ACISR for Late-Life Depression Prevention

这是对老年抑郁症预防干预和服务研究高级中心的修订申请(ACISR/LLDP：P30 MH090333-01A1)(PAR-08-088)。该应用程序响应2008年国家精神卫生战略计划，解决何时、如何以及向谁干预精神疾病的发展轨迹，以防止其发展，促进健康和独立，并减轻低收入人群在获得和提供精神卫生服务方面的不平等。鉴于抑郁症在晚年的患病率和发病率，目前避免残疾多年的治疗方法的不足，获得精神卫生保健提供系统的不平等，以及满足美国老年人心理健康需求的劳动力短缺，开发和测试先发制人的创新战略具有重大的公共卫生意义和改变做法的潜力。 ACISR/LLDP中建议的主要研究项目和研究方法开发解决了以下一个或多个问题：(1)针对风险增加的老年人(选择性预防)和/或已经生活在阈值下的抑郁症症状(指示预防)的老年人进行早期干预，能否在临床上显著降低重度抑郁症的发生率、严重性或持续时间？2)我们如何最好地组织和实施干预措施，以预防社区老年人口中的严重抑郁症？我们的目标是提高预测老年人及其照顾者抑郁的准确性；指导及时引入降低风险战略；并开发工具，使预防性干预能够针对最需要干预的人。 解决这些问题的研究将通过行政、预防试验管理、社区联网、研究伦理咨询、生物签名开发和应用以及数据管理和分析等业务核心单位得到支助。我们将在初级保健实践环境和社会服务环境中工作，以最大限度地提高与具有最大公共卫生需求的人群的临床相关性。根据NIMH对中心的要求，我们计划使用中心的资源(例如，种子资金支持、试点项目)为早期调查人员提供服务。自从我们在1995年作为NIMH P30中心首次资助以来，我们已经支持了25个成功的老年精神健康K奖申请，以及这些K获奖者指导的14个随后的ROI，为国家老年精神健康研究的研究人员管道做出了重大贡献。

This is an amended application for an Advanced Center in Intervention and Services Research in late-life depression prevention (ACISR/LLDP: P30 MH090333-01A1) (PAR-08-088). The application responds to the 2008 NIMH Strategic Plan in addressing when, how, and in whom to intervene in the developmental trajectory of mental illness to prevent its progression, to promote healthspan and independence, and to mitigate inequities in mental health services access and delivery to low-income people. Given the prevalence and morbidity of depression in later life, the inadequacies of current treatment approaches for averting years living with disability, the inequities in access to the mental health care delivery system, and the work-force shortages to meet the mental health needs of older Americans, development and testing of innovative strategies to preempt major depression are of great public health significance and potential to change practice. The principal research projects and research methods development proposed in the ACISR/LLDP address one or more of the following questions: (1) Can early intervention targeted to older individuals at increased risk (selective prevention), and/or already living with subthreshold symptoms of depression (indicated prevention), reduce incidence, severity, or duration of major depression, to a clinically significant degree? and 2) How do we best organize and implement interventions to prevent major depression in a community-dwelling elderly population? Our goals are to improve accuracy in predicting depression in older adults and in their caregivers; to guide timely introduction of risk reduction strategies; and to develop tools that allow preventive interventions to be directed at those who need them most. Research addressing these issues will be supported through Operations Core units for administration, prevention trials management, community networking, research ethics consultation, biosignature development and application, and data management and analysis. We will work in primary care practice settings and in social service settings, in order to maximize clinical relevance to populations with the greatest public health need. In accord with NIMH mandates to Centers, we plan to use Center resources (e.g., seed money support, pilot projects) in the service of Early Stage Investigators. Since our initial funding as an NIMH P30 Center in 1995, we have supported 25 successful K award applications in geriatric mental health, and 14 subsequent ROIs directed by these K Awardees, making a significant contribution to the nation's pipeline of investigators in geriatric mental health research.