Patrick Corrigan - US grants

DESCRIPTION (provided by applicant): This project will involve a collaborative endeavor between scholars from the United States and the People's Republic of China to study the effects of stigma associated with behaviorally driven health disorders on employment-related discrimination. People with three such disorders will be the focus of this study: psychotic disorders, alcohol abuse disorders, and HIV/AIDS. The study will examine the attitudes and behaviors of employers (compared to the general public) using probability samples at three urban sites: Chicago, Beijing, and Hong Kong. Central research questions include why employers endorse stigmatizing beliefs about these disorders, how these attitudes result in withholding work opportunities, and how social and political variables mitigate employer attitudes and actions. First, intensive qualitative interviews will be conducted with a diverse sample of employers at the three sites (N =360, 120/city) to explore the relevant attitudes, perceptions, and behaviors related to hiring people with behavioral health conditions. Results from this study will help inform a survey-based quantitative study, which will test social cognitive models of employer perceptions of people with behaviorally driven health conditions using a vignette assessment strategy and factorial survey design (N = 900, 300/city). This will include examination of employer attributions of causal responsibility for the disorder; attributions about the stability and recoverability of the disorder; concerns about dangerousness; concerns about incompetence; and concerns about contagion. A third study will replicate the quantitative survey on samples representing the general public in Hong Kong, Beijing, and Chicago (N=3,000, 1,000/city). Finally, the effects of socio-cultural factors (e.g., individualist vs. collectivist cultural orientation) on employer attitudes and behavior vis-a-vis people with health-related conditions will be examined. Data from this study will be especially important for the development of future stigma-change programs.

DESCRIPTION (provided by applicant): This project will involve a collaborative endeavor between scholars from the United States and the People's Republic of China to study the effects of stigma associated with behaviorally driven health disorders on employment-related discrimination. People with three such disorders will be the focus of this study: psychotic disorders, alcohol abuse disorders, and HIV/AIDS. The study will examine the attitudes and behaviors of employers (compared to the general public) using probability samples at three urban sites: Chicago, Beijing, and Hong Kong. Central research questions include why employers endorse stigmatizing beliefs about these disorders, how these attitudes result in withholding work opportunities, and how social and political variables mitigate employer attitudes and actions. First, intensive qualitative interviews will be conducted with a diverse sample of employers at the three sites (N =360, 120/city) to explore the relevant attitudes, perceptions, and behaviors related to hiring people with behavioral health conditions. Results from this study will help inform a survey-based quantitative study, which will test social cognitive models of employer perceptions of people with behaviorally driven health conditions using a vignette assessment strategy and factorial survey design (N = 900, 300/city). This will include examination of employer attributions of causal responsibility for the disorder; attributions about the stability and recoverability of the disorder; concerns about dangerousness; concerns about incompetence; and concerns about contagion. A third study will replicate the quantitative survey on samples representing the general public in Hong Kong, Beijing, and Chicago (N=3,000, 1,000/city). Finally, the effects of socio-cultural factors (e.g., individualist vs. collectivist cultural orientation) on employer attitudes and behavior vis-a-vis people with health-related conditions will be examined. Data from this study will be especially important for the development of future stigma-change programs.

DESCRIPTION (provided by applicant): Despite evidence that suggests many psychiatric services help people with serious mental illness manage their illness and attain their life goals, some individuals who might benefit from these services opt not to participate or not to fully engage after beginning treatment. Treatment adherence is a complex and sometimes contentious concept that has been discussed for decades to explain failures to fully participate in and benefit from services. In this same time period, mental health consumers, service providers and researchers have begun to develop frameworks around concepts of empowerment, which emphasize consumer choice in treatment and services. The goal of our proposed Developing Center for Interventions and/or Services Research (DCISR) is to better understand relationships among these phenomena and to examine change strategies that enhance empowerment and adherence, which, in turn, influence participation in quality services and achievement of personally meaningful goals. Treatment adherence research has a rich empirical base which, unfortunately, offers little in terms of theory or treatment concepts (except perhaps for research on extended or intensive monitoring). The empowerment literature, by comparison, have developed a strong conceptual and theoretical approach but lack much empirical testing or development. We contend that generative, positive development in both these fields can be fostered by the intentional effort to develop a national scale research program, grounded in the efforts of productive investigators. Such a research program would support developmental activities that produce emergent theoretical frameworks that can be empirically tested, and theoretically driven research that contributes to new knowledge. Such knowledge could drive public health policy towards new, pro-active directions that improve the lives of people with mental illness. RELEVANCE (See instructions): One prominent goal of services research is to identify evidence-based practices (EBPs) that help people with serious mental illness achieve these outcomes. Many people who might benefit from EBPs and other psychiatric services decide not to seek them out or fully participate in them. One way in which service participation may be understood is in terms of the number of people who might benefit from psychiatric services but never seek them out.

