The mission of the Research Methods Core (RMC) is to advance the quality and impact of research in """"""""real world settings"""""""" by addressing methodological challenges posed by the clinical and service delivery complexities of depressed elders with limited access to good care. Concerns raised by our own communitybased studies, and the field more broadly, guided the development of RMC Initiatives as well as one of our Developmental Studies and three of our Pilot Studies: Initiative 1: Predictors and Moderators of Outcomes in Intervention Development: Development of novel interventions for depressed seniors who may not respond to existing treatment approaches is a complex process. We will rely on exploratory analyses of our rich RCT databases and use predictors of outcomes and moderators of treatment response to sharpen the selection of target populations, improve our interventions, and accelerate the process of moving research into practice. Pilot 3 focuses on the feasibility of web-based training as a way of enhancing the dissemination of community interventions. Pilot 5 studies the cost of care management in home healthcare as a way of evaluating its feasibility. Initiative 2. Reduction of Bias: Interventions focusing on provider behavior as well as patient outcomes often use cluster (setting-based) randomization designs resulting in non-equivalent groups. Building on our study of propensity modeling for patient-RCTs, we will investigate the suitability of propensity modeling in adjusting for group differences in cluster based designs (also addressed in Developmental Project 4). Another source of bias is loss of data through subject attrition, a problem inherent in intervention studies of chronic disorders like geriatric depression. To address this problem, we propose a sequential, multiple imputation procedure that builds on our work in which we evaluated bias reduction using a predictive model based on multiple imputation for the analysis of incomplete, missing not at random (MNAR) data (Pilot 4). Initiative 3. Generalizability of Community-Generated Interventions: To address sampling bias in community-based studies, we propose procedures related to both within-agency generalizability (e.g., reducing the source and impact of sample bias introduced by patient or client recruitment processes) and across-agency variation (e.g., biased introduced in the process of selecting community-based research partners or in implementing interventions).

Public Health Relevance

The RMC relies on a cohesive team with complementary expertise ranging from biostatistics to social systems to develop strategies addressing critical methodological concerns in developing personalized treatments, in reducing bias, and in enhancing generalizability in community-based research of geriatric depression.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Center Core Grants (P30)
Project #
5P30MH085943-05
Application #
8465911
Study Section
Special Emphasis Panel (ZMH1-ERB-B)
Project Start
Project End
Budget Start
2013-05-01
Budget End
2014-04-30
Support Year
5
Fiscal Year
2013
Total Cost
$276,331
Indirect Cost
$81,870
Name
Weill Medical College of Cornell University
Department
Type
DUNS #
060217502
City
New York
State
NY
Country
United States
Zip Code
10065
Alexopoulos, George S; Raue, Patrick J; Gunning, Faith et al. (2016) ""Engage"" Therapy: Behavioral Activation and Improvement of Late-Life Major Depression. Am J Geriatr Psychiatry 24:320-6
Gustavson, Kristen A; Alexopoulos, George S; Niu, Grace C et al. (2016) Problem-Solving Therapy Reduces Suicidal Ideation In Depressed Older Adults with Executive Dysfunction. Am J Geriatr Psychiatry 24:11-7
Bogner, Hillary R; Joo, Jin H; Hwang, Seungyoung et al. (2016) Does a Depression Management Program Decrease Mortality in Older Adults with Specific Medical Conditions in Primary Care? An Exploratory Analysis. J Am Geriatr Soc 64:126-31
Yohannes, Abebaw Mengistu; Raue, Patrick J; Kanellopoulos, Dora et al. (2016) Predictors of All-Cause Mortality in Patients With Severe COPD and Major Depression Admitted to a Rehabilitation Hospital. Chest 149:467-73
Mahgoub, Nahla; Alexopoulos, George S (2016) Amyloid Hypothesis: Is There a Role for Antiamyloid Treatment in Late-Life Depression? Am J Geriatr Psychiatry 24:239-47
Alexopoulos, George S; Sirey, Jo Anne; Banerjee, Samprit et al. (2016) Two Behavioral Interventions for Patients with Major Depression and Severe COPD. Am J Geriatr Psychiatry 24:964-974
Gallo, Joseph J; Hwang, Seungyoung; Joo, Jin Hui et al. (2016) Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk. J Gen Intern Med 31:380-6
Alexopoulos, George S; Raue, Patrick J; McCulloch, Charles et al. (2016) Clinical Case Management versus Case Management with Problem-Solving Therapy in Low-Income, Disabled Elders with Major Depression: A Randomized Clinical Trial. Am J Geriatr Psychiatry 24:50-9
Alexopoulos, George S; Raue, Patrick J; Kiosses, Dimitris N et al. (2015) Comparing engage with PST in late-life major depression: a preliminary report. Am J Geriatr Psychiatry 23:506-13
Kiosses, Dimitris N; Ravdin, Lisa D; Gross, James J et al. (2015) Problem adaptation therapy for older adults with major depression and cognitive impairment: a randomized clinical trial. JAMA Psychiatry 72:22-30

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