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COLUMBIA UNIVERSITY
PSYCHIATRIC EPIDEMIOLOGY TRAINING PROGRAM
COLUMBIA UNIVERSITY
SCHOOL OF PUBLIC HEALTH
DEPT. OF EPIDEMIOLOGY/ PET PROGRAM
722 WEST 168TH STREET, 7TH FLOOR
NEW YORK, NY 10032
(212) 305-7789/(212) 342-4549
EMAIL: PET@COLUMBIA.EDU
_____________________________________________________________
Co-SPONSORED BY:
DEPARTMENT OF EPIDEMIOLOGY
DEPARTMENT OF PSYCHIATRY
SCHOOL OF PUBLIC HEALTH
COLLEGE OF PHYSICIANS
AND SURGEONS
PROGRAM DIRECTOR
EZRA SUSSER, M.D..
Co-DIRECTORS:
BRUCE DOHRENWEND, Ph.D.
KATHERINE M. KEYES WILD, Ph.D.
TRAINING Co-ORDINATOR:
SHARON SCHWARTZ, Ph.D.
STEERING COMMITTEE &
FACULTY:
ALAN BROWN, M.D.
DEBORAH HASIN, Ph.D
RICHARD NEUGEBAUER, Ph.D.
EZRA SUSSER, M.D.
KATHERINE M. KEYES WILD, Ph.D.
BRUCE DOHRENWEND, Ph.D.
ROBERTO LEWIS-FERNANDEZ, M.D.
SHARON SCHWARTZ, Ph.D.
MYRNA WEISSMAN, Ph.D.
FACULTY:
PAUL APPELBAUM, M.D.
CHERYL CORCORAN, M.D.
MADELYN S. GOULD, Ph.D.
CHRISTINA HOVEN, Ph.D.
CATHERINE E. MONK, Ph.D
MARK OLFSON, M.D.
BLAKE TURNER, Ph.D.
MELANIE M. WALL, Ph.D.
LAWRENCE YANG, Ph.D.
LISA BATES, Sc.D.
MINDY FULLILOVE, M.D.
MARK HATZENBUEHLER, Ph.D.
DENISE KANDEL, Ph.D.
KIMBERLY NOBEL, M.D.
RUTH OTTMAN, Ph.D.
NICOLE SCHUPF, Ph.D
KATHERINE M. KEYES WILD, Ph.D.
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2. BACKGROUND
As the longest running Psychiatric Epidemiology Training program in the country, we propose to
combine the experience that our long history provides with fresh ideas and approaches to produce a
strong training program for a new generation of scholars. At Columbia, we are fortunate to have an
exceptional faculty whose research programs allow us to propose a comprehensive approach that
seeks to advance knowledge at multiple levels (biological, individual, interpersonal and contextual) and
integrate that knowledge through an understanding of the dynamic interplay between levels. Our goal is
to recruit scholars with expertise in at least one level and to provide training that allows them to work
together across levels to develop more complete understandings of the causes and consequences of
mental illnesses. We begin the explication of our rationale for training and our plans for achieving it by
reviewing the compelling evidence that exists concerning the importance of the problem.
Based on both their prevalence and the distress and disability they produce psychiatric disorders
represent a substantial health burden in the United States and around the world (Kessler et al 2005,
Demyttenaere et al. 2004, Merikangas et al. 2010, Mathers and Loncar 2006). At the individual level,
these disorders are associated with a variety of functional impairments, emotional distress (Birnbaum
et al 2010), social dislocations (Agerbo et al 2004), serious physical illness (Prince et al. 2007) and
early death (Parks et al. 2006, Piatt et al. 2010). The societal costs are also enormous. In addition to
the costs of treatment and social services, lost income due to mental illnesses has been estimated to
be over 193 billion dollars per year in the United States (Kessler et al. 2008). Moreover, mental
illnesses are connected to major social problems such as homelessness (Folsom et al. 2005), HIV
infection (Collins et al 2006), interpersonal violence (Swanson et al. 2006) and arrest (Link et al. 2011).
At the same time epidemiological true prevalence studies consistently show that only a minority of the
people experiencing a mental disorder in the United States receive treatment (Wang et al. 2005). The
situation is even direr in developing nations where resources are limited and mental illnesses receive
low priority (Wang et al. 2007, Prince et al. 2007). These considerations highlight the importance of
continued research into the causes and consequences of psychiatric disorders and underscore the
need for continued training in this area.
