This study takes advantage of the primary care setting to consider whether we can identify presentations of depression in older adults that are characterized more by motivation disturbance (e.g., anhedonia, executive function disturbance and cognitive content related to physical illness (e.g., hopelessness, anxiety) rather than by mood disturbance (e.g. sadness).
The specific aims of this proposal to be carried out in the primary care setting are: o to systematically describe and validate a depressive syndrome, apathetic depression, that does not meet standard criteria for Major Depression in older primary care patients; o to assess how physical illness, cognitive impairment, anxiety, and hopelessness among older primary care patients alters the course of depression and associated functional impairment over time; and, o to evaluate the clinical presentation of depression and associated symptoms in late life in relation to the assessment and treatment decisions of primary care physicians. An age-stratified sample of 3000 adults aged 65 years and older who have visited one of 30 participating primary care physicians will be interviewed with a revised version of the CES-D in the physician's office. Patients above a threshold will be asked to participate in a home assessment and follow-up study. Approximately 300 patients will have significant depressive symptoms and will be asked to participate in a longitudinal, observational study with a 10% random sample of persons without depression. The main study will include a baseline in-home assessment, a 3-monthly telephone follow-up, and a 12-month in-home follow-up evaluation of depression, function, and other factors. Information on assessment and treatment of depression will be obtained from participating physicians. We seek to identify, in primary care, an anhedonic depression syndrome which appears to be associated with physical illness and significant functional limitation and for which misidentification of depression could be avoided if the syndrome were better understood.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH062210-01
Application #
2910714
Study Section
Mental Disorders of Aging Review Committee (MDA)
Program Officer
Otey, Emeline M
Project Start
2000-03-15
Project End
2004-02-29
Budget Start
2000-03-15
Budget End
2001-02-28
Support Year
1
Fiscal Year
2000
Total Cost
$302,786
Indirect Cost
Name
University of Pennsylvania
Department
Family Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
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Wittink, Marsha N; Joo, Jin Hui; Lewis, Lisa M et al. (2009) Losing faith and using faith: older African Americans discuss spirituality, religious activities, and depression. J Gen Intern Med 24:402-7
Bogner, Hillary R; Cahill, Eileen; Frauenhoffer, Christine et al. (2009) Older primary care patient views regarding antidepressants: A mixed methods approach. J Ment Health 18:57-64
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Cahill, Eileen; Lewis, Lisa M; Barg, Frances K et al. (2009) ""You don't want to burden them"": older adults' views on family involvement in care. J Fam Nurs 15:295-317
Wittink, Marsha N; Bogner, Hillary R (2008) Primary care physicians'assessments of older patients'health and psychological status and recommendation of mammography. J Am Board Fam Med 21:17-23
Nguyen, Giang T; Wittink, Marsha N; Murray, Genevra F et al. (2008) More than just a communication medium: what older adults say about television and depression. Gerontologist 48:300-10
Wittink, Marsha N; Dahlberg, Britt; Biruk, Crystal et al. (2008) How older adults combine medical and experiential notions of depression. Qual Health Res 18:1174-83
Kim, Yeowon A; Morales, Knashawn H; Bogner, Hillary R (2008) Patient ethnicity and the identification of anxiety in elderly primary care patients. J Am Geriatr Soc 56:1626-30
Crane, M K; Bogner, H R; Brown, G K et al. (2007) The link between depressive symptoms, negative cognitive bias and memory complaints in older adults. Aging Ment Health 11:708-15

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