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

以家庭为基础的初级保健干预措施，以加强老年男性的抑郁症护理

基本信息

批准号：
8860247
负责人：
WALTER LADSON HINTON
金额：
$ 26.95万
依托单位：
UNIVERSITY OF CALIFORNIA AT DAVIS
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-15 至 2017-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8860247
关键词：
Address Adult Advocate Caring Chronic Clinic Collaborations Communities Data Depressed mood Diabetes Mellitus Effectiveness of Interventions Elderly Elements Employee Strikes Family Family Relationship Family member Friends Funding Gender Health Healthcare Home environment Intervention Intervention Studies Interview Low income Major Depressive Disorder Manuals Mental Depression Mental disorders Methods Minority Modeling National Institute of Mental Health Patient Care Patients Phase Population Primary Health Care Procedures Process Protocols documentation Provider Public Health Randomized Randomized Controlled Trials Recording of previous events Research Research Support Self Efficacy Self Management Site Social Controls Social Workers Subgroup Symptoms Target Populations Testing To specify Training Visit Work accomplished suicide base chronic care model cost effective depressive symptoms improved men older men older women preference primary care setting skills social stigma theories therapy development

项目摘要

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.

描述（由申请人提供）：因为老年男性比老年妇女更有可能因抑郁症而受到治疗，因此需要更有效的策略来吸引和治疗初级保健中的老年男性。改善老年男性抑郁症护理的一种策略是建立与家人或亲密朋友的现有患者关系。这种方法基于家人在家里和诊所中提供的与健康相关的备受证明的支持，即使是相对健康或不可能的老年人。然而，家庭为医疗保健提供的支持通常在初级保健环境中的专业保健服务往往并不完善。基于家庭的干预措施以改善对其他慢性健康状况（例如糖尿病）的自我管理的干预措施已成功开发出来，但缺乏基于初级护理的干预研究，将家庭成员纳入抑郁症治疗的组成部分。从公共卫生的角度来看，有令人信服的理由这样做。家庭参与可能会减少护理障碍，例如患者不愿披露抑郁症状，污名或治疗不遵守。克服这些障碍可能对于弥合服务不足的老年人（例如老年人和少数民族）的亚组的差距尤其重要。建立现有家庭关系与老年男性的偏好保持一致，从而加强初级保健环境中的抑郁疗法，并且可能具有成本效益和持久。在此R-34应用程序中，我们将开发和测试基于家庭的干预措施，基于社区的初级保健诊所，主要是低收入和少数族裔老年人口，未治疗或治疗不足的抑郁症发生率很高。我们的干预发展方法是由理论驱动的，并将瓦格纳的慢性护理模型用作一个超大的框架。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），以指定家庭成员可以加强抑郁症护理的潜在机制。该项目的具体目的是1）进行和分析对老年男性抑郁症护理中的主要利益相关者的访谈，包括老年男性，潜在的家庭/朋友助手和诊所员工，2）通过AIM 1和我们的初步研究，以完善干预方法，以开发干预方案（例如，对疗效和实施手册）进行术语和术方法的方法，以进行术语，并进行术方法和术方法。从目标人群中得出24名沮丧的老年男性的试验。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Feasibility of a family-centered intervention for depressed older men in primary care.

对初级保健中抑郁的老年男性进行以家庭为中心的干预的可行性。

DOI：
10.1002/gps.5196
发表时间：
2019
期刊：
International journal of geriatric psychiatry
影响因子：
4
作者：
Hinton,Ladson;LaFrano,Erika;Harvey,Danielle;Alfaro,EduardoDelgadillo;Kravitz,Richard;Smith,Andrew;Apesoa-Varano,EsterCarolina;Jafri,Asma;Unutzer,Jurgen
通讯作者：
Unutzer,Jurgen