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Interventions for Mental Illness and Chronic Disease

Research undertaken by CDC includes analyses related to depression, childhood trauma, Alzheimer’s disease, sleep disorders, stigma associated with selected mental illnesses, and the relationship of mental illness to a variety of health behaviors and chronic diseases. Further, CDC partners with other federal agencies to develop strategies and policy approaches aimed at preventing mental illnesses and developing effective interventions to improve mental health.

Depression and Anxiety

In 2005, CDC partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) and states to develop two Behavioral Risk Factor Surveillance System (BRFSS) mental illness optional modules which are now in use in a majority of states. These include a Depression and Anxiety Module (the Patient Health Questionnaire (PHQ-8)) which has been validated against the nine diagnostic criteria for a depressive disorder in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and a Mental Illness and Stigma Module which screens for serious psychological distress in response to stigmatization. Both modules were funded through an interagency agreement with SAMHSA. Data from these two modules have been analyzed by CDC and SAMHSA (See Publications section).

Depression and Anxiety Module assesses the prevalence of anxiety and depressive disorders in the general population at the state level. The module uses the Patient Health Questionnaire (PHQ-8) which consists of 8 of the criteria for current diagnosis of major depression and 2 additional questions about lifetime anxiety and depression diagnosis. In 2006, 41 sites adopted this module (38 states, Washington DC, Puerto Rico, and the U.S. Virgin Islands). In 2008, the module was administered in 16 states and territories, primarily those that did not administer it in 2006. Data are available at: http://www.cdc.gov/brfss/data_documentation/index.htm
 

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Project UPLIFT for Treatment

Implemented by the Emory University Prevention Research Center, Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts) is an 8-session program delivered weekly through the Internet or by telephone to people with epilepsy who want to reduce depression. This is accomplished through a combination of cognitive behavioral therapy and mindfulness techniques. Each session includes teaching on the topic of the week, group discussion, a skill-building exercise, and a homework assignment. After the intervention was developed and focus groups were held to provide initial feedback, a pilot study was conducted to further assess acceptability and to determine if participants showed improvement in study outcomes. Depressive symptoms decreased significantly more in the intervention group than the waitlist group; internet and telephone did not differ. This effect persisted over the 8 weeks when those waitlisted received the intervention. Knowledge/skills increased significantly more in the intervention than the waitlist group. All other changes, though not significant, were in the expected direction. Findings indicate that distance delivery of group MBCT can be effective in reducing symptoms of depression in people with epilepsy.

Reference:

Thompson NJ, Reisinger Walker E, Obolensky N, Winning A, Barmon C, DiIorio C,Compton MT. Distance Delivery of Mindfulness-based Cognitive Therapy for Depression: Project UPLIFT. Epilepsy & Behavior, in press.

For more information: http://www.sph.emory.edu/ManagingEpilepsyWell/research/nih_uplift.php

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Project UPLIFT for Prevention

The Managing Epilepsy Well (MEW) Network developed a 2-year multi-site intervention on epilepsy and depression prevention, funded through the National Institutes of Health in response to the Challenge Grant Initiative. The primary goals of the Challenge Grant are to revise existing Project UPLIFT materials so that they can be used for prevention (rather than treatment) of depression, and to assess the effectiveness of the revised material in reducing the risk of depression in people with epilepsy and mild to moderate depressive symptoms. In addition, a third goal is to increase knowledge and skills for preventing depression and improving quality of life. The intervention will include delivery by either telephone or web and will be tested using a cross-over design with participants recruited at all MEW Collaborating Center sites.

For more information: http://www.sph.emory.edu/ManagingEpilepsyWell/research/nih_uplift.php
 

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PEARLS

The Prevention Research Center at the University of Washington implemented the Program to Encourage Active, Rewarding Lives (PEARLS) program. Modeled after the Chronic Care model and developed by PRC investigators, PEARLS is an effective community-based intervention that significantly reduces symptoms of minor depression or dysthymia in home-bound older adults by addressing aspects of social isolation, medical co-morbidity, physical impairment, transportation difficulties, and stigma.1 The CDC Epilepsy Program evaluated a modified version of the original PEARLS program for adults with epilepsy and comorbid depression (major and minor). Consistent with a collaborative care approach, psychiatric consultation is conducted in collaboration with the client’s neurologist or epilepsy specialist. The PEARLS evaluation in epilepsy patients found that compared with usual care patients, PEARLS intervention patients achieved lower depression severity (Hopkins Symptoms Checklist-20) and lower suicidal ideation over 12 months, and improvements in some quality of life domains.2 For more information:

References

  1. Ciechanowski P, Wagner E, Schmaling K, Schwartz S, Williams B, Diehr P, et al.
    Community-Integrated Home-Based Depression Treatment in Older Adults: A Randomized Controlled Trial. JAMA. 2004;291(13):1569-1577.
  2. Ciechanowski P, Chaytor N, Miller J, Fraser R, Russo J, Unutzer J, Gilliam F.(2010).PEARLS Depression Treatment for Individuals with Epilepsy: A Randomized Controlled Trial. Epilepsy & Behavior. 2010 Jul 5. [Epub ahead of print]

For more information: http://www.pearlsprogram.org/

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Alzheimer’s Disease

CDC has made significant advances in efforts to define public health’s role in addressing Alzheimer’s disease and other cognitive health issues – a leading concern of older Americans and their families. As part of this effort, The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health was developed and launched. In addition, a series of questions have been developed to assess the public’s beliefs about the impact of cognitive impairment. Through the Healthy Aging Research Network, a group of nine universities is conducting research on cognitive heath. Also a cooperative agreement with the Alzheimer’s Association will lead to the development and implementation of a community-based demonstration project to educate African American baby boomers on brain-healthy lifestyles. Collaboration with the Chicago Health and Aging project has yielded information on the characteristics of the disease in the general population and on possible intervenable risk factors.

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