INCOME MAINTENANCE DEPENDENCE & SERVICE SYSTEM USE: II

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In this proposed continuation of a longitudinal cohort study of persons early in their careers with severe, persistent mental illnesses, we will extend, refine, and expand upon the current investigation of' resistance or concession to chronicity, and pathways to disability, income application and receipt. The focus of this inquiry is the constellation of clinical, social, and service system factors that in complex interaction influence profoundly the life and illness courses of individuals with enduring psychiatric disorders. The specific purposes of the study are: 1) Extending the follow up period from two to five years for the 165 individuals currently comprising the study cohort; 2) Recruiting 120 new subjects, using the same criteria, procedures, and protocols to expand the sample, and to be followed for an initial period of three years; 3) Testing sociometrically and psychometrically and refining the instruments and methods developed for and in use in the current study; 4) Adding protocols for assessing alcohol and drug use, tardive dyskinesia, and violence towards others to the survey instruments, and obtaining an independent DSM III-R diagnosis for all study participants; 5) Initiating a comparative analysis on common key variables with two comparable cohorts assembled by two different investigators in two different service system settings; and 6) Developing further a conceptual and theoretical framework for understanding how clinical, social, and service system factors may contribute to the development of chronicity and disability on one end of the spectrum or to recovery and rehabilitation on the other, with fluctuations and variations in course in between. The investigation examines in the prospective, longitudinal mode, the unfolding, disrupted biographies of individuals with potentially disabling mental illnesses, assessing their adaptations and explanations about themselves and their disorders. Relatives and significant others are also interviewed in order to assess their roles in the disability income process and their contributions to the patients' daily lives.