LLD Course & Treatment Decisions: Psychosocial Influences

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DESCRIPTION (provided by applicant): LLD Course & Treatment Decisions: Psychosocial Influences. In 1999, the Principal Investigator of this K24 application, Paul Duberstein, PhD, began to develop a model that seeks to explain why late-life depression (LLD) so often goes unreported by patients and undetected by their significant others. Key variables in the model are: personality traits, social support, cognitive function, and physical health of both patients and their significant others. Funding from two NIMH grants supported research to test aspects of this model in depressed inpatients (Project 1; "Adult depression, suicidal ideation, and personality," NIMH, R01 MH60285) and primary care patients. (Project 2; "Detecting depressive symptoms in older adults," NIMH R01MH64579). Specifically, those projects hypothesized that people with particular personality traits are less likely to report mood symptoms. Moreover, their mood symptoms are less likely to be detected by others. Analyses of the Project 1 dataset are consistent with these hypotheses. Data collection for Project 2 is completed. The proposed K24 will provide support to extend this program of research, and to support mentoring activities focused on further research regarding LLD. K24 Research Aims: a) to test and refine a model of symptom detection using data collected in these R01s, and submit a new R01 based on these findings; b) to use qualitative and quantitative methods to identify the psychosocial, biological, and sociocultural influences on treatment engagement (e.g., initiation, adherence) and outcomes in LLD. The applicant and his mentees will implement a new study on LLD in public housing residents (Project 3) and conduct secondary analyses of data collected in an NIMH-funded multi-site study called the Prevention of Suicide in Primary Care Elderly - Collaborative Trial (PROSPECT, Project 4). Race differences will be explored in Projects 2-4. K24 Education Aims: a) to develop skills in qualitative methods, and b) to continue the process of enhancing skills as an effective, culturally sensitive mentor to social scientists and physicians. By the end of the Award period, the P.I. will have made a substantial contribution to the conceptualization of the treatment and prevention of LLD, acquired new research and mentoring skills, and developed a national reputation as an outstanding mentor for a diverse array of developing faculty and fellows seeking to study these important public health, clinical, and therapeutic issues.