This proposal describes a prospective study of the biological and psychological risk factors for delayed recovery following acute infections mononucleosis (IM). In this study of prognosis, a population-based inception cohort of 200 adult members of a health maintenance organization will be enrolled after presentation to primary medical providers. Subjects with positive monospots will be identified through laboratory records followed by serologic confirmation of Epstein-Barr virus infection. A comprehensive evaluation to identify risks factors present at illness onset will include a physical examination, laboratory studies, and a battery of psychosocial measures. Biological disease activity will be determined by the presence of characteristic physical (fever, adenopathy etc.) and/or laboratory (elevated transaminases, atypical lymphocytes) findings associated with IM. Psychological factors will be examined using a structured psychiatric interview and a variety of self-report measures. Other domains to be evaluated will include functional status and social support. Record review will determine frequency and pattern of health care utilization. All subjects will be followed at 1, 2, and 6 months with a repeated evaluation of clinical and psychosocial state. These evaluations will focus on delayed convalescence through subjective and objective measures of disease activity. At each follow-up the development of outcomes such as psychiatric disorders, limitations in functional status, and physical and laboratory abnormalities will be assessed. Analysis will examine the following: the time course and relationship of subjective and objective recovery from acute IM; the characteristics of subjects in whom biologic and behavioral outcomes are discordant; the contributions of biological and psychosocial factors and; the patterns of prior and current health care utilization.
