Place-based Strengths and Vulnerabilities for Mental Wellness among Rural Minority Seniors

项目摘要 农村居民抑郁症的严重不平等及其诊断和治疗 老年人与城市白人同龄人相比，死亡率、认知障碍和 多种并存，因此，随着美国人口老龄化，公共卫生问题日益受到关注。 这些健康不平等往往可归因于社会和环境因素，包括经济不安全， 创伤病史、交通和安全网服务的长期缺口(例如，食品援助、医疗保健)， 以及根植于殖民主义的政策制定过程中的差距，这使得这些群体在结构上 易受精神疾病影响。关于与社会和环境相关的保护因素的数据较少 背景，例如接近社会支持、社区依恋和有意义的地方感。而当 这种以地点为基础的因素的重要性在学术界关于社会决定因素的研究中得到了广泛的认可 健康，到目前为止，还没有专门研究这些因素如何影响抑郁症差异的研究 以及针对这些因素及其对精神健康的影响的有限的实际方法 适用于农村和少数民族人口。这个K99/R00应用程序建议将我的专业知识作为一种文化 参与定性研究和实施科学的人类学家在农村拥有新知识 心理健康研究，量化和混合方法设计，以及干预开发，以便 对心理健康差距的社会和环境原因进行概念化和干预。课程作业， 研讨会，以及太平洋研究所跨学科导师团队的专业知识 K99期间的评估和新墨西哥大学将为我提供进行以下工作的技能 拟议的R00研究，将利用定量调查、定性访谈、生态网络 研究和空间数据分析，以阐明基于地点的脆弱性和保护因素是如何形成的 新墨西哥州农村美国印第安人和拉丁裔长老的抑郁经历。以干预为导向 地图绘制，一种规划卫生干预措施的参与性方法，数据将有助于社区驱动的 计划多系统干预，针对抑郁症差异的地方原因，这将形成 为随后的R01实施和评估研究奠定基础。这项参与性和跨学科的研究 我将阐明与地点、乡村和少数族裔地位有关的差异轴如何驱动心理健康 差距。由此产生的以场所为重点的干预计划将改善老龄人口的心理健康公平。 这些数据表明，服务严重和持续不足，推动了干预和治疗的科学 实施超越了其对个人和医疗保健环境的主要关注。数据和培训将 作为一名专注于健康差距的社会原因的调查员，我的独立性有所贡献，并将 直接进入美国国立卫生研究院资助的未来研究，目标是在这一领域和 其他服务不足的人群。

Project Summary Severe inequities in depression and its diagnosis and treatment among rural-dwelling, racial/ethnic minority seniors compared to their urban White counterparts result in increased mortality, cognitive impairment, and multiple co-morbidities, thus presenting a growing public health concern as the United States population ages. These health inequities are often attributable to social and environmental factors, including economic insecurity, histories of trauma, chronic gaps in transportation and safety-net services (e.g., food assistance, health care), and disparities in access to policymaking processes rooted in colonialism that make these groups “structurally vulnerable” to mental ill health. Fewer data exist on protective factors associated with social and environmental contexts, such as proximity of social support, community attachment, and a meaningful sense of place. While the importance of such place-based factors is widely recognized in scholarship on the social determinants of health, there is to date little research specifically examining how such factors shape disparities in depression and treatment, as well as limited practical approaches to target these factors and their effects on mental wellbeing for rural and minority populations. This K99/R00 application proposes to integrate my expertise as a cultural anthropologist in participatory qualitative research and implementation science with new knowledge in rural mental health research, quantitative and mixed-method designs, and intervention development, in order to conceptualize and intervene on the social and environmental causes of mental health disparities. Coursework, workshops, and the expertise of an interdisciplinary team of mentors at the Pacific Institute for Research and Evaluation and the University of New Mexico during the K99 period will provide me with the skills to undertake the proposed R00 research, which will utilize quantitative surveys, qualitative interviews, ecological network research, and spatial data analysis to elucidate how place-based vulnerabilities and protective factors shape experiences of depression among rural American Indian and Latinx elders in New Mexico. Guided by Intervention Mapping, a participatory approach for planning health interventions, data will contribute to a community-driven plan for a multisystem intervention targeting the place-based causes of disparities in depression, which will form the basis of a subsequent R01 implementation and evaluation study. This participatory and interdisciplinary study will elucidate how axes of difference pertaining to place, rurality, and minority status drive mental health disparities. The resulting place-focused intervention plan will improve mental health equity for aging populations that data show are severely and persistently underserved and advance the science of intervention and implementation beyond its predominant focus on individuals and healthcare settings. Data and training will contribute to my independence as an investigator focused on the social causes of health disparities and translate directly into future NIH-funded research targeting the upstream causes of mental health disparities in this and other underserved populations.