New to this CRC, the Psychosocial Core creates the unique opportunity to investigate psychosocial measures in longitudinal studies of geriatric affective disorder in patients who have received rigorous biological and clinical assessments. Inclusion of these psychosocial assessments will augment the CRC's productivity by making possible investigation into previously unstudied aspects of individuals and their environment with course and outcomes of late life affective illness. Specifically, the Psychosocial Core provides training, consultation, assessment and methodological development of psychosocial constructs for use throughout the CRC. The Psychosocial Core itself will test hypotheses which extend CRC outcomes to include the patient's """"""""adaptation"""""""" to the potentially chronic course of affective illness. The Core will assess indicators of adaptation especially pertinent to the quality of life in older adults: a) disability; b) social functioning, and c) psychosocial well-being. We will investigate the contribution of biological and clinical factors to these outcomes and test the hypothesis that variation in adaptation identifies current heterogeneity in geriatric mood disorder. The Core will also assess two sets of psychosocial risk factors: a) patient characteristics (i.e., sociodemographic factors, personality, and coping strategies), and b) aspects of the patient's environment (i.e., life adversity and social support). The Psychosocial Core will investigate the extent to which the patient's environment mediates the effect of clinical factors on adaptations and the extent to which characteristics of both the individual and the environment modify the impact of clinical factors on outcomes. We will work with other CRC Cores to test the potential mediating and modifying contribution of psychosocial variables in their investigations into the course and outcomes of geriatric mood disorders. Psychosocial variables are important to the study of geriatric mood disorder as they extend CRC findings beyond the clinic walls to the home and community life of the older patient. We explicitly examine outcomes relevant to day-to-day quality of life and to longer term outcomes such as dependence, institutionalization, and survival. We also examine ways in which non-clinical aspects of a patient's life influence the course and outcomes of affective illness. These investigations will yield a richer understanding of underlying heterogeneity in geriatric mood disorder and build a foundation for targeted psychosocial interventions.
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