The goal of this independent research scientist award application is to protect the time necessary to further develop my skills as a newly independent researcher specializing in comparative effectiveness of interventions for depression in the community mental health system. This award would allow me to become a sophisticated comparative effectiveness researcher utilizing state-of-the-art methodologies and statistical approaches to study the effectiveness of interventions in alleviating mental health disorders of high public health priority. My program of research and planned career development activities are based on the definition of comparative effectiveness research elaborated by the Institute for Medicine's Committee on Comparative Effectiveness Research Prioritization. It is my goal to work with expert consultants and participate in training activities to take my comparative effectiveness research program to the next level. To complement my current program of research evaluating the effectiveness of interventions for depression in the community mental health system that inform clinical decision making at the population level, my goal is to develop expertise in methods and statistical approaches that would allow my research to address the important question of how to efficiently disseminate effective interventions to meet the needs of individual consumers of services for depression. This award would afford me the time needed to participate in classroom instruction in the newest statistical approaches, attend training seminars and institutes, work with expert consultants, and attend conferences to enhance my development as a comparative effectiveness researcher. This award would also allow me the time, expert consultation, and education needed to conduct two important studies to inform the efficient dissemination of interventions for depression in the community: a study of the patient baseline moderators of treatment effectiveness and a study of healthcare utilization and costs associated with the utilization of mental health interventions for MDD in the community mental health system.
The specific aims of this investigation include 1) to assess whether patient baseline skills deficits moderate the effectiveness of dynamic therapy and cognitive therapy for patients with major depressive disorder treated in the community mental health setting, 2) to assess whether patient baseline deficits moderate the effectiveness of dynamic therapy and cognitive therapy on secondary measures of outcome, 3) to explore additional baseline patient variables that may moderate the effectiveness of these psychotherapeutic approaches for patients with major depressive disorder treated in the community mental health setting, and 4) to evaluate healthcare utilization and associated costs for patients treated with psychotherapy for depression in the community mental health system compared to patients who receive alternative treatments.
Major depressive disorder is a severe and disabling disorder afflicting 7% of individuals in the United States annually and approximately 17% of individuals across their lifetime (Kessler et al., 2005). Depression has been ranked as the fourth greatest public health problem by the World Health Organization (Murray &Lopez, 1996) and is considered the most likely illness to result in disability (Murray &Lopez, 1996). Despite multiple investigations demonstrating that both medications as well as psychotherapeutic interventions are effective in the treatment of major depressive disorder (APA, 2000), few comparative effectiveness studies have specifically informed clinical decision making at the level of both the population and the individual patient so that interventions can be disseminated efficiently.