An Expert System to Reduce Depression in Primary Care

对于寻求抑郁症帮助的人来说，有多种有效的干预措施。然而，对于那些不寻求帮助或不接受转诊治疗的人，缺乏有效的干预措施。我们建议通过开发和测试一种基于跨理论模型的干预措施来填补这一服务空白，这种干预措施将在人群基础上主动提供给经历抑郁症状但目前未参与治疗的初级保健患者。这是治疗抑郁症的第一种方法，适用于处于所有变化阶段的个体，而不仅仅是那些准备采取行动的少数人。在快速通道计划的第一阶段，目标是规范TTM措施，开发TTM干预措施，并通过评估研究招募率和对干预材料的反应来确定这种方法的可行性。未参与治疗的轻度至中度抑郁症筛查阳性的初级保健患者将完成测量规范调查（n=100）或参与干预材料的试点测试（n=50）。如果满足可行性条件，我们将进行II期随机临床试验，评估专家系统干预抑郁症的疗效。建议的商业应用：抑郁症对医疗机构、残疾保险公司和雇主来说是一种昂贵的疾病，因为抑郁症患者的健康服务利用率、残疾索赔和生产力损失都在增加。一个有效的、低成本的专家系统，可以在人口基础上降低抑郁症的患病率，具有巨大的商业潜力。

A variety of effective interventions exist for people who seek help for depression. However, there is a lack of effective interventions for individuals who do not seek help or follow through with treatment referrals. We propose to fill this gap in services by developing and testing a Transtheoretical Model-based intervention that will be delivered proactively, on a population basis, to primary care patients who are experiencing symptoms of depression but are not currently involved in treatment. It is the first intervention for depression that is appropriate for individuals in all stages of change-not merely the minority who are prepared to take action. In Phase I of this Fast Track Initiative, the aims are to norm TTM measures, develop the TTM interventions, and determine the feasibility of this approach by assessing study recruitment rates and reactions to the intervention materials. Primary care patients who screen positive for mild to moderate depression and are not involved in treatment will complete surveys for measurement norming (n=100) or participate in a pilot-test of the intervention materials (n=50). If feasibility conditions are met, we will conduct a randomized clinical trial in Phase II to assess the efficacy of the expert system intervention for depression. PROPOSED COMMERCIAL APPLICATIONS: Depression is a costly illness for health care organizations, disability insurers, and employers because of increased health service utilization, disability claims, and lost productively among depressed individuals. An effective, low-cost expert system that can reduce the prevalence of depression on a population basis has significant commercial potential.