，2011年)。尽管Brief BA、移动平台和PCP之间存在明显的契合性，但这样的工具尚未开发出来。拟议项目的目的是为移动平台定制BA，方法是创建BA移动应用程序(行为应用)，通过PCP向抑郁症状加重的个人销售BA移动应用程序，以满足PCP及其抑郁症状加重患者目前未得到满足的需求。我们预计，通过产品开发、可接受性和可行性测试，以及与STTR第一阶段资助机制一致的改进，我们将创造出一种适销对路的产品，我们将在STTR第二阶段研究中为其进行更大规模的临床测试。

 DESCRIPTION (provided by applicant): Approximately 20-40% of the population experiences elevated depressive symptoms (Kubik et al., 2003). Despite recent research suggesting that overall population mortality would be reduced by 6.5% if the effects of subthreshold depression could be blocked completely, the majority of individuals with elevated depressive symptoms never receive evidence-based treatment (Cuijpers et al., 2013). Elevated depressive symptoms are most frequently reported to primary care physicians (PCPs; Mitchell et al., 2009), who lack evidence-based resources for the treatment of subthreshold depression. This lack of evidence-based resources leads to a number of negative outcomes for patients including: 1) the majority not receiving appropriate treatment (Kessler et al., 2005), 2) a decreased likelihood of reporting depressive symptoms again in the future (Bell et al., 2011), and 3) heightened mortality risk (Cuijpers et al., 2004). As the most likely initial contact for patients with elevated depressive symptoms, PCPs are in a unique position to provide evidence-based interventions (McDowell et al., 2011). In light of factors that deter use of evidence-based strategies by PCPs, including the necessity of additional training to support implementation and/or excessive costs to patients, mobile technologies such as mobile apps offer an ideal strategy to meet widespread treatment needs. However, there are currently no mobile apps for depressive symptoms available to PCPs that are both evidence-based and straightforward enough to be recommended to their patients. One treatment for elevated depressive symptoms that is particularly amenable to a mobile platform and could easily be recommended by PCPs is brief Behavioral Activation (brief BA; Lejuez et al., 2011). Across studies, brief BA has demonstrated effectiveness for reducing depressive symptoms among individuals with elevated depressive symptoms (Gawrysiak et al., 2009; Hopko et al., 2003; Reynolds et al., 2011). Despite this clear fit between brief BA, mobile platforms, and PCPs, such a tool has yet to be developed. The purpose of the proposed project is to customize BA for a mobile platform by creating a BA mobile application (Behavioral Apptivation) to be marketed to individuals with elevated depressive symptoms through their PCPs in order to address the currently unmet needs of PCPs and their patients with elevated depressive symptoms. We expect that via product development, acceptability and feasibility testing, and refinement consistent with the STTR Phase I funding mechanism, we will create a marketable product for which we will pursue larger scale clinical testing in an STTR Phase II study.