Pathways to Reducing Disparities in Depression Outcomes

描述（由申请人提供）：少数民族的抑郁症是一种常见的致残性疾病，在获得护理的机会、质量和结果方面存在有记录的差异，特别是在初级保健方面，这是少数民族群体的主要治疗环境。质量 初级保健的改善计划可以减少抑郁症结果的差异，但在脆弱社区很少提供。拟议的项目将使用的数据，合作伙伴关系的基础设施和研究方法的“社区合作伙伴在照顾”（CPIC）-增强了新收集的定性数据-阐明的途径，通过健康和社会差距可以减少，以及照亮科学研究如何可以告知政策的发展，以社区为重点的健康改善。CPIC是一项社区合作的随机试验，比较了激活多机构网络的社区参与和规划（CEP）干预与单个机构的技术援助模式的有效性，在洛杉矶两个资源不足的有色人种社区实施基于证据的抑郁症干预措施。6个月的客户结果分析表明，CEP干预，相对于技术援助，导致改善心理健康和身体健康，并减少精神健康状况不佳，无家可归的风险因素，并错过工作日，由于健康。社区参与性共同领导，包括领导人对种族主义和社会正义的自我反思。拟议的调查人员是CPIC的原始开发人员。拟议的新的二次分析和新的定性数据收集将澄清干预措施对关键亚组（每个社区，非洲裔美国人和拉丁美洲人，男性和女性，无家可归者）的影响的途径;使用混合方法开发解释性模型;记录这些群体的干预措施的实施情况;并探讨新的洛杉矶县社区为基础的健康改善计划的CPIC方法的适用性和普遍性。这项研究将完全与领导人合作进行， 来自受影响社区的成员使用社区合作研究方法，该方法促进所有工作阶段的平等和合作责任。该模式注重公平和所有领导人对种族主义影响的自我反思，因此拟议项目将成为解决健康差距的第四代办法的早期范例，该办法将综合干预模式和研究战略结合起来，其中纳入了种族和族裔差异的社区背景以及伙伴领导人之间的互动。.

DESCRIPTION (provided by applicant): Depression for ethnic minorities is a common, disabling condition with documented disparities in access, quality and outcomes of care, particularly in primary care, which is a main treatment setting for ethnic minority groups. Quality improvement programs in primary care can reduce disparities in depression outcomes but are seldom available in vulnerable communities. The proposed project will use the data, partnership infrastructure, and research approach of "Community Partners in Care" (CPIC)-augmented by new collection of qualitative data-to shed light on the pathways by which health and social disparities can be reduced, as well as to illuminate how scientific research can inform policy development for neighborhood-focused health improvement. CPIC is a community-partnered randomized trial comparing the effectiveness of a community engagement and planning (CEP) intervention that activates multi-agency networks versus a technical assistance model for individual agencies, in implementing evidence-based interventions for depression in two under-resourced communities of color in Los Angeles. Analyses of 6-month client outcomes indicate that the CEP intervention, relative to technical assistance, led to improved mental wellness and physical health and reduced prevalence of poor mental health, risk factors for homelessness, and missed work days due to health. CPIC was implemented with community participatory co-leadership, including leaders' self-reflection on racism and social justice. The proposed investigators are original developers of CPIC. The proposed new secondary analyses and new qualitative data collection will clarify pathways for intervention effects on key subgroups (each community, African Americans and Latinos, men and women, homeless); develop explanatory models using mixed-methods; document intervention implementation for these groups; and explore the applicability and generalizability of the CPIC approach for a new Los Angeles County neighborhood-based health improvement initiative. The public health significance of the research is enhanced by the fact that it will be conducted entirely in partnership with leaders and members from the affected communities using a Community Partnered Participatory Research approach, which promotes equality and collaborative responsibility for all phases of work. Through that model's focus on equity and self-reflection among all leaders on the impact of racism, the proposed project will serve as an early example of a fourth-generation approach to addressing health disparities, which combines comprehensive intervention models and research strategy that incorporates the community context for racial and ethnic differences and the interactions in partnered leadership. .