This proposal is for a K23 Mentored Patient Oriented Research Career Development Award that will prepare the candidate, Daniel Jimenez, become an independently funded researcher with expertise in health promotion/health behavior change interventions designed to prevent common mental illness (depression and anxiety) in at-risk racial/ethnic minority elderly. The candidate and his mentors at Dartmouth Medical School, Cambridge Health Alliance and the University of Pittsburgh have designed a career development plan, which is comprised of scholarly didactics and seminars, expert mentorship, hands-on experience at Dartmouth College, Harvard University, and the University of Pittsburgh as well as measurable productivity including peer- reviewed manuscripts and grant applications. His three career development aims are: 1) to gain expertise in the development of health promotion/health behavior change interventions to prevent common mental health disorders in high-risk older racial/ethnic minority populations; 2) to develop methodological expertise in depression and anxiety prevention research as a foundation for conducting health promotion/health behavior change research in racial/ethnic minority elderly; and 3) to gain increased knowledge on the effects of health promotion/health behavior change interventions on risk factors for depression/anxiety. Addressing these career development aims will provide the candidate with the skills and expertise to conduct the research plan in this proposal. A mixed methods approach will be used to develop and refine Happy Older Latinos are Active (HOLA), a physical activity intervention led by a community health worker, and to demonstrate feasibility, acceptability, and safety of the intervention in a randomized trial. This pilot study has three specific aims: 1) to develop and refine HOLA to address depression and anxiety prevention in a group of older Latinos with minor and subthreshold depression and anxiety; 2) to evaluate the feasibility and potential effectiveness of the newly refined HOLA compared to an enhanced psychoeducation condition with respect to: (a.) depression and anxiety prevention and (b.) depression and anxiety severity; 3) to evaluate the feasibility and potential effectiveness of HOLA compared to enhanced psychoeducation with respect to physical and psychosocial functioning. The development of a health promotion intervention designed to prevent common mental disorders could be a means of addressing multiple disparities (e.g. mental health outcomes, mental health service use, stigma) among racial/ethnic minority elderly. Should these results prove to be promising, a future R01 proposal for an adequately powered, randomized control trial will be submitted. Additionally, the results of this study could have implications fo other high risk, highly disadvantaged populations who could benefit from the proposed health promotion intervention in the service of preventing common and disabling mental disorders.
Depressive and anxiety disorders are among the most common, disabling, and costliest disorders in old age. The identification of people at greatest risk for common mental disorders (depression and anxiety) and the development of timely and empirically based interventions to prevent these mental disorders are major public health challenges. This mentored K23 career development application requests support for a pilot randomized prevention trial that seeks to compare a preventive intervention called 'Happy Older Latinos are Active (HOLA),' a CHW led group-based, health promotion intervention, to a fotonovela, an enhanced psychoeducation condition. Participants will be older Latinos with minor and subthreshold depression and anxiety.
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