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Improving Mental Health Outcomes Through a
Primary Care Intervention
Ann Peden, D.S.N.,
Principal Investigator;
Lynne Hall, Dr.P.H.,
Co-Principal Investigator;
Mary Kay Rayens, Ph.D.,
Co-investigator
Funded by the University of Kentucky Medical Research Grants Program
(1999 - 2000)
Abstract
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The ultimate goal of this program of research is to improve
clinical outcomes for women treated for depression in
primary care clinics. Depression is a major public
health problem and is the most common mental illness
experienced by women. Primary care providers are often the
first point of contact for many individuals experiencing
depression. Almost 50 percent of patients who are treated for
depression receive their treatment exclusively in primary
care clinics. The purpose of this study is to test the
efficacy of a clinical intervention in reducing clinical
depression and improving other mental health outcomes for
college women presenting with depression in primary
care. The specific aim of this study is to test the
efficacy of a cognitive-behavioral group intervention when
used in conjunction with antidepressant therapy.
The sample will consist of 48
women between 18 and 24 with a DSM-IV diagnosis
of major depression and who are being treated with
antidepressant medication in University Health Service at
UK. The inclusion criteria are: (1) full-time
student; (2) never on antidepressant medication prior to
this episode; (3) no previous psychiatric care; (4)
not suicidal as indicated by question nine on the Beck
Depression Inventory; (5) duration of depression diagnosis
of no more than two months; (6) not pregnant; and (7)
antidepressant and/or psychological counseling of less than
one month in duration. A randomized controlled trial
with repeated measures will be conducted to test the effects
of the intervention. Data on depressive symptoms, negative
thinking, self-esteem, and academic and social functioning
will be collected for both control and experimental
subjects. As women are enrolled, they will be randomly
assigned to the control or experimental condition. The
control group will consist of 24 women who received a
diagnosis of major depression from a health care provider
and who are receiving antidepressant medication and usual
clinic care. The experimental group will be composed
of 24 women who receive antidepressant medication, usual
clinic care, plus the group intervention. The
intervention consists of six one-hour per week group
sessions that target identification and management of
negative thinking as it effects depressive symptoms. Thought
stopping (Meichenbaum, 1977) and the use of affirmations
(positive self-talk) (Gordon & Tobin, 1991) are the
primary techniques that will be taught. Experimental and
control subjects will be reinterviewed at one month and four
months post-intervention to reassess their negative
thinking, depressive symptoms, self-esteem, and social and
academic functioning. Also at the one-month and
one-month follow-ups, participants will be asked whether they are
still taking medication for depression or have sought
further counseling. Data will be analyzed using
repeated measures ANOVA or ANCOVA and the Cochran-Mantel-Haenzel
c2 statistic.
This pilot study will provide the foundation for an R01
application for an extension of this randomized controlled
trial to women in primary care settings. |
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