Barriers to Mental Health Treatment in Primary Care

拟议的初级保健中心理健康治疗障碍研究要求一年的B/Start资金，以调查心理障碍对初级保健中患有抑郁症的老年人心理健康治疗、治疗行为和临床结果的患病率和影响。尽管有充分的证据表明，大多数患有抑郁症的老年人可以通过药物治疗有效地治疗重度抑郁症，但对老年人重度抑郁症的治疗不足仍然是一个重大的公共卫生问题（Hirschfeld et a., 1997 Schneider, 1996）。初步调查表明，心理障碍，如最小化治疗需求和感知耻辱，在抑郁症门诊精神治疗开始时报告可以是预测治疗行为的重要因素，如药物推荐，抗抑郁药物依从性和治疗中断（Sirey等，1999,in press）。本研究的主要目的是：1)评估初级保健中抑郁症的患病率；2)检查心理障碍对治疗开始（药物治疗或非药物干预）的影响；3)探讨心理障碍与抑郁症状改善的关系。为了实现这些目标，资金将用于支持初级保健（预防初级保健老年人的自杀：合作试验，PROSPECT; MH 59366; PI George S. Alexopoulos， M.D.）。拟议的研究将评估60康奈尔网站的前景研究报告的心理障碍)。部分（PROSPECT）样本在4个月后再次接受访谈，以评估：1)治疗行为（如开始治疗、使用的服务）；2)抑郁症状；3)回顾抑郁症的诊断标准。分析检查治疗开始的障碍，控制干预状态。其他分析将探讨障碍对随访时临床状态的影响。

The proposed study of Barriers to Mental Health Treatment in Primary Care requests one year B/Start funding to investigate the prevalence and impact of psychological barriers to mental health treatment, to treatment behaviors and to clinical outcome in older adults with depression in primary care. Inadequate treatment on major depression among older remains a significant public health concern, even though there is ample evidence that major depression can be effectively treated with pharmacotherapy in most elderly adults with depression (Hirschfeld et a., 1997 Schneider, 1996). Preliminary investigations suggest that psychological barriers, such as minimizing the need for treatment and perceived stigma, reported at the beginning of outpatient psychiatric treatment for depression can be important factors in predicting treatment behaviors such as medication recommendation, antidepressant adherence and treatment discontinuation (Sirey, et a., 1999, in press). The primary aims of this study are : 1) to assess the prevalence depression seen in primary care; 2) to examine the impact of psychological barriers on treatment initiation (either pharmacotherapy or non-pharmacologic interventions); and 3) to explore the relationship between psychological barriers and improvement in depressive symptoms. To address these aims the funding would be used to support the primary care (Prevention of Suicide in Primary Care Elderly: Collaborative Trial, PROSPECT; MH 59366; PI George S. Alexopoulos, M.D.). The proposed study would assess the psychological barriers reported by 60 Cornell site of the PROSPECT Study). A part of (PROSPECT) sample is re-interviewed four months later to assess: 1) treatment behaviors (e.g. initiation of treatment, services used); 2) depressive symptoms; and 3) review criteria for depression. Analyses examine the of barriers on treatment initiation, controlling for intervention status. Additional analyses will explore the impact of barriers on clinical status at follow-up.