Barriers and Facilitators of Mental Health Services Utilization Among Latinos

描述（申请人提供）：使用基于社区的参与性研究（CBPR）模型，这项为期5年的纵向队列研究将实证评估个人，伴侣/家庭，社会背景和更大的社区压力源对临床抑郁症，抑郁症严重程度和心血管疾病（CVD）风险的关联在劳伦斯，MA，并评估文化特定类型的社会支持和资源对这些协会的缓冲作用。这项合作的伙伴是：劳伦斯的拉丁裔居民;社区组织，包括大劳伦斯家庭健康中心、劳伦斯市市长健康工作队、劳伦斯老龄化/老年中心理事会、大劳伦斯女青年会、圣家医院、劳伦斯总医院和马萨诸塞大学医学院。这项合作始于2003年，拟议的研究建立在其先前的CBPR工作基础上。这项研究将在600名居住在马萨诸塞州劳伦斯的加勒比拉丁裔成年人中进行，劳伦斯是一个HRSA定义的医疗服务不足的社区。现有证据表明，抑郁症状和临床抑郁症在美国低收入拉丁裔中非常普遍。然而，在这一人群中缺乏抑郁症的纵向研究，并且对这一人群中这些疾病的风险和保护因素知之甚少。有证据表明，抑郁症是残疾、高死亡率和不良健康后果的独立风险因素，包括心血管疾病，这是拉丁美洲人死亡的主要原因。了解导致拉丁美洲人抑郁和心血管疾病风险的压力源对于制定有针对性的干预措施至关重要。这项研究的主要目的是：1）评估压力之间的横截面关联（在个人，伴侣/家庭，社会和更大的社区水平上测量）和临床抑郁症和抑郁症严重程度的测量; 2）评估压力之间的纵向关联（在个人、伴侣/家庭、社会和更大的社区层面上测量）以及临床抑郁症和抑郁症严重程度的测量;以及3）评估社会支持和资源（在个人、伴侣/家庭、社会和更大的社区水平上测量）对压力与临床抑郁症和抑郁症严重程度的测量之间的关联的中介作用。次要目标是：4）评估压力和抑郁症与CVD风险之间的纵向关联，5）调查健康相关行为，即饮食，体力活动，吸烟，饮酒和睡眠对压力和抑郁症与CVD风险之间的关联的中介作用。研究参与者将被随访两年，每年采取措施。CBPR的目标是：1）通过持续的自我评估加强伙伴关系的参与性基础设施; 2）评估研究结果的传播和传播的外联过程; 3）评估在实施新方案和开发基于拟议研究结果的新研究项目方面的成功。 公共卫生相关性：劳伦斯-马萨诸塞大学拉丁裔健康伙伴关系（伙伴关系）是一个为期7年的社区参与式研究（CBPR）合作，以改善生活在劳伦斯，马，一个HRSA定义的医疗服务不足的社区拉丁裔的健康。该伙伴关系成立于2003年，包括大劳伦斯家庭保健中心、劳伦斯市市长保健工作队、劳伦斯老龄问题理事会/老年人中心、大劳伦斯基督教女青年会、圣家医院、劳伦斯总医院和马萨诸塞州大学医学院。该伙伴关系建议研究压力对劳伦斯拉丁美洲人心理健康和心血管风险的影响，以及可能影响这些协会的因素，特别是社会支持和资源。该伙伴关系还将寻求加强其进程，传播研究结果，并评估该项目对新社区方案和研究项目的影响。

DESCRIPTION (provided by applicant): Using a community-based participatory research (CBPR) model, this 5-year longitudinal cohort study will empirically assess the association of individual, partner/family, social context and larger community stressors, on clinical depression, depression severity, and cardiovascular disease (CVD) risk among Caribbean Latinos in Lawrence, MA, and assess the buffering effects of culture-specific types of social support and resources on these associations. Partners in this collaboration are: individual Latino residents of Lawrence; community- based organizations including the Greater Lawrence Family Health Center, the City of Lawrence Mayor's Health Task Force, the Lawrence Council on Aging/Senior Center, the YWCA of Greater Lawrence, Holy Family Hospital, Lawrence General Hospital; and UMass Medical School (UMMS). This collaboration began in 2003 and the proposed study builds from its prior CBPR work. The study will be conducted among 600 Caribbean Latino adults living in Lawrence, MA, a HRSA defined medically underserved community. Available evidence suggests that depressive symptoms and clinical depression are highly prevalent among low-income Latinos in the US. However, there is a scarcity of longitudinal studies of depression in this population, and relatively little is known about the risk and protective factors for these conditions in this population. Evidence indicates that depression is an independent risk factor for disability, excess mortality and adverse health outcomes, including cardiovascular disease, a leading cause of death among Latinos. Understanding the stressors that contribute to depression and CVD risk among Latinos is crucial to developing targeted interventions. The primary aims of the proposed study are to: 1) assess cross-sectional associations between stress (measured at the individual, partner/family, social and larger community levels) and measures of clinical depression and depression severity; 2) assess longitudinal associations between stress (measured at the individual, partner/family, social and larger community levels) and measures of clinical depression and depression severity; and 3) assess the mediating effect of social support and resources (measured at the individual, partner/family, social and larger community levels) on the associations between stress and measures of clinical depression and depression severity. The secondary aims are to: 4) assess the longitudinal association between stress and measures of depression with CVD risk and 5) investigate the mediating effect of health-related behaviors, namely diet, physical activity, smoking, alcohol use and sleep on the association between stress and measures of depression with CVD risk. Study participants will be followed for two years with measures taken annually. CBPR aims are to: 1) enhance the participatory infrastructure of the Partnership through continuous self-assessment; 2) evaluate the outreach process for diffusion and dissemination of study results; and 3) evaluate the success in implementing new programs and developing new research projects that build from the results of the proposed study. PUBLIC HEALTH RELEVANCE: The Lawrence-UMass Latino Health Partnership (Partnership), is a 7-year community-based participatory research (CBPR) collaborative to improve the health of Latinos living in Lawrence, MA, a HRSA defined medically underserved community. Established in 2003, this Partnership includes the Greater Lawrence Family Health Center, the City of Lawrence Mayor's Health Task Force, the Lawrence Council on Aging/Senior Center, the YWCA of Greater Lawrence, Holy Family Hospital, Lawrence General Hospital and the University of Massachusetts Medical School. The Partnership proposes to study the influence of stress on mental health and cardiovascular risk among Lawrence Latinos as well as factors that may influence these associations, in particular social support and resources. The Partnership also will seek to enhance its process, disseminate the study results and evaluate the impact of the project on new community programs and research projects.