Motivational Antidepressant Therapy for Hispanics

描述（由申请人提供）：美国西班牙裔未充分利用药物治疗重度抑郁症（MOD）。在抗抑郁治疗（ADT）中，西班牙裔的保留率是大多数白人的一半。即使在调整了人口统计学和临床协变量之后，抑郁的西班牙裔人也认为ADT不太容易被接受，不太可能服用抗抑郁药处方，并且比大多数人的药物依从性更低。ADT未充分利用的三个主要原因——对治疗的不满、对早期治疗成果的过度依赖和环境障碍——在西班牙裔患者中被文化因素放大了。这些因素包括：对潜在的污名化、依赖的担忧；ADT的副作用；预期药物使用与抗抑郁药不相容；以及情绪疾病的治疗和病程的不同结构。标准ADT的低文化一致性导致许多西班牙裔人进入这种形式的治疗具有相当大的不确定性。这放大了现有环境障碍的不利影响，导致保留率低和药物依从性差。公共卫生后果包括更高的MOD发病率和复发率，以及不断上升的医疗费用。在NIMH的支持下，我们的团队开发了一种具有文化适应性的、新颖的干预措施，可以由精神科医生进行，以提高西班牙裔患者在ADT中的保留率（干预发展的第一阶段）。被称为动机性抗抑郁疗法（MADT），这种药物治疗的手动方法基于动机性访谈，这是一种减少患者参与治疗的矛盾心理的治疗方法。在MOD药物治疗的急性期，MADT在促进抑郁西班牙裔患者的保留和反应方面显示出很强的初步疗效。拟议的II期研究将在一项随机对照试验中测试MADT与标准ADT在研究诊所寻求门诊精神病治疗的西班牙裔抑郁症患者中的疗效。将在9个月的治疗期间检查保留、反应、依从性和患者满意度。混合方法方法（定量-定性）将产生有关患者、干预和影响留用的护理特征过程的信息。如果在这个II期试验中发现MADT比标准ADT更有效，混合方法数据将使我们能够进一步开发MADT用于社区环境中的III期有效性试验。

DESCRIPTION (provided by applicant): US Hispanics underutilize medication treatment for major depressive disorder (MOD). The retention rate in antidepressant therapy (ADT) among Hispanics is half that of majority whites. Depressed Hispanics also find ADT less acceptable, are less likely to fill antidepressant prescriptions, and have lower medication adherence than the majority population, even after adjusting for demographic and clinical covariates. Three main causes of ADT underutilization -dissatisfaction with treatment, over-reliance on early treatment gains, and environmental obstacles- are magnified by cultural elements in the case of Hispanics. These elements include: concerns about potential stigmatization, dependence; and side effects due to ADT; expectations of medication use incompatible with antidepressants; and alternative constructions of the treatment and course of emotional illness. The resulting low cultural congruence of standard ADT leads many Hispanics to enter into this form of treatment with considerable uncertainty. This magnifies the adverse effect of existing environmental barriers leading to low retention and poor medication adherence. The public health consequences include higher MOD morbidity and recurrence, and rising healthcare costs. With NIMH support, our team developed a culturally adapted, novel intervention for improving Hispanic retention in ADT that can be conducted by a psychiatrist (stage I of intervention development). Called Motivational Antidepressant Therapy (MADT), this manualized method of pharmacotherapy delivery is based on Motivational Interviewing, a therapeutic approach to patient engagement that reduces ambivalence about participating in treatment. MADT has shown strong preliminary efficacy in facilitating retention and response of depressed Hispanics in the acute phase of MOD pharmacotherapy. The proposed stage II study would test the efficacy of MADT in an RCT against standard ADT in depressed Hispanics seeking outpatient psychiatric care at a research clinic. Retention, response, adherence, and patient satisfaction will be examined over 9 months of treatment. A mixed-method approach (quantitative- qualitative) will yield information on patient, intervention, and process of care characteristics affecting retention. If MADT is found to be more efficacious than standard ADT in this stage II trial, the mixed- method data will allow us to further develop MADT for a stage III effectiveness trial in community settings.