ACISR for Late-Life Depression Prevention

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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.