LLD Course & Treatment Decisions: Psychosocial Influences

描述（由申请人提供）：LLD疗程和治疗决定：心理社会影响。1999年，这个K24应用程序的首席研究员Paul Duberstein博士开始开发一个模型，试图解释为什么晚期抑郁症（LLD）经常没有被患者报告，也没有被他们的另一半发现。模型中的关键变量是：患者及其重要他人的人格特征、社会支持、认知功能和身体健康。NIMH的两笔拨款支持了在抑郁症住院患者（项目1；“成人抑郁症、自杀意念和人格”，NIMH, R01 MH60285）和初级保健患者中测试该模型各个方面的研究。（项目2；“检测老年人抑郁症状”，NIMH R01MH64579）。具体来说，这些项目假设具有特定人格特质的人不太可能报告情绪症状。此外，他们的情绪症状不太可能被其他人发现。项目1数据集的分析与这些假设一致。完成项目2的数据收集。拟议的K24将为扩展该研究项目提供支持，并支持针对LLD进一步研究的指导活动。K24研究目的：a)利用这些R01收集的数据测试和完善症状检测模型，并根据这些发现提交新的R01；b)使用定性和定量方法确定对LLD治疗参与（例如，开始、坚持）和结果的心理社会、生物学和社会文化影响。申请人及其学员将进行一项有关公屋居民自杀率的新研究（项目三），并对nimh资助的多地点研究“预防初级护理长者自杀-合作试验”（PROSPECT，项目四）所收集的数据进行二次分析。项目2-4将探讨种族差异。K24教育目标：a)发展定性方法的技能；b)继续提高作为社会科学家和医生的有效的、文化敏感的导师的技能。在奖励期结束时，私家侦探将对LLD的治疗和预防的概念化作出重大贡献，获得新的研究和指导技能，并在全国树立声誉，成为寻求研究这些重要公共卫生、临床和治疗问题的各种发展中教师和研究员的杰出导师。

DESCRIPTION (provided by applicant): LLD Course & Treatment Decisions: Psychosocial Influences. In 1999, the Principal Investigator of this K24 application, Paul Duberstein, PhD, began to develop a model that seeks to explain why late-life depression (LLD) so often goes unreported by patients and undetected by their significant others. Key variables in the model are: personality traits, social support, cognitive function, and physical health of both patients and their significant others. Funding from two NIMH grants supported research to test aspects of this model in depressed inpatients (Project 1; "Adult depression, suicidal ideation, and personality," NIMH, R01 MH60285) and primary care patients. (Project 2; "Detecting depressive symptoms in older adults," NIMH R01MH64579). Specifically, those projects hypothesized that people with particular personality traits are less likely to report mood symptoms. Moreover, their mood symptoms are less likely to be detected by others. Analyses of the Project 1 dataset are consistent with these hypotheses. Data collection for Project 2 is completed. The proposed K24 will provide support to extend this program of research, and to support mentoring activities focused on further research regarding LLD. K24 Research Aims: a) to test and refine a model of symptom detection using data collected in these R01s, and submit a new R01 based on these findings; b) to use qualitative and quantitative methods to identify the psychosocial, biological, and sociocultural influences on treatment engagement (e.g., initiation, adherence) and outcomes in LLD. The applicant and his mentees will implement a new study on LLD in public housing residents (Project 3) and conduct secondary analyses of data collected in an NIMH-funded multi-site study called the Prevention of Suicide in Primary Care Elderly - Collaborative Trial (PROSPECT, Project 4). Race differences will be explored in Projects 2-4. K24 Education Aims: a) to develop skills in qualitative methods, and b) to continue the process of enhancing skills as an effective, culturally sensitive mentor to social scientists and physicians. By the end of the Award period, the P.I. will have made a substantial contribution to the conceptualization of the treatment and prevention of LLD, acquired new research and mentoring skills, and developed a national reputation as an outstanding mentor for a diverse array of developing faculty and fellows seeking to study these important public health, clinical, and therapeutic issues.