1/2-Personalized Antidepressant Adherence Strategies for Depressed Elders

1/2-针对抑郁老年人的个性化抗抑郁药物依从策略

• 批准号: 8123109
• 负责人: JO ANNE SIREY
• 金额: $ 31.63万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-10 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8123109
• 关键词: Address; Adherence; Adverse effects; Age; Aging; Alcohol consumption; Americas; Antidepressant adherence; Antidepressive Agents; Anxiety; Area; Attitude; Belief; Biometry; Caring; Cessation of life; Characteristics; Clinical; Clinical Psychology; Clinical Research; Collaborations; Communities; Comorbidity; Complement 3c; Data; Depressed mood; Discipline; Disease; Dose; Early treatment; Effectiveness; Elderly; Enrollment; Epidemiology; Foundations; Future; Geriatric Psychiatry; Goals; Health Care Costs; Healthcare; Impaired cognition; Individual; Intervention; Knowledge; Longevity; Major Depressive Disorder; Mediating; Mediator of activation protein; Medical; Mental Depression; Mental Health; Mental disorders; Methods; Michigan; National Institute of Mental Health; New York City; Nursing Homes; Outcome; Participant; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Pilot Projects; Population; Primary Care Physician; Primary Health Care; Procedures; Provider; Public Health; Race; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Regimen; Reporting; Research; Research Personnel; Research Support; Sampling; Severities; Site; Societies; Stigmata; Strategic Planning; Suicide; Targeted Research; Terminology; Testing; Translating; Treatment Effectiveness; Treatment Protocols; Universities; Work; age group; aged; arm; base; brief intervention; burden of illness; care seeking; cohort; depressive symptoms; design; environmental intervention; evidence base; experience; fall risk; flexibility; follow-up; geriatric depression; health care quality; health care service utilization; improved; innovation; intervention effect; intervention program; medical schools; medication compliance; mild neurocognitive impairment; mortality; named group; novel; older patient; prevent; primary care setting; programs; psychologic; psychosocial; public health relevance; research study; response; self reliance; social stigma; socioeconomics; suicide rate; theories; treatment adherence; treatment as usual; treatment effect

DESCRIPTION (provided by applicant): The goal of this proposed collaborative R01 randomized controlled trial is to test the effectiveness of a novel intervention, the Treatment Initiation and Participation (TIP) program, on depression treatment adherence and depression outcomes among geriatric primary care patients. TIP is a brief, psychosocial intervention aimed at reducing the multifaceted personal barriers to adhering to depression treatment. Adherence is a challenge across the lifespan, but among older adults with depression, this challenge is compounded by medical and psychiatric co-morbidity, medical regimen complexity, and skeptical attitudes towards mental illness and its care. For older adults, the effect of stigma on seeking care for mental health issues such as depression is particularly strong. The decision to begin treatment for depression entails both countering the ageist notion that depression is a normal outgrowth of aging and confronting the stigma of mental health treatment particularly prevalent in this cohort. The treatment gap created by non-adherence in later life is becoming an even more prominent issue as the nation's demographic profile shifts. The proposed RCT will be conducted with diverse community samples from two geographically complementary primary care centers (Ann Arbor, Michigan and New York City). The study will recruit 260 older adults who have been newly prescribed antidepressant medication by their primary care physician, and randomize participants to receive either the TIP intervention or usual care. To test the study hypotheses, research assessments will be conducted at study entry, and at 6, 12 and 24 weeks after enrollment. If the proposed intervention is useful in improving antidepressant adherence, it has the potential to decrease the deleterious effects of untreated depression in a growing number of older adults. As a brief manualized intervention, TIP-PC is designed to fit easily within primary care practices and to be delivered by non-MD staff. PUBLIC HEALTH RELEVANCE: Depression and its treatment in later-life presents many challenges for the growing number of older adults in our society; beyond personal suffering, untreated depression worsens the outcomes of many medical illnesses and increases the risk for falls, cognitive decline, and death. Older adults experience many barriers that interfere with their choice or ability to follow the treatment their doctor recommends. The purpose of this research is to test a personalized and flexible primary care-based program designed to help patients experience successful depression treatment.

描述（由申请人提供）：这项拟议的合作R 01随机对照试验的目的是测试一种新的干预措施，治疗启动和参与（TIP）计划，对老年初级保健患者抑郁症治疗依从性和抑郁症结局的有效性。TIP是一种简短的心理社会干预，旨在减少坚持抑郁症治疗的多方面个人障碍。坚持是整个生命周期的一个挑战，但在老年抑郁症患者中，这一挑战因医疗和精神病共病，医疗方案的复杂性以及对精神疾病及其护理的怀疑态度而变得更加复杂。对于老年人来说，污名化对寻求抑郁症等心理健康问题的影响尤其强烈。决定开始治疗抑郁症既需要反对年龄歧视的观念，即抑郁症是衰老的正常产物，也需要面对心理健康治疗的耻辱，特别是在这一群体中普遍存在。随着国家人口结构的变化，晚年不坚持治疗所造成的治疗差距正在成为一个更加突出的问题。 拟议的RCT将使用来自两个地理位置互补的初级保健中心（密歇根州安阿伯和纽约市）的不同社区样本进行。该研究将招募260名老年人，他们的初级保健医生最近开了抗抑郁药物，并随机分配参与者接受TIP干预或常规护理。为了检验研究假设，将在研究入组时以及入组后第6、12和24周进行研究评估。如果拟议的干预措施有助于改善抗抑郁药的依从性，那么它有可能减少越来越多的老年人未经治疗的抑郁症的有害影响。作为一种简单的手动干预，TIP-PC的设计很容易适应初级保健实践，并由非MD工作人员提供。 公共卫生相关性：抑郁症及其在晚年的治疗给我们社会中越来越多的老年人带来了许多挑战;除了个人痛苦，未经治疗的抑郁症会导致许多医学疾病的后果，并增加福尔斯、认知能力下降和死亡的风险。老年人经历了许多障碍，干扰他们的选择或遵循医生建议的治疗的能力。这项研究的目的是测试一个个性化和灵活的初级保健为基础的计划，旨在帮助患者体验成功的抑郁症治疗。