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

项目摘要 农村少数民族在抑郁症及其诊断和治疗方面的严重不平等 与城市白色人相比，老年人的死亡率、认知障碍和 多种共病，因此随着美国人口老龄化，公共卫生问题日益严重。 这些卫生方面的不公平现象往往是由社会和环境因素造成的，包括经济不安全， 创伤史、交通和安全网服务方面的长期缺口（例如，粮食援助、保健）， 以及植根于殖民主义的政策制定过程中的差距，使这些群体“在结构上 易受”精神疾病的影响。关于与社会和环境有关的保护因素的数据较少 背景，如社会支持，社区依恋和有意义的地方感的接近。而 这种基于地点的因素的重要性在关于社会决定因素的学术研究中得到了广泛的承认。 然而，迄今为止，很少有研究专门研究这些因素如何影响抑郁症的差异。 以及针对这些因素及其对心理健康的影响的有限实用方法 农村和少数民族人口。此K99/R 00应用程序建议将我的专业知识作为文化 参与性质性研究和农村新知识实施科学的人类学家 心理健康研究，定量和混合方法设计，以及干预措施的开发，以 对心理健康差异的社会和环境原因进行概念化和干预。课程作业， 讲习班，以及太平洋研究所多学科导师小组的专门知识， 评估和新墨西哥州大学期间的K99将为我提供的技能承担 拟议的R 00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如何形成 在新墨西哥州的美国印第安人和拉丁美洲老年人的抑郁症的经验。以干预为导向 测绘是规划卫生干预措施的一种参与性方法，数据将有助于社区驱动的 计划进行多系统干预，针对抑郁症差异的地方原因，这将形成 随后的R 01实施和评估研究的基础。这项参与性和跨学科的研究 我将阐明如何轴的差异有关的地方，农村，和少数民族地位驱动心理健康 差距。由此产生的以地点为中心的干预计划将改善老龄化人口的心理健康公平性 这些数据显示，严重和持续的服务不足，并推动科学的干预， 实施超越其主要重点是个人和医疗保健设置。数据和培训将 作为一名专注于健康差距社会原因的调查员，我的独立性有所贡献，并将其翻译成 直接投入到未来NIH资助的研究中，针对这一领域心理健康差异的上游原因， 其他弱势群体。

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.