Multimedia Internet-Based Program for Workers with Subthreshold Depression

描述（由申请人提供）：抑郁症是困扰成年人的最普遍的精神障碍之一。它严重影响角色功能，并经常复发或慢性病程。鉴于高患病率和相关损伤，抑郁症已成为一个主要的公共卫生问题。由于大多数患有抑郁症的成年人从未接受过治疗，因此迫切需要制定易于实施和广泛传播的干预措施。该项目将开发和测试一个交互式多媒体程序，向阈下抑郁症患者教授认知行为和人际交往技能，以减轻症状，改善工作场所的功能，并潜在地降低升级为完全综合征抑郁症的风险。干预将包括以知识和技能为基础的模块，包括：理解抑郁症、工作压力管理、情绪监控、愉快的活动安排、增加积极思考、减少消极思考、技能整合和未来规划。以能力为基础的教学设计将采用基于视频的教程、推荐和行为建模小片段来组织多个会议。额外的浏览器模块将包括抑郁症自我筛选，获得支持，学习放松，解决问题和沟通，以及其他资源。在线支持系统将包括一个电子公告板，每周一次与干预教练的个人会议，以及一个专家提问论坛。干预措施将包括六个目标人群：处于早期、中期和晚期的男性和女性。该计划的基本结构将对每个目标人群相同，但具体内容将针对每个用户群体进行定制。第一阶段的原型针对18-39岁的女性，提供理解抑郁症、情绪监测和安排愉快活动的培训。一项小型随机试验（n = 42）的结果显示，在抑郁症状、知识、所教技能的使用和自我效能方面，前后的变化具有中等到较大的效应。参与者发现该程序易于使用，并给予了很高的满意度和可用性评级。完全开发的II期产品将在一项大型随机试验（N = 300）中进行评估，其中包括8周的干预和1个月的随访期。II期试验预计将显示抑郁症状的减少和职业功能的增加，这些结果测量的变化预计将通过干预获得的特定技能的变化来调节。第二阶段产品的潜在商业应用是员工援助计划、行为健康组织、健康保险公司和精神健康诊所/实践。

DESCRIPTION (provided by applicant): Depression is one of the most prevalent mental disorders to afflict adults. It seriously impacts role functioning and often takes a recurrent or chronic course. Given the high prevalence and associated impairments, depression has become a major public health concern. Because most adults who suffer from depression never receive treatment, there is a critical need to develop interventions that can be easily implemented and widely disseminated. This project will develop and test an interactive multimedia program to teach cognitive-behavioral and interpersonal skills to workers with subthreshold depression in order to reduce symptoms, improve functioning at the workplace, and potentially reduce the risk for escalation to full-syndrome depression. The intervention will consist of knowledge- and skills-based modules including: understanding depression, work stress management, mood monitoring, pleasant activity scheduling, increasing positive thinking, decreasing negative thinking, skill integration, and planning for the future. The competency-based instructional design will be structured for multiple sessions using video-based tutorials, testimonials, and behavior modeling vignettes. Additional browser modules will include depression self-screening, getting support, learning to relax, problem solving and communication, and additional resources. The online support system will include an electronic bulletin board, personal weekly conferences with an intervention coach, and an ask-an-expert forum. The intervention will include six target populations: men and women in early, mid and late life. The basic structure of the program will be the same for each target population, but specific content will be customized to each user group. The Phase I prototype, targeted to 18-39 year-old women, provided training on understanding depression, mood monitoring, and scheduling pleasant activities. Results from a small randomized trial (n = 42) showed moderate to large effect sizes for pre to post change in depressive symptomatology, knowledge, use of the skills taught, and self-efficacy. Participants found the program easy to use and gave it high satisfaction and usability ratings. The fully developed Phase II product will be evaluated in a large randomized trial (N = 300) with an eight- week intervention and 1-month follow-up period. The Phase II trial is expected to show reductions in depressive symptoms and increases in occupational functioning, and these changes in the outcome measures are expected to be mediated by changes in the specific skills acquired through the intervention. The potential commercial applications of the Phase II product are to employee assistance programs, behavioral health organizations, health insurance companies, and mental health clinics/practices. PUBLIC HEALTH RELEVANCE: Depression has become a major public health concern given its high prevalence and associated impairments. Although there have been significant advances in the diagnosis and treatment of depression, the design and evaluation of interventions for subthreshold depression have received little attention to date. Because most adults who suffer from depression never receive treatment, there is a critical need to develop interventions that can be easily implemented and widely disseminated.