Step Up Wellness Program for Depression Physical Inactivity and Smoking

描述（由申请人提供）：与NIMH R34机制的目标一致，本拨款申请的主要目标是开发和评估对缺乏运动和吸烟的抑郁症患者进行精神和身体健康干预的可行性和可接受性。这个项目被设计为常规初级保健服务的辅助。虽然标准护理干预措施通常单独解决这些问题，但这些行为经常聚集在一起。这种聚类不仅加剧了每种行为的有害影响，而且可能使单独治疗每种行为变得更加困难，而且可能更加昂贵。将每一种行为的干预合并到一个单一的项目中更有效，并且可能具有协同有益的效果，而一种行为的改变会促进其他行为的改变。此外，人们更有可能参与抑郁症、尼古丁依赖或体育活动的正式治疗，如果它是在一个全面的健康计划的背景下，而不是被污名为精神健康或药物滥用计划。因此，联合干预可能比标准的常规护理提供更大的服务范围。尽管在单一干预中解决抑郁症和共病行为风险因素的理由很充分，但这还没有做到。目前的研究是我们在抑郁症护理和发展健康行为改变的单一行为干预方面工作的自然延伸。该试验的目的是开发一种干预措施，重点是同时改善抑郁症状、加强身体活动和促进戒烟。我们将进行一系列试点试验，以评估干预措施的可行性、耐受性和可接受性，包括随机试点试验。我们假设，与常规护理对照组相比，干预参与者将在3个月和6个月的随访中报告抑郁症状改善，体力活动增加，戒烟尝试增加。次要行为结果也将被探讨。此外，我们将分析健康计划数据，以描述在一个大型卫生保健机构的抑郁症患者中吸烟和低体力活动的合并症发生率。在此拨款期间收集的数据将使我们能够评估干预的可接受性和可行性，完善项目材料和概念模型，并收集数据，为未来的有效性试验提供样本和功率计算。抑郁症和危险的健康行为（如缺乏运动、吸烟）往往是共病，但标准的干预措施是分别治疗每种行为的。单独处理每一种行为比同时处理每一种行为效率更低，而且可能效果更差。目前的研究将设计和评估一种治疗方案，同时解决抑郁症、体育活动水平和吸烟问题。这项工作将为这种综合治疗方法的可行性、可接受性和影响提供有价值的信息，并为该领域的未来研究奠定基础。

DESCRIPTION (provided by applicant): Consistent with the goals of the NIMH R34 mechanism, the main objectives of this grant application are to develop and evaluate the feasibility and acceptability of a mental and physical wellness intervention for persons with depression who are also physically inactive and smoke cigarettes. This program is designed as an adjunct to usual primary care services. While standard care interventions typically address each of these issues individually, these behaviors frequently cluster. This clustering not only compounds the deleterious impact of each behavior, but can make treating each in isolation more difficult and, potentially, more costly. Combining intervention for each of these into a single program is more efficient and may have a synergistic beneficial effect, whereas change in one behavior enhances change in the others. Furthermore, people may be more likely to engage in formal treatment for depression, nicotine dependence, or physical activity when it is framed in the context of a comprehensive wellness program and not stigmatized as a mental health or substance abuse program. As a result, the combined intervention may allow a greater reach of services than does standard usual care. Despite the sound rationale for addressing depression and co-morbid behavioral risk factors in a single intervention, this is not yet being done. The current study is a natural extension of our work in depression care and developing single-behavior interventions for health behavior change. The aims of the trial are to develop an intervention focused on concurrently improving depressive symptoms, enhancing physical activity, and promoting smoking cessation. We will conduct a series of pilot tests to assess the feasibility, tolerability, and acceptability of the intervention, including a randomized pilot trial. We hypothesize that, compared to usual care controls, intervention participants will report improved depressive symptoms, increased physical activity, and increased attempts to quit smoking at 3 and 6 month follow-up. Secondary behavioral outcomes will also be explored. In addition, we will analyze health plan data to describe the co-morbid incidence of smoking and low physical activity among persons with depression in a large health care organization. Data collected during this grant will allow us to evaluate the acceptability and feasibility of the intervention, refine the program materials and conceptual model, and collect data to inform sample and power calculations for a future effectiveness trial. Depression and risky health behaviors (e.g., physical inactivity, smoking) tend to be co-morbid, but standard interventions are designed to treat each behavior separately. Treating each behavior individually is less efficient, and potentially less effective, than treating each concurrently. The current study will design and evaluate a treatment program which addresses depression, physical activity level, and smoking simultaneously. This work will provide valuable information about the feasibility, acceptability, and impact of this comprehensive treatment approach and will lay the ground work for future research in this area.