Created in 1972 the Columbia University Psychiatric Epidemiology Training Program (PET)
provides rigorous training in a multidisciplinary context focused on understanding and addressing
mental illnesses. It is one of only a few programs designed to provide research training in the
epidemiology of mental disorders. The rationale for continued training, which we elaborate below, is
supported by our 39 year record of training generations of highly productive psychiatric epidemiologists
and the ongoing need to train still new generations. The program has supported and trained 167
researchers who have made valuable contributions to the research, clinical, and community settings
where they are based. Many have become leaders in the field. As our recent experience
demonstrates, demand for training remains high with far more highly qualified applicants seeking
positions than we have positions to provide. As a consequence, the fellows we enroll are exceptionally
well qualified, extremely talented and therefore highly promising. Demand for researchers trained in
psychiatric epidemiology also remains strong as the job procurement record of recent graduates
demonstrates.
Major changes in the field of psychiatric epidemiology (e.g. Susser et al 2006, Weissman et al. in
press), advances within epidemiology more broadly (e.g. Rothman et al 2008, Schwartz et al. 2011),
progress in the conceptualization of psychiatric illness (Kessler et al. 2011, Cuthbert and Insel 2010) as
well as growing awareness of the complex interconnections between psychiatric epidemiology and the
biological, developmental and social sciences (e.g. Brown and Derkits 2010, Koenen 2010, Koenen et
al. 2009, Link 2008, Galea 2007) underscore the importance of training programs such as PET. Our
training plan incorporates themes we have emphasized since the program’s inception, elaborates them
6
and moves them in new directions and to new substantive areas. Fifteen years ago we proposed to
expand our training from a strong base in individuals’ experienced adversity (Dohrenwend 1998, 2000)
“upward” to contextual factors and “downward” toward biological and genetic ones. Ten years ago we
further expanded this conceptualization to include a life course perspective (Susser et al. 2000) that
considers a person (biology, psychology), in context (family, social network, neighborhood) through
time (development, context change). Five years ago we emphasized the need to advance this
framework by expanding our capability to conceptualize, measure, and test ideas about the dynamic
interplay among levels (e.g., biological, individual, social). This framework has been extremely useful
in articulating the range of factors that influence the onset and course of mental illnesses and in helping
us develop a strong training program to respond to the need for expertise in the areas the framework
specifies. In the next five years we plan advances in each component of our framework as described
below. In each instance our aim is to take stock of current knowledge and by so doing push
understanding further to provide the knowledge base necessary to facilitate approaches that reduce the
incidence and shorten the course of mental illnesses.
Psychiatric Epidemiology: The Core Focus of PET
We begin with a definition of epidemiology because it informs what is – and is not – highlighted in
our training program. Epidemiology is the study of the distribution (incidence and prevalence) and
determinants of states of health in human populations and the evaluation of population health
interventions designed to address those determinants. The ultimate goals of epidemiology are to
contribute to the understanding of the etiology and course of disease and thereby to its prevention and
control. Psychiatric epidemiology involves the investigation of disorders of thoughts, feelings and
behaviors. It includes the variety of problems that are described in the Diagnostic and Statistical
Manuals of the American Psychiatric Association and the kinds of basic neurobiological dysfunctions
that are envisioned by the Research Domain Criteria (Cuthburt and Insel 2010). It uses epidemiologic
methods to understand the onset, course (duration and reoccurrence) and consequences of these
disorders with the goal of transforming such understanding into useful actions designed to prevent
disorder and mitigate the distress and disability that they entail.
Principles of Training
Over the years we have developed an approach to training that prepares fellows to identify
important research problems and to tackle these problems using theory, strategic study designs, and
innovative measurement approaches in a multi-disciplinary context. Through course work, field
placements and a faculty-fellows seminar, trainees are exposed to research that follows this model in
their own area of interest and in the field more generally. Below we describe our approach using
examples of research conducted by PET faculty. All of these studies are available to fellows as
potential field placements. We provide examples of fellows’ involvement here and, more extensively, in
the Progress Report.
Framework for Identifying Important Research Questions
The Columbia University Psychiatric Epidemiology Training Program challenges trainees to identify
research questions that deepen understanding and open the possibility for effective intervention.
Identifying the questions that will matter most in these respects is a non-trivial undertaking. Our entire
program is structured to achieve the aim of effectively training new generations of scholars who are
adept at identifying such questions and skilled in answering them. To encourage the initial creative
spark that leads to a good research question we provide a strong knowledge base in the core issues
facing psychiatric epidemiology. We then encourage trainees to view these core issues from multiple
perspectives so that new ideas emerge as problems are interrogated from different vantage points.
7
We facilitate this activity by exposing trainees to the diverse interests of a large and very active faculty,
who embrace multidisciplinary approaches and work with multidisciplinary teams. In keeping with this
orientation, we set forth a framework that begins with a traditional strength of our program – its focus
on an individual’s exposure to adversity and his/her use of coping resources to adapt to that exposure.
