ACISR for Late-Life Depression Prevention

这是一份晚期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）。该应用程序响应了2008年NIMH战略计划，解决了何时、如何以及在谁身上干预精神疾病的发展轨迹，以防止其发展，促进健康跨度和独立性，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。鉴于抑郁症在老年生活中的患病率和发病率，当前治疗方法在避免残疾生活方面的不足，获得精神卫生保健系统的不公平，以及满足美国老年人心理健康需求的劳动力短缺，开发和测试预防重度抑郁症的创新策略具有重要的公共卫生意义，并有可能改变实践。

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.