Depression is three to five times more common among migraine patients than in the general population. This comorbidity is of major public health significance as it results in decreased quality of life and overall prognosis and increased risk for suicidality and disability. Importantly, the economic burden of migraine doubles when there is depression. Yet, effective treatments have not been investigated. This revised Patient-Oriented Mentored Career Development Award (K23) application proposes a training and mentorship plan focused on two overlapping areas within interventions research for psychiatric and pain comorbidity: 1) testing interventions that are "deployment-focused," i.e., those designed to facilitate broad dissemination by taking into account, early on in the experimental process, the practical realities of implementation constraints;and 2) the exploration and identification of mediators and moderators of treatment response. The K23 training component is complemented by direct experience administering a randomized controlled trial assessing the efficacy of an intensive 1-day workshop of Acceptance and Commitment Therapy plus Migraine Education (ACT-ME) versus Migraine Education Only (MEO) for depression and impairment in patients suffering from comorbid depression and migraine. It also aims to investigate mediators and moderators of therapeutic change. The format is brief and innovative, offering potential for optimal treatment adherence, participant acceptability, and broad deployment to practice settings. Since the needs of this population are different from those of patients with only psychiatric disorders, the proposal is consistent with at least two of NIMH's strategic objectives, namely developing innovative interventions, personalized for optimal use in patients with comorbid psychiatric and pain problems, and using innovative service delivery approaches. This proposal will provide a solid foundation for Dr. Dindo's long-term scientific goal of creating an independent program of research focused on developing pragmatic and innovative ways to improve the mental health and functioning of patients suffering from comorbid psychiatric and pain conditions. The work will be conducted at the University of Iowa Hospitals and Clinics, a premiere academic institution with major contributions to the treatment of depression.
Depression is prevalent in migraine patients and is associated with poorer prognosis and quality of life. Yet, effective treatments have not been investigated. This research will examine the effects of an innovative 1-day behavioral intervention on depression and disability, personalized for optimal use in patients with comorbid psychiatric and pain problems.