Changing Narratives of Depression in Rural Women of the South

描述(由申请人提供)：这项为期3年的探索性第一阶段行为治疗研究响应NIH PAR-09-173(取代PAR-06-248)，将建立数字故事作为促进患有严重抑郁障碍(MDD)的低收入农村妇女的治疗变化的一种手段。数字故事是一种自传式叙事，它已被数字音频录制，并用静止图片、视频、音乐和其他数字化媒体进行增强，并转换为可以在大多数计算机平台上播放的电影。当自传式数字故事是在治疗关系的背景下产生的，并被用来唤起抑郁症叙事中的适应性变化时，它可以作为一种机制，改善女性对自己的看法，提高她们在人际互动中的有效性，并促进社会参与，最终减少抑郁症状。叙事变化发生在与精神科护士专家的互动中，通过言语、听觉、视觉和认知过程对大脑不同区域的叙事处理和记忆的差异性和加性影响，通过女性在学习和应用新技能方面的成功经验，以及通过支持参与新的社会互动。作为第一阶段的研究，提出了一个理论框架，提供了丰富的社会和行为科学文献，将MDD与叙事中断、交互痛苦和社交退缩联系在一起。提出了建立这些联系的多方法案例研究设计。使用结合了定性和定量研究方法的内部和跨案例分析，调查小组将1)建立教学、治疗和技术程序，促进患有MDD的农村低收入妇女的疾病叙事的适应性变化，2)确定自传体疾病叙事在数字故事的创作和制作过程中如何变化，b)什么治疗和技术过程影响叙事变化，以及c)与完成数字故事相关的结果，以及3)确定与对数字故事的创作和制作的反应和不反应相关的个人、个人内部、人际关系、叙事和其他特征。这项密集的研究结果包括数字故事的治疗程序手册、评估叙事变化及其对结果的影响的方法，以及关于与数字故事相关的潜在变化机制的假设，这些假设可以在未来的R01级随机临床试验中进行测试。 公共卫生相关性：抑郁症影响多达40%的低收入农村妇女，但她们获得治疗的可能性低于城市妇女。这种未得到满足的需求，显然是由于农村卫生保健资源有限，以及农村人口拒绝正式的精神卫生治疗，导致农村人口过度共病、频繁住院和更高的自杀率。这项拟议的研究测试了一种对性别和文化敏感的抑郁症替代疗法，该疗法有可能在资源贫乏的农村卫生和社区环境中被接受、负担得起和可持续。

DESCRIPTION (provided by applicant): This 3-year, exploratory, Stage I behavioral treatment research study responding to NIH PAR-09-173 (replacing PAR-06-248), will establish digital story as a means of promoting therapeutic change among low- income rural women with major depressive disorder (MDD). Digital story is an autobiographical narrative that has been digitally audio recorded, augmented with still pictures, video, music, and other digitized media and converted to a movie that can be played on most computer platforms. When the autobiographical digital story is produced within the context of a therapeutic relationship and used to evoke adaptive change in the depression illness narrative, it can serve as a mechanism for improving women's view of themselves, for increasing their effectiveness in interpersonal interaction, and for promoting social engagement, ultimately reducing depressive symptoms. Narrative change occurs in interaction with the psychiatric nurse specialist, through the differential and additive effects of speech, audio, visual, and cognitive processes on narrative processing and memory in diverse areas of the brain, by women's experience of success in learning and applying new skills, and through supported engagement in new social interactions. As Stage I research, a theoretical framework is presented informed by a diverse and extensive social and behavioral science literature that links MDD with narrative disruption, interactional distress, and social withdrawal. A multi-method case study research design establishing those linkages is proposed. Using within and across case analyses that integrate qualitative and quantitative research approaches the investigative team will 1) Establish instructional, therapeutic, and technological procedures that foster adaptive change in illness narratives of rural, low-income women with MDD, 2) Determine a) how autobiographical illness narratives change during the process of creation and production of a digital story, b) what therapeutic and technological processes effect narrative change, and c) outcomes associated with completing digital story, and 3) Identify personal, intrapersonal, interpersonal, narrative and other characteristics associated with response and non-response to the creation and production of digital story. Outcomes of this intensive research study include a treatment procedure manual for digital story, methods for evaluating narrative change and its effect on outcomes, and hypotheses about potential change mechanisms associated with digital story that can be tested in a future, R01 level randomized clinical trial. PUBLIC HEALTH RELEVANCE: Depression affects as many as 40% of low-income rural women, yet they are less likely than urban women to obtain treatment. This unmet need, apparently due to limited rural health care resources, and reject of formal mental health treatments by rural populations, has led to excessive co-morbidity, frequent hospitalizations, and higher rates of suicide among rural populations. The proposed research tests a gender and culturally sensitive alternative treatment for depression that has the potential to be acceptable, affordable, and sustainable in resource poor rural health and community settings.