Group Self-Management of Depression and Medical Illness
| Status: | Completed |
|---|---|
| Conditions: | Depression, Depression |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/2/2016 |
| Start Date: | September 2013 |
| End Date: | September 2014 |
| Contact: | David Camacho, MSW, MSG |
| Email: | dcamacho@usc.edu |
| Phone: | 3234424051 |
Group Self-Management for Persons With Depression and Medical Illness
This project addresses the important public health need to reduce ethnic disparities in
depression care by pilot testing and refining a culturally tailored, low-cost intervention
for improving both depression and general medical outcomes among Latinos in safety net
primary care settings. Cuerpo Sano, Mente Sana is a newly developed, lay-led, group
self-management intervention that educates and empowers patients in their own health care
and has the potential for widespread implementation and sustainability in primary care
because it is responsive to patient, provider, and system preferences and needs. After
completing an assessment of study clinic sites, we will conduct a pilot test of Cuerpo Sano,
Mente Sana with 30 low-income, Spanish-speaking primary care patients. After reviewing pilot
findings, we will revise the intervention and study plan, and will conduct a second pilot
trial. After reviewing findings from this second trial, we will finalize the intervention
and study plan in preparation for larger studies to test Cuerpo Sano, Mente Sana versus
other interventions for addressing depression among Latinos in safety net primary care.
depression care by pilot testing and refining a culturally tailored, low-cost intervention
for improving both depression and general medical outcomes among Latinos in safety net
primary care settings. Cuerpo Sano, Mente Sana is a newly developed, lay-led, group
self-management intervention that educates and empowers patients in their own health care
and has the potential for widespread implementation and sustainability in primary care
because it is responsive to patient, provider, and system preferences and needs. After
completing an assessment of study clinic sites, we will conduct a pilot test of Cuerpo Sano,
Mente Sana with 30 low-income, Spanish-speaking primary care patients. After reviewing pilot
findings, we will revise the intervention and study plan, and will conduct a second pilot
trial. After reviewing findings from this second trial, we will finalize the intervention
and study plan in preparation for larger studies to test Cuerpo Sano, Mente Sana versus
other interventions for addressing depression among Latinos in safety net primary care.
Latinos suffer a greater disability burden from depression than whites due to low rates of
quality depression care. Depression is common among Latinos in primary care settings and is
also often chronic, recurring, and comorbid with chronic medical illness. Improving outcomes
for both depression and chronic medical illness requires patients to become educated, active
partners in managing their illnesses. Latinos desire education regarding general and mental
health; have stigma-related concerns regarding mental health care; and prefer psychotherapy
to medication. However, safety net primary care providers and clinics often prioritize
improving medical outcomes and lack the resources for depression care, especially
psychotherapy. There is an important public health need to develop a culturally tailored,
low cost intervention that includes educational and psychotherapeutic elements, targets
medical illness and depression, and destigmatizes depression care.
In response to patient, provider, and clinic preferences and resources for depression care,
we developed but have not yet tested an innovative, theoretically-based group intervention,
drawing upon two evidence-based interventions that improve self-efficacy: group cognitive
behavioral therapy (CBT) for depression and group self-management for chronic medical
illness. Professionally-led group CBT is effective for depression among ethnic minorities in
primary care but is difficult to sustain. Among patients with chronic medical illness,
lay-led group self-management programs educate and empower patients to engage in healthful
behaviors and participate in their care. The groups improve self-efficacy, health-related
behaviors, and outcomes; have been adapted for diverse conditions; and have been widely
disseminated and sustained. However, standard self-management groups do not improve
depression. We thus enhanced the Spanish-language Tomando Control de su Salud chronic
disease self-management program by adding depression-related educational and skill-building
content from group CBT.
We will pilot test and refine Cuerpo Sano, Mente Sana, our newly enhanced self-management
program for depression and chronic medical illness. Following a framework for successful
implementation of interventions, we will 1) evaluate intervention context and refine our
intervention and implementation strategy; 2) conduct a randomized trial with 30 low-income
Spanish-speaking patients with depressive disorder and chronic medical illness; 3) review
pilot findings of feasibility, implementation, and potential sustainability with a
multistakeholder panel and then revise our materials and procedures; 4) conduct a second
trial with 30 additional patients; and 5) review additional pilot findings (including 3- and
6-month intervention effects on self-efficacy, self-care behaviors, and depression and
health outcomes and interviews with clinic stakeholders) and finalize the intervention and
implementation strategy. This study lays the groundwork for future comparative effectiveness
studies of strategies to address depression among Latinos in safety net primary care.
quality depression care. Depression is common among Latinos in primary care settings and is
also often chronic, recurring, and comorbid with chronic medical illness. Improving outcomes
for both depression and chronic medical illness requires patients to become educated, active
partners in managing their illnesses. Latinos desire education regarding general and mental
health; have stigma-related concerns regarding mental health care; and prefer psychotherapy
to medication. However, safety net primary care providers and clinics often prioritize
improving medical outcomes and lack the resources for depression care, especially
psychotherapy. There is an important public health need to develop a culturally tailored,
low cost intervention that includes educational and psychotherapeutic elements, targets
medical illness and depression, and destigmatizes depression care.
In response to patient, provider, and clinic preferences and resources for depression care,
we developed but have not yet tested an innovative, theoretically-based group intervention,
drawing upon two evidence-based interventions that improve self-efficacy: group cognitive
behavioral therapy (CBT) for depression and group self-management for chronic medical
illness. Professionally-led group CBT is effective for depression among ethnic minorities in
primary care but is difficult to sustain. Among patients with chronic medical illness,
lay-led group self-management programs educate and empower patients to engage in healthful
behaviors and participate in their care. The groups improve self-efficacy, health-related
behaviors, and outcomes; have been adapted for diverse conditions; and have been widely
disseminated and sustained. However, standard self-management groups do not improve
depression. We thus enhanced the Spanish-language Tomando Control de su Salud chronic
disease self-management program by adding depression-related educational and skill-building
content from group CBT.
We will pilot test and refine Cuerpo Sano, Mente Sana, our newly enhanced self-management
program for depression and chronic medical illness. Following a framework for successful
implementation of interventions, we will 1) evaluate intervention context and refine our
intervention and implementation strategy; 2) conduct a randomized trial with 30 low-income
Spanish-speaking patients with depressive disorder and chronic medical illness; 3) review
pilot findings of feasibility, implementation, and potential sustainability with a
multistakeholder panel and then revise our materials and procedures; 4) conduct a second
trial with 30 additional patients; and 5) review additional pilot findings (including 3- and
6-month intervention effects on self-efficacy, self-care behaviors, and depression and
health outcomes and interviews with clinic stakeholders) and finalize the intervention and
implementation strategy. This study lays the groundwork for future comparative effectiveness
studies of strategies to address depression among Latinos in safety net primary care.
Inclusion Criteria:
- Established primary care patient
- Spanish-speaking
- Depression (major depression, dysthymia, minor depression)
- Chronic medical illness (diabetes, hypertension, dyslipidemia, heart disease, lung
disease, cerebrovascular disease, arthritis)
Exclusion Criteria:
- Bipolar disorder
- Psychosis
- Cognitive impairment
- Active suicidal ideation
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