A New Measure of Adaptive Strategies and its Relation to Late-Life Depression

描述（由申请人提供）：迫切需要确定预测老年人面临的健康挑战的最佳反应的因素。自我调节模型（由控制理论提供信息）可以帮助我们理解有效适应策略背后的关键动机问题。主要控制策略侧重于改变环境，而次要控制策略侧重于改变自我。初级和二级控制策略的使用与中年和老年成年人的身体健康（如死亡率、身体功能、住院和皮质醇分泌）和精神健康结果（如抑郁和幸福）有关。然而，主要和次要控制策略的评估一直不系统。具体来说，原本不打算评估控制策略的项目在事后被合并；复杂的措辞限制了样本中项目的有用性；社会期望反应偏差还没有被评估。本建议描述了一种新的主要和次要控制策略的自我报告测量方法的发展，以促进控制策略对整个生命周期身心健康影响的研究。我们提出了两项研究：1)对中老年成年人进行访谈研究，以建立项目库；2)采用传统和先进的（项目反应理论）心理测量方法进行量表开发研究。这两项研究都将包括具有一系列功能障碍的中年和老年受试者。我们的目的是：1)描述中年人和老年人追求健康目标的主要和次要策略；2)运用项目反应理论和结构方程模型，对这些策略进行自我报告测量；3)研究控制策略与抑郁症和功能障碍之间的关系，特别是在老年抑郁症患者中。更好地评估初级和二级控制策略将帮助我们预测哪些老年人在面临健康衰退时可能会经历抑郁症，哪些老年人更有可能从治疗老年抑郁症的干预措施中受益。了解控制策略、身体功能和抑郁之间的关系也将帮助我们设计出更有效的、基于证据的治疗老年抑郁症的方法。对卫生挑战制定更好的适应性应对措施（一级和二级控制战略）对公共卫生很重要，因为它可以用作筛查工具。具体来说，这项新措施可以帮助我们确定哪些老年人在健康状况下降时有患抑郁症的风险，哪些老年人最有可能从某些治疗中受益。了解适应性反应、身体机能和抑郁症之间的关系，也可以帮助我们设计出更好的治疗老年抑郁症的方法。

DESCRIPTION (provided by applicant): There is a pressing need to identify factors that predict optimal responses to the health challenges faced by older adults. Models of self-regulation (informed by control theory) can help us understand key motivational issues underlying effective adaptive strategies. Primary control strategies focus on changing the environment, whereas secondary control strategies focus on changing the self. Use of primary and secondary control strategies has been related to both physical health (e.g., mortality, physical functioning, hospitalization, and cortisol secretion) and mental health outcomes (e.g., depression and well-being) among both mid- and late-life adults. However, the assessment of primary and secondary control strategies has been unsystematic. Specifically, items not originally intended to assess control strategies have been combined post hoc; complex wording has limited the usefulness of items in samples with minimal education; and social desirability response bias has not been assessed. This proposal describes the development of a new self-report measure of primary and secondary control strategies in order to promote research on the influence of control strategies on physical and mental health across the lifespan. We propose two research studies: 1) an interview study of mid-life and late-life adults in order to generate an item pool, and 2) a scale development study using traditional and advanced (item response theory) psychometric methods. Both studies will include mid- and late-life subjects with a range of functional impairment. Our aims are 1) to describe the primary and secondary strategies mid- and late-life adults use to pursue health goals; 2) to use item response theory and structural equation models to develop a self-report measure of these strategies; and 3) to examine the relations between control strategies and both depression and functional impairment, particularly among older adults with depression. Better assessment of primary and secondary control strategies will help us predict which older adults are likely to experience depression in the face of health declines and which are more likely to benefit from interventions treating geriatric depression. Understanding the relations between control strategies, physical functioning, and depression will also help us to design more effective, evidence-based treatments for late-life depression. Developing a better measure of adaptive responses (primary and secondary control strategies) to health challenges is important to public health because it can be used as a screening tool. Specifically, this new measure may help us identify which older adults are at risk of becoming depressed when their health declines and which are most likely to benefit from certain treatments. Understanding the relations between adaptive responses, physical functioning, and depression may also help us design better treatments for late-life depression.