(provided by candidate): The proposed research plan seeks to foster the skills necessary for achieving my long-term goal of developing culturally-competent behavioral treatments for Hispanics with major depression and related disorders. In pursuing the necessary skills, the research plan seeks to develop a brief behavioral treatment for improving antidepressant adherence among Hispanic patients. Specifically, a Motivational Interviewing treatment manual will be developed with specific attention to cultural-competence. We are seeking to develop a four session manual and test its ability to improve adherence (i.e., medication-taking behavior) when used as an adjunct to antidepressant therapy. The developmental progression of the proposed research plan was informed by a stage model of behavioral treatment development. The proposed research plan represents the initial phase, which consists of formulating an intervention manual (Phase 1a) and collecting preliminary efficacy data (Phase 1b). Project One (Phase 1a) is geared to provide the candidate with hands-on experience in developing culturally-competent behavioral treatment manuals. Project One will involve collecting qualitative data, via three focus groups, that are relevant to Hispanic groups on the issue of antidepressant adherence. These data will inform the treatment to be developed (4 sessions), so that it addresses adherence in a manner consonant with the attitudes and values of Hispanic populations. Once a preliminary version of the manual is developed, six """"""""test cases"""""""" will be treated and subsequently be invited to participate in a focus group to discuss their experience with the intervention. The experiences of these participants will be used to fine-tune the intervention before beginning Project Two. Project Two (Phase 1 b) will provide the candidate with hands-on training for evaluating the efficacy of behavioral treatments. Project Two will examine the Motivational Interviewing manual's preliminary feasibility and efficacy via randomized controlled trial (n = 60). Participants receiving antidepressant treatment will be randomized to receive the Motivational Interviewing intervention (n=30), as an adjunct to antidepressant therapy and treatment-as-usual, or a treatment-as-usual control group (n=30). Both groups will be compared on their antidepressant adherence to generate an effect size of the treatment. Antidepressant adherence will be measured using the Medication Event Monitoring System (MEMS). The MEMS is a medication container, whose cap contains a microchip. The MEMS records the whether medications are correctly taken over a period of time. Project Two will also conduct analyses to evaluate whether a model of adherence mediates the outcome of the behavioral treatment. If promising, the preliminary data generated will be used to seek R01 funding for a Phase II clinical trial.
