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1/2-Personalized Antidepressant Adherence Strategies for Depressed Elders

1/2-针对抑郁老年人的个性化抗抑郁药物依从策略

基本信息

批准号：
8677972
负责人：
JO ANNE SIREY
金额：
$ 28.47万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-10 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8677972
关键词：
Address Adherence Adverse effects Age Aging Alcohol consumption Americas Antidepressant adherence Antidepressive Agents Anxiety Area Attitude Belief Biometry Caring Cessation of life Characteristics Clinical Clinical Psychology Clinical Research Collaborations Communities Comorbidity Complement 3c Data Depressed mood Discipline Disease Dose Early treatment Effectiveness Elderly Enrollment Epidemiology Foundations Future Geriatric Psychiatry Goals Health Care Costs Healthcare Impaired cognition Individual Intervention Knowledge Longevity Major Depressive Disorder Mediating Mediator of activation protein Medical Mental Depression Mental Health Mental disorders Methods Michigan National Institute of Mental Health New York City Nursing Homes Outcome Participant Patients Pattern Persons Pharmaceutical Preparations Pharmacotherapy Physicians Pilot Projects Population Primary Care Physician Primary Health Care Procedures Provider Public Health Race Randomized Randomized Clinical Trials Randomized Controlled Trials Recruitment Activity Regimen Reporting Research Research Personnel Research Support Sampling Severities Site Societies Strategic Planning Suicide Targeted Research Terminology Testing Translating Treatment Effectiveness Treatment Protocols Universities Work age group aged arm base brief intervention burden of illness care seeking cohort depressive symptoms design environmental intervention evidence base experience fall risk flexibility follow-up geriatric depression health care quality health care service utilization improved innovation intervention effect intervention program medical schools medication compliance mild cognitive impairment mortality named group novel older patient prevent primary care setting programs psychologic psychosocial research study response self reliance social stigma socioeconomics suicide rate theories treatment adherence treatment as usual treatment effect

项目摘要

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.

描述（由申请人提供）：这项拟议的R01随机对照试验的目的是测试一种新型干预措施的有效性，即治疗开始和参与（TIP）计划，对老年初级保健患者抑郁症治疗依从性和抑郁症结局的影响。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。坚持治疗是一项贯穿一生的挑战，但在老年抑郁症患者中，这一挑战因医疗和精神病学合并症、医疗方案的复杂性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，耻辱对寻求抑郁症等心理健康问题治疗的影响尤其强烈。开始治疗抑郁症的决定既需要反驳年龄歧视的观念，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在这一群体中特别普遍的耻辱。随着国家人口结构的变化，老年生活中不坚持服药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在两个地理位置互补的初级保健中心（密歇根州安娜堡和纽约市）的不同社区样本中进行。这项研究将招募260名新近被初级保健医生开过抗抑郁药物的老年人，并随机分配参与者接受TIP干预或常规护理。为了检验研究假设，研究评估将在研究开始时、入组后6周、12周和24周进行。如果提出的干预措施有助于提高抗抑郁药物的依从性，它就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。作为一种简短的人工干预，TIP-PC的设计很容易适应初级保健实践，并由非md工作人员提供。