Detecting Depressive Symptoms in Older Adults

描述（由申请人提供）：自杀文献中一个一致且令人不安的发现迫使这项调查。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意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因素阻碍了老年人抑郁症的检测、诊断和治疗。寻求ROl资助，以在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，这些患者被招募到一项自然主义研究中，“初级保健老年人的抑郁结果”（DPC） （NIMH ROl MH61429-O1A1， J. Lyness, m.d.， P.I.）。对于这个拟议的ROl，我们将从DPC研究参与者的社会网络成员的举报人那里收集数据，以检查举报人对抑郁症和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举报人，并计划收集超过628名举报人的数据。我们将询问举报人关于他们自己和DPC参与者的精神症状的问题。具体来说，我们将检验举报人对抑郁症的检测作为以下因素的函数：患者精神疾病的严重程度和病史（目标1），患者的社会心理（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），以及举报人的精神病史和自我报告的健康（目标4）。我们将探讨告密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，在以下情况下，检测结果会较差：不太严重和首发的疾病（Aim1）；具有某些人格特征（如低外向性、低经验开放性）或身体健康状况不佳的患者（目标2）；男性和未婚参与者（目标3）。如果举报人以前没有抑郁症病史或身体健康状况不佳，检出率也会较低（目标4）。对于目标2，将检验社会支持的中介作用。如果这些假设得到证实，将表明需要对目前研究老年抑郁症和自杀的方法进行修正。研究结果将有助于指导筛查工具、教育和临床干预以及监测策略的发展，以减轻未被认识和未经治疗的抑郁症对公众健康的影响。

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.