1/2-Personalized Antidepressant Adherence Strategies for Depressed Elders

描述(由申请人提供)：这项合作的R01随机对照试验的目标是测试一种新的干预措施，即治疗启动和参与(TIP)计划，对老年初级保健患者的抑郁症治疗依从性和抑郁结果的有效性。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。坚持治疗是终生的挑战，但在患有抑郁症的老年人中，这一挑战因内科和精神科并存、医疗方案复杂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，耻辱对寻求治疗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对抗年龄歧视的观念，即抑郁症是年龄增长的正常结果，也需要面对心理健康治疗的耻辱，这一耻辱在这一群体中特别普遍。随着美国人口结构的变化，晚年不坚持治疗造成的治疗差距正成为一个更加突出的问题。拟议的随机对照试验将采用来自两个地理互补的初级保健中心(密歇根州安娜堡和纽约市)的不同社区样本进行。这项研究将招募260名老年人，他们的初级保健医生新开了抗抑郁药物，并随机选择参与者接受TIP干预或常规护理。为了验证研究假设，研究评估将在研究开始时以及注册后6、12和24周进行。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。作为一种简短的手动干预，TIP-PC旨在轻松适应初级保健实践，并由非MD工作人员提供。 与公共卫生相关：抑郁症及其晚年治疗对我们社会中越来越多的老年人提出了许多挑战；除了个人痛苦之外，未经治疗的抑郁症还会恶化许多医学疾病的结果，并增加摔倒、认知能力下降和死亡的风险。老年人经历了许多障碍，这些障碍干扰了他们选择或遵循医生推荐的治疗方案的能力。这项研究的目的是测试一种个性化和灵活的基于初级保健的计划，旨在帮助患者体验成功的抑郁症治疗。

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.