CSRD Research Career Scientist Award Application

Amy Byers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VA医疗保健高度相关并具有非常高的影响。50岁及以上的退伍军人 自杀死亡人数最多，占退伍军人人口的大多数（> 70%）。老年 成年人，特别是老年退伍军人积累了大量的生活经验，包括痛苦， 多种合并症，损失和创伤，影响他们的身心健康。进一步 增加了复杂性，精神卫生保健往往发生在非精神卫生环境的影响下， 个人和社会对精神疾病和衰老的观念和耻辱。拜尔斯博士的实验室 能够进行如此复杂的研究拜尔斯医生已经开发了一种深度的，临床相关的 了解晚年心理健康的性质、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 健康服务使用与年龄，老年抑郁症，老年生物统计学。特别是，理解 老年人/退伍军人的自杀相关结局需要完全不同的概念和方法 考虑，拜尔斯博士和她的团队是唯一有资格承担。有4个过度 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 奖励期：1）描述和确定卫生服务使用模式和诊断概况， 国家一级的老年人/退伍军人谁经历了晚年自杀或精神健康障碍; 2)确定晚年自杀的预测因素; 3）推进晚年自杀和心理健康研究， 突出的健康差距和弱势群体;以及4）推进自杀和神经精神病学研究， 退伍军人被监禁，并在以后的生活中返回社区。总而言之，前三个目标得到以下方面的支持： 正在进行的VA CSR&D优异奖（I 01 CX 001119; PI：Byers）。目标2和3进一步得到了 天才奖（PI：Byes）来自UCSF老年美国人独立中心（NIA资助的胡椒中心）。 Aim 4由NIMH Multi-PI R 01资助，并与密歇根大学的丽莎巴里博士合作。 康涅狄格州（MH 117604;多PI：拜尔斯/巴里）。此外，拜尔斯博士和巴里博士最近被授予 NIMH/NIA父母补助金的补充，以确定阿尔茨海默病和相关疾病的负担 有近期监禁史的老年人/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发表的高引用论文，以支持这些正在进行的活动。 仅举几例，她是第一个确定晚年情绪和焦虑症的高发生率的人， 在国家一级，首先确定和表征全国大多数（约70%）有情绪的老年人 或焦虑症没有使用精神卫生服务，首先确定退伍军人65 在自杀企图之前最后一次在初级保健中看到的年龄在10岁及以上的人，首先要在全国范围内确定 最近被诊断为轻度认知障碍的退伍军人自杀未遂风险增加的队列 或痴呆症（在JAMA精神病学出版），第一次提供证据表明激素治疗是一个指标， 中年至老年女性退伍军人的自杀风险（即使不依赖精神活性药物），以及 工作显示，从老年退伍军人过渡到老年退伍军人的随后自杀企图的风险增加了近5倍。 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， 晚年自杀风险（由I 01 CX 001119支持），包括“高风险”药物使用（即，苯并二氮杂， 镇静催眠药、阿片类药物、抗抑郁药、抗癫痫药和抗精神病药）和多种药物模式， 进行开创性的研究，以确定与老年人自杀风险有因果关系的特定药物， 老兵此外，她还积极开展更多关于弱势群体（女性、少数民族、无家可归者、 和创伤后应激障碍），包括退伍军人从监禁过渡到社区在以后的生活。

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.