The proposed study will examine the adverse and protective factors that affect adjustment over time of long-term mentally ill adults. Previous research indicates that although they may improve in social relations and florid symptoms, significant deficits often remain. Little is known about relations among social, environmental, and health factors that influence utilization and success of mental health services for this population. Specifically, the study will examine the ways in which changes in symptoms and health status combine with life events and social supports to influence subsequent adjustment, relapse, and mental health service utilization. Goals of the project include the identification of targets for mental health intervention, evaluation of the ways in which social services and indigenous social supports combine and substitute one another to help maintain independent functioning, and assessment of life events and family stressors that may lead to relapse or poor functioning. The design will be a three-wave longitudinal study of four age cohorts of long-term patients from age 40 onwards. Four hundred subjects, identified from records of mental health institutions in a four catchment areas in Kentucky and southern Indiana, will include those with diagnoses of schizophrenia, affective disorders with multiple episodes, and atypical psychoses. An initial assessment of subjects' health, social networks, family environment, psychiatric history, and symptom status will be supplemented with family interviews and medical record reviews. Two subsequent waves of data will be collected at three-month intervals. Results of the project will be of value in improving services to elderly long-term mentally ill persons by identifying the current role and effectiveness of health and mental health services in providing care, and by also identifying factors most likely to lead to functional dependence or relapse, thus providing specific targets for future intervention.
