The proposed Independent Scientist Award provides five years of salary support for Dr. Jeffrey Swanson to develop and carry out an integrated program of research, building on his previous work but incorporating new perspectives and methods to address several related topics: epidemiology of violence and psychiatric disorder, schizophrenia treatment effectiveness, decisional incapacity in severe mental illness (SMI), and implementation of psychiatric advance directives. First, he will conduct systematic comparative analysis of several datasets to provide a better understanding of the multifaceted problem of violent behavior that affects a proportion of persons with severe mental illness in the community. Second, he will use new data from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) to examine and compare the effects of treatment with specific antipsychotic medications on violence risk in persons with schizophrenia. Third, he will use CATIE data to investigate the extent to which, for some persons with SMI, fluctuating insight into illness and decisional incapacity may limit access to effective treatment that might otherwise prevent violent behavior. Fourth, Dr. Swanson's research will address the potential impact of a new legal instrument--psychiatric advance directives (PADs)--on violence and related outcomes for persons with SMI at risk of decisional incapacity, using data from 1-R01-MH63949-01 (Effectively Implementing Psychiatric Advance Directives.) As part of his career development plan, Dr. Swanson also proposes to work with experts in several disciplines to develop a theoretical model of violence, mental disorder, and treatment effectiveness. These experts will bring novel viewpoints and methods that will both deepen and broaden his intellectual endeavors: Dr. Sue Estroff in medical anthropology and social medicine; Dr. John Fairbank in medical psychology, trauma and substance abuse interventions; Dr. Martha Shumway in health psychology, mental health treatment outcomes and preferences measurement; and Dr. William Winslade in medical philosophy, ethics, and legal psychiatry. The proposed award will enable Dr. Swanson to concentrate his research career in the areas of his greatest interest and potential to make a significant contribution in the future; to conduct an integrated program of scholarship, synthesizing findings from his previous work and addressing important, inter-connected questions in new ways. Through additional R01-fundable projects to be developed, this work will lead eventually to better-targeted interventions and policies for reducing violence risk and improving quality of life for persons with SMI.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Scientist Development Award - Research (K02)
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Services Research Review Committee (SRV)
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Juliano-Bult, Denise M
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Duke University
Schools of Medicine
United States
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Swanson, Jeffrey W; McGinty, E Elizabeth; Fazel, Seena et al. (2015) Mental illness and reduction of gun violence and suicide: bringing epidemiologic research to policy. Ann Epidemiol 25:366-76
Wilder, Christine M; Elbogen, Eric B; Moser, Lorna L et al. (2010) Medication preferences and adherence among individuals with severe mental illness and psychiatric advance directives. Psychiatr Serv 61:380-5
Volavka, Jan; Swanson, Jeffrey (2010) Violent behavior in mental illness: the role of substance abuse. JAMA 304:563-4
Swanson, Jeffrey W (2008) Preventing the unpredicted: managing violence risk in mental health care. Psychiatr Serv 59:191-3
Swanson, Jeffrey; Van Dorn, Richard A; Swartz, Marvin S (2007) Effectiveness of atypical antipsychotics for substance use in schizophrenia patients. Schizophr Res 94:114-8
Wilder, Christine M; Elbogen, Eric B; Swartz, Marvin S et al. (2007) Effect of patients'reasons for refusing treatment on implementing psychiatric advance directives. Psychiatr Serv 58:1348-50
Elbogen, Eric B; Swanson, Jeffrey W; Appelbaum, Paul S et al. (2007) Competence to complete psychiatric advance directives: effects of facilitated decision making. Law Hum Behav 31:275-89
Swanson, Jeffrey W; Van McCrary, S; Swartz, Marvin S et al. (2007) Overriding psychiatric advance directives: factors associated with psychiatrists'decisions to preempt patients'advance refusal of hospitalization and medication. Law Hum Behav 31:77-90
Swanson, Jeffrey W; Swartz, Marvin S; Elbogen, Eric B et al. (2006) Facilitated psychiatric advance directives: a randomized trial of an intervention to foster advance treatment planning among persons with severe mental illness. Am J Psychiatry 163:1943-51
Swanson, Jeffrey W; McCrary, S Van; Swartz, Marvin S et al. (2006) Superseding psychiatric advance directives: ethical and legal considerations. J Am Acad Psychiatry Law 34:385-94

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