A Family-based Primary Care Intervention to Enhance Older Men's Depression Care

描述(由申请人提供)：由于老年男性比老年女性更有可能因抑郁而得不到足够的治疗并自杀，因此需要更有效的战略来吸引老年男性并在初级保健中治疗抑郁症。改善老年男性抑郁症护理的一个策略是建立与家人或亲密朋友的现有患者关系。这种方法建立在家庭成员在家里和诊所提供的与健康相关的良好支持的基础上，即使是在相对健康或非残疾的老年人中也是如此。然而，家庭为医疗保健提供的支持往往没有与初级保健环境中专业提供的护理很好地结合在一起。针对其他慢性健康状况(如糖尿病)改善自我管理的以家庭为基础的干预措施已经成功制定，但将家庭成员作为抑郁症治疗的一个组成部分的以初级保健为基础的干预研究显着缺乏。从公共卫生的角度来看，有令人信服的理由这样做。家庭的参与可能会减少护理的障碍，例如患者不愿透露抑郁症状、耻辱或不坚持治疗。克服这些障碍对于弥合老年人中服务不足的群体，如老年男子和少数群体的护理差距，可能尤为重要。通过建立现有的家庭关系来加强初级保健环境中的抑郁症治疗，符合老年男性的偏好，而且可能既具有成本效益，又具有持久性。在这项R-34应用中，我们将开发和测试一种 以社区为基础的初级保健诊所的家庭干预，服务于以低收入和少数族裔为主的老年人口，他们的抑郁症未得到治疗或治疗不足的比例很高。我们的干预发展方法是理论驱动的，并使用瓦格纳的慢性护理模型作为总体框架。它还借鉴了其他几个理论框架(例如，自我效能、社会控制、关系协调)来具体说明家庭成员可能加强抑郁症护理的潜在机制。该项目的具体目标是1)对老年男性抑郁症护理的主要利益相关者进行36次访谈并进行深入分析，其中包括老年男性、潜在的家庭/朋友帮助者和诊所工作人员；2)根据Aim 1和我们的初步研究，改进干预方法和制定干预方案(例如治疗和实施手册)；以及3)从目标人群中抽取24名患有抑郁症的老年男性进行试点随机对照试验，测试干预和研究方法的可行性和可接受性。

DESCRIPTION (provided by applicant): Because older men are more likely than older women to be under-treated for depression and to commit suicide, more effective strategies are needed to engage and treat depressed older men in primary care. One strategy to improve depression care for older men is to build upon existing patient relationships with family members or close friends. This approach builds on the well-documented health-related support that family members provide both in the home and in the clinic, even among relatively healthy or nondisabled older adults. Yet the support that families provide for healthcare is often not well-integrated with professionally-delivered care in primary care settings. Family-based interventions to improve self-management for other chronic health conditions (e.g. diabetes) have been successfully developed but there is a striking lack of primary-care based intervention studies that incorporate family members as an integral part of depression treatment. From a public health perspective, there are compelling reasons to do so. Family involvement may reduce barriers to care, such as the patient's reluctance to disclose depressive symptoms, stigma or treatment nonadherence. Overcoming these barriers may be particularly important to close gaps in care for under-served subgroups of older adults, such as older men and minorities. Strengthening depression treatment in primary care settings by building on existing family relationships aligns with the preferences of older men and may be both cost effective and enduring. In this R-34 application, we will develop and test the feasibility and acceptability of a family-based intervention in a community-based primary care clinic serving a predominantly low-income and minority older adult population with high rates of untreated or undertreated depression. Our approach to intervention development is theory-driven and uses Wagner's chronic care model as an over-arching framework. It also draws on several other theoretical frameworks (e.g. self-efficacy, social control, relational coordination) to specify potential mechanisms through which family members may strengthen depression care. Specific aims of this project are 1) To conduct and analyze in-depth 36 interviews with key stakeholders in older men's depression care, including older men, potential family/friend helpers and clinic staff, 2) Informed by Aim 1 and our preliminary studies, to refine the intervention approach and to develop the intervention protocol (e.g. treatment and implementation manuals) and 3) To test the feasibility and acceptability of the intervention and study methods in a pilot randomized controlled trial of 24 depressed older men drawn from the target population.