A New Measure of Adaptive Strategies and its Relation to Late-Life Depression

描述（由申请人提供）：迫切需要确定预测老年人面临的健康挑战的最佳反应的因素。自我调节模型（由控制理论提供信息）可以帮助我们理解有效适应策略背后的关键动机问题。初级控制策略侧重于改变环境，而次级控制策略侧重于改变自我。一级和二级控制策略的使用与身体健康（例如，死亡率、身体功能、住院和皮质醇分泌）和心理健康结果（例如，抑郁症和幸福）在中年和老年人中。然而，对一级和二级控制策略的评估一直是不系统的。具体而言，项目原本不打算评估控制策略已合并事后;复杂的措辞限制了有用的项目在样本中的教育程度最低;和社会期望反应偏差尚未进行评估。该提案描述了一个新的自我报告措施的主要和次要控制策略的发展，以促进控制策略对整个生命周期的身心健康的影响的研究。我们提出了两个研究：1）中年和晚年的成年人的访谈研究，以产生一个项目池，和2）规模的发展研究，使用传统和先进的（项目反应理论）的心理测量方法。这两项研究都将纳入患有一系列功能障碍的中年和老年受试者。我们的目标是：1）描述中年和晚年成年人用于追求健康目标的主要和次要策略; 2）使用项目反应理论和结构方程模型来开发这些策略的自我报告测量; 3）检查控制策略与抑郁症和功能障碍之间的关系，特别是在老年抑郁症患者中。更好地评估初级和二级控制策略将有助于我们预测哪些老年人在健康状况下降时可能会经历抑郁症，哪些老年人更有可能从治疗老年抑郁症的干预措施中受益。了解控制策略，身体功能和抑郁症之间的关系也将有助于我们设计更有效的，以证据为基础的治疗晚年抑郁症。制定一个更好的措施，适应性反应（一级和二级控制战略）的健康挑战是重要的公共卫生，因为它可以作为一个筛选工具。具体来说，这项新措施可以帮助我们确定哪些老年人在健康状况下降时有患抑郁症的风险，哪些老年人最有可能从某些治疗中受益。了解适应性反应，身体功能和抑郁症之间的关系也可以帮助我们设计更好的晚年抑郁症治疗方法。

DESCRIPTION (provided by applicant): There is a pressing need to identify factors that predict optimal responses to the health challenges faced by older adults. Models of self-regulation (informed by control theory) can help us understand key motivational issues underlying effective adaptive strategies. Primary control strategies focus on changing the environment, whereas secondary control strategies focus on changing the self. Use of primary and secondary control strategies has been related to both physical health (e.g., mortality, physical functioning, hospitalization, and cortisol secretion) and mental health outcomes (e.g., depression and well-being) among both mid- and late-life adults. However, the assessment of primary and secondary control strategies has been unsystematic. Specifically, items not originally intended to assess control strategies have been combined post hoc; complex wording has limited the usefulness of items in samples with minimal education; and social desirability response bias has not been assessed. This proposal describes the development of a new self-report measure of primary and secondary control strategies in order to promote research on the influence of control strategies on physical and mental health across the lifespan. We propose two research studies: 1) an interview study of mid-life and late-life adults in order to generate an item pool, and 2) a scale development study using traditional and advanced (item response theory) psychometric methods. Both studies will include mid- and late-life subjects with a range of functional impairment. Our aims are 1) to describe the primary and secondary strategies mid- and late-life adults use to pursue health goals; 2) to use item response theory and structural equation models to develop a self-report measure of these strategies; and 3) to examine the relations between control strategies and both depression and functional impairment, particularly among older adults with depression. Better assessment of primary and secondary control strategies will help us predict which older adults are likely to experience depression in the face of health declines and which are more likely to benefit from interventions treating geriatric depression. Understanding the relations between control strategies, physical functioning, and depression will also help us to design more effective, evidence-based treatments for late-life depression. Developing a better measure of adaptive responses (primary and secondary control strategies) to health challenges is important to public health because it can be used as a screening tool. Specifically, this new measure may help us identify which older adults are at risk of becoming depressed when their health declines and which are most likely to benefit from certain treatments. Understanding the relations between adaptive responses, physical functioning, and depression may also help us design better treatments for late-life depression.