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症而治疗不足并自杀，因此需要更有效的策略来参与和治疗初级保健中的抑郁老年男性。改善老年男性抑郁症护理的一个策略是建立在现有的患者与家庭成员或亲密朋友的关系上。这种方法建立在家庭成员在家中和诊所提供的有据可查的健康相关支持的基础上，甚至在相对健康或无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很好地与初级保健环境中的专业护理相结合。以家庭为基础的干预措施，以改善自我管理的其他慢性健康状况（如糖尿病）已经成功地开发，但有一个显着缺乏初级保健为基础的干预研究，将家庭成员作为抑郁症治疗的一个组成部分。从公共卫生的角度来看，有令人信服的理由这样做。家庭参与可以减少护理障碍，例如患者不愿透露抑郁症状，耻辱或治疗不依从性。克服这些障碍对于缩小老年男子和少数群体等服务不足的老年人群体的护理差距可能特别重要。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，可能既具有成本效益又具有持久性。在这个R-34应用中，我们将开发和测试一个 在以社区为基础的初级保健诊所开展以家庭为基础的干预，为主要是低收入和少数老年人的抑郁症未得到治疗或治疗不足的比例很高的人群提供服务。我们的干预发展的方法是理论驱动的，并使用瓦格纳的慢性病护理模式作为一个过度干预的框架。它还借鉴了其他几个理论框架（如自我效能，社会控制，关系协调），以指定潜在的机制，通过家庭成员可以加强抑郁症护理。本研究的具体目的是：1）对老年男性抑郁症护理中的关键利益相关者（包括老年男性、潜在的家庭/朋友帮助者和诊所工作人员）进行深入访谈，并分析36次访谈。2）根据目标1和我们的初步研究，完善干预方法并制定干预方案（如治疗和实施手册）和3）测试的可行性和可接受性的干预和研究方法的试点随机对照试验的24抑郁症老年男性从目标人群中抽取。

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.