Barriers to Mental Health Treatment in Primary Care

拟议的初级保健中精神健康治疗障碍研究要求一年B/START资金，以调查初级保健中精神健康治疗的心理障碍的患病率和影响，治疗行为和临床结果。对老年抑郁症的治疗不足仍然是一个重大的公共卫生问题，尽管有充分的证据表明，在大多数患有抑郁症的老年人中，可以通过药物治疗有效地治疗重度抑郁症(Hirschfeld et a.，1997 Schneider，1996)。初步调查表明，心理障碍，如最大限度地减少治疗的需要和感觉到的耻辱，在抑郁症门诊精神治疗开始时报告的，可能是预测治疗行为的重要因素，如药物推荐、抗抑郁药物坚持和停止治疗(Sirey等人，1999年出版)。这项研究的主要目的是：1)评估初级保健中抑郁症的患病率；2)检查心理障碍对治疗开始的影响(无论是药物治疗还是非药物干预)；3)探索心理障碍与抑郁症状改善的关系。为了实现这些目标，资金将用于支持初级保健(预防初级保健老年人自杀：合作试验，PROPE；MH 59366；Pi George S.Alexopoulos，M.D.)。这项拟议的研究将评估60号康奈尔大学报告的心理障碍)。四个月后，部分(前景)样本被重新访谈，以评估：1)治疗行为(例如，开始治疗、使用的服务)；2)抑郁症状；以及3)抑郁的审查标准。分析检查启动治疗的障碍，控制干预状态。其他分析将探索障碍对后续临床状态的影响。

The proposed study of Barriers to Mental Health Treatment in Primary Care requests one year B/Start funding to investigate the prevalence and impact of psychological barriers to mental health treatment, to treatment behaviors and to clinical outcome in older adults with depression in primary care. Inadequate treatment on major depression among older remains a significant public health concern, even though there is ample evidence that major depression can be effectively treated with pharmacotherapy in most elderly adults with depression (Hirschfeld et a., 1997 Schneider, 1996). Preliminary investigations suggest that psychological barriers, such as minimizing the need for treatment and perceived stigma, reported at the beginning of outpatient psychiatric treatment for depression can be important factors in predicting treatment behaviors such as medication recommendation, antidepressant adherence and treatment discontinuation (Sirey, et a., 1999, in press). The primary aims of this study are : 1) to assess the prevalence depression seen in primary care; 2) to examine the impact of psychological barriers on treatment initiation (either pharmacotherapy or non-pharmacologic interventions); and 3) to explore the relationship between psychological barriers and improvement in depressive symptoms. To address these aims the funding would be used to support the primary care (Prevention of Suicide in Primary Care Elderly: Collaborative Trial, PROSPECT; MH 59366; PI George S. Alexopoulos, M.D.). The proposed study would assess the psychological barriers reported by 60 Cornell site of the PROSPECT Study). A part of (PROSPECT) sample is re-interviewed four months later to assess: 1) treatment behaviors (e.g. initiation of treatment, services used); 2) depressive symptoms; and 3) review criteria for depression. Analyses examine the of barriers on treatment initiation, controlling for intervention status. Additional analyses will explore the impact of barriers on clinical status at follow-up.