This application is designed to provide the candidate with the skills necessary to improve the care of patients with anxiety disorders presenting to providers in primary care (PC) settings. While there is a growing body of work examining the need for care, processes of care, and outcomes of care for patients with depressive disorders in PC settings, there are few published studies providing similar information about patients with anxiety disorders. The focus of the proposed research is panic disorder(PD), a severely disabling condition which is highly prevalent in PC settings. PD is common among high utilizers of PC services and among PC patients who are perceived as """"""""difficult-to- treat"""""""" by their clinicians. Yet the limited available data suggests that PD is frequently not recognized and that the rate of recovery from this illness in PC populations is low. We know little about the factors which contribute to these poor recognition and recovery rates. There is evidence to suggest that African American patients with PD experience unique barriers to care and are even more likely than other racial groups to present with panic symptoms to PC providers. Yet there is no available empirical work that sheds light on the process of care or illness outcomes for this group. Another barrier to research in this area is the absence of validated psychometric tools for assessing PD in PC settings. Finally, there is an absence of a practical approach to identification of the targeted population. Therefore, the major goals of this proposal are to (1) explore fundamental issues regarding the processes and outcomes of services provided to patients with PD served in PC settings; (2) validate instruments for clinical and research use in this population; and (3) to develop a practical approach to case identification. New knowledge gained from this research will subsequently inform the development of PC interventions that will improve the quality of care provided for patients with PD in PC settings. In order to develop the skills necessary for carrying out this research the candidate will implement a program which will provide an opportunity for mentoring from experts in PCservices research and anxiety disorders in African Americans, as well as supervision with research methods and statistics and the use of computer technologies for applying psychometric instruments. The candidate's short-term career goal is to become an independent investigator studying the processes, cultural appropriateness, and outcomes of care for patients with PD in PC settings. His long-term goal is to develop effective and efficient interventions to improve the quality of PC services for individuals of different racial groups with panic and other anxiety disorders. The proposed research will be carried out in a set of three PC clinics which together serve large patient populations of both African Americans and Caucasians from all socioeconomic groups.
| Johnson, Michael; Mills, Terry L; Deleon, Jessica M et al. (2009) Lives in isolation: stories and struggles of low-income African American women with panic disorder. CNS Neurosci Ther 15:210-9 |
| Frueh, B C; Dalton, M E; Johnson, M R et al. (2000) Trauma within the psychiatric setting: conceptual framework, research directions, and policy implications. Adm Policy Ment Health 28:147-54 |
