Course and risk factors for depression in late life

晚年抑郁症的病程和危险因素

基本信息

批准号：
7895888
负责人：
HILLARY R BOGNER
金额：
$ 40万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-17 至 2013-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7895888
关键词：
Address Adult Age Antidepressive Agents Attention Characteristics Clinical Clinical assessments Cognitive Comorbidity DSM-IV Data Data Set Depressed mood Development Diagnosis Diagnostic Diagnostic and Statistical Manual Disease Elderly Emotional Engineering Enrollment Evaluation Exposure to Feeling hopeless Feeling suicidal Foundations Funding Goals Growth Guidelines Health Status Healthcare Impaired cognition Intervention Intervention Studies Intervention Trial Lead Longitudinal Studies Major Depressive Disorder Mediating Medical Medicine Mental Depression Mental disorders Minor Modeling Modification NIH Consensus Development Conferences National Institute of Mental Health Nature Outcome Patients Pennsylvania Personal Communication Pharmaceutical Preparations Phase Play Positioning Attribute Prevention Primary Care Physician Primary Health Care Psychiatry Psychopathology Psychotherapy Public Health Randomized Randomized Clinical Trials Records Recovery Relative (related person)Reporting Research Research Personnel Resources Risk Risk Factors Sampling Screening procedure Severity of illness Shapes Signs and Symptoms Site Specialist Staging Strategic Planning Subgroup Suicide prevention Symptoms Syndrome System Time United States Agency for Healthcare Research and Quality Universities Work base collaborative care collaborative trial depressive symptoms follow up assessment follow-up geriatric depression geriatric major depression improved intervention effect meetings minor depressive disorder older patient primary care setting prospective public health relevance response suicide rate treatment as usual young adult

项目摘要

DESCRIPTION (provided by applicant): This application building on a randomized clinical trial carried out in primary care to study trajectories of depressive symptoms and medical comorbidity in relation to the outcomes of Major Depression and suicidal ideation at 2 years aligns with the NIMH Strategic Plan and is submitted in response to PA-07-082, "Risk factors for psychopathology using existing data sets," released 11 May 2007. Recent studies have demonstrated that a variety of primary care interventions can improve late life Major Depression outcomes. However, these interventions have not been found to be effective for minor depression. While some research has previously identified subtypes of depression, little work has focused on subtypes of late life depression, and that work has been conducted in cross-sectional data and not in the context of an intervention trial. The specific aims of this study are: (1) To identify subgroups of primary care elderly patients based on baseline characteristics and two different types of longitudinal profiles: 1) depressive symptoms and 2) overall medical comorbidity, and the association of subgroups with criterion-based Major Depression and/or suicidal ideation at 2 years; (2) To assess whether the different subgroups identified in Aim 1 on the basis of either depressive symptoms or overall medical comorbidity modify the effect of the collaborative care intervention on criterion- based Major Depression and/or suicidal ideation at 2 years, such that the intervention will show significant effects in certain subgroups; and (3) To assess how the effect modification of the intervention effect on criterion-based Major Depression or suicidal ideation at 2 years in Aim 1 is mediated by varying intensity of exposure to antidepressant medication or psychotherapy. To accomplish these aims, we will capitalize on screening, clinical assessment, treatment, and follow-up assessments which have occurred for up to 2 years in PROSPECT (the "Prevention of Suicide in Primary Care Elderly: Collaborative Trial"). In all, 1,226 patients, including all patients who screened positive for depression and a random sample of patients who screened negative, were enrolled in the 2-year longitudinal study. The primary care practices were randomized into: (1) treatment as usual by the primary care practice (n = 617 patients); and (2) a guideline management intervention consisting of antidepressant or psychotherapeutic treatment for depression following AHCPR guidelines, revised for the elderly, under the responsibility of the primary care physician who is assisted by a Masters-level specialist (the intervention condition; n = 609 patients). Among the sample of 1226 primary care elderly patients, we want to emphasize that our analysis will be based on course of depressive symptoms and not DSM-IV diagnoses. We propose to supplement PROSPECT data with medication records to classify and quantify medical comorbidity over the course of the 2-year follow-up interval. The foundation for the analysis to improve our understanding of the dynamic association of course of depressive symptoms and medical comorbidity will be the general growth curve mixture model (GGCMM). This project can have a significant public health impact because a further understanding of the association of the course of depressive symptoms and the onset and course of medical comorbidity among elderly primary care patients would be a key step in intervening to improve recognition and treatment of late life depression. PUBLIC HEALTH RELEVANCE: The overall goal of this application is to identify subgroups of primary care elderly patients, based on baseline characteristics and two different types of longitudinal profiles: 1) depressive symptoms and 2) overall medical comorbidity, for whom the collaborative care intervention reduces the persistence or onset of Major Depression and/or suicidal ideation. This project can have a significant public health impact because a further understanding of the association of the course of depressive symptoms and the onset and course of medical comorbidity among primary care elderly patients would be a key step in intervening to improve recognition and treatment of depression in late life.

