Anxiety and Depression among Elderly Public Housing Residents
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DESCRIPTION (provided by the applicant): Background: Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. There is a great need for new cost-effective community programs that improve detection and treatment of late-life anxiety and depression. Elderly public housing high-rises are a promising venue to develop and test such programs due to the high concentration of older adults with many risk factors. Few studies, however, have taken advantage of the potential opportunities these high-rises offer, and further work is needed to characterize anxiety, depression, mental health needs, and service utilization patterns in this population. Research Aims: The proposed study will examine anxiety and depression in elderly residents of public housing high-rises. Aim 1 is to evaluate syndromal and subsyndromal anxiety and depression prevalence and unmet mental healthcare need, as well as the correlates of anxiety and depression symptom severity; subsyndromal conditions occur when there are clinically significant levels of symptoms, but full syndromal diagnostic criteria are unmet. A secondary aim is to establish the sensitivity and specificity of brief anxiety and depression questionnaires in this setting. Aim 2 is to develop statistical models characterizing the association of anxiety and depression symptom severity with utilization of on-site aging services social workers, formal services, and informal services after accounting for demographic and other additional factors. We hypothesize that severity of anxiety and depression symptoms is positively associated with utilization of on-site social workers, formal services, and informal services. Study Design: The Rochester Housing Authority devotes four public housing high-rises to older adults in Rochester, NY. We will conduct a two-stage cross-sectional study and aim to recruit 174 public housing high-rise residents aged 60 years and older. During the first stage all residents living in the older adult high- rises will receive a brief general health questionnaire. We will provide residents with assistance in completing the questionnaire because illiteracy may be a barrier for some. Residents can elect to participate in a second stage survey, which will include all English-speaking residents aged 60 years and older who volunteer. The second stage consists of an in-depth, in-person interview that will assess anxiety and depression, demographics, early and current achievement, social integration, vulnerability/protective factors, life events, and coping methods, as well as service utilization. Anxiety and depression will be characterized categorically (i.e., syndromal and subsyndromal conditions) and dimensionally (i.e., symptom severity). We will use the Structured Clinical Interview for the DSM-IV (SCID) to diagnostically assess anxiety and depression, as well as brief survey scales to measure anxiety and depression symptom severity. Descriptive statistics and multiple regression modeling will address our aims. To our knowledge, this study will be the first to examine subsyndromal anxiety and depression, characterize on-site social worker utilization, and conduct an in-depth analysis of social engagement and support in elderly public housing residents; partial replication of a previous work describing psychiatric disorder prevalence, correlates, and service utilization in this setting will be additional contributions. Findings from the proposed research should be instrumental in describing the mental health burden and needs of this primarily minority population. Furthermore, this research may generate a novel and sustainable aging services-based method for using on-site social workers to increase access to care by identifying, referring (to existing primary care and behavioral health networks), or providing on-site care for anxious and depressed elderly public housing residents.
