The SocioCultural Context of Depression in Late Life

描述(由申请人提供)：拟议研究的主要目标是提高我们对初级保健环境中老年人抑郁的理解。人类学方法允许获取研究参与者的主位或内部观点(在这种情况下是关于抑郁症的经历和症状)，以及对抑郁症的更标准的、精神的或外部的科学解释。这项混合方法研究将在65岁及以上的基层护理患者中进行，其具体目的是：1)描述老年人及其家人在晚年如何经历抑郁症，以及他们如何将抑郁症的症状与医疗条件结合起来；2)研究医疗合并症、认知障碍、焦虑、绝望和载脂蛋白E基因对患者及其家人晚年抑郁症病程及相关功能障碍的影响；3)跨种族评估目标1和2，以提高我们为老年初级保健患者及其家人设计可接受的干预措施的能力。这项拟议的研究利用了NIMH资助的一项名为“光谱调查”的老年初级保健患者抑郁症状研究中的筛查和后续项目。在这项由基金资助的研究中，我们将对450名已经登记参加观察性研究的初级保健患者进行跟踪调查，该研究旨在描述和验证一种抑郁综合征，即不符合严重抑郁症标准的麻木抑郁症。我们建议在对主要研究进行为期12个月的访谈后，通过对160名患者(包括30名患者家属)进行单一的半结构化访谈来加强这项资助的研究。我们将利用文化共识分析和民族志话语中心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。我们计划将我们从拟议采访中获得的数据与脚本化的频谱调查数据相结合，以测试我们正在开发的解释性模型，并在必要时修改我们的抽样和采访策略。混合方法的使用将帮助我们从流行病学和人类学的角度更好地理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.