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.

Public Health Relevance

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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Mental Health Services in Non-Specialty Settings (SRNS)
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Evans, Jovier D
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University of California Davis
Schools of Medicine
United States
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Apesoa-Varano, Ester Carolina; Barker, Judith C; Unutzer, Jurgen et al. (2015) Depression Attributes Among White Non-Hispanic and Mexican-Origin Older Men. Am J Geriatr Psychiatry 23:960-9
Apesoa-Varano, Ester Carolina; Barker, Judith C; Hinton, Ladson (2015) Shards of sorrow: Older men's accounts of their depression experience. Soc Sci Med 124:1-8
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Dwight Johnson, Megan; Apesoa-Varano, Carolina; Hay, Joel et al. (2013) Depression treatment preferences of older white and Mexican origin men. Gen Hosp Psychiatry 35:59-65
Hinton, Ladson; Apesoa-Varano, Ester Carolina; González, Hector M et al. (2012) Falling through the cracks: gaps in depression treatment among older Mexican-origin and white men. Int J Geriatr Psychiatry 27:1283-90
Apesoa-Varano, Ester Carolina; Hinton, Ladson; Barker, Judith C et al. (2010) Clinician approaches and strategies for engaging older men in depression care. Am J Geriatr Psychiatry 18:586-95
Hinton, Ladson (2010) Qualitative research on geriatric mental health: progress, challenges, and opportunities. Am J Geriatr Psychiatry 18:563-6