Developing Telephone CBT for HIV Related Depression

描述（由申请人提供）：高达40%的接受HIV治疗的个体符合DSM-IV共同发生的抑郁症的标准。与单独感染艾滋病毒的人相比，患有艾滋病毒和抑郁症的人对抗逆转录病毒药物的依从性较差，与艾滋病毒相关的发病率增加，妇女死亡率更高。先前的研究表明，心理健康干预可能会改善抑郁症和艾滋病毒相关的结果。然而，由于许多感染艾滋病毒的抑郁症患者可能难以获得精神卫生服务，因此迫切需要进行治疗试验，以评估在城市艾滋病毒护理机构中针对抑郁症患者的治疗是否会同时改善抑郁症和艾滋病毒相关的结果。这项R-34申请的目标是使用行为治疗研究的阶段模型来适应、进一步开发和试点测试一种基于电话的认知行为治疗（CBT）干预，针对在成人门诊HIV诊所接受治疗的HIV感染抑郁症患者。这一应用有两个目的，与行为治疗研究阶段1A和阶段1B相一致。首先，我们将适应并进一步发展（阶段1A）基于电话的CBT干预，使用来自多个观点的迭代反馈——患者、提供者和专家。其次，我们将测试适应性电话心理治疗的初步有效性（阶段1B）。共有60名艾滋病毒感染者和抑郁症患者在城市艾滋病门诊接受治疗，将被随机分配接受CBT电话心理治疗干预或非指导性电话治疗。研究结果将为电话心理治疗干预HIV感染抑郁症患者是否能有效减少抑郁提供初步数据。结果还将用于确定可行性，可及性，并为未来的有效性试验产生更准确的样本量估计，并将作为R01应用程序的基础，将该研究扩展到更大的样本和多个站点。如果我们的假设是正确的，并且我们发现基于电话的心理治疗干预导致了更好的保留，更好的满意度和更好的抑郁结果，我们将使用这些数据来开发一个R-01应用程序，用于针对艾滋病毒护理环境中抑郁症的电话心理治疗的全面随机对照试验。这项规模更大的试验将使我们不仅能够调查改善的抑郁症治疗是否会改善抑郁症的预后，还能调查改善的艾滋病相关医疗护理是否会改善艾滋病相关的预后。

DESCRIPTION (provided by applicant): Up to 40% of individuals receiving medical care for HIV meet DSM-IV criteria for co- occurring depressive disorder. Individuals with HIV and depressive disorders, compared to those with HIV alone, have been shown to have worse adherence to taking antiretroviral medication, increased HIV related morbidity and among woman a higher mortality. Previous research suggests that mental health interventions may lead to improved depressive and HIV related outcomes. However because many HIV infected depressed individuals may have trouble accessing mental health services, there is an urgent need for treatment trials to assess whether treatment of depression targeting patients in urban HIV care settings will result in both improved depressive and HIV related outcomes. The goal of this R-34 application is to use the stage model of behavioral therapy research to adapt, further develop and pilot test a telephone based cognitive behavioral therapy (CBT) intervention targeting HIV infected depressed individuals receiving care in adult outpatient HIV clinics. This application has two aims consistent with stage 1A and stage 1B of the stage of behavioral therapy research. First, we will adapt and further develop (Stage 1A) the telephone based CBT intervention using iterative feedback from multiple viewpoints --patients, providers and experts. Second, we will test the preliminary effectiveness (Stage 1B) of the adapted telephone psychotherapy. A total of 60 HIV infected, depressed individuals receiving care at an urban, outpatient HIV clinic will be randomly assigned to receive either the CBT telephone psychotherapy intervention or a non-directive telephone based therapy. The results will provide preliminary data on whether the telephone psychotherapy intervention for HIV infected depressed individuals is effective in reducing depression. The results will also be used to determine feasibility, accessibility, and generate a more accurate estimate of the needed sample size for future effectiveness trials and will serve as the basis for a R01 application to extend this research to larger samples, and multiple sites. If our hypothesis is correct and we find that a telephone based psychotherapy intervention leads to improved retention, better satisfaction and better depression outcomes, we will use these data to develop an R-01 application for a full-scale, randomized controlled trial of the telephone psychotherapy targeting depression in the HIV care setting. This larger trial will enable us to investigate not only whether improved treatment of depression leads to improved depressive outcomes but whether it leads to improved access to HIV related medical care leading to improved HIV related outcomes.