Testing Peer Support to Enhance Outcomes for Mood Disorders

描述（由申请人提供）：情绪障碍是所有精神疾病中最普遍和最顽固的疾病之一，它给疾病带来了巨大的负担，并对生活质量和生产力产生了广泛的负面影响。虽然专业干预改善了许多患者的生活，但很多人在同伴领导的社区精神健康互助组织（MHOs）中寻求额外的支持，例如抑郁症和双相情感障碍支持联盟（DBSA）。从世卫组织在成瘾领域的研究推断24，以精神卫生为重点的世卫组织参与可能是专业护理的一种具有成本效益的临床辅助手段，但尚未得到系统评估。DBSA是美国现有最大的心理健康MHO，每周在数千次小组会议中提供持续的同伴主导的康复支持。MHOs可以通过提供非正式监测、个人责任、社区意识、丰富的社会支持、交换康复信息（面对面和在线）以及持续的免费服务来帮助长期精神稳定24。然而，尽管DBSA和专业人员的共同目标是支持缓解和恢复，但从科学的角度来看，它们的综合临床影响以及MHO的参与如何延长或增强专业治疗的效果还不得而知。从物质使用障碍（SUD）领域吸取的经验教训表明，像DBSA这样的精神健康mho有可能与更专业的联系，可以提高患者的精神健康结果并降低医疗成本——这是一个非常有利的组合，符合《平价医疗法案》（2010）和新兴的负责任医疗组织（ACOs）的目标。然而，在缺乏证据的情况下，这些潜在的宝贵和广泛的社区精神卫生资源可能没有得到充分利用，从而损害患者、家庭、卫生保健经济和整个社会。这条研究路线的长期目标是开发和测试一种临床干预，旨在让DBSA患者参与进来，以确定临床联系是否能改善功能和生活质量，并降低情绪障碍患者的医疗成本，就像参加匿名戒酒会（AA）在SUD24患者中所显示的那样。然而，由于缺乏关于谁使用DBSA或DBSA吸引和留住个人并授予利益的能力的任何系统的经验证据，因此R21是必要的第一步。为此，本研究提出以下具体目标：对200名DBSA参与者进行横断面调查；2. 在为期6个月的随访中，为有情绪障碍的新DBSA参与者（N=60）提供DBSA的出席率、保留率和停药率的估计，并检查哪些患者亚组（如抑郁症/双相情感障碍、男性/女性、精神严重程度等）最有可能参与/停药。3. 对新DBSA成员（N=60）和匹配对照组（N= 100；年龄、性别、情绪障碍、精神严重程度匹配）进行前瞻性组间研究，以检查6个月期间DBSA参与的获益程度。

DESCRIPTION (provided by applicant): Mood disorders are among the most pervasive and intransigent of all psychiatric conditions, conferring an extraordinary burden of disease and a widespread negative impact on quality of life and productivity. While professional interventions have improved many sufferers' lives, a high number of individuals seek out additional support in peer-led, community mental health mutual-help organizations (MHOs), such as the Depression and Bipolar Support Alliance (DBSA). Extrapolating from MHO research in the addiction field24, mental health focused MHO participation could potentially represent a cost-effective clinical adjunct to professional care, but has not been systematically evaluated. DBSA is the largest existing mental health MHO in the U.S., providing ongoing peer-led recovery support during thousands of group meetings each week. MHOs may aid long-term psychiatric stabilization by providing informal monitoring, personal accountability, a sense of community, rich social support, exchange of recovery information (in-person and online), and continuous cost free services24. However, despite the common goals of DBSA and professional efforts to support remission and recovery, nothing is known from a scientific standpoint about their combined clinical impact and how MHO participation may extend or potentiate the effects of professional treatments. Lessons learned from the substance use disorder (SUD) field suggest there is potential that greater professional linkage to mental health MHOs, like DBSA, could enhance patients' mental health outcomes and reduce healthcare costs - a highly favorable combination that is in keeping with the goals of the Affordable Care Act (2010) and emerging Accountable Care Organizations (ACOs). In the absence of evidence, however, these potentially valuable and widespread community mental health resources may be under-utilized, to the detriment of patients, families, the health care economy, and society at large. The long-term goal of this line of research is to develop and test a clinical intervention designed to engage patients with DBSA to determine whether clinical linkage improves functioning and quality of life, and reduces health care costs among those suffering from mood disorders, as participation in Alcoholics Anonymous (AA) has been shown to do among those suffering from SUD24. However, given the absence of any systematic empirical evidence on who uses DBSA or on DBSA's ability to engage and retain individuals and confer benefit, this R21 is a necessary first step. To this end, this study proposes the following specific aims: 1. To conduct a cross-sectional survey of DBSA participants (N=200); 2. To provide estimates of rates of attendance, retention in, and discontinuation from, DBSA, for new DBSA attendees (N=60) with mood disorders over a 6-month follow-up and examine which patient sub-groups (e.g., depressed/bipolar, men/women, psychiatric severity etc.) appear most likely to engage/discontinue. 3. To conduct a prospective between-group study of new DBSA members (N=60) and matched controls (n=100; matched on age, gender, mood disorder, psychiatric severity) in order to examine the degree of benefit attributable to DBSA participation over a 6-month period).