This is a revised application for a Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders (1 P30 MH 52247-01)/. The MHCRC/LLMD expands and integrates our current research program in geriatric affective disorders by serving a diversified portfolio of R01's, institutional training grants, and individual career-development awards related to late-life mood disorders. In response to the November, 1993 summary statement, the number of new projects has been reduced by one third, and the service and training missions of the center have been strengthened. As reflected in our current research ams, we believe that there are many pathways to and from depression in late life and many determinants of outcome. (The major research mission of the MHCRC/LLMD is to map pathways and to model variation in outcomes such as wellness, recurrence of depression, suicide, and placement in long-term care. Determinants of outcome fall into several broad domains: medical/psychiatric, psychosocial, cognitive, neurobiologic, and pharmacologic. These domains have governed our choice of cores and have guided the design of the MHCRC/LLMD asssessment battery.) Using a center-wide care registry and a relational database, we propose a long-term follow-up (three years) of all patients coming into the MHCRC/LLMD to document illness course and outcomes. Long- term follow-up will also track changes in social support, in medical burden,a nd in cognition as well as life events and treatment for mood disorders. These variables are hypothesized to mediate and/or moderate various outcomes, although some (such as medical burden and cognitive change) are important outcomes in their own right. (The major hypotheses of the MHCRC/LLMD are longitudinal and integrative, using measures from each conceptual domain of the assessment battery.) more specific hypotheses are tested within each core. We predict that severity of medical burden, of cognitive impairment, and of psychiatric co-morbidity will be related to poor course and outcome; whereas level of social support and integration will influence or moderate the relationship between depression and overall functional impairment.
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