This application for an NIMH Mid-Career Investigator Award in Patient-Oriented Research (K24) requests support for the Pi's continued career development and emergence as a leader nationally, as a clinical researcher and as a mentor to more junior investigators. The investigative focus is the relationships of depression and medical comorbidity in older adults, including their associations with key quality of life outcomes during the latter stages of life. Integrated research and mentoring plans are proposed with the following goals: (1) To continue to develop the Pi's research program on depression and medical comorbidity in primary care elders, specifically examining the naturalistic history of minor and subsyndromal depressive conditions, and to extend his previous work by testing psychological moderators and studying end of life outcomes. This will be supported by a current R01 (Project 1) and by a planned competitive continuation R01 application (Project 2). (2) To further extend the Pi's research by examining the relationships among depression and specified biological and psychological factors, and their associations with quality of life outcomes and mortality, in older patients with severe heart failure. This new initiative's pilot phase will be followed by an R01-supported study (Project 3). Heart failure is the leading cause of death among older adults, complementing Project 2's 'latter stages of life' theme. (3) To train junior investigators from a range of clinical backgrounds, including physicians, in the design and conduct of geriatric psychiatry studies, particularly those related to depression and medical comorbidity. The application describes the mentoring plans and their feasibility, including the Pi's qualifications, plans for further development of his mentoring skills, and the resources to attract and support trainees. Projects 1-3, and other funded investigations, will be the main research vehicles for such training. Trainees at the Pi's institution will be supported by several existing or pending institutional training grants. The PI also will mentor early career researchers at other institutions through national-level training grants and meetings.
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