This revised application for an NIMH Mentored Patient-Oriented Research Career Development (K23) Award, entitled """"""""Tailoring depression treatment services to older adults,"""""""" seeks support for the development of a program of research related to the treatment of depression in primary health care. The PI will gain additional research skills to collect and analyze data related to older patients'beliefs about depression and its treatment and to acquire the skills associated with the design, evaluation and dissemination of interventions to be implemented in the primary care setting. The proposed research plan, linked to the educational activities and interaction with mentors, consists of four phases that together will form the basis for studying the impact of patient factors on acceptability and initial engagement in depression treatment. Phase 1 will employ responses from older adults participating in the NIMH-funded Spectrum survey to examine the personal, cognitive, and affective characteristics as they relate to different personal explanatory models of depression and its treatment and reported use of mental health services. Phase 2 will relate the explanatory models to characteristics of treatment that are most valued. In Phase2, the participants will be sampled based on ethnicity and other characteristics. By following up with the persons participating in Phase 2, we will be able to assess the consistency of different explanatory models about depression across samples and with relation to treatment experience over time. Phase 3 will test the feasibility of an intervention protocol guided by the result from Phase 1 and 2. Phase 3 will consist of a pilot study that tailors treatment to patient derived characteristics that emerge from the findings of Phases 1 and 2. Tailoring will take explanatory models or treatment characteristics most valued by patients into account with regard to treatment modality. Phase 4, using the findings from Phase 1, 2, 3, will guide the development of an R01- funded intervention, sketched out in the final section of this K23 to tailor treatment to patient characteristics with the goal of improving treatment acceptability and engagement. Relevance: The primary care setting is pivotal to improving depression treatment for the public, but drop out rates from interventions limit their public health impact. Tailoring treatments to incorporate aspects of care that patients value most will be studied with the goal of improving uptake of depression treatment among older persons.
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