APPLYING DEVELOPMENTAL EPIDEMIOLOGY TO YOUTH SERVICES

Duke University, Durham NC

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Abstract

This is a request for renewal for five years of an Independent Scientist Award (K02) first awarded in September, 1993. The continuing goal is to pursue a program of work in developmental epidemiology, and its application to areas of child mental health. The focus of this renewal application is to develop a public health, primary prevention model of child mental health care. This application is in response to PA-95-050. Developmental epidemiology is concerned with understanding the causes, course, and outcome of psychiatric disorders, within the context of human development. Psychiatric epidemiology has only recently begun to integrate clinical with developmental understanding. The implications for child and adolescent mental health of a developmental approach to psychiatric epidemiology have yet to be fully realized. Over the past five years the applicant has been instrumental in revising the national agenda for child psychiatric epidemiology through papers, presentations, service on federal advisory committees, and through an integrated program of research that focuses on developmental science as a necessary and integral part of the study of psychiatric epidemiology and mental health policy and services. The first specific aim of this application is to continue to explore the implications of a developmental approach to child psychiatric epidemiology. Adopting a definition of epidemiology as "pre-prevention science"[NIMH,1998 number...], with both etiologic and public health goals, my aim is to use the data sets to which I have access through the Developmental Epidemiology Center to develop a model of child psychopathology that will help us to integrate findings about the causes of mental illness ("etiologic epidemiology") with a better understanding of risk factors and the options for prevention ("public health epidemiology"). This Aim will be realized in two phases: first, in further work on the Great Smoky Mountains Study data set, and in the second phase, using other data sets such as Caring for Children in the Community and the Virginia Twin Study to replicate findings, test hypotheses, and examine the sensitivity of models to sample characteristics. The second specific aim is to use the findings from the first two phases as the basis for developing a set of propositions about a primary prevention approach to child mental illness. The third specific aim is to design the next set of studies needed to test these propositions. The fourth specific aim is to disseminate through training, mentoring, consulting, scientific papers and books, and all available means, information that will help to move forward developmental epidemiology as the basic paradigm for child and adolescent psychiatric epidemiology.