This application requests two years of support for the continued statistical analyses of the data recently acquired by a major long-term follow-up of chronic mental patients in the community. 269 Vermont State Hospital patients, most with diagnoses of schizophrenia, some with primary affective disorders, and other psychiatric illnesses were originally selected for chronic disability, rehabilitated, and released to the community in the mid-1950's. 97% of this group has been located and/or accounted for twenty years post index discharge but our catamnesis years range from 21 to 58 years. Two field interviews have been conducted with each live proband (N=190). The first interview provided a multivariate cross-sectional assessment of outcome. The second interview included a Meyer/Leighton Life Chart and contributed a longitudinal documentation of patterns, shifts, and trends in the course for members of the cohort. These patterns were derived from a multidimensional year-by-year follow-along and follow-back over the 20-year period. Informants who knew the subjects well were interviewed to verify current status and historical data. The Vermont Community Questionnaire instrument battery (VCQ) contained an innovative weaving of several new and classic scales and schedules which obtained structured measures of outcome. Hospital and Vocational Rehabilitation records were reviewed with the Hospital Record Review battery (HRRF) compiled from a modification of W.H.O.'s Psychiatric and Personal History Form and Strauss' Case Record Review. By November 1, 1983, the first of the major statistical cross-sectional analyses will be completed on the live cohort, who have been rediagnosed as having been in the DSM III schizophrenic category. Current preliminary analyses on the entire live cohort reveal over half have recovered and that outcome is very heterogeneous across domains. Many important questions still need to be addressed, utilizing the year-by-year longitudinal follow-back information as significant and modifying variables across current status within and between domains.
Specific Aims are: 1) to delineate the long-term community career patterns, shifts, and trends; 2) to provide evidence in support or denial of a """"""""turn-around time"""""""" toward improvement and increased functioning; and 3) to identify predictors which might differentiate long-term outcome for patients selected for their chronicity. Complex multivariate statistical strategies have been described.
