Reducing Disparities in Depression Care for Ethnically Diverse Older Men

描述（由申请人提供）：美国老年（即60岁及以上）男性自杀的流行是一场公共卫生危机。老年男性的自杀率比老年女性高8到10倍。由于抑郁症是自杀的最大危险因素之一，改善初级环境中对抑郁症的护理是预防自杀和抑郁症其他不良后果的重要公共卫生战略。抑郁症在女性中比在男性中更常见，但患抑郁症的老年男性和少数族裔接受有效治疗的可能性较小。为了解决这一知识差距并减少老年男性和少数民族的差异，我们提出了一项研究，采用定性和定量方法来更好地了解不同种族的老年抑郁症男性和治疗他们的初级保健提供者的观点、经验和护理偏好。我们对特定性别的关注和对年龄相关因素的关注将使我们能够检查老年男性在他们如何经历和处理抑郁症方面的潜在重要但研究不足的变异性，并使我们能够进一步发展我们的概念模型并制定策略，以吸引更难以接触到的不同老年男性的子群体。初级保健是进行这项研究的一个合乎逻辑的地点，因为它是大多数老年抑郁症男性可能被发现和治疗的地方。我们将对来自两个城市的初级保健诊所的100名老年男性（50名墨西哥裔美国人和50名非西班牙裔白人）进行系统筛查，以确定有代表性的样本，然后对他们和他们的初级保健医生进行访谈（n = 48）。本研究的目的是：1)研究男性特征和年龄相关的变化和态度（如健康状况、主要角色转换、正常衰老的概念）如何影响男性抑郁症的疾病含义、经历和求助模式；2)系统地研究老年男性对抑郁症治疗的偏好；3)从初级保健医生的角度确定阻碍或促进抑郁症治疗的因素。这项提议汇集了一个跨学科的调查小组，他们在老年人和少数民族人群的工作中具有丰富的经验，并直接建立在已发表的初步数据基础上（Hinton等人，2006年）。这项提议的目的是产生经验数据，以帮助缩小抑郁症护理中的性别和种族差距，减少相关的健康差距，并减轻老年男性的高自杀率。由于抑郁症是自杀的最大危险因素之一，而且自杀的男子经常最近曾与他们的初级保健医生有过事先接触，因此，改善初级保健机构对抑郁症的护理是预防自杀和抑郁症其他不良后果的一项重要公共卫生战略。然而，患抑郁症的老年男性比女性接受有效治疗的可能性要小得多。尽管它对公共卫生很重要，但对老年男性抑郁症护理的障碍还没有得到很好的理解。通过对老年抑郁症男性及其初级保健提供者的观点和偏好进行集中和深入的研究，本研究将产生经验数据，以减少初级保健机构中老年抑郁症男性护理的障碍。

DESCRIPTION (provided by applicant): The epidemic of suicide among older (i.e. age 60 and above) men in the US is a public health crisis. Older men have eight to ten-times higher rates of completed suicide than older women. Because depression is one of the strongest risk factors for suicide, improving care for depression in primary settings is a vital public health strategy to prevent suicide and other adverse outcomes of depression. Depression is more common in women than in men, but depressed older men and minorities are less likely to receive effective treatment. To address this knowledge gap and reduce disparities in older men and minorities, we propose a study that applies both qualitative and quantitative methods to better understand the perspectives, experiences, and preferences for care of ethnically diverse depressed older men and the primary care providers who treat them. Our focus gender-specific focus and attention to age-related factors will enable us to examine potentially important but under-studied variability among older men in how they experience and deal with their depression and will allow us to further develop our conceptual model and to develop strategies to engage more difficult to reach subgroups of diverse older men. Primary care is a logical site for this research because it is the setting where most depressed older men can potentially be recognized and treated. We will conduct systematic screening to identify a representative sample of 100 older men (50 Mexican-American and 50 white non- Hispanic) older men with treated and untreated clinical depression from primary care clinics in two cities and then conduct interviews with them and their primary care physicians (n = 48). This proposal's aims are 1) to examine how forms of masculinity and age-related changes and attitudes (i.e. health status, major role transitions, conceptions of normal aging) influence men's depression illness meanings, experience, and patterns of help-seeking, 2) to systematically examine older men's preferences for depression treatment, and 3) to identify factors that impede or facilitate depression care from the perspectives of primary care physicians. This proposal brings together an interdisciplinary group of investigators with extensive experience in working with older and minority populations and builds directly on published preliminary data (Hinton et al, 2006). It is the intention of this proposal to generate empirical data to help close the gender and ethnic gap in depression care, reduce associated health disparities, and mitigate high suicide rates in older men. Because depression is one of the strongest risk factors for suicide and because men who kill themselves frequently have had recent prior contact with their primary care physicians, improving care for depression in primary care settings is a vital public health strategy to prevent suicide and other adverse outcomes of depression. Depressed older men, however, are significantly less likely than women to receive effective depression treatment. Despite its public health importance, the barriers to depression care for older men are not well understood. Through a focused and in-depth examination of the perspectives and preferences of depressed older men and their primary care providers, this research will generate empirical data to reduce barriers to depression care for older men in primary care settings.