CSRD Research Career Scientist Award Application

艾米·拜尔斯博士的研究主要集中在老年退伍军人的自杀预防上。这项工作是 与退伍军人和退伍军人医疗保健高度相关，并对其产生非常大的影响。50岁及以上的退伍军人 自杀死亡人数最多，占退伍军人总数的70%。更老的 成年人，尤其是年长的退伍军人积累了大量的生活经验，包括痛苦 多种并存、损失和创伤，这些都会影响他们的身心健康。走得更远 增加复杂性的是，精神卫生保健经常发生在非精神卫生环境中，受 关于精神疾病和衰老的个人和社会观念和污名。拜尔斯博士的实验室独一无二 定位于在这种复杂程度上进行研究。拜尔斯博士已经开发出一种深度的、临床上相关的 了解晚年心理健康的本质、过程、治疗和影响。她的研究涵盖了 晚年心理健康的多个子领域，即晚年自杀、晚年创伤后应激障碍、精神 卫生服务使用年龄、老年性抑郁症和老年学生物统计学。尤其是，理解 老年人/退伍军人的自杀相关结果需要有很大不同的概念和方法 考虑，拜尔斯博士和她的团队是唯一有资格承担的。有4个拱顶 拜尔斯博士在拟议的研究职业科学家期间将积极追求的研究领域和目标 获奖期：1)描述和确定卫生服务的使用模式和诊断概况 在国家一级，在经历过晚年自杀或精神健康障碍的老年人/退伍军人中； 2)找出晚年自杀的预测因素；3)推进晚年自杀与心理健康的研究 突出的健康差距和弱势群体；以及4)推动自杀和神经精神病学研究 退伍军人被监禁，并在以后的生活中重返社区。总而言之，前3个目标得到以下支持 正在进行的退伍军人事务部CSR&D功勋奖(I01 CX001119；PI：Byers)。目标2和目标3进一步得到了一个 加州大学旧金山分校老年美国人独立中心(NIA资助的胡椒中心)颁发的天才奖(PI：BYES)。 AIM 4得到了NIMH多PI R01赠款的支持，该基金与加州大学的丽莎·巴里博士合作 康涅狄格州(MH117604；多PI：拜尔斯/巴里)。此外，拜尔斯博士和巴里博士最近获得了 NIMH/NIA父母补助金补充，以确定阿尔茨海默病和相关疾病的负担 老年人/有近期监禁史的退伍军人的疾病。有许多开创性的贡献 拜尔斯博士实验室在高影响力期刊上高被引用的论文，以支持这些正在进行的活动。 举几个例子，她是第一个确定老年情绪和焦虑症发生率较高的人 国家一级，首次在全国范围内确定和描述大多数(~70%)有情绪的老年人 或者焦虑症没有使用精神健康服务，首先确定了退伍军人65的共病特征 在自杀未遂之前最后一次在初级保健中心看到的人，第一次在国家 新近诊断为轻度认知障碍的退伍军人自杀未遂风险增加 或痴呆症(在《美国医学会精神病学》杂志上发表)，第一次提供了激素治疗是 中年女性退伍军人(甚至不依赖精神活性药物)和精液的自杀风险 一项研究显示，从退伍军人过渡到退伍军人的老年人随后自杀未遂的风险增加了近5倍 从监狱到社区。拜尔斯博士正在研究其他独特的潜在标志物和预测因子模式 晚年自杀风险(由I01 CX001119支持)，包括“高风险”药物使用(即苯二氮卓类药物， 镇静剂-催眠药、阿片类药物、抗抑郁药、抗癫痫药和抗精神病药物)和多药联用模式， 并进行开创性研究，以确定特定药物与老年人自杀风险的因果关系 退伍军人。此外，她还积极开展对弱势群体(女性、少数族裔、无家可归者、 和创伤后应激障碍)，包括退伍军人在以后的生活中从监禁过渡到社区。

Dr. Amy Byers’ research is predominately focused on suicide prevention in older Veterans. This work is highly relevant to and has very high impact on Veterans and VA healthcare. Veterans 50 years and older have the highest number of lives lost to suicide and make up the majority (> 70%) of the Veteran population. Older adults and, in particular, older Veterans accumulate a significant amount of life experiences, including suffering multiple comorbidities, losses, and traumas, that impact their mental and physical well-being. Even further adding to the complexity, mental health care often occurs in non-mental health settings under the influence of personal and society notions and stigmas about mental illness and about aging. Dr. Byers’ Lab is uniquely positioned to conduct research at this level of complexity. Dr. Byers has developed a deep, clinically relevant understanding of the nature of mental health in late life, its course, treatment and impact. Her research covers multiple sub-areas of late-life mental health, i.e., late-life suicide, late-life posttraumatic stress disorder, mental health services use with age, geriatric depression, and gerontological biostatistics. In particular, understanding suicide-related outcomes in older adults/Veterans requires substantially different conceptual and methodologic considerations, which Dr. Byers and her team are uniquely qualified to undertake. There are 4 over-arching research areas and Aims that Dr. Byers will actively pursue during the proposed Research Career Scientist Award period: 1) To characterize and identify patterns of health services use and diagnostic profiles at a national level among older adults/Veterans who have experienced late-life suicide or mental health disorders; 2) To identify predictors of late-life suicide; 3) To advance late-life suicide and mental health research in prominent health disparity and vulnerable groups; and 4) To advance suicide and neuropsychiatric research in Veterans incarcerated and returning to community in later life. In summary, the first 3 Aims are supported by an on-going VA CSR&D Merit Award (I01 CX001119; PI: Byers). Aim 2 and 3 are further supported by a Genius Award (PI: Byes) from the UCSF Older Americans Independence Center (NIA-funded Pepper Center). Aim 4 is supported by a NIMH Multi-PI R01 grant in collaboration with Dr. Lisa Barry from University of Connecticut (MH117604; Multi-PI: Byers/Barry). Additionally, Dr. Byers and Dr. Barry were recently awarded a NIMH/NIA Supplement to the parent grant to determine the burden of Alzheimer’s disease and related diseases in older adults/Veterans with a recent history of incarceration. There are many seminal contributions by Dr. Byers’ Lab in terms of highly cited papers in high impact journals in support of these on-going activities. To name a few, she was the first to determine the high occurrence of late-life mood and anxiety disorders at a national level, first to determine and characterize nationally that the majority (~70%) of older adults with mood or anxiety disorders did not use mental health services, first to identify comorbidity profiles in Veterans 65 years and older who were last seen in primary care prior to a suicide attempt, first to determine in a national cohort that risk of suicide attempt was increased in Veterans recently diagnosed with mild cognitive impairment or dementia (in press at JAMA Psychiatry), first to provide evidence that hormone therapy is an indicator of suicide risk among midlife to older women Veterans (even independent of psychoactive drugs), and seminal work showing a nearly 5-fold greater risk of a subsequent suicide attempt in older Veterans transitioning from prison to community. Dr. Byers is investigating other unique patterns of potential markers and predictors of late-life suicide risk (supported by I01 CX001119), including “high-risk” medication use (i.e., benzodiazepines, sedative-hypnotics, opioids, antidepressants, antiepileptics, and antipsychotics) and polypharmacy patterns, and conducting seminal research to determine specific medications causally linked to risk of suicide in older Veterans. Moreover, she is actively pursuing more research on vulnerable groups (female, minority, homeless, and PTSD), including Veterans transitioning from incarceration to community in later life.