We expand from that focus to consider both broader contextual factors and biological mechanisms by
conceptualizing persons in context through time. This multifaceted, multilevel approach provides the
fellows a rich source of potential research questions.
The Focus on Adversity in Explaining Mental Health Disparities
The Columbia Program has traditionally emphasized the role of adversity in the etiology and course
of psychiatric disorders. This emphasis derived from the consistent association between
socioeconomic status and mental disorder, studies of extreme situations, and conceptualization of the
stress process. Under the direction of Bruce Dohrenwend, the program made great strides toward
understanding the role of adversity. These include findings from his innovative quasi-experimental
study reported in Science that tested the relative importance of social causation versus social selection
in explaining the association between socioeconomic status and several mental illnesses (Dohrenwend
et al. 1992).
The emphasis on adversity remains prominent in the work of PET faculty. For example,
Dohrenwend (2006) has tackled the problem of within category variability to develop a more powerful
measure of stressful circumstances. Additionally in a more recent Science article Dohrenwend and
colleagues (2006) supplemented data from the National Vietnam Veterans Readjustment Study
(NVVRS) with information from military records to provide strong objective measures of exposure to
combat. These painstakingly collected records avoid biases that could cloud the interpretation of self
report measures thereby allowing a declarative statement concerning the role of combat exposure in
the development of PTSD. Current fellow Ben Adams, a co-author of the 2006 Science paper, is using
data from this study to put forward and test a theory about the role of post-traumatic appraisal in the
stress process. This work integrates the objective measures of the combat exposure with the soldiers’
subjective appraisal of the event to provide a more complete framework for understanding the
consequences of combat exposure.
Working within the domain of adversity, Meyer, Schwartz and Frost (2008) constructed
comprehensive measures of adversity including measures derived from the Dohrenwend approach
mentioned above. By constructing a novel sample of people who varied in terms of sexual preference,
ethnic minority status and gender this team was able to investigate whether and to what extent
disadvantaged statuses were associated with stress exposure of many kinds and whether stress
exposure was related to mental disorder and suicide ideation. The novel sample and the
comprehensive set of measures addresses core issues pertinent to the role of adversity in mental
health that could not be addressed before. Current fellows Alicia Lukachko and David Barnes are
using these data to examine contextual factors that change the role of religious affiliation for Gay,
Lesbian and Bisexual populations. Tracy McFarlane is using these data to test a theory of positive
marginality – the benefits that can accrue from stigmatized group membership.
The Expansion to Contextual Factors and Biological Mechanisms.
Expanding from our program’s roots in adversity and stress we have developed our program’s focus
in two directions. One of these involves the revitalization of epidemiology's concern with the health of
populations through a greater emphasis on the social, cultural and historical contexts in which
individual risk factors occur. The second involves the incorporation and development of research that
uses biological concepts and measures to study the origins of mental disorders. Our rationale for this
8
two-pronged expansion derived from critiques of epidemiology’s overly narrow and excessively
descriptive risk-factor approach (Susser and Susser 1996). Needed, we argued, was an analytical
epidemiology that could investigate mechanistic explanations from a socio-cultural and/or a biological
vantage point to create what some of us have called an “eco epidemiology” (Susser and Susser 1996)
that “adopts, develops and teaches methods to understand both biological and social complexities”
(March and Susser 2006).
Progress and Plans Regarding Expansion “Up” to Contexts
We propose a continuation of our emphasis on contexts with a move to a deeper consideration of
global mental health. Before explicating our plans in this regard we briefly recount the rationale for an
emphasis on contexts more generally and provide a description of some of the U.S.-based work we
have done and are doing in this area.
Rationale for a Focus on Contexts. Our rationale for a focus on contexts stems from many
sources. From “eco epidemiology” comes the idea that biologic events are context dependent; "no
biological entity can conform entirely to universal laws because of the overarching contexts and
interactions between levels within a biological structure" (Susser and Susser 1996). Contexts are also
critical in Link and Phelan’s concept of "fundamental social causes" of mental and physical health
problems (1995, 2008, 2010). This is the idea that social factors such as socioeconomic status remain
associated with disease through time even though specific risk factors for disease and the prevalence
of the diseases themselves change in dramatic ways. Thus, it is critical to study contextual factors that
characterize groups of people linked through such factors as neighborhood, occupation, friendship, or
family. Finally Galea (2007) focuses attention on what he terms “macrosocial determinants” that “are
beyond the individual and are explicitly a function of population systems such as culture, economics,
political systems and population dynamics such as migration and urbanization.”
