LONGITUDINAL STUDY IN PSYCHIATRIC EPIDEMIOLOGY

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The purpose of this proposal is to build on information gathered recently as part of a longitudinal investigation of psychiatric epidemiology among adult samples of a general population. The overall objective is to provide a 40-year perspective on historical trends regarding psychiatric disorders. The site in Atlantic Canada has been given the pseudonym of "Stirling County" for protection of identity. The specific aims are to continue analysis of the accumulated body of data and to prepare a series of reports in which findings from the study will be described and, where appropriate, compared with those of recent studies. The study involves three repeated cross-sectional sample surveys (1952, 1970, and 1992) and two panel follow-up intervals (1952-1970- and 1970- 1992). Time trends will be reported regarding prevalence, incidence, clinical course, and mortality outcomes among approximately 4000 subjects. Two types of information have been gathered from the beginning of the investigation: 1.) structured interviews with subjects concerning depression, anxiety, and medical conditions.; and 2.) semi-structured interviews by psychiatrists with general physicians who have been named by subjects and asked about the medical and psychiatric histories of these subjects. The recent wave of data-gathering included administration of sections of the NIMH Diagnostic Interview Schedule and the Modified Mini-Mental Status Examination. Findings from these schedules will aid comparison to studies such as the NIMH Epidemiologic Catchment Area Program and the National Comorbidity Study, especially for common disorders such as those involving depression, anxiety, alcohol abuse, and cognitive dysfunction associated with aging. The risk factors and trends to be investigated include: birth cohort effects, aging, gender, changes in the role of women, socio-economic status, family history of psychiatric disorders, marriage and family patterns, religious/ethnic identity, and comorbidity between psychiatric and medical disorders and also within the psychiatric spectrum. The effects of health policy changes will be investigated since Canadian national health insurance was introduced into the area at the mid-point of the study interval. Analysis of data will make use of multivariate techniques such as loglinear analysis, survival regressions, and structural equation modelling. Reliability and validity of psychiatric diagnoses will be assessed.