BRIGHTEN HEART: REDUCING DISPARITIES IN LATE LIFE DEPRESSION & METABOLIC SYNDROME

与白人相比，年长的黑人和西班牙裔成年人患心血管疾病的许多主要风险因素的比例更高：缺乏运动、肥胖、空腹高血糖和血脂异常。黑人的高血压患病率也较高，而西班牙裔的代谢综合征患病率也较高。 除了心血管疾病，这些人群还面临着主要和创伤性生活应激源的高暴露，导致抑郁和焦虑症状的高比率。抑郁症和心血管疾病之间的联系是有据可查的。尽管如此，针对抑郁症的干预措施并未显示出心血管死亡率的改善，针对单一危险因素的策略也未能减少健康差距，拉什城市健康公平中心的调查人员建议测试 针对个人心理和行为风险的多层次方法，1)优先关注抑郁症的治疗，2)在初级保健环境中建立一个多学科团队，将抑郁症的治疗和饮食、活动和服药依从性等行为风险因素整合到减少代谢综合征的服务中。光明之心(通过电子网络连接老年健康团队的资源~心脏)试验的主要目的是确定光明之心是否可以减轻患有抑郁症和代谢综合征的老年少数族裔成年人的抑郁症状。次要目标是确定是否能使 与注意力对照相比，心脏干预可以降低代谢综合征的患病率，并测试中介假设，即光明心脏干预会改善对药物的依从性。探索性目的是探索创伤和主要生活应激源对干预结果的影响。方法：250名黑人和西班牙裔成年人将从芝加哥的三个大型社区卫生中心招募。受试者必须超过65岁，有BMI S25.0，并有通过PHQ-g仪器记录的抑郁症症状。然后，受试者将被随机分为两组，一组接受多层次的亮心团队干预，另一组受邀参加为老年人提供定期健康教育的会员计划。所有受试者都将被跟踪观察六个月。 结果测量将包括PHQ-9抑郁仪和心脏代谢风险因素，包括空腹血糖、血红蛋白、高密度脂蛋白胆固醇、血压和心脏C反应蛋白。该试验还将为少数族裔学生和早期职业卫生专业人员提供差异研究培训。

Relative to whites, older black and Hispanic adults experience higher rates of many major risk factors for cardiovascular disease: physical inactivity, obesity, fasting hyperglycemia, and dyslipidemia. Blacks also have elevated rates of hypertension, while Hispanlcs have elevated rates of the metabolic syndrome. Beyond cardiovascular disease, these populations also face high exposures to major and traumatic life stressors, contributing to high rates of depression and anxiety symptoms. Linkages between depression and cardiovascular disease are well documented. Despite this, interventions targeting depression have not shown improvements in cardiovascular mortality, and strategies targeting single risk factors have also failed to reduce health disparities, investigators from the Rush Center for Urban Health Equity propose to test a multi-level approach that targets 1) individual psychological and behavioral risk by providing preferential attention to the treatment of depression and 2) the health care system by building a multi-disciplinary team in a primary care setting, in which treatment of depression and behavioral risk factors of diet, activity, and medication adherence are integrated in the service of reducing the metabolic syndrome. The primary aim of the BRIGHTEN Heart (Bridging Resources of a Geriatric Health Team via Electronic Networking ~ Heart) trial is to determine whether BRIGHTEN Heart can reduce depression symptoms in older minority adults with comorbid depression and metabolic syndrome. Secondary aims are to determine whether the BRIGHTEN Heart intervention can result in reduced prevalence of metabolic syndrome as compared to an attention control and to test the mediating hypothesis that the BRIGHTEN Heart intervention results in improvements in adherence with medications. An exploratory aim is to explore the impact of trauma and major life stressors on the results of the intervention. Methods: 250 black and Hispanic adults will be recruited from three large community health centers in Chicago. Subjects must be over age 65, have a BMI S25.0, and have symptoms of depression documented via the PHQ-g instrument. Subjects will then be randomized to either receive the multi-level BRIGHTEN Heart team intervention or be invited to participate in a membership program providing regular health education to older adults. All subjects will be followed for six months. Outcome measures will include the PHQ-9 depression instrument, and cardiometabolic risk factors including fasting blood glucose, hemoglobin Ale, HDL cholesterol, blood pressure, and cardiac CRP. The trial will also provide disparities research training for minority students and early career health professionals.