描述（由申请人提供）：该申请在初级保健中进行的随机临床试验进行了研究，以研究抑郁症状和医学合并症的轨迹，与重大抑郁症和自杀念头的结果有关，与NIMH战略计划相吻合，并响应于PA-07-082的风险因素，并将其释放为pa-07-082，“初级保健干预措施可以改善后期的重大抑郁症结果。但是，这些干预措施尚未发现对轻微抑郁症有效。尽管一些研究以前已经确定了抑郁症的亚型，但很少有工作重点是生命抑郁症的亚型，并且这项工作是在横断面数据中进行的，而不是在干预试验的背景下进行的。这项研究的具体目的是：（1）基于基线特征和两种不同类型的纵向特征来鉴定初级保健老年患者的亚组：1）抑郁症状和2）2）总体合并症，以及亚组与基于标准的大抑郁症和/或自杀式观念的关联；（2）评估AIM 1中根据抑郁症状或整体医学合并症确定的不同子组是否会改变协作护理干预对基于标准的重大抑郁症和/或自杀念头的影响，以便干预措施在某些子组中显示出重大影响；（3）为了评估AIM 1（在AIM 1）在2年中基于标准的重大抑郁症或自杀意念的效果修改如何通过不同暴露于抗抑郁药或心理治疗的强度来介导。为了实现这些目标，我们将利用筛查，临床评估，治疗和随访评估，这些评估已在前景中进行了长达2年（“预防初级保健老年人自杀：协作试验”）。总共有1,226名患者，包括所有因抑郁症呈阳性的患者和筛查阴性筛查的患者的随机样本，都参加了为期两年的纵向研究。初级保健实践被随机地分解为：（1）根据初级保健实践的治疗（n = 617例）；（2）在AHCPR指南后，由抗抑郁药或心理治疗抑郁症组成的指南管理干预措施，在AHCPR指南后对老年人进行修订，并在由Masters级专家（干预措施； n = 609名患者）协助下的初级保健医生的责任。在1226名初级保健老年患者的样本中，我们要强调，我们的分析将基于抑郁症状的过程，而不是DSM-IV诊断。我们建议在两年的随访时间间隔内对药物记录进行补充潜在数据，以对医疗合并症进行分类和量化。分析的基础是我们对抑郁症状和医疗合并症的动态关联的理解的理解将是一般生长曲线混合模型（GGCMM）。该项目可能会产生重大的公共卫生影响，因为对老年初级保健患者的抑郁症状和医疗合并症的开始和医疗过程的进一步了解将是干预以改善对晚期生活抑郁症的认识和治疗的关键一步。公共卫生相关性：本应用的总体目标是根据基线特征和两种不同类型的纵向特征来识别初级保健老年患者的亚组：1）抑郁症状和2）整体医疗合并症，协作性护理干预措施可降低重大抑郁症的持久性或重大抑郁症和/或/或/或/或自杀式的势力。该项目可能会产生重大的公共卫生影响，因为对初级保健老年患者的抑郁症状过程以及医疗合并症的起步和医疗过程的进一步了解将是干预以改善晚期抑郁症的认识和治疗的关键一步。