University of Pittsburgh
Grant: $443,919 - National Institutes of Health - May. 5, 2009
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Award Description: One-half of all depressed patients present for treatment with serious and distressing symptoms of anxiety or panic. Patients whose depression is complicated by co-existing anxiety features display a more severe and recurrent form of depression, poorer work and social function, a greater risk of suicide, and a poorer response to traditional depression treatments. While medication treatment may reduce symptoms among depressed and anxious patients, medication treatment alone is insufficient to produce full symptom remission and functional recovery in this population. Given the severity and poor prognosis displayed by depressed and anxious patients, combined treatments including both medication and personalized psychotherapy (talk therapy) may be required to achieve full and sustained symptom remission. This project will test the feasibility of a model of care designed to improve treatment outcome among depressed patients whose anxiety symptoms place them at risk for non-remission with traditional depression treatment. Our research group has developed a structured yet individualized intervention that can be combined with medication treatment to address depression and a variety of the anxiety symptom profiles that commonly accompany major depressive disorder. Specifically, we have developed an intervention that integrates interpersonal treatment for depression (IPT) and adapted components of cognitive, behavioral, and emotion-focused therapies to treat co-occurring symptoms of panic, anxiety, and avoidance. We call this treatment interpersonal psychotherapy for depression with panic and anxiety symptoms, or IPT-PS. As part of this study, we will recruit 40 depressed and anxious adults to receive a 20-week course of treatment with medication and psychotherapy. All patients will receive medication treatment with citalopram. In addition, patients will be randomly assigned to receive 16 outpatient sessions of psychotherapy with either: (a) IPT-PS, or (b) a standard depression psychotherapy, brief supportive psychotherapy (BSP). We hypothesize that combining medication management with a therapy specifically developed to address patients' unique anxiety symptoms will lead to superior outcomes with respect to reductions in depression and anxiety as well as enhancements in work and social function. The proposed work will also provide infrastructure support to move our research clinic away from pencil-and-paper assessments and toward more cost-effective and environmentally-sustainable computer-based patient-reported assessment systems. We view the integration of computer-based assessments as a promising tool to facilitate personalized depression care. During the first year of the project, we will purchase three tablet computers and will undertake programming and data systems work to convert study assessments from pencil-and-paper to computer-based formats. Then, during year 2, we will conduct surveys of clinic patients regarding the acceptability, ease-of-use and perceived confidentiality of computer-based assessments. Thus, the proposed project will support the infrastructure development needed to incorporate novel computer-adaptive testing (CAT) strategies to minimize patient assessment burden while providing clinicians with the personalized patient information needed to optimize depression treatment selection and delivery.
Project Description: The first quarter of work on this project saw the initiation of both the proposed treatment trial as well as the initial infrastructure development work needed to move our research clinic toward a model of computer-based patient assessment. Within these first three months, we have focused on modifying our IRB protocol to reflect the proposed study design; staff hiring and training needed to support project completion; development of data entry and quality control systems; and development of study recruitment materials. Initial study start-up activities have also involved conducting therapist training modules and initiating weekly therapist supervision meetings to oversee the manualized IPT-PS and BSP psychotherapy interventions. Patient recruitment was initiated in August. As of September 10, we had consented 4 patients to undergo study evaluation, 1 of whom has been enrolled into the trial and has initiated treatment. [Reasons for study exclusion include: uncontrolled medical illness (N=2), and anxiety symptoms did not reach threshold for study entry (N=1).] With respect to developing the computer-based patient assessment infrastructure, we have now purchased two tablet computers, which are in the process of being formatted for patient use. We are also in the process of converting our pencil-and-paper assessments into computerized assessment formats. Of the 20 self-report assessments eligible for conversion, we have now entered and formatted 13 (65%) into computer-based formats. Plans for next quarter include: implementing additional advertisement and recruitment initiatives; continuation of patient recruitment, assessment, and treatment as per the pilot RCT study; completing initial conversion of the remaining self-report assessment materials into computer-based format; conducting computerized form checks and initial (non-patient) testing of computer forms; and developing data systems associated with the computerized assessment forms.
Jobs Summary: Prime Recipient created a Research Project Clinician(pt) and a Research Project Assistant. Prime Recipient retained an Associate Professor, Assistant Professors, Research Psychiatrist, Psychiatric Social Worker II, Project Coordinator, Research Systems Specialist II, Clinical Research Manager, Senior Clinician, Computer Programmer, Computer Consultant, and Clinic Coordinator. (Total jobs reported: 3)
Project Status: Less Than 50% Completed
This award's data was last updated on May. 5, 2009. Help expand these official descriptions using the wiki below.
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