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Epidemiology of
Mental Disorders
Elmer L. Struening, Ph.D., Director
Dr. Struening, with Dr. Lawrence Welkowitz and colleagues, conducted a study of 5867 participants who attended a nation-wide anxiety screening program, and who had never received mental health treatment. This study focused on those subjects who indicated, on the research questionnaire, that they had been suffering from symptoms of obsessive-compulsive disorder. In other words, they had, during the last thirty days, exhibited either compulsive behaviors, obsessive, or both. Those who had neither type of symptoms comprised the comparison group. Significant differences were found between the groups in interference with daily living, readiness for treatment, and number of comorbid anxiety problems. These findings shed light on the extent to which undiagnosed and untreated persons with obsessive and/or compulsive symptoms experience other psychiatric disorders, a decline in daily functioning, and the desire to obtain treatment.
Dr. Mark Olfson, with Dr. Elmer L. Struening, Mary Guardino, Fredric Hellman, and colleagues, conducted a study of Barriers to The Treatment of Social Anxiety, using the data from the 1996 National Anxiety Disorder Screening Day. Those persons with both social anxiety symptoms (N=6,130) were compared to those with neither of the social anxiety symptoms (A=4,507). The results of the study showed that social anxiety was strongly associated with functional impairment, feelings of social isolation, and suicidal ideation. Regarding barriers to treatment, it was found that those subjects with symptoms of social anxiety were significantly more likely to report that financial barriers, uncertainty over where to go for help, and fear of what others might think or say prevented them from seeking treatment. The authors conclude that treatment access for persons suffering from social anxiety could be improved by building public awareness of local available services, easing the psychological and financial burdens of entering treatment, and increasing health care professionals' skill in detecting clinically significant social anxiety.
Drs. Patricia Cohen, Stephanie Kasen, Jeffrey Johnson, Henian Chen, Jocelyn Brown, and collegues began the 26th year of the Children in the Community (CIC) longitudinal study of risks for and course of psychopathology from early childhood to adulthood. Field work began on the final stages of the coordinated methodological study of memory and psychopathology effects on the retrospective reports of life experiences of young adults in an NIMH funded study. At a conference on Violence against Women and Family Violence, using data collected under funding by the National Institute of Justice, Dr. Cohen reported findings based on official records of arrest and history of child abuse or neglect. Findings on risks predicting the longitudinal course of personality disorder from adolescence to young adulthood were also presented by Dr. Cohen at the American Psychiatric Association annual meeting and at invited sessions of other mental health groups. With new four-year funding from the NIMH, the group began preparing for a sixth wave of interviews of this cohort, now in their fourth decade of life.
Among the more highly noted papers published this year from this group was an article in the Journal of the American Medical Association (first authored by Dr. Johnson) in which it was shown that adolescent smoking was an independent risk for several newly diagnosed anxiety disorders in adulthood, particularly panic disorder. Another article of particular interest, published in the Journal of Quantitative Criminology (first author Dr. Cohen), was based on the detailed narrative interviews of young adults. This study showed that high financial independence of youth between the ages of 17 and 27 was a risk for arrest, but that these arrests tended to occur in the month following low financial self-support. The study was unusual in showing short-term and long-term effects of a risk to work in opposite directions.
Dr. Cohen also continued her work with the panel on Youth Crime and Justice of the National Research Council, and chaired a select panel for NIH to evaluate the evidence regarding the protective effects of condoms in preventing STDs.
Dr. Link is the Principal Investigator of a new National Academic Center of Excellence that is funded by the Centers for Disease Control and focused on youth violence prevention research. The Center Grant includes three research grants plus core funding. The goal of the center is to develop a research-based understanding of youth violence with the aim of developing a multi-level intervention plan designed to reduce such violence.
