In 1981 the Epidemiologic Catchment Area (ECA) survey completed interviews with 3481 respondents from a probability sample of East Baltimore, as part of a national, five site effort. By 1996, 846 of these respondents had died (24%). In 1993-1996, the Baltimore ECA follow up completed interviews with 1914 respondents who were interviewed in 1981 (73% of the survivors). By the end of the funding period, analyses will have been completed, and papers submitted for publication, on all five specific aims of the Follow up award. Over 50 papers have been published or accepted for publication, and more than 15 submitted, as of the date of the application. The ECA surveys were the first on this continent to obtain data on specific mental disorders, and Baltimore is the only site following the entire wave 1 sample. The data include age of onset and most recent occurrence at the level of symptoms, syndromes, and disorders, and have unusual potential to describe the complex evolution of psychopathology over the course of adult life, regardless of whether treatment is sought or received. This request is for funds to support three additional analytic aims: (1) the evolution of comorbidity and syndrome structures, including the overlap between physical and psychiatric disorders; (2) the process of seeking and obtaining treatment, including the study of its long-term consequences; and (3) the consequences of psychopathology, including disability, marriage breakup, occupational careers, social networks, and mortality. Investigators include a multi disciplinary team with a history of successful collaboration. In addition to analysis of available data, we propose to track the sample, and gather some new data, without face to face contact. Tracking will include yearly mailing of the rich data, including: longitudinal latent variable models; threshold analyses; adaptations of the case-crossover design; a generalization of the life table; and an integration of growth and survival approaches. Results will provide clinicians and other a more comprehensive longitudinal picture of psychopathology; demonstrate the importance of psychopathology for general health; show the impact of psychopathology on use of general health services; provide information for policy decisions regarding mental health care and health insurance; and help integrate the ideologies of general and mental health.
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