Racial Differences in Geriatric Antidepressant Adherence

老年人抗抑郁药物依从性的种族差异

• 批准号: 7270113
• 负责人: Helen C Kales
• 金额: $ 19.92万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7270113
• 关键词: Acute; Address; Adherence; Affect; African American; Age; Aging; Antidepressant adherence; Antidepressive Agents; Attention; Baseline Surveys; Belief; Caring; Cessation of life; Characteristics; Chronic; Clinic; Clinical; Clinical Research; Communities; Counseling; Count; Data; Depressed mood; Depth; Developed Countries; Developing Countries; Development; Diagnosis; Diagnostic; Elderly; Event; Focus Groups; Freedom; Future; Gap Junctions; Gender; Guidelines; Health; Health Personnel; Health system; Healthcare; Heart Diseases; Improve Access; Individual; Intervention; Kale - dietary; Knowledge; Lead; Major Depressive Disorder; Medical; Mental Depression; Mental Health; Mental disorders; Methods; Minority; Modeling; Morbidity - disease rate; Nexus (resin cement); Outcome; Patients; Pharmaceutical Preparations; Phase; Population; Primary Health Care; Process; Provider; Psychotherapy; Qualitative Methods; Quality of life; Race; Rate; Recurrence; Research; Research Personnel; Risk; Sampling; Screening procedure; Services; Severities; Site; Spirituality; Stigmata; Suicide; Surveys; Veterans; Vulnerable Populations; Work; World Health Organization; age group; age related; clinically significant; collaborative care; design; disability; executive function; experience; follow-up; geriatric depression; health disparity; health related quality of life; improved; innovation; medication compliance; mortality; older patient; prescription document; prescription procedure; prospective memory; psychologic; psychosocial; racial difference; social stigma; suicidal risk

DESCRIPTION (provided by applicant): Geriatric depression is often chronic or recurrent, and is associated with substantial suffering, disability, suicide risk and decreased health-related quality of life. Although antidepressants and psychotherapy are clearly effective, older patients often fail to take them as prescribed or recommended and as many as 40% discontinues medication use prematurely. Even with successful health system changes such as collaborative care models in primary care, treatment gaps remain, and thus, poor treatment adherence may limit the extent to which many geriatric patients realize the benefits of these efficacious treatments. While there are racial differences in clinical diagnostic rates of depression, substantially less is known about racial differences in depression treatment adherence rates or the key determinants of adherence among older patients. Limited data from mixed-age samples suggests that African-American patients may be even less willing to engage in psychotherapy or accept antidepressant treatment than white patients. This study will use a mixed methods approach in order to identify the key modifiable determinants of depression treatment adherence among older African-American and white patients. A baseline survey including both quantitative and qualitative components will assess key constructs potentially determining adherence, with particular attention to possible factors (spirituality and stigma) that may differ across racial groups. In addition, four focus groups held with a subset of patients (n=6-8 for each group) will allow us to obtain more in-depth qualitative information and inform the addition of new domains to the follow-up survey. African-American (n=103) and white (n=103) patients 60 years old or over with the recent diagnosis of clinically significant depression in five participating primary care clinic sites will be eligible. Using the baseline and a four-month follow-up survey, we will compare rates of adherence between African-American and white patients and identify the determinants most significantly associated with non-adherence in the acute phase following a new diagnosis of depression. By identifying the key modifiable determinants of depression treatment adherence among both African-American and white elders, clinicians and researchers will be much more effective in identifying at-risk individuals and developing tailored interventions that may improve their treatment adherence and depression outcomes.

描述（由申请人提供）：老年抑郁症通常是慢性或复发性的，并与严重的痛苦、残疾、自杀风险和健康相关生活质量下降有关。尽管抗抑郁药物和心理治疗显然有效，但老年患者往往无法按照处方或建议服用，并且多达 40% 的患者过早停止用药。即使卫生系统取得了成功，例如初级保健中的协作护理模式，治疗差距仍然存在，因此，治疗依从性差可能会限制许多老年患者认识到这些有效治疗的益处的程度。虽然抑郁症的临床诊断率存在种族差异，但人们对抑郁症治疗依从率的种族差异或老年患者依从性的关键决定因素知之甚少。来自混合年龄样本的有限数据表明，非洲裔美国患者可能比白人患者更不愿意接受心理治疗或接受抗抑郁治疗。本研究将采用混合方法来确定老年非裔美国人和白人患者抑郁症治疗依从性的关键可改变决定因素。包括定量和定性成分的基线调查将评估可能决定依从性的关键结构，特别关注不同种族群体可能存在差异的可能因素（精神和耻辱）。此外，与一部分患者一起举行的四个焦点小组（每组 n=6-8）将使我们能够获得更深入的定性信息，并为后续调查添加新领域提供信息。近期在五个参与的初级保健诊所诊断出临床显着抑郁症的 60 岁或以上非裔美国人 (n=103) 和白人 (n=103) 患者将符合资格。使用基线和为期四个月的随访调查，我们将比较非裔美国人和白人患者的依从率，并确定与新诊断抑郁症后急性期不依从最显着相关的决定因素。通过确定非裔美国人和白人老年人抑郁症治疗依从性的关键可改变决定因素，临床医生和研究人员将更有效地识别高危个体并制定量身定制的干预措施，以提高他们的治疗依从性和抑郁症结果。