The Principal Research Core is directed by Dr. James Coyne. This section of the application describes a) the background and rationale for our focus on latelife depression in medical care settings; b) """"""""bulleted"""""""" descriptions of recent research findings; c) current and planned research grants enabled and facilitated through the Center; and d) specific pilot research projects. The pilots reflect a number of themes of the Center: the focus on both enabling research and investigator development; the use of qualitative as well as quantitative methods, and newer as well as standard designs; investigations of both psychotherapy and pharmacotherapy; the locus of studies in primary-, medical specialty-, and long-term care settings; and the design of studies to facilitate the evaluation of findings between- as well as within- comorbidities and contexts. There are four sets of pilot projects: a) Qualitative and quantitative follow-up of providers and patients who participated in the Prevention of Suicide in Primary Care Elderly: Collaborating Trial (PROSPECT) and PRISMe studies. They will allow us to incorporate what stakeholders have learned from research participation in the dissemination of findings and the design of subsequent interventions. b) Pilot studies on the course of minor depression in older and middle-aged women with breast cancer, and older patients, women and men, in primary-care. These studies will inform the design of a """"""""biased-coin toss"""""""", adaptive randomization design to help to evaluate """"""""early treatment"""""""" versus """"""""watchful waiting strategies"""""""", and to determine the optimal period of """"""""watchful waiting"""""""" before the initiation of treatment for each group. c) Studies to evaluate patients' preferences and to estimate effect sizes for continued antidepressant treatment versus drug discontinuation and monitoring for nursing home residents and primary-care patients in remission from a first episode of late-life depression. These pilots will facilitate the design of a partially randomized patient preference study designed to evaluate the benefits versus the risks of maintenance treatment for patients who recover from a first episode of geriatric depression. d) Studies evaluating the feasibility and the nature of the adaptations to standard methods that are necessary to allow the delivery of cognitive therapy for depression to patients with Parkinson's disease, developing a manual for this treatment, and early tests of its outcomes.
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