A telephone-delivered mindfulness intervention for patients with comorbid depression and chronic disease

项目摘要/摘要 抑郁症是世界范围内导致残疾的第二大原因，并且经常与慢性病患者并存。与没有抑郁症的人相比，患有抑郁症和合并慢性病的人经历了更差的疾病结局和更高的死亡风险。高达38%的高血压患者--这是门诊护理实践中最常见的诊断--患有抑郁障碍，抑郁与血压控制不佳和这些患者的死亡率增加高达14倍独立相关。尽管抑郁症很常见，而且可以很好地治疗，但50%的抑郁症患者仍然没有得到诊断或在初级保健环境中没有得到充分的治疗。 这个项目的主要重点是调查非常有希望的证据，即电话传递的正念干预(提升；使用练习和学习增加积极的想法)，减少癫痫患者的抑郁，可能有效地减少高血压患者的抑郁症状。与其他治疗抑郁症的心理疗法相比，Uplift具有成本、可及性和可扩展性优势，因为它不需要有执照的临床医生提供，并以小组形式通过电话提供。这项拟议的研究将：1)调整和确定隆起在高血压患者中的可行性和可接受性；2)在一项试点随机对照试验中建立隆起与常规护理的效应大小估计；以及3)探索和测试隆起效应的有前景的中介和调节因素。 研究项目的目标不仅集中在解决初级保健环境中对广泛获得和基于证据的抑郁症治疗的需求，而且已经被开发来向候选人传授关键能力，其长期职业目标是为患有抑郁症和慢性病的患者建立负担得起的、可获得的和可扩展的心身干预的证据基础。研究培训的目标领域包括：1)以实践为基础的临床试验；2)心理生物学评估(即活动记录仪和生态瞬时评估)；3)高级研究设计和分析；以及4)保护人类受试者。对拟议的项目和培训目标的支持将由纽约大学朗格内医学中心提供的特殊资源和候选人指导团队的专业知识提供，该团队由国家公认的、由NIH资助的行为科学家(奥杰德贝博士和斯普鲁尔博士)和睡眠科学家(让-路易斯博士)组成。该项目的顾问将在混合方法研究和生物统计领域提供更多的专门知识。

Project Summary/Abstract Depression is the second leading cause of disability worldwide and frequently co-occurs in patients with chronic diseases. Individuals with depression and comorbid chronic disease experience poorer disease outcomes and increased risk for mortality, compared to those without depression. Up to 38% of people with hypertension—the most common diagnosis in ambulatory care practices— have comorbid depressive disorders, and depression is independently associated with poor blood pressure control and an up to 14-fold increase in mortality in these patients. Although depression is common and eminently treatable, 50% of patients with depression remain undiagnosed or inadequately treated in primary care settings. The primary focus of this project is to investigate highly promising evidence that a telephone-delivered mindfulness intervention (UPLIFT; Using Practice and Learning to Increase Favorable Thoughts), which reduces depression in patients with epilepsy, may be effective for reducing depressive symptoms in hypertension patients. UPLIFT has cost, accessibility, and scalability advantages over other psychological treatments for depression because it does not require licensed clinicians for delivery and is delivered by phone in a group-based format. The proposed research will: 1) adapt and establish the feasibility and acceptability of UPLIFT in patients with hypertension; 2) establish effect size estimates of UPLIFT vs. usual care in a pilot randomized controlled trial; and 3) explore and test promising mediators and moderators of the effects of UPLIFT. The research project goals focus not only on addressing the need for widely accessible and evidence-based depression treatments in primary care settings, but have been developed to impart key competencies to the candidate whose long-term career goal is to establish an evidence base for affordable, accessible, and scalable mind-body interventions for patients with the often debilitating combination of depression and chronic disease. Targeted areas of research training include: 1) practice-based clinical trials; 2) psychobiological assessments (i.e., actigraphy and ecological momentary assessment); 3) advanced research design and analysis; and 4) protection of human subjects. Support for the proposed project and training goals will be provided by the exceptional resources available at the NYU Langone Medical Center and by the expertise of the candidate’s mentoring team comprised of nationally recognized and NIH-funded behavioral (Drs. Ogedegbe and Spruill) and sleep (Dr. Jean-Louis) scientists. Consultants on the project will provide additional expertise in the areas of mixed methods research and biostatistics.