DESCRIPTION (provided by applicant): This application lays the foundation for the Sri Lanka Healthy Minds Study (SLHMS), a new collaborative research project between Duke University and the Faculty of Medicine at the University of Ruhuna that aims to describe the epidemiology of depression and cognitive impairment among elderly Sri Lankans. The SLHMS will be a population based study where individual, caregiver, and other family level factors will be examined using a lifecourse perspective to better understand depression risk and its influence on cognitive impairment. An important goal of our current proposal is to build sustained research capacity and technical expertise in epidemiological research at the University of Ruhuna in order to facilitate the SLHMS as well as other long term collaborative projects. While Sri Lanka is one of Asia's most rapidly aging countries, there is a lack of epidemiological data on the most common neuropsychiatric conditions among the elderly in Sri Lanka and it is this gap that our research program plans to address. A recent estimate of 28% depression among those over 60 is especially troubling, as the condition is associated with significantly worse prognosis of most other health problems, including cognitive impairment and its associated disability. The overarching goal is to both describe the epidemiology of depression and cognitive impairment and to identify modifiable psychosocial factors, which can be utilized in future health promoting efforts as well as healthcare resource allocation. The specific aims of this proposal are to: (1) use qualitative methods to examine local understanding of depression and cognitive decline among elderly in Sri Lanka, concepts such as successful aging and attitudes towards mental illness; (2) validate measures of depression and other constructs to be used in a household survey; (3) pilot a household survey to establish feasibility and generate preliminary data for R01 submission, and (4) develop the research capacities at the University of Ruhuna which will lead to long term research collaborations. Our long term research goal is to examine prospectively the role of the caregiver and other family members in relation to the depression and cognitive impairment status of the elderly family member. Ultimately, we hope that our findings will provide concrete evidence to guide cost-effective, community based interventions to prevent, or ameliorate the impact of, depression and cognitive impairment among Sri Lankan elderly. PUBLIC HEALTH RELEVANCE: The quickly aging population of a developing country like Sri Lanka poses significant challenges to not just the health care system but the traditional systems of caregiving as well. It is imperative to identify the culturally salient risk and protective factors against the most common neuropsychiatric problems of this population, namely depression and cognitive impairment. The proposed study aims to elucidate these factors, which can then serve as building blocks for health promoting interventions and policies.

The quickly aging population of a developing country like Sri Lanka poses significant challenges to not just the health care system but the traditional systems of caregiving as well. It is imperative to identify the culturally salient risk and protective factors against the most common neuropsychiatric problems of this population, namely depression and cognitive impairment. The proposed study aims to elucidate these factors, which can then serve as building blocks for health promoting interventions and policies.