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

EM/BACT研究摘要 60岁及以上的成年人中有10%受到虐待。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/BACT，一种针对抑郁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， 服务以及与法律的服务的联系。CIMT建立在一个模型上，该模型假设慢性压力 促进认知控制（CCN）和奖励网络的功能障碍，损害受害者的能力， 灵活地对环境做出反应，并限制他们的奖励活动。EM/CIMT使用简单易用 移动的技术来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/CIMT是在与社区EM的迭代过程中设计的 纽约市老龄化部门（DFTA）的供应商使用机构的常规PHQ-9抑郁症筛查 和转诊服务。 该项目将检查EM/PROTECT的范围、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。我们的首要 假设接受EM服务和EMT治疗（EM/EMT）的受害者将 与接受EM的受害者相比，抑郁症的减少和生活质量的改善更大 服务和心理健康转介（EM-MH）。我们认为，压力的降低将介导 电磁/电磁辐射的不同影响。 我们将与纽约市的两个EM机构一起制定PHQ-9筛查、移交、联系和同意的程序 过程、EM行动跟踪和临床进展。EM受害者将从两个随机分配的 EM机构，将产生60名受试者的样本（40名EM/MITT和20名EM-MH）。研究 将在基线、第6、9和12周进行评估，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。我们将 通过记录筛查率、确定的抑郁症患者、每种疾病的转诊情况， 拒绝和缺乏后续行动; EM/CRTT的可行性将基于辍学，完成 评估和使用智能手机;可接受性将基于客户满意度。我们将分析 具有受试者特定随机截距和斜率的单独线性混合模型中的有效性指标 以及时间、治疗和EM代理的固定效应。 该项目的结果将用于支持R 01应用程序，以正式测试可行性， 可接受性、有效性、不可计费的成本以及在严格的 随机对照试验。我们计划在全国范围内与EM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.