Together with Dr. Jo Phelan, Dr. Bruce Link is working on a study of stigma funded by the Ethical, Legal and Social Issues (ELSI) of the National Institutes of Health Human Genome Project. This project examines the impact of knowledge about genetic etiology of major mental disorders on stigmatizing responses to persons with such disorders. The study includes both a large nationally representative survey and a smaller qualitative study of persons from five ethnic groups (Puerto Rican, Mexican American, African American, Chinese American, and Italian American).
Dr. Link continues his work on the connection between psychosis and violent behaviors and plans future research focused on determining the clinical significance of epidemiological findings showing such a connection. Dr. Link also continues his research on the social determinants of health and mental health through a Robert Wood Johnson Health Policy Investigator Award and also continues as Director of the NIMH-funded Psychiatric Epidemiology Training Program.
Dr. Howard Andrews, Director of the Data Coordinating Center (DCC), continues to provide comprehensive data management and/or statistical services to a number of major research initiatives, at Psychiatric Institute and the CPMC campus. These projects include (with principal investigators indicated in parenthesis): the HIV Center (Anke Ehrhardt, Ph.D.), the Child Environmental Health Center (Frederica Perera, Ph.D.), the Prevention of Alzheimer's Disease with Estrogens clinical trial (Mary Sano, Ph.D.), the Washington Heights/Inwood Columbia Aging Project (Richard Mayeux, M.D.), and the Childhood Transitions Study (Patricia Cohen, Ph.D.). With colleague Dr. Virginia Rauh, Dr. Andrews is also pursuing his own research focused on the impact of perinatal and community risk factors on cognitive and emotional development. Dr. Andrews, in collaboration with Psychiatric Institute's Chief Information Architect, Gerry Segal, has developed the Research Information Services Consortium (RISC). RISC has developed a number of research systems that take full advantage of recent advances in information technology. These applications include web-based data entry and data management systems and web-based screening.
Dr. Daniel Herman continued his research focusing on service delivery for adults with severe mental illness. He received a five-year NIMH RO1 award entitled Critical Time Intervention in the Transition from Hospital to Community to conduct a randomized controlled trial of a psychosocial intervention designed to prevent homelessness among severely mentally ill men and women following discharge from a state hospital. This study is being carried out in close collaboration with the New York State Office of Mental Health, which is providing considerable in-kind support.
Dr. Susan Barrow has continued her research on housing and long-term homelessness. During 2000, Dr. Barrow and Gloria Soto Rodriguez completed a first wave of program-level data collection on approaches to service engagement and housing in a mixed-method four-city study of multiply disabled adults with long-term homelessness. Dr. Barrow has also continued to collaborate with Drs. Carole Siegel and Kim Hopper at NKI's Center for the Study of Issues in Public Mental health in an outcome study comparing supported housing models and clinically managed residential alternatives, funded through a multi-site Cooperative Agreement administered by SAMSHA's Center for Mental Health Services. With Dr. Hopper she has directed an ongoing ethnographic study of the housing models. Initial ethnographic findings have been applied to a cross-site assessment of the validity of population descriptors and outcome measures. Current work is examining within-model variability on critical dimension of housing and services; the consequences of neighborhood variables for fidelity to housing models; and the ways critical concepts ("recovery," "support," "community") are operationalized across housing settings. In a second collaborative project with the Center, Dr. Barrow has been completing analyses of caretaking and custody arrangements for children of mentally ill mothers residing in NYC shelters for single adults, to be followed by an exploratory field study of parent, caretaker, and clinical perspectives on the parenting practices through which homeless women diagnosed with severe mental disorders remain involved with their children.
In 2000, Dr. Wallace completed his studies under an Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation, work which focused on the "failure of containment" which ensures the diffusion of "inner city problems" into the suburbs. He has begun using an information theory formalism adapted from statistical mechanics to study certain classes of mental disorder as the perturbation of a canonical condensation between a neural network, seen as an information source, in a general sense, and an embedding culture, also seen as a generalized language. This work resulted in a conventional published paper, a posted electronic manuscript, and a completed book manuscript, which is now being circulated to publishers.
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