CONTINUITY OF CARE & OUTCOME OF SEVERE MENTAL DISORDERS

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A five-year research and educational program is proposed to prepare the principal investigator a career in mental health services research with a focus on patients with severe mental disorders. The candidate's long-term research goal is to apply the rigorous methods and analytic tools of epidemiology in services research for these patient groups and to investigate the optimal approaches to their care, especially in the early phases of the illness. Such knowledge will be essential for planning empirically-based services for this population. The program has two major components: an educational plan and a research project. The educational plan involves course work in epidemiology, biostatistics and mental health services research. In addition a group of highly experienced experts in psychiatric epidemiology, mental health services research, early intervention and schizophrenia research will provide tutorials, supervision and consultation. The research and educational programs will be pursued at the Department of Psychiatry, Columbia University, in collaboration with researchers in a number of other institutions. The research project aims to investigate the impact of continuity of care on the course and outcome of the first admission patients with schizophrenia and affective psychoses. The impact of early treatment career on the subsequent course and outcome of psychotic of psychotic disorders has attracted much attention in recent years. This project focuses continuity of care which is an essential element of the early treatment career. Continuity of care is defined here as the degree to which the service system links episodes of treatment in a seamless whole. The impact of continuity of care on the short- and medium term course and outcome of patients in two samples will be examined: a) the Suffolk County Mental Health Project (SCMHP), an epidemiological longitudinal study of first admission psychotic patients in Suffolk County, New York, and b) the National Collaborative Study of Early Psychosis and Suicide (NCSEPS), a large- scale study of first admission patients with schizophrenia and affective psychoses among US military personnel with follow-up through VA services. The project has four specific aims, the first three pertain to the SCMHP sample and the fourth to the NCSEPS. The specific aims are, 1) to describe the treatment career of patients with schizophrenia and affective psychoses; 2) to study the impact of continuity of care in the early course of illness on the 24- and 48-month outcomes; 3) To determine whether the impact of continuity of care on outcomes is similar for different diagnostic groups; and 4) in the NCSEPS sample, toe examine the impact of discontinuity in the care of servicemen and -women who are admitted for the first time in the military hospitals with a diagnosis of schizophrenia or affective psychosis and are referred to the VA system for continuation of treatment after discharge.