Research Assessment and Training

Jean Endicott, Ph.D., Director
Jennifer Downey, M.D., Psychiatrist II
Margaret Spinelli, M.D., Psychiatrist (Research) II
Deborah Hasin, Ph.D., Research Scientist VI
John Nee, Ph.D., Research Scientist V
Richard Blumenthal, Ph.D., Research Scientist V
Dianne Schechter, Ph.D., Research Scientist IV

Members of the Department of Research Assessment and Training are involved in a variety of research studies focused upon obtaining a better understanding of the diagnosis, evaluation of severity of symptoms and functioning, genetics, course of illness, and treatment of patients with mood disorders and/or substance abuse/dependence. These projects include the Collaborative Depression Study -- a large, multifacility study of the course of illness in patients with major mood disorders, genetics studies of bipolar disorder, treatment of antepartum depression, treatment of premenstrual dysphoric disorder, genetic studies of alcohol abuse, general population validity of the diagnoses of alcohol abuse and dependence, and the effects of comorbidity on the course of illness in patients with drug use disorders. The department is also continuing to develop and improve procedures to aid clinicians and investigators in their assessment of both patients and non-patients and to develop training programs for their use and computer programs for analysis of data collected with them. In addition, the department continues to run a Normal Recruitment Program to help identify individuals who are potentially suitable to serve as control subjects for studies conducted at the New York State Psychiatric Institute.

Some highlights of the work of the department during the period covered by this report are described below.

Studies Focused on Mood Disorders
Course of Illness of Major Mood Disorders Respondents of the NIMH sponsored Collaborative Depression Study (Dr. Jean Endicott, PI) have been followed for up to 24 years with over 75% of those not known to be dead still participating. Recent findings indicate that among the many measures used to characterize the course of illness, those pertaining to suicidal behavior were the clearest correlates of risk for completed suicide. Other analyses, focused upon multiple recurrences of unipolar major depressive disorder, found that elevated psychosocial impairment was significantly associated with subsequent recurrence of major depression.

Genetics of Bipolar Disorder Recruitment of families (N=158), evaluations of family members (over 1,000), and collection of blood samples (over 800) was recently completed in a NIMH sponsored study (Dr. Miron Baron, PI). Best Estimate Consensus Diagnoses are nearly complete and analyses will begin soon.

Treatment of Premenstrual Dysphoric Disorder (PMDD) Members of the department have continued to explore various treatments for PMDD. Dr. Endicott helped design and Dr. Margaret Spinelli was the Principal Investigator on a study testing a new medication developed by Pherin Pharmaceuticals: “Phase II Study of Vomeronasal Administration of Intranasal Ph80 for Management of the Symptoms of Clinically Significant Premenstrual Syndrome.” Women with premenstrual problems with their mood and behavior were quite eager to try the new treatment, which involved the use of a nasal spray, and the study was completed without any major adverse events.

Studies of Alcohol and Drug Use Disorders
Genetics of Alcoholism ADH2*2, an allele of a gene encoding a liver isozyme involved in alcohol metabolism, was shown to be protective against heavy drinking in Israeli Jewish respondents. A gene-environment interaction was suggested by the fact that the ADH2*2 effect was not found in a sub-sample of Russian immigrants to Israel who had been exposed to a very heavy-drinking environment in Russia.

Alcohol Dependence: General Population Validity Among former drinkers in a large general population sample, a history of DSM-IV alcohol dependence was found to substantially increase the risk for current major depression, controlling for drug use, smoking, and other variables. Thus, the increased risk of depression among alcoholics is not due to diagnostic confusion, but to more clinically meaningful factors.

Course of Substance Use Disorders: Effects of Comorbidity Among a large sample of treated alcoholics and drug addicts a history of early-onset major depression reduced the probability of achieving sustained remission from substance dependence. In addition, major depressive episodes during sustained remission substantially increased the chances of relapse and of lifetime suicide attempts, suggesting the clinical importance of depression even when substance use appears to be in remission.

Work on Assessment Procedures
The Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ) has become a widely used procedure capable of detecting drug-drug and drug-placebo differences in treatment outcome in patients with a wide variety of mood and anxiety disorders as well in studies of patients with schizophrenia. It has also been found to be useful in studies of patients with general medical conditions and in nonpatient community samples. It has been translated into 30 languages.

The usefulness of the QLESQ led to the recent development of a Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQLESQ). It has already been shown to be reliable and valid in large samples of depressed patients aged 6-l7.

The Endicott Work Productivity Scale (EWPS), which was initially tested in patients with major depressive disorder, was also found to have high reliability and validity among a large sample of patients with Social Anxiety Disorder. The use of this procedure has increased and it has now been translated into French and Spanish.

The Normal Recruitment Program
The Normal Recruitment Program is directed by Dr. Dianne Schechter and sponsored by a COGENT grant from NIMH. The staff recruited comparison group subjects for 28 studies and worked with 22 investigators. The importance of systematic clinical assessment of volunteers for control groups continues to be demonstrated. For example, only 21% of the currently active 695 potential subjects have never met criteria for a mental disorder.

Honors and Activities
Dr. Deborah Hasin received a NIAAA supplement to the project “Alcohol Dependence, General Population Validity” to study the effects of September 11, 2001 on stress-related drinking.

Dr. Jennifer Downey received funding from the Kornfeld Foundation for her project “Refusal of Cancer Care: Cultural and Religious Factors in Dominican People.” which was motivated by an observation that many Dominican patients interrupt cancer treatment before completion. She went to the Dominican Republic three times and visited a variety of health care facilities to learn about what factors motivate people to accept or avoid available health care.