Stony Brook University Hospital. Stony Brook School of Medicine and Neurosciences Institute director Evelyn Bromet leads the Suffolk County Mental Health Project, which does research into psychiatric epidemiology. ARACELY JIMENEZ/STATESMAN FILE

The Suffolk County Mental Health Project — led by the director of the Epidemiology Research Group in the Stony Brook School of Medicine and Neurosciences Institute, Dr. Evelyn Bromet — focuses on the challenges individuals with mental illnesses battle with over a long span of time.

What once began as an observational study on patients with schizophrenia in 1989, has now branched out into two decades worth of an in-depth look into psychiatric epidemiology, the study of what societal factors cause mental illness.  

The study was originally designed under the assumption that people with schizophrenia end up in the hospital. However, as the study reached its six-month mark, Bromet and her team found that not all of the participants had schizophrenia, but rather a collection of varying psychotic symptoms. The participants were then properly diagnosed with bipolar disorder, depression and other psychotic disorders.

This discovery led to two distinguished papers published last year in the November issue of the American Journal of Psychiatry as the study reached its 20-year mark: “The 20-Year Longitudinal Trajectories of Social Functioning in Individuals with Psychotic Disorders,” and “Declining Clinical Course of Psychotic Disorders Over the Two Decades Following First Hospitalization: Evidence From the Suffolk County Mental Health Project,” both worked on by Bromet and Dr. Roman Kotov, an associate professor in the Department of Psychiatry and Behavioral Health at Stony Brook Medicine.  

The first paper focused on social functioning over time and found that “origins of these differences could be traced to childhood, when some warning signs, although subtle, could be observed,” according to a press release from the Stony Brook Neurosciences Institute. The second paper concluded that it is “not just social functioning that is affected when one is living with a psychosis. Although some participants do very well, others continued to carry a heavy burden of symptoms.” The research project will continue to study the participants at the 25-year mark from when the paper was originally published and beyond.

The team of researchers from Stony Brook Medicine sought out participants between the ages of 15 and 60 that resided in Suffolk County and were initially hospitalized between September 1989 and December 1995.

The researchers were not directly involved in the participants’ treatments but rather held interviews with and gave questionnaires to the participants about how they functioned and the satisfaction of the treatments they received in their own surroundings.

What Bromet concluded was that these individuals struggled with health issues other than mental illnesses and that physical and mental health are “different sides of the same coin.”

Bromet found how difficult it was for patients to get their treatment in the county, noting how they were always changing providers and the terrible transportation system. Many of these people ended up relying on Medicaid and living in poverty, not receiving the resources they need. Sixty-three percent of the participants required some form of public assistance at the 20-year follow-up in comparison with 54 percent overall during the first four years of the study.

 Kotov, who joined the study in 2006, was the primary investigator of the 20-year follow-up. He was tasked with overseeing data collection and analysis.

“There are studies that have the same points as ours, but not in the United States,” Kotov said. He went on to explain that what sets the Stony Brook study apart is its long span and focus on the consequences of mental illnesses, excluding the illness itself. These consequences include how many people with mental illnesses also struggle with morbid obesity and face terrible side effects from their medication.

Kotov explained that good outcomes for people with mental illnesses are possible, but for the majority, it is only possible with much support from society and the health care system. He noted that barriers such as paperwork, bills and limited hours for doctor appointments often prevent good outcomes.

In Kotov’s eyes, the American health care system is so focused on short-term solutions that it often does not end up benefiting patients with mental illnesses. “We need to have more resources and need to provide easier access,” he said.


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