DESCRIPTION (provided by applicant): People who are homeless have high incidence and prevalence of physical illnesses that are further exacerbated by co-occurring serious mental illnesses. African Americans are disproportionately affected by homelessness with as many as 50 percent of homeless people being African American. In Illinois, the homeless population is increasing and expected to rise 5 percent. In Chicago from 2006-2010, shelter use rose 28.4 percent and those unsheltered surged to 40.4 percent. One neighborhood especially hard hit is the Edgewater-Uptown area with among the highest rate of homeless people with co-occurring mental illness in the country. Although integrated care programs have been proposed and developed for this population, they have limited impact in part because they have not fully incorporated the voice of the homeless in development and implementation. Hence, we propose a community based participatory research (CBPR) project meant to target the health care needs of African Americans who are homeless with serious mental illness. A preliminary needs assessment with the group has helped to direct this proposal. We will establish a Community Advisory Board (CAB) comprised of African Americans with lived experience and co-chaired by the co-PIs including an African American with lived experience. The CAB will have control over all aspects of this proposal. To define the problem, we will conduct qualitative interviews of people with lived experience and other stakeholders and then cross-validate this information with a second group in a quantitative survey. The CAB will use this information to design an intervention using an integrated care model. Feasibility, acceptability, and impact of the intervention will then be tested in a pilot evaluation. Outcomes will include assessments of perceived availability, program satisfaction, physical and mental health, and quality of life with longitudinal design (e.g., baseline, midpoint, and follow-up). RELEVANCE (See Instructions): African Americans who are homeless with serious mental illness suffer a catastrophic level of morbidity and mortality. Through community based participatory research, we will identify specific health concerns of this population in Chicago's Edgewater-Uptown neighborhood and develop an integration meant to promote integrated care therein. The project will also include a pilot investigation of the acceptability and impact of thi intervention.

? DESCRIPTION (provided by applicant): Obesity is a significant risk factor for many comorbid health conditions contributing to earlier deaths of people with severe mental illnesses. Weight problems and obesity are even worse among African Americans with severe mental illnesses. Doing community- based participatory research (CBPR) with a consumer advisory board (CAB), we will conduct mixed methods research with African Americans with severe mental illness to better understand the nature of the problem and possible solutions. While some success has been found in adapting cognitive-behavior weight loss strategies (e.g., diet and exercise) for people with severe mental illnesses, research suggests such strategies may be muted for African Americans. Hence, the CAB and Community Coalition will specifically consider adaptations to cognitive behavior weight loss strategies for peers in their community. Diet and exercise programs are especially difficult in low income communities marked by food and activity deserts. The CAB and Community Coalition will consider this challenge in their adaptation. Earlier CBPR funded by NIMHD and PCORI has shown healthcare outcomes for people of color are enhanced when complemented by peer navigators, specially trained service providers from the same ethnic background with a history of similar behavioral health challenges. Peer navigators will help program participants achieve diet and exercise goals in these communities. This study represents a partnership between Heartland Health Outreach (HHO), and the NIMH-funded Center on Adherence and Self-Determination at the Illinois Institute of Technology. The ultimate, randomized controlled trial will have three conditions (depending ultimately on CBPR feedback): treatment as usual (TAU which is integrated care), TAU plus behavioral weight loss intervention, or TAU, the weight loss intervention, with peer navigators. Impact will be assessed baseline, 6, 12, and 18 months examining weight change, health behavior, physical and mental health, recovery, and quality of life. Findings will advance knowledge and services to reduce racial disparities in obesity and comorbid health conditions for African Americans with severe mental illnesses.