EXCEED THE SPACE PROVIDED. The overarching goal of the proposed study is to improve our understanding of depression among older adults in primary care settings (submitted in response to PA-02-043, 'Social and cultural dimensions of health,' released 21 December 2001). Anthropological methods allow access the emic or insider perspective of research participants (in this case on the experience and symptoms of depression) as well as more standard etic or external scientific interpretations of depression.
The specific aims of this mixed methods study to be carried out among primary care patients aged 65 years and older in an observational follow-up survey are: 1 to describe how older persons and their families experience depression in late life and how they integrate symptoms of depression with medical conditions; 2 to examine the influence of medical comorbidity, cognitive impairment, anxiety, hopelessness, and apolipoprotein E genotype on course of depression and associated functional impairment in late life for patients and their families; and, 3 to evaluate aims 1 and 2 across ethnic .qroups in order to increase our ability to design acceptable interventions for older primary care patients and their families. The proposed study takes advantage of the screening and follow-up project taking place in an NIMH-funded study of depressive symptoms in older primary care patients called the 'Spectrum survey.' In the funded study, we will follow up with 450 primary care patients already enrolled in an observational study designed to describe and validate a depressive syndrome, apathetic depression, which does not meet standard criteria for Major Depression. We are proposing to enhance the funded study with a single semi-structured interview of 160 patients (including 30 patient- family dyads) after the 12-month interview of the main study. We will make use of cultural consensus analysis and ethnographic discourse-centered analysis to identify the explanatory model for depression and to characterize the domain of 'depression' according to the perspective of the patient. We plan to integrate the data we obtain from the proposed interviews with the scripted Spectrum survey data in order to test our developing explanatory models and to modify our sampling and interview strategies if necessary. Use of mixed methods will help us better understand how older adults may experience depression in social and cultural context from both an epidemiologic and anthropologic perspective. PERFORMANCESITE( ========================================Section End===========================================
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