Epidemiology of Mental Disorders

Elmer L. Struening, Ph.D., Director
Patricia Cohen, Ph.D., Principal Research Scientist
Bruce G. Link, Ph.D., Research Scientist V
Howard Andrews, Ph.D. Research Scientist V
Daniel Herman, D.S.W., Research Scientist IV
Susan Barrow, Ph.D., Research Scientist III
Rodrick Wallace, Ph.D., Research Scientist III
Fredric Hellman, B.A., Program Evaluation Specialist II


Overview
The research of the Epidemiology of Mental Disorders Department is focused on two areas: 1) risks influencing the onset and course of mental disorders and 2) factors affecting the quality of life of persons with mental disorder in the community. In addition to the research in these areas, members of the Department provide data management and statistical services to a number of major research studies at Psychiatric Institute and the Columbia Medical Center (the Data Coordinating Center), helped to develop and actively participate in PI's Research Information Services Consortium, and oversee the Psychiatric Epidemiology Training program.

Research
In a study of 461 caregivers of persons with serious mental disorders (primarily schizophrenia and bipolar disorder) Elmer L. Struening, Deborah A. Perlick, Bruce G. Link, Fredric Hellman, Daniel Herman and Jo Anne Sirey found that 70 percent of all caregivers indicated a belief that most people devalue consumers and 43 percent expressed a belief that most people also devalue the families of consumers. In view of the strong research evidence that the caregiver role is very demanding, often distressing and sometimes harmful and injurious to the quality of the caregiver’s life, it was concluded that the development and implementation of effective interventions to create more supportive and understanding communities would be a challenging and worthwhile endeavor.

Among the findings from the Children in the Community longitudinal study that appeared this year were several emphasizing the fact that mental disorders in childhood have strong implications for adult health and function. These include an article in the Archives of General Psychiatry demonstrating a relationship between adolescent major depression and adult personality disorder. Childhood risks also had long term effects, including adult onset of panic and other anxiety disorders in adolescent smokers as described in a JAMA article and persistent effects of maladaptive parental behavior, child abuse or neglect, and parental conflict on the risk of adult psychopathology and criminal behavior of offspring.

A new study of the mothers of the Children in the Community cohort was funded by NIMH in this year. This investigation, led by Stephanie Kasen and Pat Cohen, is employing the 25 years of data on these women as a base for new explorations of the major factors influencing changes in the well being of women in the general population over the middle decades of their lives. In addition, this year saw the completion of a National Institute of Justice investigation of the longitudinal sample of offspring, with several studies submitted for publication, and the onset of fieldwork for the NIMH-funded sixth wave of interviews to be completed as they reach their early 30's.

Dr. Bruce Link continued his program of research focusing on the connection between mental illnesses and violent behaviors, the role of stigma in the lives of people with mental illnesses and their families, and on the connections between social inequality and health and mental health. Together with Dr. Peter Bearman from the Graduate School of Arts and Sciences Faculty Dr. Link successfully competed to procure one of six Robert Wood Johnson Health and Society Scholars Postdoctoral Programs. The program provides 4.5 million dollars over 5 years to train fellows in population health. In his work on stigma Dr. Link was asked by NIMH to prepare a “whitepaper” on the measurement of stigma in the area of mental illnesses. During the past year Dr. Link and his colleagues successfully competed to attain five more years of funding for the Psychiatric Epidemiology Training Program thereby insuring the continuation of the longest running and largest such program in the nation. Finally, in a research project funded by the New York State Department of Mental Hygiene Dr. Link is conducting a naturalistic follow-up study of persons enrolled in New York States outpatient commitment program. The five-year project will provide information to policy makers about the success of this program in New York State.

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 on service delivery for adults with severe mental illness. He is conducting a five year randomized trial of a psychosocial intervention (Critical Time Intervention) designed to prevent homelessness among severely mentally ill men and women following discharge from state hospitals. Dr. Herman is also collaborating with researchers from the Nathan Kline Institute for Psychiatric Research on another study of Critical Time Intervention with homeless families.

Following September 11, 2001, Dr. Herman led a state funded effort to assess the level of mental health need in the population of the state resulting from the attacks. He was the lead author on a report of this assessment that was submitted by the NYSOMH to the Center for Mental Health Services of the US Department of Health and Human Services. Dr. Herman continues to be involved in research related to documenting service needs resulting from the terror attacks and in evaluating the impact of services provided in this area.

Dr. Susan Barrow has continued her research on housing and long term homelessness. During the second year of a mixed method four city study, she and Gloria Soto Rodriguez completed a second wave of data collection on service engagement and housing outcomes for 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 on an outcome study comparing supported housing models and clinically managed residential alternatives, funded through a multi site Cooperative Agreement administered by SAMHSA’s Center for Mental Health Services. She and Dr. Hopper are currently analyzing data on community integration from an ethnographic study of the housing models. In a second collaborative project with the Center, Dr. Barrow has studied caretaking and custody arrangements for children of mentally ill mothers residing in NYC shelters for single adults, finding that a variety of supports (income support, drug treatment, child care by maternal relatives) were significantly associated with continued mother child contact, despite homelessness and separation. In 2001, Dr. Barrow also collaborated with Dr. Judith Samuels of NKI to initiate a study of family composition, separation and reunification in homeless families in Westchester County

Dr. Rodrick Wallace continued work on an information dynamics model of how structured psychosocial stress literally writes itself onto immune function and other fundamental biological processes in human populations. Work has begun on extending the model to prostate and breast cancer. Preliminary results indicate that structured psychosocial stress in human populations is as important to the basic biology of cancer as oncogenes and T cells.