POPULATION BASED PSYCHIATRIC INTERVENTION--PRIMARY CARE

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This is a request for an NIMH Independent Scientist Award (ISA). This grant builds on Dr. Katon's extensive research in developing cost- effective interventions to improve the quality of care of common psychiatric illnesses such as major depression within the primary care and the specialty medical systems and to improve understanding about the connection between affective and anxiety disorders, unexplained medical symptoms, health care utilization and costs, functional disability and quality of life. The research program builds on an R01 held by the applicant as well as other ongoing studies aimed at improving mental health care in medical systems. The four specific career goals that will be met by the ISA are: 1) to test the generalizability of the population-based disease management interventions that my research group hs developed and tested in urban HMO patients in other geographic, socioeconomic, and clinical populations; 2) To continue to extend my research teams' knowledge and expertise to provide cost-effective intervention for major depression to the 23 primary care clinics of Group Health Cooperative; 3) To develop cooperative ties with a multi-site research network or large managed care system in order to demonstrate that improving the treatment of major depression in patients with chronic medical illness will improve: habituation to aversive medical symptoms, functioning, quality of life, and adherence to medical regimens; and 4) To continue my extensive local and national mentorship of junior investigators. These goals will be met through continued and expanded research activities, collaborations with senior scientists both locally and nationally, and graduate level course work in epidemiology, health economics at the University of Washington School of Public Health. I propose specifically to increase my knowledge about population-based disease management methods that have been tested to improve the care of common medical illness such as hypertension and diabetes in the primary care system, increase my sophistication and knowledge in cost- effectiveness and cost-utility analysis, and improve the knowledge base of the field in measurement of indirect costs of depression such as decreases in work productivity and family burden. An ISA at this stage of the applicant's career will provide release from administrative responsibilities and will provide the time and resources needed to capitalize on an excellent network of senior investigators who will provide outstanding training activities and collaborative opportunities.