The proposed Independent Scientist Award provides five years of salary support for Dr. Jeffrey Swanson to develop and carry out an integrated program of research, building on his previous work but incorporating new perspectives and methods to address several related topics: epidemiology of violence and psychiatric disorder, schizophrenia treatment effectiveness, decisional incapacity in severe mental illness (SMI), and implementation of psychiatric advance directives. First, he will conduct systematic comparative analysis of several datasets to provide a better understanding of the multifaceted problem of violent behavior that affects a proportion of persons with severe mental illness in the community. Second, he will use new data from the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) to examine and compare the effects of treatment with specific antipsychotic medications on violence risk in persons with schizophrenia. Third, he will use CATIE data to investigate the extent to which, for some persons with SMI, fluctuating insight into illness and decisional incapacity may limit access to effective treatment that might otherwise prevent violent behavior. Fourth, Dr. Swanson's research will address the potential impact of a new legal instrument--psychiatric advance directives (PADs)--on violence and related outcomes for persons with SMI at risk of decisional incapacity, using data from 1-R01-MH63949-01 (Effectively Implementing Psychiatric Advance Directives.) As part of his career development plan, Dr. Swanson also proposes to work with experts in several disciplines to develop a theoretical model of violence, mental disorder, and treatment effectiveness. These experts will bring novel viewpoints and methods that will both deepen and broaden his intellectual endeavors: Dr. Sue Estroff in medical anthropology and social medicine; Dr. John Fairbank in medical psychology, trauma and substance abuse interventions; Dr. Martha Shumway in health psychology, mental health treatment outcomes and preferences measurement; and Dr. William Winslade in medical philosophy, ethics, and legal psychiatry. The proposed award will enable Dr. Swanson to concentrate his research career in the areas of his greatest interest and potential to make a significant contribution in the future; to conduct an integrated program of scholarship, synthesizing findings from his previous work and addressing important, inter-connected questions in new ways. Through additional R01-fundable projects to be developed, this work will lead eventually to better-targeted interventions and policies for reducing violence risk and improving quality of life for persons with SMI.
Showing the most recent 10 out of 12 publications
