Detecting Depressive Symptoms in Older Adults

描述（由申请人提供）：自杀文献中的一个一致和令人不安的发现迫使进行这项调查。大多数自杀的老年人都有情感障碍，但家庭成员和卫生专业人员没有认识到自杀的潜在风险。我们的症状检测模型的中心主旨是，特定的因素阻碍了老年人抑郁症的检测、诊断和治疗。ROI资金寻求在1000名65岁及以上的初级保健患者的人口统计学和临床异质性样本中测试该模型的各个方面。从2001年8月开始，这些患者被招募到自然主义研究“初级护理老年人的抑郁结果”（DPC）（NIMHRO 1 MH 61429 - 01 A1，J. Lyness，M.D.，P.I.）。对于该提议的ROI，我们将从作为DPC研究中的参与者的社交网络的成员的线人收集数据，以检查线人对抑郁障碍以及抑郁和焦虑症状的检测。我们将努力为该研究的每个受试者招募一名信息提供者，并计划从超过628名信息提供者那里收集数据。我们将询问被调查者关于他们自己和DPC参与者的精神症状的问题。具体来说，我们将研究被调查者的抑郁检测作为一个功能：患者的精神疾病的严重程度和历史（目标1），患者的心理社会（人格和社会支持）特征和身体健康参数（目标2），患者的人口统计学特征（目标3），和被调查者的精神病史和自我报告的健康（目标4）。我们将探讨被调查者的人格特质和对精神疾病的态度的作用，并探讨非洲裔美国人和白人之间的差异。我们假设检测将较差：不太严重和首次发作的疾病（Aim 1）;具有某些人格特征的患者（例如，低外向性;低开放性的经验）或身体健康状况不佳（目标2）;和男性和未婚的参与者（目标3）。如果举报人没有抑郁症病史或身体健康状况不佳，检测效果也会较差（目标4）。对于目标2，将检验社会支持的中介作用。这些假设的证实将表明需要修改目前的方法来晚年抑郁症和自杀。研究结果将有助于指导筛查工具，教育和临床干预措施以及监测策略的发展，以减少未被识别和未经治疗的抑郁症对公共卫生的影响。

DESCRIPTION (provided by applicant): One consistent and disturbing finding in the suicide literature compels this investigation. Most older adults who take their own lives have an affective disorder, but the potential risk for suicide was unrecognized by family members and health professionals. The central thrust of our symptom detection model is that specific factors deter the detection, diagnosis, and treatment of depression in older adults. ROl funding is sought to test aspects of this model in a demographically and clinically heterogeneous sample of 1000 primary care patients 65 years of age and older. Beginning in August 2001, these patients were recruited into a naturalistic study, "Depression Outcome in Primary Care Elderly" (DPC) (NIMH ROl MH61429-O1A1, J. Lyness, M.D., P.I.). For this proposed ROl, we will collect data from informants who are members of the social networks of participants in the DPC study in order to examine informant detection of depressive disorders and symptoms of depression and anxiety. We will strive to recruit one informant for each subject in that study, and plan to collect data from more than 628 informants. We will ask the informants questions about themselves and the DPC participants' psychiatric symptoms. Specifically, we will examine informant detection of depression as a function of: the severity and history of patients' psychiatric disorders (Aim 1), patients' psychosocial (personality and social support) characteristics and physical health parameters (Aim 2), patients' demographic characteristics (Aim 3), and informants' psychiatric history and self-reported health (Aim 4). We will explore the role of informants' personality traits and attitudes toward mental illness, and differences between African-Americans and Whites will be explored. We hypothesize the detection will be poorer for: disorders that are less severe and first episode (Aim1); patients with certain personality traits (e.g., low extraversion; low openness to experience) or poor physical health (Aim 2); and men and unmarried participants (Aim 3). Detection will also be poorer when informants have no prior history of depression or are in poor physical health (Aim 4). For Aim 2, the mediating effect of social support will be examined. Confirmation of these hypotheses will indicate needed revisions in current approaches to late-life depression and suicide. Findings will help guide the development of screening instruments, educational and clinical interventions, and surveillance strategies to lessen the public health impact of unrecognized and untreated depression.