A follow-up wave of interviews, 22 years after baseline in 1981, is proposed for the Baltimore ECA sample, the only ECA site to continue follow-up of its sample. The last full survey in 1993/6, with 1920 respondents, focused on incidence and natural course of mental disorders, and consequences of psychopathology for physical conditions whose risk periods were beginning and peaking for the cohort. The proposed wave in 2003 continues these interests, but shifts focus to problems of aging and the elderly, including depression, cognitive impairment, disability, and services use. The follow-up presents opportunities for assessing and explaining trends in incidence; examining risk factors unavailable at the prior follow-up, including retirement, work environment, religiosity, and genes such as the APOE gene. Using the Life Chart Interview again allows examination of 22 year long cumulative effects of life events, occupational trajectories, convoys of attachment, and episodes of mental disorders, on a variety of outcomes. The research team includes leaders in the field who are familiar with the data. About 80 manuscripts (60 published or in press) have been produced since the last competitive renewal, in a wide range of top-tier peer-reviewed Journals. About 1550 interviews are expected to be completed, which amounts to 70 percent of the estimated survivors of the 1981 sample. Interviews will include measures included in prior surveys, the new risk factors listed above, the NEO personality inventory for those in the sample who have not completed it, an objective measure of performance functioning, and blood for DNA. Interviews will be complemented with a search of the National Death Index, which provides cause of death information (NDI+). Analysis includes standard linear and logistic regression, survival and random effects models, GEE models of change, and latent variable analyses in the presence of transition and prediction. The ECA ushered in the so-called third generation of psychiatric epidemiology, with its use of psychiatric diagnostic interviews in field surveys. In the 1993/6 follow-up a widely disseminated series of results was the unexpectedly strong predictive relationship of depressive disorder with important physical conditions. The proposed follow-up will allow us to understand how this evolving mental/physical comorbidity bears on the important problem of functioning, disability, and services use in middle aged and elderly adults. The proposal includes plans to make anonymous data available for public use.
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