The Mentored Patient-Oriented Research Career Development Award (K23) will support the candidate in building the foundation for a programmatic line of research developing and testing brief psychosocial treatments to improve treatment adherence and clinical outcome for primary care patients with mood disorders, and integrating them across the spectrum of primary care settings. Major depression is prevalent, a leading cause of disability, and not optimally treated in primary care. Poor adherence to evidence-based treatment for depression is a pervasive impediment to satisfactory clinical outcomes, yet few psychosocial treatments have been specifically developed and tested to improve adherence. The proposal includes intensive multidisciplinary mentoring toward developing skills in measuring adherence and identifying baseline and mediating determinants of adherence and clinical course, and designing and implementing randomized clinical trials and conducting research with underserved and minority individuals. Detailed formal coursework, site visits, and targeted consultations will complete the educational plan. The proposed project aims to refine and test an empirically-based, structured psychosocial intervention provided by the treating physician to improve adherence to pharmacotherapy, Adapted Motivational Interviewing (AMI). The project will include two phases. In phase 1, AMI will be piloted with 16 patients to assess feasibility and acceptability from patient and physician perspectives and for treatment fidelity. These findings will be used to refine the treatment, assessment, and physician training procedures and to finalize the brief AMI sessions. In Phase 2, a small randomized controlled trial with 160 patients will be conducted to: 1) compare AMI combined with Guideline-Based Medical Management for Depression (GBMM) to GBMM alone in improving adherence to antidepressant therapy and in improving depressive symptoms for patients beginning a new treatment episode for depression;and 2) generate effect sizes for a trial to detect unproved depression remission. The educational and research activities will provide the candidate with the skills and expertise needed to launch a systematic program of research aimed at developing and implementing effective psychosocial treatments for primary care patients with mood disorders at risk for poor adherence to depression treatment. The treatments will contribute to reducing the suffering associated with poor antidepressant adherence.
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