Management of Depressive Symptoms and Hypertension: A Socio-Culturally Informed Approach

Vanderbilt University Medical Center, Nashville TN

Investigators

Abstract

Debra Dixon, MD, MS is an Instructor at Vanderbilt University Medical Center. Her goal is to lead a research program focused on reducing heart failure (HF) incidence and mortality as an expert in intervention design, evaluation, and implementation. This application details the complementary career development and research activities foundational to Dr. Dixon’s successful transition to an independent investigator. With the primary mentorship of Deepak Gupta, MD, MSCI, Dr. Dixon will acquire new expertise in 4 domains: (1) conduct of clinical trials, (2) community engaged research (3) qualitative methods, and (4) intervention design and adaptation. Black individuals, particularly those with low socioeconomic status (SES), experience disproportionately higher rates of incident HF. Suboptimal risk factor management in Black individuals with low SES contributes to this difference. In a predominantly Black population with low SES in the Southern Community Cohort Study (SCCS), we demonstrated depressive symptoms and hypertension (HTN) were highly prevalent and independently associated with greater HF risk. Dr. Dixon demonstrated 1) depressive symptoms partially mediated the association between SES and incident HF and 2) the risk of incident HF associated with greater depressive symptoms was attenuated among individuals using anti-depressant medications. Thus, both depressive symptoms and HTN may be modifiable HF risk factors. Yet, rates of treatment and control for depressive symptoms and HTN are low in Black individuals with low SES, raising the need for novel approaches to optimize management. Socio-culturally informed approaches to treatment are guideline recommended and can improve treatment uptake and adherence. Furthermore, mobile health technology can reduce barriers to accessing effective interventions that support self-management. Emerging data indicate mindfulness-based interventions (MBI) not only address depressive symptoms, but also may improve HTN control. App-based MBI (MBI-app) are available but have not been adapted to be culturally relevant for Black individuals with low SES and for management of depressive symptoms and HTN. Thus, this project aims to: 1) characterize socio-culturally informed approaches to treat depressive symptoms and HTN, 2) adapt an MBI-app using a community engaged approach, and 3) evaluate the feasibility and acceptability of the MBI-app and randomized trial protocol for management of depressive symptoms and HTN in Black individuals with low SES. Dr. Dixon will leverage Vanderbilt’s extensive resources and her mentorship team’s complementary expertise to execute her career development plan and research aims. This study will inform future R01s evaluating treatment plan development using a socio-cultural lens and the effect of an MBI-app on HF risk factor management. Through this award, Dr. Dixon will develop a unique combination of expertise in intervention design, adaptation, and implementation and prepare to be an independent clinical investigator focused on reducing the burden of HF and improving public health.