Population-Based Psychiatric Intervention in Primary Care

描述(由申请人提供)：这是一份竞争续签NIMH以患者为导向研究的职业中期调查员奖的请求(NIMH工作人员已建议Katon博士，他可以作为正式教授提交竞争续签他的K-24奖项)。这份K-24将建立在Katon博士先前研究的基础上：1)开发创新的“协作性护理”干预措施，以改善初级保健环境中抑郁和焦虑症患者的护理质量和结果；2)增进对焦虑和抑郁障碍对常见医疗疾病患者的不利影响的了解；以及3)开发干预措施，以改善慢性内科疾病患者以及合并抑郁和焦虑症的患者的精神结果。这项建议的具体目标包括：1)继续提高Katon博士的流行病学、生物统计学和卫生经济学技能，以便在以人群为基础的研究中证明抑郁症和慢性疾病之间的双向不利互动。这些以人群为基础的研究的证据将通过：a)在横断面和纵向研究中显示抑郁症对医疗症状负担、功能障碍、坚持医疗方案、医疗并发症和死亡率的不利影响；以及b)在纵向研究中证明残留的抑郁症症状和医疗疾病的并发症与发展为严重抑郁症和新的功能缺陷的风险更高有关。其他目标包括：2)开发和测试针对抑郁症和慢性内科疾病患者的协作式护理模式的适应性，旨在改善医疗疾病控制、行为风险因素以及提高抑郁症护理质量；3)继续调整协作式护理干预措施，并在精神健康护理质量存在差异的新人群中测试其有效性，例如青少年抑郁症人群、生活在农村地区的注意力缺陷多动障碍(ADHD)青少年以及在妇产科接受治疗的抑郁症患者；以及4)继续扩大Katon博士对心理健康服务研究领域初级研究员的指导。这些目标将通过持续和扩大的研究活动、流行病学、生物统计学和卫生经济学的课程以及外部顾问的指导来实现。这些课程、与导师的互动和辅导读物将提高Katon博士作为导师的能力，并加强他的卫生服务部门的尖端研究。相关性：将在本奖项颁发过程中完成的研究将增加对慢性内科疾病患者抑郁症筛查和治疗重要性的了解；测试抑郁症和慢性内科疾病患者的新护理模式，旨在提高抑郁症和医疗护理的质量；并使协作护理模式适用于在精神卫生保健质量方面存在差异的新人群(患有ADHD和抑郁症的青少年以及在妇产科接受治疗的妇女)。

DESCRIPTION (provided by applicant): This is a request for a competing renewal of an NIMH Midcareer Investigator Award in Patient-Oriented Research (NIMH staff has advised Dr. Katon that he could submit a competing renewal of his K-24 award as a full professor). This K-24 will build on Dr. Katon's prior research in: 1) developing innovative "collaborative care" interventions to improve the quality of care and outcomes of patients with depressive and anxiety disorders within primary care settings; 2) improving understanding about the adverse impact of anxiety and depressive disorders in patients with common medical disorders; and 3) developing interventions to improve psychiatric outcomes in patients with chronic medical illness and comorbid depressive and anxiety disorders. The specific aims of this proposal include: 1) to continue to enhance Dr. Katon's epidemiologic, biostatistical and health economic skills in order to demonstrate in population-based studies the bidirectional adverse interactions between depression and chronic medical illness. The evidence from these population- based studies will be developed by a) showing in cross-sectional and longitudinal studies the adverse impact of depression on medical symptom burden, functional impairment, adherence to medical regimens, medical complications and mortality; and b) by demonstrating in longitudinal studies that residual depressive symptoms and incident complications of medical illness are associated with a higher risk of developing major depression and new deficits in functioning. Additional aims include: 2) to develop and test adaptations of collaborative care models in patients with depression and chronic medical illness that are targeted at improving medical disease control, behavioral risk factors, as well as improving quality of depression care; 3) to continue to adapt collaborative care interventions and test their effectiveness in new populations experiencing disparities in quality of mental health care such as adolescent populations with depression, youth with attention-deficit hyperactivity disorder (ADHD) living in rural settings, and women with depression treated in Ob-Gyn settings; and 4) To continue to expand Dr. Katon's mentorship of junior investigators in mental health services research. These goals will be met through continued and expanded research activities, coursework in epidemiology, biostatistics and health economics and mentorship from external consultants. These courses, interactions with mentors, and mentored readings will improve Dr. Katon's ability as a mentor as well as enhancing the cutting edge research of his Health Services Division. RELEVANCE: The research that will be completed during the course of this award will increase knowledge about the importance of screening for and treating depression in patients with chronic medical illnesses; test new models of care in patients with depression and chronic medical illnesses aimed at improving quality of quality of depression and medical care; and adapt the collaborative care model to new populations (youth with ADHD and depression and women treated in Ob-Gyn settings) that experience disparities in quality of mental health care.