ALACRITY for Late- and Mid-Life Mood Disorders

Alexopoulos, George

Abstract

ALACRITY CENTER ABSTRACT The rapid increase of older persons (73% increase anticipated in US by 2020) and the diseases and disabilities complicating their care make research in this area a national priority. We focus on late- and mid-life mood disorders because they are the leading cause of disability, increase medical morbidity and mortality, cause suffering, and increase the cost of care. Pharmacotherapy addresses the needs of no more than half of these persons and most non-pharmacological therapies are complex and have limited scalability and reach. We propose to put into action a novel model of deployment-based behavioral interventions and implementation, streamlined based on neurobiology models and augmented by mobile technology. Rather than focusing exclusively on uptake and sustainability of available interventions, many of which are too complex for community use, we are working to both simplify the treatments themselves and improve their delivery. Accordingly, our model: 1) Targets groups identified by consumers, community partners, and our team. 2) Develops its interventions jointly with community partners and a transdisciplinary team and uses neurobiological concepts as a ?simplification rule? for streamlining behavioral interventions so that they can be used by community clinicians; 3) integrates mobile technology to community interventions at the assessment, the intervention, and the adherence monitoring levels; and 4) tests its interventions at community sites using community clinicians to shorten the way to uptake and sustainability. To maximize our impact, we will work both in settings in which most older and middle-aged people receive care (primary care) and in settings serving persons with special clinical (elder mistreatment) and social needs (poverty). The Center's approach is a clear departure from traditional intervention and services research and can lead to a revolutionary change in how the field thinks about T2 intervention development and deployment in the community. Our Methods Core will provide quality control for the Center's projects, serve as an incubator for innovative approaches to novel design and analytic methods that enhance the information yield of effectiveness data. It also uses big-data to aid the identification of populations in need of novel interventions, provides policy support, and integrates novel mobile technology approaches to community interventions. The Core will also evaluate the Center's productivity and impact on the field and disseminate its methodological advances. We are confident that we can meet the challenges of this work because of our 20 years of working together with stakeholders and community partners in intervention planning and implementation supported by 4 consecutive NIMH-funded Center grants, a large portfolio of independently funded studies, and a strong record of research training and career development of junior investigators.

Public Health Relevance

We propose to study a novel model for developing behavioral interventions to improve the care of older and middle-aged adults with mood disorders treated in the community. Our interventions are simplified based on input by consumers and community clinicians, guided by neurobiological models, and supported by mobile technology. As a result, we expect that our novel interventions can become part of the practice of a variety of community settings and help many who are inadequately treated and suffering.