Improving Antidepressant Adherence in Older Adults

描述（由申请人提供）：本提案为K23指导面向患者的研究科学家奖。申请人是康奈尔老年情绪障碍干预研究中心的临床心理学家和发展中的研究者。本申请的目的是提供进一步的跨学科培训和研究机会，使申请人成为干预研究的独立研究者。申请人的职业目标是开发干预措施，以提高初级保健中抑郁症老年人抗抑郁治疗的依从性。本申请的职业发展目标是学习：1)行为改变干预的理论基础；2)晚年抑郁干预的设计与评估；3)老年人的态度和信念评估；4)影响疾病治疗依从性的因素。该培训将提供知识和技能，以评估和解决有关以下方面的负面态度和信念：1)抑郁症和治疗效果的有效性，2)污名，以及3)治疗自我效能。该研究建议将试行一种简短的、个性化的干预措施，以提高初级保健医生开具的老年人对SSRI抗抑郁治疗的依从性。干预的目的是提高依从性，通过解决消极的态度和信念的障碍，坚持对老年抑郁症的成年人。虽然这种干预不是一种减少抑郁的疗法；但由于抑郁本身会导致消极的态度和信念，干预的目标之一是缓冲抑郁对坚持的影响。干预措施针对坚持治疗的障碍，如果证明有效，将是一种手动和可行的方法，以减少初级保健中老年人晚年抑郁症治疗不足的个人和公共卫生成本。

DESCRIPTION (provided by applicant): This proposal is for a K23 Mentored Patient-Oriented Research Scientist Award. The applicant is a clinical psychologist and a developing investigator in the Cornell Intervention Research Center for Geriatric Mood Disorders. The goal of this application is to provide further interdisciplinary training and research opportunities to transition the applicant to become an independent investigator in interventions research. The career goal of the applicant is to develop interventions to improve adherence to antidepressant treatment among depressed older adults in primary care. The career development objectives of this application are to learn: 1) the theories underlying behavioral change interventions: 2) the design and evaluation of interventions in late-life depression; 3) assessment of older adults' attitudes and beliefs; and 4) factors that affect treatment adherence across illnesses. This training will provide the knowledge and skills to assess and to address negative attitudes and beliefs about: 1) depression and the usefulness of treatment efficacy, 2) stigma, and 3) treatment self-efficacy. The research proposed will pilot the usefulness of a brief, individualized intervention to improve adherence to SSRI antidepressant therapy by older adults prescribed by Primary Care Physicians. The intervention is designed to improve adherence by addressing the negative attitudes and beliefs that are obstacles to adherence for adults with late-life depression. Although the intervention is not a therapy to reduce depression; but because depression itself can contribute to negative attitudes and beliefs, one of the goals of the intervention is to buffer the effect of depression on adherence. The intervention targets obstacles to adherence and if proven useful, would be a manualized and feasible way to reduce the personal and public health costs of under treatment of late-life depression in older adults seen in primary care.