Detecting Depressive Symptoms in Older Adults

描述(由申请人提供)：自杀文献中一个一致和令人不安的发现迫使我们进行调查。大多数自杀的老年人都有情感障碍，但家人和卫生专业人员没有意识到自杀的潜在风险。我们的症状检测模型的核心是特定的因素阻碍了老年人抑郁症的检测、诊断和治疗。ROL资金被寻求在人口统计学和临床异质性的1000名65岁及以上的初级保健患者的样本中测试这一模式的各个方面。从2001年8月开始，这些患者被纳入一项自然主义研究--“老年初级护理中的抑郁结局”(NIMH rol MH61429-O1A1，J.Lyness，M.D.，P.I.)。对于这项拟议的ROL，我们将从DPC研究参与者的社交网络成员中收集线人的数据，以检查线人对抑郁障碍以及抑郁和焦虑症状的检测。我们将努力为该研究中的每个主题招聘一名线人，并计划从628多名线人那里收集数据。我们将向举报人询问有关他们自己和DPC参与者的精神症状的问题。具体地说，我们将审查举报人发现抑郁症的作用是：患者精神障碍的严重程度和病史(目标1)、患者的心理社会(个性和社会支持)特征和身体健康参数(目标2)、患者的人口统计特征(目标3)以及举报人的精神病史和自我报告的健康(目标4)。我们将探索告密者的人格特征和对精神疾病的态度所起的作用，并将探索非裔美国人和白人之间的差异。我们假设：不那么严重和第一次发作的障碍(Aim1)；具有某些个性特征的患者(例如，低外向；对经验的开放性低)或身体健康状况不佳(目标2)；以及男性和未婚参与者(目标3)，检测将较差。当报案者没有抑郁症病史或身体健康状况不佳时，侦测也会较差(目标4)。对于目标2，将考察社会支持的中介作用。这些假说的确认将表明，目前对晚年抑郁和自杀的方法需要进行修订。研究结果将有助于指导筛查工具、教育和临床干预以及监测战略的发展，以减少未发现和未治疗的抑郁症对公共健康的影响。

DESCRIPTION (provided by applicant): One consistent and disturbing finding in the suicide literature compels this investigation. Most older adults who take their own lives have an affective disorder, but the potential risk for suicide was unrecognized by family members and health professionals. The central thrust of our symptom detection model is that specific factors deter the detection, diagnosis, and treatment of depression in older adults. ROl funding is sought to test aspects of this model in a demographically and clinically heterogeneous sample of 1000 primary care patients 65 years of age and older. Beginning in August 2001, these patients were recruited into a naturalistic study, "Depression Outcome in Primary Care Elderly" (DPC) (NIMH ROl MH61429-O1A1, J. Lyness, M.D., P.I.). For this proposed ROl, we will collect data from informants who are members of the social networks of participants in the DPC study in order to examine informant detection of depressive disorders and symptoms of depression and anxiety. We will strive to recruit one informant for each subject in that study, and plan to collect data from more than 628 informants. We will ask the informants questions about themselves and the DPC participants' psychiatric symptoms. Specifically, we will examine informant detection of depression as a function of: the severity and history of patients' psychiatric disorders (Aim 1), patients' psychosocial (personality and social support) characteristics and physical health parameters (Aim 2), patients' demographic characteristics (Aim 3), and informants' psychiatric history and self-reported health (Aim 4). We will explore the role of informants' personality traits and attitudes toward mental illness, and differences between African-Americans and Whites will be explored. We hypothesize the detection will be poorer for: disorders that are less severe and first episode (Aim1); patients with certain personality traits (e.g., low extraversion; low openness to experience) or poor physical health (Aim 2); and men and unmarried participants (Aim 3). Detection will also be poorer when informants have no prior history of depression or are in poor physical health (Aim 4). For Aim 2, the mediating effect of social support will be examined. Confirmation of these hypotheses will indicate needed revisions in current approaches to late-life depression and suicide. Findings will help guide the development of screening instruments, educational and clinical interventions, and surveillance strategies to lessen the public health impact of unrecognized and untreated depression.