A community intervention to promote evidence-based mental health care for olderadults with depressive and anxiety symptoms.

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PROJECT SUMMARY/ABSTRACT This is an application to the K43 Fogarty Emerging Global Leader Award for Oscar Flores-Flores, MD, MSc. Dr. Flores-Flores has shown great promise as a young investigator and has experience conducting research in the epidemiology of aging and chronic diseases in low- and middle-income countries (LMICs). However, he is now proposing to gain expertise in implementation science and requires additional training and mentorship to do so. His overall career goal is to become an independent investigator in the implementation of evidence- based mental health care interventions for older adults, and this award will provide Dr. Flores-Flores with the support and training to accomplish this goal. He has assembled an experienced mentorship team including: Dr. Jose Parodi [Primary LMIC Mentor, geriatrics & public health, Associate Professor (USMP)]; Prof. Joseph Gallo [Primary U.S Mentor, mixed methods research, Professor (JHSPH)]; Prof. Marina Piazza [Co- Mentor, Implementation Science, Professor (UPCH)]; and Dr. William Checkley [Co-Mentor, hybrid effectiveness- implementation study Designs, Associate Professor (JHSPH)]. Through a combination of close mentorship, practical experience and key coursework, Dr. Flores-Flores proposes to accomplish the following training goals: 1) training in implementation science; 2) training in experimental study designs; and 3) advanced training in mixed-methods research; 2) Depression and anxiety symptoms are highly prevalent in older adults, and often present together. Evidence-based care exists to reduce depression and anxiety symptoms in older age. Trans-diagnostic approaches such as problem-solving therapy (PST) have been shown to be effective and have been recommended by the World Health Organization (WHO). However, there are myriad barriers to accessing mental health care in older adults. Thus, interventions that systematically and effectively target those barriers are urgently needed. Dr. Flores-Flores proposes to adapt, test, and refine a multi-faceted intervention strategy to deliver mental health care to older adults in low resource settings in Lima, Peru. He proposed to determine whether delivering mental health care via community health workers will have high uptake and will improve symptoms of depression and anxiety in older adults. Results from this study will generate preliminary data to compete for an R01-level award to conduct a large cluster implementation-effectiveness trial in multiple communities and determine the effect of the intervention on depressive/anxiety symptoms and other health- related outcomes.