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Mental Health

Training and Funding Opportunities

Psychiatric Epidemiology Training Program

The goal of the Psychiatric Epidemiology Training Program, which is funded by the National Institute of Mental Health, is to train the next generation of investigators in psychiatric epidemiology. The program provides an opportunity for pre-doctoral and post-doctoral students to pursue advanced training in the methodology and application of psychiatric epidemiology to problems of mental and behavioral health. Pre-doctoral trainees must complete the required coursework for their degree program as well as complete all qualifying examinations and a research dissertation under the supervision of their advisor. Post-doctoral fellows are expected to engage in original research under the supervision of a faculty member.

Faculty in the Psychiatric Epidemiology research area are involved in multiple projects, offering a range of training experiences for our students.  Below are some of the resources that can be made available to trainees.

The Epidemiologic Catchment Area (ECA) Study

The Baltimore ECA Follow-up is the name for the research program involving the follow-up of participants in the Eastern Baltimore Epidemiologic Catchment Area sample who were originally interviewed in 1981. This sample was one of five sites (New Haven, Baltimore, St. Louis, Raleigh/Durham, and Los Angeles) commissioned by the NIMH Epidemiologic Catchment Area Project after the publication of the Diagnostic and Statistical Manual of Mental Disorders(DSM) III in 1980. All five sites completed baseline interviews in 1979-82 (“wave 1”) and follow-up interviews in 1980-83 (“wave 2”).

The Baltimore site of the ECA Program was the only site to designate the entire sample interviewed at the baseline (1981 – “wave 1”) for followup (1982 – “wave 2”). Beyond the baseline and one-year follow-up interviews, there were household followup interviews in 1993-1996 (“wave 3”) and 2004-2005 (“wave 4”). The Baltimore ECA Followup data include a range of Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic variables, including diagnoses of drug and alcohol abuse and dependence at all four waves. At all four waves there are extensive questions on family relationships, socioeconomic and employment status, quantity and frequency of drinking alcohol, use of health and mental health care services, physical illnesses, health behaviors, activities of daily living, disability, social networks. At waves 3 and 4 there are additional data on life events, social supports, neighborhoods, and work environment. The baseline household sample of 3481 has been linked to the National Death Index through 2008. In the 2004-2005 wave of assessments, subjects donated biological specimens for DNA.

The Baltimore ECA has been the source for hundreds of peer-reviewed publications and more than a dozen doctoral dissertations in the Bloomberg School of Public Health.

The Prevention Research Center (PRC) Studies

In 1985, under the leadership of former chair Sheppard Kellam, 19 elementary schools were chosen from the same local community mental health center catchment areas as the Baltimore ECA study. With funding from the NIMH for a Prevention Research Center (PRC), 2311 first graders in 1985 and 1986 were assessed and randomly assigned to standard-setting classrooms or classrooms in which new behavioral and curricular techniques were employed. In the ensuing quarter century there have been eleven separate assessments of these children, including in 2009-2011 at the age of about 30, which included a request for biological specimens for DNA. The resulting data allow unusual insight into the development of psychopathology in youth and young adulthood, and into the transitions in stages of drug use, abuse, dependence, and termination. The PRC data have been the source for hundreds of peer-reviewed publications and more than a dozen doctoral dissertations.

Collaboration with Community Psychiatry Programs: The department is collaborating with the leaders of the Community Psychiatry Programs of the Johns Hopkins and Bayview Hospitals on two projects of assessment and followup of patients at these programs. The Access 2 Wellness (A2W) project establishes a primary health care home in a community mental health center at Bayview, staffed by a nurse practitioner, and is led by Dr. Anita Everett, who obtained funding for the clinical care aspects for the project from the State of Maryland. The project is aiming to improve health and lower mortality among the severely mentally ill, who have about 25 years shorter life expectancy than the general population, due mostly to illnesses that are prevented or well-treated in the general population, such as diabetes, high blood pressure, heart disease and stroke. The randomized controlled trial of this system change includes a follow-up assessment with more than 200 subjects in the new and normal treatment arms, respectively, and has the potential to establish an evidence base for an intervention that could be widely adopted due to its feasibility and relatively low cost. A second project aims to identify new predictors of recovery over a three year period in persons with psychotic illnesses.

