Reducing Disparities in Depression Care for Ethnically Diverse Older Men

描述（由申请人提供）：美国老年男性（即60岁及以上）自杀的流行是一场公共卫生危机。老年男性的自杀率比老年女性高8到10倍。由于抑郁症是自杀的最强风险因素之一，因此改善初级环境中的抑郁症护理是预防自杀和抑郁症其他不良后果的重要公共卫生策略。抑郁症在女性中比男性更常见，但抑郁的老年男性和少数民族接受有效治疗的可能性较小。为了解决这一知识差距，减少老年男性和少数民族之间的差距，我们提出了一项研究，采用定性和定量的方法，以更好地了解不同种族的抑郁症老年男性和治疗他们的初级保健提供者的观点，经验和偏好。我们的重点性别特定的重点和关注与年龄有关的因素，将使我们能够检查潜在的重要，但研究不足的变化，老年男性在他们如何体验和处理他们的抑郁症，并将使我们能够进一步发展我们的概念模型，并制定战略，从事更难以达到不同的老年男性亚组。初级保健是这项研究的一个合乎逻辑的网站，因为它是最抑郁的老年男性可能被识别和治疗的设置。我们将进行系统筛选，以确定100名老年男性（50名墨西哥裔美国人和50名白色非西班牙裔）的代表性样本，这些老年男性患有来自两个城市的初级保健诊所的治疗和未治疗的临床抑郁症，然后与他们及其初级保健医生进行访谈（n = 48）。这项建议的目的是：1）研究男性气质的形式以及与年龄有关的变化和态度（即健康状况、主要角色转换、正常衰老观念）影响男性抑郁症的疾病意义、经历和求助模式; 2）系统考察老年男性对抑郁症治疗的偏好;以及3）从初级保健医生的角度来确定阻碍或促进抑郁症护理的因素。该提案汇集了一个跨学科的研究人员小组，该小组在与老年人和少数族裔群体合作方面拥有丰富的经验，并直接建立在已发表的初步数据（欣顿等人，2006年）的基础上。这项提案的目的是产生经验数据，以帮助缩小抑郁症护理中的性别和种族差距，减少相关的健康差异，并减轻老年男性的高自杀率。由于抑郁症是自杀的最强风险因素之一，而且经常自杀的男性最近与他们的初级保健医生有过接触，因此改善初级保健环境中的抑郁症护理是预防自杀和抑郁症其他不良后果的重要公共卫生策略。然而，抑郁的老年男性接受有效抑郁治疗的可能性明显低于女性。尽管其公共卫生的重要性，障碍抑郁症护理老年男性还没有得到很好的理解。通过集中和深入的研究抑郁症老年男性及其初级保健提供者的观点和偏好，本研究将产生经验数据，以减少障碍，抑郁症护理的老年男性在初级保健设置。

DESCRIPTION (provided by applicant): The epidemic of suicide among older (i.e. age 60 and above) men in the US is a public health crisis. Older men have eight to ten-times higher rates of completed suicide than older women. Because depression is one of the strongest risk factors for suicide, improving care for depression in primary settings is a vital public health strategy to prevent suicide and other adverse outcomes of depression. Depression is more common in women than in men, but depressed older men and minorities are less likely to receive effective treatment. To address this knowledge gap and reduce disparities in older men and minorities, we propose a study that applies both qualitative and quantitative methods to better understand the perspectives, experiences, and preferences for care of ethnically diverse depressed older men and the primary care providers who treat them. Our focus gender-specific focus and attention to age-related factors will enable us to examine potentially important but under-studied variability among older men in how they experience and deal with their depression and will allow us to further develop our conceptual model and to develop strategies to engage more difficult to reach subgroups of diverse older men. Primary care is a logical site for this research because it is the setting where most depressed older men can potentially be recognized and treated. We will conduct systematic screening to identify a representative sample of 100 older men (50 Mexican-American and 50 white non- Hispanic) older men with treated and untreated clinical depression from primary care clinics in two cities and then conduct interviews with them and their primary care physicians (n = 48). This proposal's aims are 1) to examine how forms of masculinity and age-related changes and attitudes (i.e. health status, major role transitions, conceptions of normal aging) influence men's depression illness meanings, experience, and patterns of help-seeking, 2) to systematically examine older men's preferences for depression treatment, and 3) to identify factors that impede or facilitate depression care from the perspectives of primary care physicians. This proposal brings together an interdisciplinary group of investigators with extensive experience in working with older and minority populations and builds directly on published preliminary data (Hinton et al, 2006). It is the intention of this proposal to generate empirical data to help close the gender and ethnic gap in depression care, reduce associated health disparities, and mitigate high suicide rates in older men. Because depression is one of the strongest risk factors for suicide and because men who kill themselves frequently have had recent prior contact with their primary care physicians, improving care for depression in primary care settings is a vital public health strategy to prevent suicide and other adverse outcomes of depression. Depressed older men, however, are significantly less likely than women to receive effective depression treatment. Despite its public health importance, the barriers to depression care for older men are not well understood. Through a focused and in-depth examination of the perspectives and preferences of depressed older men and their primary care providers, this research will generate empirical data to reduce barriers to depression care for older men in primary care settings.