PROJECT SUMMARY
1 Many patients with multiple chronic conditions (MCC) have anxious and depressive symptoms and
2 unmet social needs (housing, food, finances). These are associated with worse health outcomes and high
3 healthcare costs. The Biopsychosocial Model provides a framework for conceptualizing the influence that
4 psychosocial factors have on the management of disease. To date, components of the model have not been
5 adequately assessed among patients with MCCs. Preliminary research has independently linked psychosocial
6 variables to MCC outcomes, though the psychological and social realms of the model have not been evaluated
7 as latent constructs. Further, lack of longitudinal studies leaves the temporal relation between psychosocial
8 factors and MCC management poorly understood. The proposed study will fill these gaps by conducting a
9 secondary analysis from an ongoing randomized controlled trial examining the effectiveness of enhanced care
10 planning for better managing MCC for 600 primary care practice patients (Enhanced Care Planning [ECP];
11 AHRQ 1R01HS026223-01A1, PI Alex Krist). All patients in the sample will complete assessments of social
12 needs, mental health, daily functioning, and overall health at baseline, six-, and twelve-months. I will (1)
13 describe the prevalence of anxious and depressive symptoms, their relation to social needs, and patient
14 prioritization of needs, (2) assess components of the biopsychosocial model and the longitudinal relation
15 between anxiety/depressive symptoms, social needs and MCC management, (3) qualitatively explore
16 underlying factors (e.g. self-efficacy, locus of control) that contribute to improvements in patients’ MCC control.
17 Data sources include the care planning tool, surveys, the electronic health record (EHR), and semi-structured
18 interviews. This proposal has four training goals for the development of emerging expertise in: (1) the empirical
19 study of chronic disease management and implementation science; (2) the use of structural equation modeling;
20 (3) qualitative methods of data analysis; and (4) scholarly writing and presentation skills. The training plan
21 consists of core and supplemental activities for each goal, including coursework and didactics, SEM and
22 qualitative analysis workshops, individual mentorship, and dissemination activities. My mentorship team is
23 comprised of national leaders in the relevant topic areas who have an established record of collaborating
24 together; they will help me develop my own expertise. This training plan will inform the proposed study’s
25 completion and dissemination. Results are expected to advance our understanding of patient priorities with
26 psychosocial factors and priorities that lead to meaningful improvements in MCC. This award affords me with
27 protected time needed to complete the study and training activities. It will also allow me to develop expertise
28 and necessary skills for a career as an independent researcher. Results will serve as the foundation for my
29 research program to improve primary care interventions for mental health and uncontrolled MCC. This study
30 aligns with NIMH’s Strategic Plan, to ‘strengthen the public health impact of NIMH-supported research’.
