The SocioCultural Context of Depression in Late Life

描述（由申请人提供）：拟议研究的总体目标是提高我们对初级保健机构中老年人抑郁症的理解。人类学的方法允许研究参与者（在这个案例中是关于抑郁症的经历和症状）的主观或内部观点，以及对抑郁症的更标准的内在或外部科学解释。这项混合方法研究的具体目的是在65岁及以上的初级保健患者中进行观察性随访调查：1)描述老年人及其家庭在晚年如何经历抑郁以及他们如何将抑郁症状与医疗条件相结合；2)探讨医学合并症、认知障碍、焦虑、绝望、载脂蛋白E基因型对患者及其家属晚年抑郁病程及相关功能障碍的影响；3)跨种族评估目标1和目标2，以提高我们为老年初级保健患者及其家属设计可接受干预措施的能力。拟议的研究利用了nimh资助的老年初级保健患者抑郁症状的筛查和随访项目，称为“频谱调查”。在这项资助的研究中，我们将对450名已经参加了一项观察性研究的初级保健患者进行随访，该研究旨在描述和验证一种抑郁综合征，即不符合重度抑郁症标准的冷漠型抑郁症。我们建议在主研究进行12个月的访谈后，对160名患者（包括30名患者家属）进行单次半结构化访谈，以加强资助研究。我们将利用文化共识分析和以民族志话语为中心的分析来确定抑郁症的解释模型，并根据患者的角度来表征“抑郁症”的领域。我们计划将我们从提议的访谈中获得的数据与脚本化的频谱调查数据整合起来，以测试我们正在开发的解释模型，并在必要时修改我们的抽样和访谈策略。使用混合方法将有助于我们从流行病学和人类学的角度更好地了解老年人在社会和文化背景下如何经历抑郁症。

DESCRIPTION (provided by applicant): The overarching goal of the proposed study is to improve our understanding of depression among older adults in primary care settings. Anthropological methods allow access the emic or insider perspective of research participants (in this case on the experience and symptoms of depression) as well as more standard etic or external scientific interpretations of depression. The specific aims of this mixed methods study to be carried out among primary care patients aged 65 years and older in an observational follow-up survey are: 1) to describe how older persons and their families experience depression in late life and how they integrate symptoms of depression with medical conditions; 2) to examine the influence of medical comorbidity, cognitive impairment, anxiety, hopelessness, and apolipoprotein E genotype on course of depression and associated functional impairment in late life for patients and their families; and, 3) to evaluate aims 1 and 2 across ethnic groups in order to increase our ability to design acceptable interventions for older primary care patients and their families. The proposed study takes advantage of the screening and follow-up project taking place in an NIMH-funded study of depressive symptoms in older primary care patients called the "Spectrum survey." In the funded study, we will follow up with 450 primary care patients already enrolled in an observational study designed to describe and validate a depressive syndrome, apathetic depression, which does not meet standard criteria for Major Depression. We are proposing to enhance the funded study with a single semi-structured interview of 160 patients (including 30 patient family dyads) after the 12-month interview of the main study. We will make use of cultural consensus analysis and ethnographic discourse-centered analysis to identify the explanatory model for depression and to characterize the domain of "depression" according to the perspective of the patient. We plan to integrate the data we obtain from the proposed interviews with the scripted Spectrum survey data in order to test our developing explanatory models and to modify our sampling and interview strategies if necessary. Use of mixed methods will help us better understand how older adults may experience depression in social and cultural context from both an epidemiologic and anthropologic perspective.