The purpose of this proposal is to develop an infrastructure to support the first major mental health services program for women. The theme of the research proposed is the treatment effectiveness in women with mood, anxiety and eating disorders. Mood and anxiety disorders are highly prevalent and much more likely to affect women than men. Most patients who seek help in mental health settings, and most subjects who participate in clinical research studies, are women. Yet little is known about mental health outcome for the majority of women with these disorders. Epidemiologic studies indicate few women diagnosed with anxiety or depression receive treatment. Moreover, even among those seen in psychiatric clinics, most are not eligible for clinical research studies. For example, women who are pregnant or lactating and women with complex comorbid symptomatology are usually excluded. It is not known if efficacy results are generalizable to these women. There is a need to test effectiveness in different """"""""real world"""""""" settings, of treatments whose efficacy has been demonstrated in controlled clinical research environments. Women's health programming is rapidly developing, and there is a need for services research to guide these programs. The proposal described in this application will: 1) bring together clinical researchers, health services researchers, and community leaders involved in provision of services to women; 2) provide infrastructure support for thematic research on treatment effectiveness in women; and 3) establish a unified data base for women's services studies. This planned research links treatment effectiveness studies with ongoing R01 funded efficacy studies in women with mood, anxiety and eating disorders. A central feature of this application is the plan to conduct studies at three different sites: outpatient psychiatric clinics, primary care health centers, and low income minority housing projects. There are large groups of understudied women at each site, and representation from each is needed to answer pressing questions about how best to help women with mental illness.
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