Vascular Depression in African Americans: Phenomenology, treatment, and course of

非裔美国人的血管抑郁症：现象学、治疗和病程

• 批准号: 7991203
• 负责人: JOEL R. SNEED
• 金额: $ 25.87万
• 依托单位: QUEENS COLLEGE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7991203
• 关键词: Acute; Address; African American; Age; American; Anisotropy; Antidepressive Agents; Blood Vessels; Build-it; Cardiovascular Diseases; Cause of Death; Cerebrovascular Disorders; Clinical; Clinical Trials; Color; Communities; Data; Depressive Syndromes; Development; Disease; Elderly; Epidemic; Feasibility Studies; Functional disorder; Funding; Goals; Hypertension; Imaging Techniques; Impaired cognition; Impairment; Ischemia; Leadership; Left; Lesion; Magnetic Resonance Imaging; Major Depressive Disorder; Medical; Mental Depression; Mental Health; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Modeling; Neuropsychological Tests; Obesity; Participant; Patients; Pattern; Phase; Population; Pre-Post Tests; Process; Prospective Studies; Psyche structure; Public Health; Public Hospitals; Recruitment Activity; Relapse; Research; Research Personnel; Risk; Risk Factors; Sampling; Stroke; Testing; United States; United States National Institutes of Health; Vascular Dementia; base; brain behavior; cognitive function; diabetes risk; economic implication; executive function; follow-up; high risk; inner city; innovation; interest; meetings; public health relevance; response; social; treatment response; vascular depression; white matter

DESCRIPTION (provided by applicant): The vascular depression hypothesis proposes that "cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes". African Americans (AAs) have among the highest rates of vascular risk factors in the United States, including hypertension, which is among the highest in the world. AAs also have higher rates of ischemia diseases such as cardiovascular disease, stroke, and vascular dementia. Indeed, vascular dementia has been deemed a "silent epidemic" among older adult African Americans. The proposed study is based on the hypothesis that because of these high rates AAs are at high risk for vascular depression. However, this association has yet to be tested as AAs are underrepresented in mental research in general and clinical trials in particular despite mandates from the NIH that have existed for decades. The goal of this proposal is to establish the feasibility of conducting mental health research in an inner-city, public hospital serving the needs of a primarily African American population. It builds on the community-academic partnership Dr. Sneed and Singh (PIs) have developed over the past four years as part of Dr. Sneed's K23 award. We propose to 1) recruit twenty AAs (age >=50) per year with major depression for a one year study involving acute antidepressant treatment, repeat neuropsychological testing, and pre-post structural MRI; 2) demonstrate an 80% retention rate in the acute treatment phase; and 3) demonstrate a 75% retention rate among patients completing the acute treatment phase at 1-year follow-up. The community-academic partnership, focus on a high risk population, and incorporation of advanced imaging techniques represents an innovative next step in the study of vascular depression. The pilot data generated by this feasibility study will support a subsequent R01 examining acute treatment response, relapse rates, and progression of cognitive impairment and white matter lesion burden in AAs with vascular depression. Furthermore, this proposal meets each of NIMH's strategic objectives: 1) develops an integrative understanding of brain- behavior processes underlying vascular depression; 2) characterizes the developmental trajectory to determine when, where, and how to intervene; 3) develops a community- academic partnership; and 4) meets the needs of an underserved and understudied population in an inner city, public hospital setting; and ultimately (if funded), promotes the public health impact of NIMH-sponsored research. PUBLIC HEALTH RELEVANCE: African Americans have the highest rates of hypertension in the world, and not surprisingly, higher rates of cardiovascular disease, stroke, and vascular dementia. Given that the number of African American older adults is expected to increase fivefold by 2050, the social and economic implications of being at high risk for vascular depression could be staggering. Building on a community-academic partnership model, the proposed study addresses this important public health need by establishing the feasibility of conducting mental research in an inner-city, public hospital setting.

描述（由申请人提供）：血管性抑郁假说提出“脑血管疾病可能易患、促成或延续某些老年抑郁综合征”。非洲裔美国人（AAs）在美国的血管风险因素发病率最高，包括高血压，这是世界上最高的。AA也有较高的缺血性疾病的发病率，如心血管疾病，中风和血管性痴呆。事实上，血管性痴呆已被认为是老年非裔美国人中的一种“沉默的流行病”。拟议的研究是基于这样的假设，即由于这些高比率，AA具有血管抑制的高风险。然而，这种关联尚未得到测试，因为尽管NIH的授权已经存在了几十年，但一般来说，AA在精神研究和临床试验中的代表性不足。这项提案的目标是确定在一家主要为非洲裔美国人服务的市中心公立医院进行心理健康研究的可行性。它建立在Sneed博士和Singh（PI）在过去四年中发展的社区学术伙伴关系的基础上，作为Sneed博士K23奖的一部分。我们建议：1）每年招募20名患有重度抑郁症的AA（年龄≥ 50岁），进行为期1年的研究，包括急性抗抑郁治疗、重复神经心理学测试和前后结构MRI; 2）在急性治疗期显示80%的留存率; 3）在1年随访时完成急性治疗期的患者中显示75%的留存率。社区-学术伙伴关系，重点是高风险人群，并结合先进的成像技术，代表了血管性抑郁症研究的创新下一步。本可行性研究生成的初步数据将支持随后的R 01，该R 01检查了血管性抑郁AA患者的急性治疗应答、复发率、认知障碍进展和白色病变负荷。此外，该提案符合NIMH的每一个战略目标：1）发展对血管性抑郁症潜在的脑行为过程的综合理解; 2）描述发展轨迹以确定何时，何地以及如何干预; 3）发展社区-学术伙伴关系;以及4）满足内城，公立医院环境中服务不足和研究不足的人群的需求;最终（如果得到资助），促进NIMH赞助的研究对公共卫生的影响。 公共卫生相关性：非洲裔美国人的高血压发病率是世界上最高的，毫不奇怪，心血管疾病、中风和血管性痴呆的发病率也更高。鉴于非洲裔美国老年人的数量预计到2050年将增加五倍，血管性抑郁症高风险的社会和经济影响可能是惊人的。基于社区-学术合作模式，拟议的研究通过建立在市中心公立医院环境中进行心理研究的可行性来解决这一重要的公共卫生需求。