A Family-based Primary Care Intervention to Enhance Older Men's Depression Care

以家庭为基础的初级保健干预措施，以加强老年男性的抑郁症护理

• 批准号: 8701404
• 负责人: WALTER LADSON HINTON
• 金额: $ 20.55万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8701404
• 关键词: Address; Adult; Advocate; Caring; Chronic; Clinic; Collaborations; Communities; Data; Depressed mood; Diabetes Mellitus; Effectiveness of Interventions; Elderly; Elements; Employee Strikes; Endogenous depression; Family; Family Relationship; Family member; Friends; Funding; Gender; Health; Healthcare; Home environment; Intervention; Intervention Studies; Interview; Low income; Manuals; Mental Depression; Mental disorders; Methods; Minority; Modeling; National Institute of Mental Health; Patient Care; Patients; Phase; Population; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Public Health; Randomized; Randomized Controlled Trials; Recording of previous events; Research; Research Support; Self Efficacy; Self Management; Site; Social Controls; Social Workers; Subgroup; Symptoms; Target Populations; Testing; To specify; Training; Visit; Work; accomplished suicide; base; chronic care model; cost effective; depressive symptoms; improved; men; older men; older women; preference; primary care setting; public health relevance; skills; social stigma; theories; therapy development

DESCRIPTION (provided by applicant): Because older men are more likely than older women to be under-treated for depression and to commit suicide, more effective strategies are needed to engage and treat depressed older men in primary care. One strategy to improve depression care for older men is to build upon existing patient relationships with family members or close friends. This approach builds on the well-documented health-related support that family members provide both in the home and in the clinic, even among relatively healthy or nondisabled older adults. Yet the support that families provide for healthcare is often not well-integrated with professionally-delivered care in primary care settings. Family-based interventions to improve self-management for other chronic health conditions (e.g. diabetes) have been successfully developed but there is a striking lack of primary-care based intervention studies that incorporate family members as an integral part of depression treatment. From a public health perspective, there are compelling reasons to do so. Family involvement may reduce barriers to care, such as the patient's reluctance to disclose depressive symptoms, stigma or treatment nonadherence. Overcoming these barriers may be particularly important to close gaps in care for under-served subgroups of older adults, such as older men and minorities. Strengthening depression treatment in primary care settings by building on existing family relationships aligns with the preferences of older men and may be both cost effective and enduring. In this R-34 application, we will develop and test the feasibility and acceptability of a family-based intervention in a community-based primary care clinic serving a predominantly low-income and minority older adult population with high rates of untreated or undertreated depression. Our approach to intervention development is theory-driven and uses Wagner's chronic care model as an over-arching framework. It also draws on several other theoretical frameworks (e.g. self-efficacy, social control, relational coordination) to specify potential mechanisms through which family members may strengthen depression care. Specific aims of this project are 1) To conduct and analyze in-depth 36 interviews with key stakeholders in older men's depression care, including older men, potential family/friend helpers and clinic staff, 2) Informed by Aim 1 and our preliminary studies, to refine the intervention approach and to develop the intervention protocol (e.g. treatment and implementation manuals) and 3) To test the feasibility and acceptability of the intervention and study methods in a pilot randomized controlled trial of 24 depressed older men drawn from the target population.

描述（由申请人提供）：由于老年男性比老年女性更容易因抑郁症得不到充分治疗而自杀，因此需要更有效的策略来参与和治疗初级保健中的老年男性抑郁症。改善老年男性抑郁症护理的一个策略是建立与家庭成员或亲密朋友的现有患者关系。这种方法建立在家庭成员在家庭和诊所提供的有充分记录的健康相关支持的基础上，甚至在相对健康或无残疾的老年人中也是如此。然而，家庭为卫生保健提供的支持往往没有很好地与初级保健机构中专业人员提供的保健相结合。以家庭为基础的干预措施已成功发展，以改善对其他慢性健康状况（如糖尿病）的自我管理，但明显缺乏将家庭成员纳入抑郁症治疗的一个组成部分的以初级保健为基础的干预研究。从公共卫生的角度来看，有令人信服的理由这样做。家庭参与可能会减少护理的障碍，例如患者不愿透露抑郁症状、耻辱或治疗不依从。克服这些障碍对于缩小对老年男子和少数民族等服务不足的老年人亚群体的护理差距可能特别重要。在现有家庭关系的基础上加强初级保健机构的抑郁症治疗符合老年男性的偏好，可能既具有成本效益，又具有持久性。在这个R-34应用程序中，我们将开发和测试a的可行性和可接受性