Depression and Disability in Older Persons: Untangling Complexities

描述（由申请人提供）：本修订提案为K01指导研究科学家发展奖。申请人是耶鲁大学医学院的流行病学家和发展研究者。她的目标是在社会心理流行病学和功能状态的界面上成为老龄化流行病学的专家和领导者。她实现这一目标的方法是学习先进的统计方法，以阐明抑郁症和残疾之间的关系，随着时间的推移，鉴于残疾的新范式是动态的和高度复杂的。拟议的培训和研究计划旨在相互补充和加强。具体的培训目标是：(1)获得残疾和抑郁症流行病学方面的专门知识，获得初级数据收集方面的新技能；(2)发展复杂纵向数据分析的专业知识；(3)发展和完善一套“生存”技能，这些技能对于独立研究者成功的职业生涯至关重要（例如，拨款写作）；(4)增强她在老龄化创新研究方面的知识基础。第二个目标是获得临床试验研究开发和实施的“实践”知识。拟议的研究旨在严格评估抑郁症和残疾之间关系的相互性质，作为残疾负担和临床有意义的亚型进行操作。此外，申请人建议系统地确定抑郁症和残疾之间相互关系的机制，并评估这种关系是否因性别而异。该研究将使用耶鲁PEP（突发事件项目）研究的数据进行，PEP是一项正在进行的nia资助的纵向研究，研究对象是754名最初没有残疾的社区生活老年人。使用这些数据来测试假设的概念和方法上的挑战，旨在确定抑郁症和残疾之间是否存在反馈循环，这将加强申请人的正式培训。提高我们对抑郁如何影响残疾复杂轨迹的理解的研究对衰老领域具有重要意义；它将突出一个因素，如果适当查明和管理，可以帮助预防残疾的发展和进展。另外，提高我们对这种关系的理解可能有助于确定预防抑郁症发展和进展的机会。

DESCRIPTION (provided by applicant): This amended proposal is for a K01 Mentored Research Scientist Development Award. The applicant is an epidemiologist and developing investigator at the Yale School of Medicine. Her goal is to become an expert and leader in the epidemiology of aging at the interface of psychosocial epidemiology and functional status. Her approach to achieving this goal is to learn advanced statistical methodology to elucidate the relationship between depression and disability over time in light of the emerging paradigm of disability as dynamic and highly complex. The proposed training and research plans are designed to complement and reinforce one another. The specific training objectives are to (1) acquire expertise in the epidemiology of disability and depression and obtain new skills in primary data collection; (2) develop expertise in the analysis of complex longitudinal data; (3) develop and refine a set of "survival" skills that are critical for a successful career as an independent investigator (e.g., grant writing); and (4) enhance her knowledge base regarding innovative research in aging. A secondary goal is to gain "hands-on" knowledge of the development and implementation of clinical trials research. The proposed research is designed to rigorously evaluate the reciprocal nature of the relationship between depression and disability, operationalized as disability burden and clinically-meaningful subtypes. Additionally, the applicant proposes to systematically determining the mechanisms that underlie the reciprocal relationship between depression and disability, and to evaluate if this relationship differs according to gender. The research will be conducted using data from the Yale PEP (Precipitating Events Project) Study, an ongoing NIA-funded, longitudinal study of 754 initially non-disabled community-living older persons. The conceptual and methodological challenges of using these data to test hypotheses directed at determining if a feedback loop exists between depression and disability over time will reinforce the applicant's formal training. Research that improves our understanding of how depression influences the complex trajectory of disability is highly significant to the field of aging; it will highlight a factor that, if adequately identified and managed, could help to prevent the development and progression of disability. Alternately, improving our understanding of this relationship may help to identify opportunities to prevent the development and progression of depression.