Telepsychiatry & Culturally Sensitive Treatment of Depressed Asian Americans

描述（由申请人提供）：与其他种族相比，亚裔美国人倾向于不充分利用心理健康服务，延迟治疗和更高的流失率（Kung, 2003）。当出现精神疾病症状时，许多得不到服务的华裔美国人会向他们的初级保健医生（pcp）寻求帮助（Yeung et al., 2004a）。2003年，申请人获得职业发展奖，研究文化敏感协作治疗（CSCT）在初级保健中治疗服务不足的美籍华人重度抑郁症（MDD）的有效性。CSCT的关键要素是积极筛查，以提高对抑郁症患者的认识，精神科医生的文化敏感咨询和护理管理。初步研究结果表明，CSCT提高了病例识别，促进了参与，并减少了治疗不足的美籍华人重度抑郁症患者的治疗差异（Yeung et al., 2006; Yeung, 2007）。本研究旨在探讨利用基于远程精神病学的CSCT （T-CSCT）将CSCT模式扩展到偏远诊所服务不足的华裔美国人的可行性和有效性。本研究的具体目的是：1)调查远程精神病学咨询是否被服务不足的MDD华裔美国人及其pcp所接受；2)调查T-CSCT对改善偏远诊所服务不足的MDD华裔美国人治疗效果的有效性。受试者将通过在初级保健诊所进行抑郁症筛查和通过宣传抑郁症自我筛查的广告来招募。200名治疗不足的MDD筛查阳性的华裔美国患者将随机接受T-CSCT或常规治疗（UC）。比较两组患者的治疗效果。本研究将探讨以远端精神病学为基础的文化敏感精神病学治疗对服务不足的美籍华人重度抑郁症患者的可接受性和有效性。其目标是增加获得精神卫生服务的机会，并减少少数民族患者在治疗抑郁症方面的差异。

DESCRIPTION (provided by applicant): Asian Americans tend to underutilize mental health services compared to other ethnic groups, with delayed treatment and higher attrition rates (Kung, 2003). When suffering from symptoms of mental illnesses, many underserved Chinese Americans seek help from their primary care physicians (PCPs) (Yeung et al., 2004a). In 2003, the applicant received a Career Development Award to study the effectiveness of Culturally Sensitive Collaborative Treatment (CSCT) for the treatment of underserved Chinese Americans with major depressive disorder (MDD) in primary care. The key elements of CSCT are active screening to increase recognition of depressed patients, culturally sensitive consultation by a psychiatrist and care management. Preliminary findings show that CSCT improves case recognition, facilitates engagement, and decreases the disparities of treatment among underserved Chinese Americans with MDD (Yeung et al., 2006; Yeung, 2007). This proposed study will investigate the feasibility and effectiveness of using Telepsychiatry-based CSCT (T-CSCT) to extend the CSCT model to underserved Chinese Americans in remote clinics. The specific aims of this study are: 1) To investigate whether telepsychiatry consultation is acceptable to underserved Chinese Americans with MDD and to their PCPs, and 2) To investigate the effectiveness of T-CSCT on improving treatment outcomes of underserved Chinese Americans with MDD in remote clinics. Subjects will be recruited by depression screening in primary care clinics and by advertisements to promote depression self-screening. Two hundred underserved Chinese American patients who screen positive for MDD will be randomized to receive either T-CSCT or Usual Care (UC). Treatment outcomes of patients in these two groups will be compared. This study will examine the acceptability and effectiveness of telepsychiatry- based culturally sensitive psychiatric treatment for underserved Chinese Americans with major depressive disorder. The goal is to increase access to mental health services and to decrease disparities in the treatment of depression among ethnic minority patients.