Pharmacotherapy and cognitive behavioral therapy are efficacious
treatments of depression among diverse groups, however adherence to
medication, adherence to CBT homework, and appointment attendance are
barriers to effective treatmen in the community, particularly among
low income populations. This line of research seeks to investigate
whether text messaging (SMS) can be used to improve adherence to
treatment for depression by sending medication and appointment
reminders along with using SMS as a medium for CBT homework completion
to reinforce thought tracking and behavioral activation. This project
is currently in the initial feasibility/usability stage in preparation
for a randomized trial.
The mission of the Internet World Health Research Center (IWHRC, pronounced
“I work”) is to harness the power of the Internet to reach
those most in need with behavioral health interventions that are as effective
as traditional interventions and that can be administered directly to
them via the World Wide Web.
The Tobacco Related Disease Research Program funded the establishment
of the Spanish/English Web Site for Smoking Cessation Trials at www.stopsmoking.ucsf.edu
. This project of the University of California, San Francisco/San Francisco
General Hospital Latino Mental Health Research Program is being conducted
in collaboration with the University of California, San Francisco Medical
Effectiveness Research Center for Diverse Populations (MERC) and the University
of California, San Diego. During Phase I of the study, we created the
basic site and tested its ability to 1) recruit participants, 2) obtain
informed consent, 3) obtain initial assessment data, 4) provide one intervention,
and 5) obtain follow-up data, all with minimal human intervention. We
recruited over 4500 smokers, of whom over 1000 were Spanish-speaking.
During Phase II we carried out three sets of studies comparing two
smoking cessation conditions to each other. Publications from the first
two phases include:
Lenert L, Muñoz RF, Stoddard J, Delucchi K, Bansond A, Skoczen S, Perez-Stable
EJ (2003). Design and pilot evaluation of an internet smoking cessation
program. J Am Med Inform Assoc .; 10(1):16-20.
Lenert L, Muñoz RF, Perez JE, Bansod A (2004).
Automated e-mail messaging as a tool for improving quit
rates in an internet smoking cessation intervention. J Am Med Inform
Assoc.; 11(4):235-40. Epub 2004 Apr 2.
Stoddard J, Delucchi K, Muñoz R, Collins N, Pérez-Stable
EJ, Augustson E, Lenert L (2005). Smoking cessation research via
the internet: a feasibility study. J Health Commun.; 10(1):27-41.
Muñoz RF, Lenert LL , Delucchi K, Stoddard J, Pérez JE, Penilla
C, Pérez-Stable EJ (2006
).Toward evidence-based Internet interventions: A Spanish/English Web
site for international smoking cessation trials. Nicotine &
Tobacco Research, 8. 77-87.
Tobacco-Related Disease Research Program Grant # 10RT-0326
“Spanish/English web site for smoking cessation trials.”
Principal Investigator: Ricardo F. Muñoz, Ph.D.
Leslie Lenert, M.D.,
Eliseo J. Pérez-Stable, M.D.,
Kevin Delucchi, Ph.D.
During Phase III, we compared four methods to stop smoking via the Web in a randomized control trial.
Publications from this phase include:
Muñoz RF, Barrera AZ, Delucchi K, Penilla C, Torres LD, Pérez-Stable EJ. International Spanish/English Internet smoking cessation trial yields 20% abstinence rates at 1 year. Nicotine Tob Res. 2009 Sep;11(9):1025-34. Epub 2009 Jul 29.
Torres LD, Barrera AZ, Delucchi K, Penilla C, Pérez-Stable EJ, Muñoz RF. Quitting smoking does not increase the risk of major depressive episodes among users of Internet smoking cessation interventions. Psychol Med. 2009 Jul 23;:1-9 [Epub ahead of print]
Barrera AZ, Pérez-Stable EJ, Delucchi KL, Muñoz RF. Global reach of an Internet smoking cessation intervention among Spanish- and English- speaking smokers from 157 countries. Int J Environ Res Public Health. 2009 Mar;6(3):927-40. Epub 2009 Feb 26.
During Phase IV, we carried out an exploratory smoking cessation study on the Web to estimate smoking cessation rates in a participant's preference outcome study, in which participants choose among the several self-help elements that we have been testing in the randomized trials described above.
Phase V is currently recruiting participants in the United States.
We welcome Spanish and English speaking smokers to join our study.
English site: www.stopsmoking.ucsf.edu
Spanish site: https://www.stopsmoking.ucsf.edu/es/intro/home.aspx
Risk for major depression appears to be transmitted across generations.
Pregnancy and the postpartum period are key periods to study because maternal
emotion regulation deficits may affect both maternal and child outcomes.
Children of parents with emotion regulation problems are at higher risk
for developing similar problems over time.
The Mothers and Babies: Mood and Health Project was launched in 1998 by
the Latino Mental Health Research Program at the University of California,
San Francisco/San Francisco General Hospital. Its aims are: (1) to identify
pregnant women at imminent risk for major depressive episodes, and (2)
to test whether a cognitive-behavioral intervention reduces risk for maternal
depression and improves maternal and child functioning in high risk low-income
pregnant English and Spanish-speaking women.