The Cache County Study

This is a population-based prospective study of the elderly residents of Cache County, Utah. The study involves collaborators from Utah State University, Duke University, University of Washington, and The Johns Hopkins University. It was initiated in 1995, and the participants have been followed over four assessments spanning 15 years. The goal of the study is to identify genetic and environmental risk and protective factors for cognitive impairments in aging.

The Alzheimer’s Anti-Inflammatory Prevention Trial (ADAPT) and Follow-up Study (ADAPT-FS)

ADAPT was a multi-center, placebo-controlled, randomized primary prevention trial to test the efficacy of two different non-steroidal anti-inflammatory drugs (NSAIDs) to prevent the onset of Alzheimer’s disease among elderly individuals at risk due to a family history of the disease. The trial was terminated prematurely because of cardiovascular safety concerns with NSAID use among the elderly. The participants in the trial continue to be followed to assess the long-term effects of NSAID use on cognition and risk of Alzheimer’s disease.

Women’s Health and Aging Study II: Cognitive Pathways

This is a 10-year, observational study of 436 cognitively and physically well-functioning women aged 70-79 living in Baltimore City. This study examined the natural history of cognitive and functional declines and the cognitive antecedents of functional decline and disability. Health, psychosocial, lifestyle, anthropometric, serum and genotypic biomarkers, and other information were prospectively obtained to evaluate hypothesized risk factors of cognitive and physical disability. We further carefully adjudicated both prevalent and incident major chronic diseases of aging, including Alzheimer’s disease, cardiovascular disease, and diabetes. An array of standardized cognitive tests and performance-based measures of independent function were prospectively obtained, including medication compliance, balance, grip strength, visual acuity, hearing, and frailty.

Ginkgo Evaluation of Memory (GEMS) Randomized Controlled Trial

This randomized, controlled trial was initiated in 2000 to evaluate whether ginkgo biloba was effective in preventing and delaying the onset of dementia and mitigate rates of cognitive decline in older adults. 3,069 persons 75 years and older and their proxies were recruited and randomized to ginkgo or placebo in 4 U.S. communities, including the Johns Hopkins site in Washington County, MD. Participants received a comprehensive neuropsychological evaluation with blood draw at baseline and all participants and proxies visited the clinic every 6 months to detect changes in cognitive and functional health, which would necessitate a diagnostic neuropsychological and neurologic evaluation, including MRI. The GEMS trial concluded in spring 2008 and study PI’s have since published two outcome papers in JAMA demonstrating no effect of ginkgo biloba (240 mg/day) in reducing risk for dementia or mitigating rates of cognitive decline. An ancillary substudy across sites is examining the utility of MRI brain volumetric and white matter hyperintensity data in a subset of healthy vs. MCI participants.

CHS Cognition Study

This ancillary study to the CHS examined in 3660 participants whether 5-year changes in white matter hyperintensities on MRI were associated with an increased risk of Alzheimer’s and vascular dementias, potentially providing new approaches to early detection and prevention. Participants were approximately 76 years old during the initial brain MRI in 1992-3, and received a second MRI in 1997-8. The study adjudicated participants who developed clinical dementia, and is now evaluating the relationships among genotypic data, biomarkers of inflammation, subclinical cardiovascular disease, incident clinical cardiovascular disease, hypertension and diabetes, and risk of dementia in relation to MRI variables.

Public Use Data in Psychiatric Epidemiology

In addition to research carried out through these studies, faculty in the Program of Psychiatric Epidemiology may engage in secondary data analyses of large, nationally collected datasets to investigate specific research questions about mental and behavioral disorders. Examples of datasets that are available for such analyses include: