LATE LIFE DEPRESSION OUTCOME & MEDICAL ILLNESS SEVERITY

描述：晚年抑郁状态的公共卫生意义 在初级保健环境中是公认的。特别是，横截面 抑郁症状不符合重大疾病诊断标准的发病率 抑郁症比严重抑郁症本身更严重。然而，它并不是 知道这种情况是否会持续，导致更严重的抑郁 条件，或有其他长期的疾病。因此，本修订后的R01 应用程序建议检验这样一种假设，即手术治疗的患者 定义的轻微/亚综合征抑郁症的中间时间为3-4年 结果(与非抑郁对照组和重度抑郁症患者相比 抑郁)在以下领域中：抑郁症状和诊断， 医疗疾病严重程度、死亡率、功能状态和医疗保健 利用率和成本。此外，调查还将检验有关以下方面的假设 基于特定理论的变量与上述变量之间的关联 结果。预测因素涉及生物、心理和社会领域，包括 脑血管危险因素、总体医疗负担、功能状态、 人格特质、社会支持、宗教信仰和人格特质的五因素模型 人生大事。研究人员将招募并跟踪1000名受试者，年龄 &gt；=65岁，来自纽约门罗县的各种初级保健地点 人口。研究评估将来自病历审查和 HCFA数据以及使用经验证的半结构化患者访谈 针对DSM-IV的结构化临床访谈和 纵向间隔随访评价。将使用协方差分析 检查两组结果的差异。多元回归技术将 用于确定假设预报器的独立关联 带着结果。这些结果将直接为未来的研究提供信息，包括 确定干预的对象以及确定理论 抑郁症发病机制的模型值得进行更明确的测试。

DESCRIPTION: The public health significance of later life depressive conditions in primary care settings is well recognized. In particular, the cross-sectional morbidity of depressive symptoms not meeting diagnostic criteria for major depression is greater than that of major depression alone. However, it is not known whether such conditions persist, lead to more severe depressive conditions, or have other long term morbidity. Accordingly, this revised R01 application proposes to test the hypothesis that patients with operationally defined minor/subsyndromal depression will have an intermediate 3-4 year outcome (as compared to non-depressed controls and to patients with major depression) in the following domains: depressive symptoms and diagnoses, medical illness severity, mortality, functional status, and health care utilization and costs. Also, the investigation will test hypotheses regarding the associations of specific theoretically based variables with the above outcomes. The predictors range across the biopsychosocial spectrum, including cerebrovascular risk factors, overall medical burden, functional status, the Five Factor Model of personality traits, social support, religiousness, and life events. The Study investigators Will recruit and follow 1000 subjects, age >= 65 years, from a variety of primary care sites serving the Monroe County, NY population. Study assessments will be derived from medical chart reviews and HCFA data as well as semi-structured patient interviews using validated measures such as the Structured Clinical Interview for DSM-IV and the Longitudinal Interval Follow-up Evaluation. Analysis of covariance will be used to examine group differences in outcomes. Multiple regression techniques will be used to determine the independent association of hypothesized predictors with outcomes. The results will directly inform future research, including identifying subjects for interventions as well as identifying theoretical models of depression pathogenesis that merit more definitive testing.