The goal of this application for a K23 Mentored Patient-Oriented Research Career Award is to prepare the candidate, Trina Chang, M.D., M.P.H., for a career in patient-oriented research focusing on behavioral interventions for minority patients with diabetes and depression. This is an area of enormous public health importance, as diabetes and depression are both common and costly chronic illnesses that often co-occur. Dr. Chang is a clinical researcher and community psychiatrist with a background in public health, research with minorities, and the development, implementation and evaluation of programs at the interface of psychiatry and primary care. She is based at the Massachusetts General Hospital and has access to the expertise of the Depression Clinical and Research Program, the Behavioral Medicine Program, and the Diabetes Center, as well as access to a community health center for subject recruitment. Her immediate career goal is to develop a research program testing an intervention based on problem-solving treatment (PST) to promote diabetes treatment adherence in an underserved Hispanic population;ultimately, she intends to build a career around developing and evaluating behavioral interventions for diabetes and depression in disadvantaged populations, with an eye toward interventions that address the socioeconomic conditions underlying their health problems. The training goals of this career development award are for the candidate to 1) gain experience conducting behavioral research in diabetes, 2) build expertise in developing community interventions for disadvantaged or high-stress populations, particularly Hispanics, 3) advance her skills in adapting PST for different populations and purposes, and 4) learn to conduct mediator analyses. The candidate will also take coursework in biostatistics, methods of community research and behavioral research, cultural anthropology, and the relationship between stress, disparities and health, as well as the responsible conduct of research. The research component of this project will involve a randomized, waitlist-controlled trial of a novel group intervention featuring Problem-solving, Information, Support and Motivation (PRISM) for Spanish-speaking Hispanics with poorly controlled type 2 diabetes. The primary aims will be to refine the intervention and evaluate its efficacy for improving treatment adherence, diabetes, and depression;a secondary aim will be to investigate mediators of its effect. Results of this project will form the basis of an R01 grant application. Combined, this research and training plan will enable Dr. Chang to become an independent investigator in an area with significant need and broad public health applications: treating diabetes and depression in disadvantaged populations by creating innovative behavioral interventions that address the fundamental causes of disease.
Diabetes is a highly prevalent and costly chronic illness, one whose toll is multiplied when it co-occurs with depression. The goal of the proposed project is to reduce the impact of these two illnesses in Spanish- speaking Hispanics with poorly controlled Type 2 by promoting diabetes treatment adherence, using a group intervention based on enhanced problem-solving treatment. If successful, this intervention could provide a cost-effective way to reach a high-need population and empower them to deal with causes of health disparities.