We recruited 100 Spanish and English-speaking, low-income, pregnant women
obtaining their prenatal care at the SFGH Women’s Clinic. Beginning
in the second trimester of pregnancy and continuing monthly through the
first six months postpartum, we assessed their depression level and associated
risk factors. We found that women with emotion regulation deficits (“high
risk”), but not suffering from clinical depression when recruited,
experienced more new major depressive episodes during the one-year prospective
study period than those we had categorized as “low-risk” women.
Specifically, 24.1% of the “high-risk” group developed a major
depressive episode within one year, compared to 2.6% of the “low-risk”
group. Our findings indicate that we are able to identify pregnant women
at high risk for developing major depressive episodes.
Diaz, M. A., Le, H-N., Cooper, B. A., & Muñoz, R. F. (2007). Interpersonal factors and perinatal
depressive symptomatology in a Latina sample. Cultural Diversity and Ethnic Minority Psychology, 13(4) 328-336.
Le, H-N., Muñoz, R. F., Soto, J., Delucchi, K., & Ghosh Ippen, C. (2004). Identifying risk for onset of major depressive episodes in a low-income Latinas during pregnancy and postpartum. Hispanic Journal of Behavioral Sciences, 26, 463-482.
Le, H. N., Ramos, M. A., & Munoz, R. F. (2007). The relationship between alexithymia and perinatal depressive symptomatology. Journal of Psychosomatic Research, 62(2), 215-222.
University of California Office of the President
Private donors: Dr. Cloyce L. Duncan and Dr. Gwendolyn Evans-Duncan.
Principal Investigators: Huynh-Nhu Le, Ph.D., and Ricardo F. Muñoz,
Building on the results of our Depression Risk Study, we recruited 57
“high-risk” pregnant women for a pilot randomized controlled
trial. Our aim was to pilot test the Mothers
and Babies Course, an adaptation of our Depression Prevention Course
for pregnant women, to see whether difficulties in emotion regulation
can be improved with a psycho-educational intervention, and whether promoting
optimal levels of emotion regulation produces measurable differences in
maternal efficacy. The course includes a 12-week group session that occurs
during pregnancy, and 4 booster sessions during the first year postpartum
(months 1, 3, 6, and 12). Thirty-four women were randomized to the intervention
condition and 23 to a no-intervention control condition. Our results to
date indicate that low-income, primarily Latina women found the Mothers
and Babies Course useful, attended the course sessions, and are available
for follow-up up to 1½ years after birth. We are currently analyzing
other study outcomes.
Urizar, G. G., Milazzo, M., Munoz, R. F., Le, H-N., Delucchi, K., & Sotelo, R. (2004). Impact of preventive interventions on the regulation of mood and cortisol during pregnancy. Biological Psychology, 67, 275-282.
Muñoz, R. F., Le H-N., Ghosh Ippen, C., Diaz, M.A., Urizar, G.G., Soto, J. et al. (2007). Prevention of postpartum depression in low-income women: Development of the Mamás y Bebés/Mothers and Babies Course. Cognitive and Behavioral Practice, 14, 70-83.
NIMH R21 MH 596056 Intervention Development Grant (2000-2004)
Principal Investigator: Ricardo F. Muñoz, Ph.D.
Co-investigators: Huynh-Nhu Le, Ph.D., and Chandra Ghosh Ippen, Ph.D.
Participants from the Risk and Intervention Development studies were re-contacted to study the socioemotional functioning of the mothers and babies over time. We assessed the children from the Depression Risk Cohort at 3½ years of age, and the children of the Intervention Development Cohort at 1½ years of age. This study's primary aims were (1) to assess the psychosocial and cognitive functioning of each index child, and (2) to examine the relation between the index child's current psychosocial and cognitive development and the mother's depression levels during pregnancy and currently. We collected behavioral and observational data on the children, as well as self-report data from the mothers. This study suggests that we are able to follow up urban, low-income Latinas and their children longitudinally, and that we can reliably measure and document the effects of maternal perinatal depression on the index children's development.
UC Mexus Grant
Co-principal investigators: Guido Urizar, Ph.D. and Ricardo F. Muñoz,
Yan Leykin, Ph.D.
Ricardo Muñoz, Ph.D.
Untreated depression accounts for more than 11% of the world total disease burden. Depression is associated with up to 60% of suicide deaths, deteriorating health, and social problems. Most affected individuals are not receiving adequate treatment. The long-term objective of this project is to address the issue of untreated depression by developing and evaluating an effective Web-based intervention for depression, available at no cost and in multiple languages to depressed and dysphoric individuals anywhere in the world.
The current project is the first step towards that goal. We have developed a self-contained, interactive, modular, Web-based self-help intervention for depression. The intervention is based on cognitive-behavioral therapy, an empirically supported treatment for depression. Participants from the Internet community are invited to sign up for a customized eight-lesson intervention. This is a proof-of-concept study, with the goal of assessing the degree of interest in and the demand for Web interventions, and to obtain initial information about the effectiveness of this intervention.
We are currently recruiting participants: