Incentivizing Evidence Based Antidepressant Medication Treatment of Major Depressive Disorder

项目摘要 改善重度抑郁症的管理是我们健康面临的重大挑战之一 护理系统。虽然持续的抗抑郁治疗可以减少复发和症状复发，但早期 治疗中断是常见的，并且会减慢恢复。迫切需要开发新的， 可接受且易于实施的策略，以优化治疗连续性并改善临床过程 重度抑郁症的成年人。在一些医疗环境中，直接的患者经济激励措施 增加有益健康的行为，包括坚持服药。然而，在持久性方面存在不确定性。 行为改变的影响，是由财政激励措施和这种激励措施的最佳设计。在 治疗重度抑郁症，可能只需要在治疗的早期提供激励措施，直到 患者的情绪开始好转，治疗依从性开始自我强化。这项试点研究测试了两个 理论不同的激励计划，每天抗抑郁药的坚持。它将比较通常的护理与 适度的、有时限的、逐步增加或逐步减少的经济激励措施， 非老年抑郁症患者中抗抑郁药依从性和抑郁症状 抗抑郁治疗主要目的是：1）比较短期（6周）的财务影响， 对抗抑郁药治疗依从性、抑郁症状和生活质量的激励; 2）确定 在第6周结束的激励措施是否在第12周继续影响这些患者的结局;以及 3)评估激励措施对感知到的强迫、对参与研究的后悔、 信任治疗精神病医生，以及患者参与抑郁症护理。我们还将探讨 当前偏差和风险厌恶对两种激励方案的有效性起调节作用。成人心理健康 门诊患者（N -= 120）患有重度抑郁症谁已被规定抗抑郁药将是 随机分配至：1）常规护理，2）常规护理和每日抗抑郁药的每日递增奖励 治疗（第1 - 6周为2、3、4、5、6和7美元）或3）常规护理和从 每天7美元/天至2美元/天，每周递减一次。每日抗抑郁药 依从性将通过无线电子药瓶、患者自我报告和医嘱来测量。 将进行基线、6周和12周的抑郁症状、生活质量、 感知到的强迫，对参与研究的后悔，对治疗精神病医生的信任，以及参与 抑郁症护理这项初步研究的结果将产生关于认知和 重度抑郁症患者抗抑郁药依从性的动机障碍

PROJECT SUMMARY Improving the management of major depressive disorder is one of the great challenges confronting our health care system. Although continuous antidepressant treatment reduces relapse and symptom recurrence, early treatment discontinuation is common and slows recovery. There is a pressing need to develop new, acceptable, and easily implemented strategies to optimize treatment continuity and improve the clinical course of adults with major depressive disorder. In several medical contexts, direct patient financial incentives increase beneficial health behaviors, including medication adherence. Yet uncertainty exists over the durability of behavior change that is effected by financial incentives and the optimal design of such incentives. In the care of major depressive disorder, it may only be necessary to provide incentives early in treatment until the patients' mood begins to lift and treatment adherence becomes self-reinforcing. This pilot study tests two theory different incentive schedules for daily antidepressant adherence. It will compare usual care with either modest time-limited escalating or de-escalating financial incentives with respect to their effects on daily antidepressant adherence and depressive symptoms among non-elderly depressed adults initiating antidepressant treatment. The primary aims are 1) to compare short-term (6 weeks) effects of financial incentives on adherence to antidepressant treatment, depressive symptoms, and quality of life; 2) to determine whether the incentives, which end at 6 weeks, continue at 12 weeks to influence these patient outcomes; and 3) to assess potential negative effects of the incentives on perceived coercion, regret over study participation, trust in the treating psychiatrist, and patient participation in depression care. We will also explore whether present bias and risk aversion moderate the effectiveness of the two incentive schedules. Adult mental health outpatients ( N -= 120) with major depressive disorder who have been prescribed antidepressants will be randomly assigned to: 1) usual care, 2) usual care and escalating daily rewards for daily antidepressant treatment ($2, $3, $4, $5, $6, and $7 in weeks 1 through 6) or 3) usual care and de-escalating incentives from $7/day to $2/day for each day of antidepressant adherence with weekly decrements. Daily antidepressant adherence will be measured with a wireless electronic pill bottle, patient self-report, and physician orders. Baseline, six week, and twelve week assessments will be performed of depressive symptoms, quality of life, perceived coercion, regret over study participation, trust in the treating psychiatrist, and participation in depression care. The results of this pilot study will yield important new information on cognitive and motivational barriers to antidepressant adherence in major depressive disorder.