The National Collaborative Study of Early Psychosis and Suicide (NCSEPS), conducted in conjunction with the Department of Defense (DoD) and the Department of Veterans Affairs (VA), investigates active duty personnel hospitalized for bipolar disorder, major depressive disorder, or schizophrenia while in the military, and a set of control personnel. The initial goals of the NCSEPS were 1) to assess the characteristics of those hospitalized for these disorders; 2) to determine the rates of these illnesses; 3) to detect and decrease the occurrence of long-term morbidity associated with these disorders; 4) to determine what benefits result from early intervention in patients first manifesting the symptoms of these disorders; and 5) to decrease the risk of suicide in those affected by the disorders. The Armed Forces are an excellent context to study these disorders given evidence that mostly of those affected by psychosis during military service become so early in their military careers at an age of highest risk for developing schizophrenia and bipolar disorder. It also provides an opportunity to study the benefits of early intervention. The controlled environment additionally gives a unique opportunity to offer therapy and to follow those individuals prospectively through the VA system. NCSEPS has amassed hospitalization data and sociolodemographic characteristics on approximately 13,000 patients and more than 135,000 controls. These data are a unique resource that will provide essential comparative data with US Armed Services colleagues, and may be expanded through additional years of follow up using the same methods. Great care has been given to cleaning the database and creating a codebook to subsequent analysis. Published findings and ongoing analyses include the following: HEIGHT, WEIGHT, BMI, AND DIAGNOSIS. Researchers investigated the relationship between body type (height, weight, and BMI) and psychiatric diagnoses. No differences were found between patients with the psychiatric disorders (N=7500) and controls (n=86,000) [Psychological Medicine 33: 363-368]. USE OF VA SERVICES BY THE NCSEPS SAMPLE. Demographic and diagnostic variables were examined to discern patterns of use of VA mental health outpatient services in 2,500 patients who were hospitalzed with bipolar disorder, major depressive disorder, or schizophrenia while on active duty and subsequently discharged from the military. Patients were followed for at least two years and were eligible for VA services. Fifty-two percent received outpatient care. Those with schizophrenia or bipolar disorder, women, and older individuals were more likely to seek VA care [Psychiatric Services 54: 383-388]. FIRST HOSPITALIZATION FOR BIPOLAR DISORDER, MAJOR DEPRESSIVE DISORDER, AND SCHIZOPHRENIA IN ACTIVE DUTY MILITARY PERSONNEL. The incidence of first hospitalization for these disorders was found to be 2.0 per 10,000 for bipolar disorder, 7.2 per 10,000 for major depressive disorder, and 1.6 per 10,000 for schizophrenia in active duty personnel. This large sample (n=8,700 patients) provides an important addition to the literature of mental illness in the military. This manuscript is nearly complete for submission for publication. ALL CAUSE MORTALITY AND SUICIDE IN THE ARMED FORCES. Data on mortality for all patients and a sample of controls was submitted to the National Death Index (NDI). All cause mortality and especially death by suicide are substantially elevated in those who were hospitalized for severe psychiatric disorders. It has been decided that this paper will gain substantial value with a longer period of follow-up, and the request will be resubmitted to extend the number of years searched in the NDI database. THE IMPACT OF LIFE EVENTS ON THE DEVELOPMENT OF PSYCHIATRIC DISORDERS. With collaborators at Walter Reed Army Medical Center (WRAMC), NCSEPS researchers reviewed medical boards for 74 individuals hospitalized at WRMAC who developed one of the index disorders within the first year of their medical service. Eighty percent had a new psychosis. Onset occurred about 180 days into the term of duty. Precipitant stressors were not apparent for these patients. SCHIZOPHRENIA AND SEASON OF BIRTH. Much research has indicated an effect of season of birth on the incidence of schizophrenia. This large sample of patients with this disorder will provide an excellent sample to replicate and evaluate these early findings. PSYCHOMETRIC AND RELIABILITY STUDIES. Measures used in evaluation of new recruits and multiple assessment of patients' diagnoses are being evaluated for their psychometric properties and reliability.
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