The purpose of this application is to prepare the PI for an independent research career focused on primary care mental health services for depression. Depression is a highly prevalent primary care health problem with impact comparable to the burden of major medical illness, and is associated with high morbidity, mortality, diminished quality of life, and health services costs ($44 billion in 1990). Although effective depression treatments including medication are available, a majority of primary care patients who are prescribed antidepressant medication decide to either decline or discontinue medication soon after starting it. Little is known about how people make depression treatment decisions, including key influences on decision making and appropriateness of decision making as related to health status and health system outcomes. Research on patient decision making can provide information that is needed to develop patient-focused interventions to improve depression treatment outcomes.
The aims of the proposed award are for the PI to: 1) develop knowledge of health services research concepts and methods for primary care and mental health services research; 2) develop and test measurement and analytic strategies for examining relationships between primary care patient decision making, antidepressant medication use, and health services outcomes; and 3) conduct two pilot studies as the basis for a R01 application to test a nurse-implemented patient decision support intervention for depression treatment in primary care. The PI will gain needed health services research skills to carry out these aims through a program of formal course work, directed study, and supervised research field experiences. The goal of research Project #1, a patient decision support intervention for primary care depression treatment will be pilot-tested for feasibility in research Project #2. The PI's long-term goal is to improve the quality of primary care services for depression through implementation of decision support interventions for diverse populations of patients undergoing depression treatment.
