Depressive disorders are highly prevalent in Mexican American (MA) elders and in cross-sectional studies are associated with significant morbidity, disability and risk of institutionalization. Despite the significance of these disorders in MA elders longitudinal data on their natural history, prognostic factors, and associated health outcomes are lacking. This proposal will extend the scope of an on-going project examining case-finding strategies for depressive disorders in the primary care setting to include vital longitudinal follow-up information. The primary short-term objectives of the proposed investigation are to: 1) delineate the one-year natural history and predictors of remission from depressive disorders in Mexican American elders and 2) to examine the relationship between affective function and disability. Secondary objectives are to: 1) describe the utilization patterns of traditional and alternative medical therapies by MA elders with depression, and 2) pilot a questionnaire that examines MA elders' health beliefs about depressive disorders. Our long-term goals is to help MA elders maintain functional independence by developing effective treatments for depression that may be delivered in the primary care setting. Mexican American elders exceeding threshold on the Geriatric Depression Screen who are without major psychiatric comorbidity will be entered into a 12 month natural history study. Criterion standard diagnosis will be established independently, and a comprehensive battery of medical comorbidity, physical, social, and cognitive functioning measures will be examined to identify key determinants of the course of depression in this growing minority. The complete battery of measures will be assessed in face-to-face interviews at enrollment, 6 and 12 months. To more fully describe the course of depressive disorders, affective function will be assessed by telephone interview at 6 week intervals. Primary data analysis will use descriptive graphs and Kaplan-Meier estimates to describe the course of depression. Stochastic models which describe the probability of transitions from one state to another, will be used to more fully describe the pattern of remissions and relapses. Multivariable techniques will be used to examine the predictors of remission from depression or progression to Major Depressive Disorder. Finally, a pilot questionnaire designed to discriminate differing knowledge, beliefs, and attitudes about depression will be developed and pre-tested for comprehensibility, language, and cultural appropriateness. Results from this study will provide essential knowledge about depressive disorders in MA elders that may lead to the development of culturally appropriate and feasible interventions.
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