Racial Differences in Geriatric Antidepressant Adherence

描述（由申请人提供）：老年抑郁症通常是慢性或复发性的，与严重的痛苦、残疾、自杀风险和与健康相关的生活质量下降有关。尽管抗抑郁药和心理治疗明显有效，但老年患者往往不能按照处方或建议服用这些药物，多达40%的患者过早停止使用药物。即使成功地改变了卫生系统，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，非裔美国患者可能比白人患者更不愿意接受心理治疗或抗抑郁治疗。本研究将采用混合方法，以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。包括定量和定性组成部分的基线调查将评估可能决定依从性的关键结构，特别注意可能在种族群体中存在差异的因素（精神和耻辱）。此外，与患者子集（每组n=6-8）举行的四个焦点小组将使我们能够获得更深入的定性信息，并告知在后续调查中添加新的领域。非洲裔美国人（n=103）和白人（n=103） 60岁或以上，最近在5个参与的初级保健诊所诊断为临床显著抑郁症的患者将符合条件。使用基线和四个月的随访调查，我们将比较非裔美国人和白人患者的依从率，并确定在新诊断为抑郁症的急性期与不依从性最显著相关的决定因素。通过确定非裔美国人和白人老年人坚持抑郁症治疗的关键因素，临床医生和研究人员将更有效地识别高危人群，并制定量身定制的干预措施，以改善他们的治疗依从性和抑郁症的结果。

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.