Health Promotion in the Prevention of Anxiety and Depression: The Happy Older Latinos are Active (HOLA Study)

摘要 考虑到抑郁症在晚年的流行和发病率， 目前的治疗方法是避免多年来生活在残疾中、在获得 精神卫生保健提供系统，以及满足心理健康的劳动力短缺 老年拉美裔人的需求，制定和测试预防抑郁症的创新战略 焦虑和焦虑对公共卫生具有重大意义，并有可能改变做法。 在这项拟议的研究中，240名60岁以上的拉美裔老年抑郁症或焦虑症患者-- 在PHQ-9或GAD-7上定义为≥5-将被随机分配到HOLA(n=120)或 健康生活方式教育项目(n=120)。参与者将接受长达24个月的跟踪调查 通过对临床、健康相关和心理社会结果的重复评估(基线， 干预后、干预后6、12、18和24个月)。这项研究有三个具体的 目标：(1)比较居留权和健康生活方式教育在减少 老年拉丁裔抑郁症和广泛性焦虑症的危险因素 阈值以下的抑郁或焦虑；(1b)比较HOLA和健康生活方式的影响 在减少重度抑郁症和全面性抑郁症2年发病率和复发率方面的教育 有阈值以下抑郁或焦虑的拉美裔老年患者的焦虑症；(2)比较 HOLA和健康生活方式教育在改善健康相关结局中的有效性 在患有轻微或阈值以下抑郁或焦虑的年长拉丁裔中(例如，支持和反对 炎性细胞因子、身体健康的客观指标和与健康相关的生活质量) 在患有轻度或阈值以下抑郁或焦虑的年长拉丁裔中；(3)并识别 可变性的生物和心理社会来源，可预测治疗性或 患有阈值以下抑郁或焦虑的拉丁裔老年患者的治疗不良结果。为 目标1a和目标2，主要的分析策略将是对主要影响的混合影响建模 组、时间和逐个治疗的时间交互作用。对于目标1b，主要的分析战略将是 HOLA中重度抑郁发作或广泛性焦虑症的生存时间分析， 健康的生活方式教育，和轮候名单控制。对于目标3，我们将使用“联合”模型 将事件发生时间模型(即COX比例风险)与风险因素模型相结合 探索治疗反应或无反应的最强预测因素的轨迹，这是 定义为症状严重性降低50%。最后，我们将确定预防性的 如果检测到干预效果，则通过感知的社会变化来调节或缓和干预效果 支持或全身性炎症。健康促进干预是一种潜在的解决方案 对于年长的拉丁裔人所经历的多重差异。这样的方法可能对老年人有吸引力 拉美裔人作为传统心理健康的非污名化和文化可接受的替代品 服务。

Abstract Given the prevalence and morbidity of depression in later life, the inadequacies of current treatment approaches for averting years living with disability, the inequities in access to the mental health care delivery system, and the workforce shortages to meet the mental health needs of older Latinos, development and testing of innovative strategies to prevent depression and anxiety are of great public health significance and have the potential to change practice. In the proposed study, 240 older Latinos age 60+ with subthreshold depression or anxiety – defined as ≥ 5 on the PHQ-9 OR GAD-7 – will be randomized to either HOLA (n=120) or the healthy lifestyles education program (n=120). Participants will be followed for up to 24 months with repeated assessments of clinical, health-related, and psychosocial outcomes (at baseline, post intervention, 6, 12, 18, and 24 months post intervention). The study has three specific aims: (1a) to compare the effectiveness of HOLA and healthy lifestyles education in reducing risk factors for major depression and generalized anxiety disorder among older Latinos with subthreshold depression or anxiety; (1b) to compare the impact of HOLA and healthy lifestyles education in reducing the 2-year incidence and recurrence of major depression and generalized anxiety disorder among older Latinos with subthreshold depression or anxiety; (2) To compare the effectiveness of HOLA and healthy lifestyles education in improving health-related outcomes among older Latinos with minor or subthreshold depression or anxiety (e.g. pro and anti- inflammatory cytokines, objective measures of physical fitness, and health-related quality of life) among older Latinos with minor or subthreshold depression or anxiety; (3) and to identify biological and psychosocial sources of variability that are predictive of either therapeutic or adverse outcomes to treatment in older Latinos with subthreshold depression or anxiety. For Aims 1a and 2, the primary analytic strategy will be mixed effect modeling for main effects of group, time, and time-by-treatment interaction. For Aim 1b, the primary analytic strategy will be survival analysis of time to major depressive episode or generalized anxiety disorder in HOLA, healthy lifestyles education, and wait list control. For Aim 3, we will use a “joint” model that integrates time-to-event models (i.e. Cox proportional hazards) with models for risk factor trajectories to explore the strongest predictors of treatment response or non-response, which is defined as a 50% decrease in symptom severity. Finally, we will determine whether preventive intervention effects, if detected, are mediated or moderated by changes in perceived social support or systemic inflammation. Health promotion interventions represent a potential solution to the multiple disparities experienced by older Latinos. Such an approach could appeal to older Latinos as a nonstigmatizing and culturally acceptable alternative to traditional mental health services.