Postdoctoral Associate Stafford and Gonzalez-Guarda Submit NIH/NIMHD K99/R00 Pathway to Independence Award Application

Kudos to Allison Stafford, postdoctoral associate; and her mentor Rosa Gonzalez-Guarda, associate professor; for the submission of her NIH/NIMHD K99/R00 Pathway to Independence Award application entitled "Harnessing Implementation Science to Address Disparities in Depression Treatment among Latina Adolescents."  This proposal requests funding for a two-year K99 period and a three-year R00 period with a proposed start date of April 1, 2020. 

Despite experiencing a higher prevalence of depressive symptoms, Latina (female) adolescents are significantly less likely to receive treatment for Major Depressive Disorder (MDD) and are more likely to drop out of psychotherapy prematurely than their non-Latina White peers. Research is needed to develop patient-and family-focused implementation strategies to promote Latina adolescents’ initiation of and retention in psychotherapy for depression. In the K99 phase of the award, the candidate aims to: 1) Determine facilitators of and barriers to receiving evidence-based antidepressant and psychotherapy treatment among Latina adolescents from multiple stakeholder perspectives; and 2) identify a patient-and family-focused implementation strategy that will target barriers to psychotherapy attendance among Latina adolescents. Qualitative descriptive methods will be used to conduct individual interviews and four focus groups with Latina adolescents, their parents/guardians, and healthcare providers (N=60). In the K99 phase, the candidate will also obtain critical training in population health, implementation science, and adolescent depression treatment to achieve the R00 aims. The R00 aims are to: 1) Determine the preliminary effectiveness of evidence-based psychotherapy and a patient-and family-focused implementation strategy on depressive symptoms and psychotherapy attendance among Latina adolescents (N=60); and 2) determine facilitators, barriers, and early implementation outcomes (acceptability, adoption, feasibility, and fidelity) related to the implementation of the strategy and psychotherapy among Latina adolescents. Latina adolescents diagnosed with MDD or Persistent Depressive Disorder and referred to psychotherapy will be randomly assigned to the implementation strategy or treatment as usual group (n=30 each). Measurements will be taken at baseline, 12 weeks, and 24 weeks. Hierarchical random coefficients regression models will be used to test for group differences in the trajectory of depression outcomes over three time points. Wilcoxon Two-Sample Tests will be used to compare group differences in the number of psychotherapy visits. Qualitative interviews with Latina adolescents, parents, and healthcare providers will be conducted to complete a mixed-methods evaluation of implementation process outcomes. The results of the study will lay a foundation for afull-scale R01 implementation-effectiveness trial. The identified patient-and family-focused implementation strategy might also serve as a model for addressing behavioral health disparities among other groups of ethnic minority and immigrant youth. The proposed award will support the candidate’s long-term goal of promoting mental health equity among Latina adolescents and her transition into an independent, health disparities researcher.