Pathways to Reducing Disparities in Depression Outcomes

说明(申请人提供)：少数民族抑郁症是一种常见的致残疾病，在获得护理的机会、质量和结果方面有记载的差异，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，但在脆弱的社区很少有。拟议的项目将使用“社区关怀伙伴”(CPIC)的数据、伙伴关系基础设施和研究方法--并通过新的定性数据收集加以补充--阐明缩小健康和社会差距的途径，并阐明科学研究如何为以社区为重点的卫生改善政策制定提供信息。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)干预与针对单个机构的技术援助模式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的有效性。对6个月客户结果的分析表明，与技术援助相比，CEP干预导致了心理健康和身体健康的改善，并减少了心理健康不良、无家可归的风险因素和因健康原因缺勤的发生率。社区参与共同领导，包括领导人对种族主义和社会正义的自我反思，实施了社区参与合作。拟议的调查人员是CPIC的原始开发商。拟议的新的二级分析和新的定性数据收集将澄清对关键亚群(每个社区，非裔美国人和拉丁裔，男性和女性，无家可归者)的干预效果的途径；使用混合方法开发解释性模型；记录对这些群体的干预实施；并探索CPIC方法对洛杉矶县新的以社区为基础的健康改善倡议的适用性和普适性。这项研究的公共卫生意义得到加强，因为它将完全与领导人和 来自受影响社区的成员使用社区合作研究方法，促进所有工作阶段的平等和合作责任。通过这一模式注重公平和所有领导人对种族主义影响的自我反思，拟议的项目将成为解决健康差距问题的第四代方法的早期范例，这种方法结合了综合干预模式和研究战略，纳入了种族和族裔差异的社区背景以及伙伴领导的互动。。

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. .