Comparative Effectiveness of Medication vs. CBT in Depressed Low-Income Women

描述（由申请人提供）：重度抑郁症是一种早期发病的疾病，通常是慢性的，给个体带来很高的疼痛、痛苦和残疾负担。大多数抑郁症治疗研究主要包括白人和中产阶级人群，因此对少数民族和穷人的现有治疗方法的有效性知之甚少。抑郁症研究的一个常见特征是，随着时间的推移，由于患者往往遵循不同的轨迹，结果在受试者之间存在相当大的异质性。当比较不同治疗的有效性时，重要的是要识别和考虑这些不同的轨迹，因为干预的有效性可能取决于参与者的轨迹类别。增长混合模型（GMM）允许分析人员在研究过程中估计几种不同的轨迹。通过这种方式，GMM可以更好地捕捉受试者之间的可变性，因为它不要求所有个体随时间遵循相同的轨迹。在这个应用程序中，我们建议使用来自WECare研究的数据来比较药物治疗和认知行为治疗的有效性，WECare研究是一项针对低收入少数族裔抑郁症女性的纵向抑郁症治疗研究。使用GMM，我们将识别和预测整个研究过程中的反应轨迹。我们的具体目标是：(1)确定WECare受试者的临床反应轨迹亚型，然后在这些轨迹中比较抗抑郁药物和认知行为治疗的有效性。(2)根据受试者的基线特征（包括社会经济和临床特征）对不同反应轨迹的受试者进行分类，以确定哪些患者更有可能从给定的干预中受益。(3)扩展现有的GMM方法来处理退出研究的参与者。这项研究有可能在个人层面上确定最有效的抑郁症治疗方法。

DESCRIPTION (provided by applicant): Major depression, a disorder with early onset and often chronic course, imposes a high individual burden of pain, suffering, and disability. Most depression treatment studies include primarily White and middle-class populations so that little is known about the effectiveness of established treatments for ethnic minority and poor individuals. A frequent characteristic of depression studies is that outcomes over time are subject to considerable between-subject heterogeneity due to the fact that patients often follow different trajectories over time. When comparing the effectiveness of different treatments, it is important to identify and take into account these different trajectories because the effectiveness of an intervention may depend on the trajectory class of the participants. Growth mixture modeling (GMM) allows the analyst to estimate several different trajectories over the course of a study. In this way, GMM may do a better job of capturing between-subject variability because it does not require that all individuals follow the same trajectory over time. In this application, we propose to compare the effectiveness of medication versus cognitive behavioral therapy using data from the WECare study, a longitudinal depression treatment study of low-income mostly minority women with depression. Using GMM we will identify and predict response trajectories over the course of the study. Our specific aims are (1) Identify subtypes of clinical response trajectories among WECare subjects and then compare the effectiveness of antidepressant medication and cognitive behavioral therapy within these trajectories. (2) Classify subjects in the various response trajectories in terms of their baseline characteristics including socioeconomic and clinical features to identify which patients are more likely to benefit from a given intervention. (3) Extend existing GMM approaches to handle participants who drop out a study. This research has the potential to identify the most effective depression treatments at the individual level. PUBLIC HEALTH RELEVANCE: Project Narrative: This project will estimate the different trajectories that participants follow in response to treatment for depression and the socioeconomic and clinical features associated with these trajectories. The comparative effectiveness of antidepressant medication versus cognitive behavioral therapy will be estimated within trajectories. The overall goal is to contribute to the development of personalized depression interventions for disadvantaged populations.