In an attempt to identify possible genetic markers, not only for susceptibility to these diseases themselves but for other mental health conditions, Harvey led a recently completed cooperative study of 9,500 veterans with a diagnosis of schizophrenia or bipolar disorder who were seen at 26 sites over a period of three years. In the largest genetic study of mental illness conducted to date, each participant was extensively genotyped and assessed for cognitive functioning, as well as for other illness-related variables such as PTSD, depression, or suicidality. The genomic data gathered over that period, said Harvey, will help sort out whether disability and cognition – which look very similar among people with bipolar disorder and schizophrenia – share a genetic underpinning.
“In terms of relevance to veterans, we’re very interested in figuring out, once genomic contributors are discovered, whether or not interventions can be tailored to people based on their genome,” Harvey said.
The Mental Health Quality Enhancement Research Initiative (QUERI) program is coordinated from the John L. McClellan Memorial Veterans Hospital in Little Rock, Arkansas. Photo courtesy of the Veterans Health Administration
Harvey and colleagues have also recently completed a clinical trial comparing the comparative efficacy of treating schizophrenic patients – veterans and nonveterans alike – with a computerized cognitive remediation therapy intervention, or a more structured (and more expensive) psychosocial intervention, or both, to improve real-world functioning. The combined intervention, the study revealed, yielded significant functional improvements that lasted – and actually improved, 12 weeks after the intervention was completed.
Harvey – who last year became the first psychologist to be awarded the prestigious John Blair Barnwell Award, the highest honor for scientific achievement presented by the Clinical Science Research and Development division of the VA’s Office of Research and Development – hopes to build on these studies with what he describes as, “a big VA-wide trial where you take people both with schizophrenia and with bipolar disorder, do this intervention, and also collect genomic information from them that we could then link back into the genomics of cognition we’re going to be examining in our big VA study. We’re very interested in expanding this.”
Suicide Prevention: Identifying Risk
Among the future benefits of the large-scale genomic study, Harvey said, may be the ability to compare the genomics of suicidality among veterans with schizophrenia and bipolar disorder. “What we discovered,” he said, “was that 68 percent of the veterans with bipolar disorder and 62 percent of the veterans with schizophrenia actually either had a suicide attempt or serious suicidal ideation at some point since they were diagnosed with their illness.”
While much VA research is focused on identifying and reducing suicide risk in primary care and other non-mental health care settings, many veterans, already known to be at a high risk for suicide, receive services at VA mental health centers – and substantial clinical research is aimed at preventing suicide among these veterans.
In 2007, VA and several partners launched an intensive suicide prevention effort, aimed at both quantifying the problem and reducing suicide among veterans, in part by expanding access to care. The clinical support system and surveillance network established through this effort has yielded data that researchers and clinicians are examining to determine if current suicide prevention programs are having an effect, whether gaps exist in access or results, and where there’s room for improvement.
VA researchers recently launched the Behavioral Health Autopsy Program, led by Dr. Janet Kemp of the Center of Excellence for Suicide Prevention at the Canandaigua, VA Medical Center in New York. Using death records provided by 11 participating state governments, program investigators continue to interview family members of the deceased and examine primary care medical records. “This is an organized effort to try to get as much information as we possibly can on veterans who died by suicide,” said Dr. Ken Conner, director of the CoE for Suicide Prevention, “in order to understand if and what gaps in care there might have been, or signs that they might have been at risk, as well as to help really characterize the struggles that people who take their own lives are having.”