(provided by candidate): This is a resubmission of an application for a Mentored Patient-Oriented Research Career Development Award (K23). The candidate is a geriatric psychiatrist and post-doctoral research fellow at the University of Pittsburgh. She proposes to become an expert in clinical mental-health prevention research. This proposal focuses on post-stroke major depression (PSMD) as this illness is a model of geriatric depression and is an illness ready for preventive intervention research. To develop the skills needed to conduct clinical mental-health prevention research, the candidate will learn from the related fields of epidemiology, public health prevention research, and traditional mental-health pharmacologic intervention research. She will gain the skills needed (1) to design and conduct prevention studies, and (2) to select at-risk populations that would benefit from preventive interventions through the identification and modeling of risk factors. In addition, the candidate will develop the skills needed to assess psychiatric and functional outcomes in subjects with neurological illness. The candidate will also learn about biostatistical analysis pertinent to prevention trials and the ethical issues involved in clinical research. Funding of this award will provide time and resources necessary for the candidate to develop into an independent investigator capable of conducting psychiatric prevention and intervention trials in impaired elderly depressed patients. Studies of stroke survivors indicate that Major Depression is common after stroke and is associated with poorer rehabilitation outcomes, increased disability, and increased mortality. While the response rate in treatment trials of PSMD is typically 65%, it is unclear whether successful treatment of PSMD translates into improved rehabilitation outcomes. Therefore, preventing the onset of PSMD may be a more beneficial approach in terms of both mental and physical health. The proposed research is a pilot double-blind placebo controlled trial of citalopram in the prevention of PSMD in stroke survivors at high-risk for developing PSMD. The proposed activities will take place at the University of Pittsburgh under the auspices of the NIMH-funded Intervention Research Center for Late Life Mood Disorders, directed by the candidate's sponsor.
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