Developmental Project 1: EM/PROTECT: Improving Depression in Elder Mistreatment Victims

EM/PROTECT研究摘要 在60岁及以上的成年人中，虐待老年人的比例高达10%。大约三分之一的受害者在临床上 严重的抑郁症状。我们开发了EM/Protect，一种针对抑郁的EM的行为干预 受害者与EM虐待解决服务协同工作，提供安全规划、支持 服务以及与法律服务的联系。保护建立在一个模型的基础上，该模型假定慢性压力 促进认知控制(CCN)和奖赏网络的功能障碍，损害受害者的 对环境作出灵活的反应，限制他们的奖励活动。EM/PROTECT利用简单易用 移动技术支持受害者的行动计划，帮助治疗师有针对性地进行治疗，并跟踪情绪， 压力和社会互动。EM/Protect是与社区EM在迭代过程中设计的 纽约市老年局(DFTA)的提供者使用机构的常规PHQ-9抑郁症筛查 和转介服务。 该项目将检查EM/PROTECT的覆盖范围、可行性、可接受性和初步有效性 目标是建立一个可广泛实施的可持续的心理健康计划。我们的初选 假设，接受EM服务和保护性治疗(EM/保护性)的受害者将有 与接受EM治疗的患者相比，抑郁症的减轻和生活质量的改善更大 服务和精神健康转介(EM-MH)。我们认为，压力的减轻将在 EM/PROTECT的差异影响。 我们将与纽约市的两个新兴市场机构一起，制定PHQ-9筛选、移交、联系、同意等程序 过程、EM行动的跟踪和临床进展。EM受害者将从两个随机分配的 EM机构将产生60个样本(40个EM/PROTECT和20个EM-MH)。研究 评估将在基线、6周、9周和12周进行，以评估抑郁、生活质量、慢性 压力、奖励活动以及经济、身体和心理虐待和忽视事件。我们会 通过记录筛查的比率、确定的抑郁症患者、每种情况的转介 拒绝和缺乏后续行动；EM/保护的可行性将基于辍学、完成 评估和智能手机的使用；可接受性将基于客户满意度。我们将分析 具有特定对象的随机截距和斜率的分离线性混合模型的有效性度量 以及对时间、治疗和EM代理的固定效果。 该项目的结果将用于支持R01应用程序，以正式测试可行性， 可接受性、有效性、不可计费成本和实施保护的障碍 随机对照试验。我们计划在全国范围内与新兴市场机构进行试验。

EM/PROTECT Study Abstract Elder mistreatment afflicts up to 10% of adults 60 years and older. Approximately 1/3 of victims have clinically significant depressive symptoms. We developed EM/PROTECT, a behavioral intervention for depressed EM victims to work in synergy with EM mistreatment resolution services that provide safety planning, support services, and linkages to legal services. PROTECT is built on a model, which postulates that chronic stress promotes dysfunction of the cognitive control (CCN) and the reward networks impairing the victims' ability to flexibly respond to the environment and limits their rewarding activities. EM/PROTECT utilizes simple to use mobile technology to support the victim's action plans, help therapists to target their sessions, and track mood, stress and social interaction. EM/PROTECT has been designed in an iterative process with community EM providers of the NYC Department for the Aging (DFTA) to use agencies' routine PHQ-9 depression screening and referral for services. This project will examine the reach, feasibility, acceptability, and preliminary effectiveness of EM/PROTECT with the goal of building a sustainable mental health program that can be broadly implemented. Our primary hypotheses postulate that victims who receive EM services and PROTECT therapy (EM/PROTECT) will have greater reduction in depression and improvement in quality of life compared to victims who receive EM Services and a mental health referral (EM-MH). We propose that reductions in stress will mediate the differential impact of EM/PROTECT. With two NYC EM agencies, we will develop procedures for PHQ-9 screening, hand-off, linkages, consent process, tracking of EM actions, and clinical progress. EM victims will be recruited from two randomly assigned EM agencies that will yield a sample of 60 subjects (40 EM/PROTECT and 20 EM-MH). Research assessments will be conducted at baseline, 6, 9 and 12 weeks to evaluate depression, quality of Life, chronic stress, rewarding activities and incidents of financial, physical and psychological abuse and neglect. We will assess reach by recording the rates of screening, identified depressed victims, referrals to each condition, refusal and lack of follow-through; feasibility of EM/PROTECT will be based on drop-out, completion of assessments, and use of smartphones; and acceptability will be based on client satisfaction. We will analyze measures of effectiveness in separate linear mixed models with a subject-specific random intercept and slope and fixed effects for time, treatment, and EM agency. The results of this project will be used to support an R01 application to formally test the feasibility, acceptability, effectiveness, non-billable costs, and barriers to implementation of PROTECT in in a rigorous randomized controlled trial. We plan to conduct the trial with EM agencies nationwide.