Although health care for older persons is a major policy concern and the impact of depression on social and physical functioning, quality of life, and health care costs for elderly persons is severe, and effective treatments for depression exist, under-treatment and non-treatment is common. More needs to be known about the factors associated with the use of mental health services by elderly persons, yet there are very few researchers examining these issues. In addition, the data that are currently available for analyses were not designed for geriatric mental health services research, and all have significant limitations for this type of research. The applicant has a strong background of academic and research training in health economics, statistics, econometrics, health policy, and utilization of mental health services, but needs further training to become an effective geriatric mental health services researcher. The applicant is requesting. five years of funding through the Mentored Career Development Award (KO 1) program to improve his knowledge of geriatric psychiatry and medical sociology and obtain methodological skills in survey design and administration to become a geriatric mental health services researcher. These activities will take place within the NIMH supported Intervention Research Center for Late-Life Mood Disorders at the University of Pittsburgh, with Charles F. Reynolds serving as mentor, and Linda George, Martha Bruce, Herbert C. Schulberg, Judy Lage, Richard Schulz, and Scott Beach serving as consultants. The applicant will then use this training to create a pilot database, combining survey and claims data, that can be used to examine the relative role of social and economic factors on the utilization of mental health services for the treatment of late-life depression. By determining the relative role of social and economic factors on the use of mental health services by elderly persons, health policy and other interventions can be designed that can improve rates of recognition and treatment of depression in this population. The research plan for this award involves the collection of pilot survey data that will be linked to Medicare HMO encounter data. The survey will collect information on economic and social factors related to the use of mental health services, as well as information on mental and physical health status, physical functioning, and medical and psychiatric history. This survey data will then be linked to respondents' HMO encounter data. Information from this pilot database, such as reliability and validity of measures, response rates, and effect sizes, will be used to develop an RO1 application to create a large, longitudinal, and comprehensive database that can be used for geriatric mental health services research.
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