Results from the NIMH Collaborative Depression Study (CDS) and the findings of other researchers provide strong evidence that affective illness must be conceptualized as a lifetime disorder with characteristics of course that require long-term observation. Preliminary analysis of the first 10 years of follow-up of the probands shows that very high ongoing rates of recovery, recurrence and changes in other outcomes such as co- morbidity, inter-episode functioning, minor affective syndromes, psychosocial functioning, morbidity, mortality and suicide. Prospectively charting the long-term course of mood disorders with methodologic rigor in a large sample makes this study invaluable in providing additional data of importance to the public health. The general aims of this proposal are to provide data to the field that will help: 1. Describe the long-term patterns of psychopathology of affective disorders using the recovery and recurrence of syndromes as the outcome; 2. Study the influence of somatic treatment as a mediating variable affecting outcome in naturalistic studies and to describe the type and dose of somatic and psychosocial treatment received by patients suffering from major affective illness; 3. Further contrast diagnostic groups in light of much longer observation periods; 4. Extend the domains of outcome studied to include: psychosocial functioning, physical health, medical co-morbidity, and personality functioning; 5. Study suicide, mortality and medical morbidity as long-term outcomes of affective disorders. In order to accomplish these aims, this application requests funds to extend the prospective annual follow-up of the CDS proband sample to at least 16 years on all subjects.
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