This Mentored Patient-Oriented Research Career Development Award will support the candidate in laying the foundation for a programmatic line of research developing psychosocial treatments for patients with comorbid mood disorders and chronic pain in primary care, testing them in real world settings, and integrating them into usual clinical practice. Mood disorders and chronic pain are highly prevalent and frequently comorbid. Major depression and chronic pain are both leading causes of disability in the US. Depression predicts the onset and persistence of pain, and reciprocally, pain increases risk for onset and severity of depression. Patients with comorbid depression and pain have poorer responses to treatments for depression and for pain. Yet no psychosocial treatments have been developed and prospectively tested specifically for patients with mood disorders like depression and chronic pain. Further, many patients with mood disorders and chronic pain, particularly low-income patients, seek care from their primary care physicians. This suggests that primary care settings present an excellent opportunity for treating this population of patients. The proposed study aims to refine and test a psychosocial intervention designed to be administered in primary care settings for the treatment of comorbid mood disorders and chronic pain, Interpersonal Therapy for Depression and Pain (IPT-P). The proposal includes intensive multidisciplinary mentoring toward developing skills in: measuring comorbid depression and pain and identifying moderators of clinical course;designing and implementing randomized clinical trials;and conducting research with low- income and minority individuals. Detailed formal coursework, site visits, and targeted consultation complete the educational plan. The proposed project is a two-phase study and operationalizes mood disorders as major depression and chronic pain as chronic pelvic pain. In Phase 1, IPT-P will be piloted with 15 low- income gynecology patients with major depression and chronic pelvic pain. The findings will be used to refine the treatment, assessment, and therapist training procedures and finalize the manual. In Phase 2, a randomized controlled trial with 60 patients will be conducted to: 1) assess feasibility, adherence, and acceptability of IPT-P;2) generate effect sizes for a full-scale randomized controlled trial;and 3) compare IPT-P to treatment as usual in decreasing depressive symptoms and improving secondary outcomes among women's health patients with major depression and chronic pelvic pain. 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 patients with mood disorders and comorbid pain in primary care settings. These treatments will contribute to the efforts needed to reduce the suffering and expense caused by the deleterious impact of comorbid mood disorders and pain.
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