The revision includes new details on hypotheses, severe mental disorders, race/ethnicity, attrition, and schedule. The Epidemiologic Catchment Area (ECA) cohorts, interviewed from 1979-1983, are the earliest in the nation to include a wide range of psychopathology according to operational diagnostic criteria. Follow-up of the ECA cohorts after 25 years provides unprecedented opportunity to study consequences of common mental disorders in community samples. The proposed research strategy is to enrich ECA data via linkage to available record systems. One consequence is mortality. The 11,519 individuals interviewed in the first three ECA sites (New Haven, Baltimore, and St. Louis) will be linked to the National Death Index Plus (NDI+) from 1979-2008, generating more than 260,000 person years of risk. The NDI+ identifies respondents who have died and provides the contents of the death certificate, including causes of death according to ICD codes. The literature on mortality and mental disorder has focused on psychiatric treatment, including only scant data on mortality among persons with common mental disorders in the general population. A second consequence is costs. There are extensive data in the Baltimore ECA site interviews in 1981, 1982, 1993, and 2004 on reports by the respondent of use of health care facilities. The 1920 subjects from the 1993 Baltimore ECA site follow-up will be linked to Medicare and Medicaid records for the years 1995-2004 to improve estimates of direct costs. Extensive reports of employment, marital, and socioeconomic status, as well as of disability and functioning, will help estimate indirect costs. Data on mortality will be incorporated into estimates of indirect costs. These data will be enriched by linking Baltimore ECA respondents to records of the Maryland Department of Motor Vehicles and the Maryland Criminal Justice System. There are no similar estimates of costs of common mental disorders available. A third type of consequence is non-monetary, involving social functioning and psychological well being. The population-based sample in Baltimore, diagnostically-oriented interviews at baseline, and follow-up interviews one and two decades after baseline, with a wide range of measures of mental and social functioning, facilitate documentation of these consequences. Mortality, costs, and non-monetary costs of mental disorders are affected by treatment. Data on treatments received reported in the Baltimore cohort will facilitate exploration in a community setting of the long-term consequences of receiving, or not receiving, treatment for common mental disorders.
This project will provide the most accurate estimates available in the United States of the long-term consequences of common mental disorders for mortality, direct and indirect costs, social functioning, and psychological well-being. It will show the consequences of receiving, and not receiving, treatment for common mental disorders. Documentation of mortality, costs, and consequences provides basic information for the public health approach to mental disorders.
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