This application is for a Mentored Research Scientist Development Award (K01). The candidate is a geriatric psychiatrist who proposes to acquire the specific skills and to develop methods he needs to become an independent investigator and leader in geropsychiatry effectiveness research. During the Award he will become proficient in the conduct of antidepressant effectiveness trials in a network of community-based primary care (PC) practices. Effectiveness research is a growing field with unique methodology dedicated to determining the real-world applicability of interventions already shown to be safe and efficacious under optimal conditions. To improve public health, progress in the treatment of late-life depression has to be realized in the PC sector where most older Americans receive care for their mental health problems or disorders. To date, interventions developed in the psychiatric sector have not been transferable to PC settings. Similarly, research methods used in psychiatric settings are not transportable to PC practices. Thus, assessing the effectiveness of interventions in PC practices requires specialized skills and methods. The proposed career development activities will promote the acquisition of skills related to: (1) recruitment and retention of PC practices in a research network; (2) specialized issues in sampling and treatment assignment in PC; (3) specialized data collection and management procedures; (4) specialized innovative analytical techniques. This educational program will complement three method-development projects which aim at developing and validating: (I) a simplified case-finding approach; (II) a simplified battery of outcome measures that address symptomatic improvement, function, quality of life, satisfaction, and cost; (III) methods to overcome barriers to effectiveness research in PC by enhancing motivation and cooperation of PC providers, allowing optimal recruitment and retention of older depressed research subjects.
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