Development and Evaluation of a Depression Risk Calculator

描述（由申请人提供）：数以百万计的老年人患有抑郁症。患者参与应用有效治疗的一个关键障碍是难以量化抑郁症的严重程度和预测未来抑郁的时间。更精确的抑郁症风险模型将为患者提供有关其未来病程的更好信息，并允许更有效的共同决策。我提出了一项为期四年、有指导的研究计划，以开发和评估“抑郁风险计算器”。该工具将有助于识别有抑郁风险的患者，为他们提供更多关于抑郁轨迹的信息，识别与抑郁相关的其他症状，并加强患者和提供者之间的共同决策。为了实现这一目标，我将学习纵向数据分析和定性方法的课程，并获得在初级保健中应用共享决策的经验。利用老年人的三个大型纵向数据库（CHS， HRS和IMPACT），我将开发抑郁症风险计算器的算法。我将向5名曾接受过抑郁症治疗的患者寻求意见，了解计算器的信息如何对他们最有利，并相应地调整输出。然后，我将确定抑郁症风险计算器的反馈对患者层面结果的影响，特别是患者的参与和治疗的使用。我会将计算器的反馈提供给20名患者，并将他们的经历与对照组20名患者的经历进行对比，随访一年。这项研究将产生假设，并为使用风险模型改善老年抑郁症治疗的更大规模研究产生初步结果。

DESCRIPTION (provided by applicant): Millions of older adults suffer from depression. A key barrier to patient engagement in application of effective treatments is the difficulty in quantifying depression severity and anticipating future time spent depressed. More refined models of depression risk would give patients better information about their future course, and allow more effective shared decision making. I propose a four-year, mentored research plan to develop and evaluate a "depression risk calculator". This tool will be useful for identifying patients at risk for depression, giving them more information about their depression trajectory, identifying other symptoms associated with depression, and enhancing shared decision making between patients and providers. In order to accomplish this end, I will take courses in longitudinal data analysis and qualitative methods, and gain experience in applying shared decision making in primary care. Using three large longitudinal databases of older adults (CHS, HRS, and IMPACT) I will develop algorithms for a depression risk calculator. I will seek input from five patients previously treated for depression about how information from the calculator would have the most benefit for them, and will tailor the outputs accordingly. I will then ascertain the effects of feedback from a depression risk calculator on patient-level outcomes, particularly patient engagement and use of treatments. I will provide feedback from the calculator to 20 patients, and compare their experiences with those of a control group of 20 patients, followed for one year. This research will generate hypotheses and produce preliminary results for larger studies of using risk models to improve treatment for geriatric depression. PUBLIC HEALTH RELEVANCE: Millions of older adults suffer from depression, but it can be challenging for them and their providers to appreciate how severe their symptoms are, and how they will change over time. For other conditions, risk calculators can identify a patient's likelihood of developing and continuing in a disease, which can help patients and providers to decide on the most fitting treatments. For example, the Framingham risk calculator, which is freely available on-line, estimates an individual's risk of having a heart attack, and can assist patients and providers in making decisions. I plan, by using data from four large studies which surveyed older adults over long periods of time, to develop a depression risk calculator, which will (1) project the amount of time a patient is likely to spend depressed in the future, (2) identify the related factors that may be contributing to depression, and (3) estimate the effects of treatments on future course. I will assess how feedback from such a calculator would help older adults and their providers to improve knowledge, decisions, and use of treatments for depression.