APA Links to Research

One of the features that best distinguishes APA as a professional organization is the Association’s close affiliation with academic psychiatry and with the broad range of allied organizations that partner in supporting psychiatric research and education. Under the leadership of the APA Council on Research and the Board of Directors of our 501(c)(3) component, the American Psychiatric Institute for Research and Education (APIRE), APA works to ensure that research on the causes, treatment, and prevention of mental disorders continues to be a priority on the national health and human services agenda.

Darrel Regier, M.D., M.P.H., serves as director of the Division of Research under APA and as executive director of APIRE. The APIRE board of 15 members, chaired by Herbert Pardes, M.D., oversees a research and education program funded by federal and private grants of approximately $5 million a year. With this funding, a multidisciplinary and talented APA staff conduct clinical and health services research, foster careers in psychiatric research, and provide the scientific evidence for policy, legislative, and practice initiatives that serve both the patients and the practitioners we represent.

The Division of Research has recently been reorganized to include the Quality Improvement in Psychiatric Services (QIPS) and the Office on HIV/AIDS programs. Hence, in addition to being responsible for maintaining and revising the Diagnostic and Statistical Manual (DSM), the division will be responsible for overseeing production of the practice guidelines and quality-of-care indicators for APA. Publications from these programs generate about $5 million a year (after expenses) through APPI and APA, which together with the $5 million in grants support APA’s research and education programs and account for about 19 percent of the total APA income and 14 percent of the expenses. There are 15 staff members in the Division of Research and another 10 supported by APIRE with three part-time consultants; thus, the total staffing is slightly more than 10 percent of the overall APA staff.

In this column I can only briefly sketch the breadth and far-reaching implications of our activities in the research arena. A more detailed enumeration and description—including research fellowship application and contact information—can be found on the APA Web site under the subheading “Research Resources.” Likewise, our quarterly newsletter, Psychiatric Research Report, provides information about current research opportunities and activities in the field at large. Subscriptions are available free of charge by e-mailing [email protected].

Within APIRE, the Practice Research Network harnesses the voluntary participation of psychiatric practitioners to create a research database on the characteristics of patients, treatments, and professional practice across a full range of treatment settings. The resulting data are used to provide a research base for a wide variety of clinical and policy issues, such as the need for new treatment guidelines, the impact of defunding our public mental health system, and the impact of parity in private health insurance coverage.

A major endeavor undertaken jointly by APIRE and the Council on Research is a long-term development process to produce a synchronous revision of the DSM and the International Classification of Diseases (ICD). The objective of this joint project with the World Health Organization is to develop identical diagnostic criteria for use in international clinical practice and research. The first phase of the process was completed in 2002 with the publication of a volume that defines the tasks to be undertaken and the problems to be solved before the actual revision process begins. A Research Agenda for DSM-V, edited by David Kupfer, M.D., Michael First, M.D., and Dr. Regier, was designed to facilitate the integration of a rapidly expanding body of scientific information spanning the research spectrum from basic studies to clinical, epidemiological, and cross-cultural research.

Currently, APA is embarking on the next step in the DSM-ICD research-planning process. A series of NIH-funded conferences will review the research advances made since the publication of DSM-IV in 1994 and identify specific research opportunities to improve the validity of our diagnostic concepts and criteria in up to 10 substantive areas. The international scientific community will then be encouraged to address research gaps to improve our understanding of the etiology, pathophysiology, and variations in the clinical expression of mental disorders in different groups. The results of these combined efforts will ultimately provide the evidence upon which DSM-V and ICD-11 will be based—now scheduled for publication in approximately 2010.

The very foundation, of course, for all the advances in our diagnostic, treatment, and service capabilities lies in the promise held by young physicians who choose research and academic career paths. In the context of a decade-long decline in the numbers of psychiatry residents who elect to remain in academia, APA—along with the National Institutes of Health, Association of American Medical Colleges, Association of Directors of Psychiatric Residency Training, American Association of Chairs of Departments of Psychiatry, Residency Review Committee, and other professional and advocacy groups—is intensely engaged in multiple activities to find solutions that will reverse this deleterious trend.

We invite your participation in all of these efforts, as we at APA headquarters work to foster greater linkages between each of our APA district branches and the national network of academicians and researchers who have become such an important part of the APA membership. In this way, we hope to provide a smooth transition of newly graduating residents into full professional participation and to assure maximum exposure to new research and practice development for all of our members.

I welcome your comments about APA’s research work, as well as other matters on your mind. Please contact me by e-mail at [email protected]. ▪