These frameworks all point to important contextual issues that must be addressed in any
comprehensive account of mental health problems. First, stress exposure can involve entire contexts
as recent studies directed by PET faculty underscore. For example Christina Hoven and colleagues
(2005) documented the substantial consequences of the 9/11 attacks on children in grades 4-12 six
months after the attack. Faculty member Sandro Galea has directed studies of the mental health
effects of civil war in Liberia (Galea et al. 2010), hurricane Katrina (Schumacher et al. 2010) and of the
long term consequence of 9/11 on adults (Digrande et al. 2011). When entire populations are impacted
in this way the salience of contextual factors becomes even more apparent. Whether and to what
extent infrastructure at the contextual level exists to address stressors (e.g. provide housing) or deliver
needed mental health services is critical to the health of populations in these very stressful
circumstances.
Second, social, cultural and historical contexts can also put people “at risk of risk” (Link and Phelan
1995, 2010). That is, contextual factors determine exposure to individually based risk factors such as
stressful life events, infections or environmental toxins. A striking example is the association between
famine and the subsequent development of schizophrenia. Both Susser et al.’s (1996) study of the
Dutch Famine and the two recent replications of that finding in China (St. Clair et al. 2005; Xu et al.
2009) indicate that large scale social and political factors shape exposure to poor nutrition which
subsequently puts people at risk for schizophrenia. Another example studied by PET faculty and
fellows concerns the growing evidence that migration sets the stage for subsequent racial
discrimination and exclusion that is associated with the onset of psychosis in Western Europe and
elsewhere (March et al. 2008, March et al. 2010, Veling et al. 2010).
9
Third, contextual factors such as stress exposure can modify genetic or other biological risk factors
(e.g., Caspi et al. 2003). Although the replication of the specific Caspi et al. finding has been debated,
the more general idea that genes and environments interact or are mutually related through epigenetic
and other processes is strong. The interplay between genes and environments is of great interest to
PET faculty and a strong program of research is building in this area. One example is newly recruited
faculty member (and former PET fellow) Karestan Koenen, whose research career has included an
emphasis on gene-environment interplay. A recent study conducted by Koenen, Galea and colleagues
(2009) examined the influence of the interplay between the serotonin transporter polymorphism 5HTTLPR and the county-level social environment (e.g., crime rate and unemployment) on PTSD in the
Hurricane Ike study. Susser is a participant in ongoing follow-up studies of the Dutch famine, which
reported that early prenatal famine leaves epigenetic marks (reduced methylation) on the imprinted
gene IGF2 that remain detectable sixty years after the exposure (Heijmans et al. 2008). While he and
colleagues are investigating the role of epigenetic effects in linking early prenatal famine to
schizophrenia, they have also suggested an alternative hypothesis that periconceptional famine may
predispose to genetic mutations (e.g. individually rare copy number variations or CNVs) that have been
related to schizophrenia in recent studies (e.g., McClellan et al. 2006; 2007). Similarly, the relation of
older paternal age at conception to both schizophrenia and autism, first established by PET faculty
(Brown et al. 2002; Reichenberg et al. 2006, Malaspina et al. 2009), have been hypothesized to be
related to either epigenetic effects or de novo mutations in the male germ line (Malaspina et al., 2002).
As research on the interplay between genes and environments grows it is clearly critically important for
fellows to be familiar with both domains and with the many ways in which genes and environment can
influence one another. One sign of our growing recognition in this area is that early career social
epidemiologists from Europe often come to spend six month periods at Columbia with us, in order to
learn more about the integration of epigenetics and genetics with psychiatric epidemiology. For
example, in the past year we have had such visiting faculty from Cambridge University, UK; Leiden,
Netherlands; and University of Oslo, Norway.
Fourth contexts are important because as Link (2008) points out the diffusion of any new health
enhancing knowledge or technology is strongly influenced by contextual factors. This has been shown
for example in studies of the diffusion of statins and beta blockers as they influence cholesterol levels
and recovery from acute myocardial infarctions respectively (Chang and Lauderdale 2009; Skinner and
Stager 2005). As advances are made in the pharmacological and psychosocial treatment of mental
illnesses these same processes are likely to apply and, as a consequence, their diffusion needs to be
understood and addressed so that benefits are distributed as rapidly (to improve population health) and
as evenly as possible (to minimize disparities).
Growing Emphasis on Global Mental Health. Each element of the rationale for training in
contextual factors mentioned above is strongly implicated in an area in which we plan to expand our
emphasis in the five years ahead – global mental health. In no way minimizing our attention to such
factors in the United States we turn to global mental health because of the critical nature of the
problems associated with the global burden of disease, our own interest and expertise in the area and
the emphasis that has been placed on this domain within NIMH.
Estimates of the life time prevalence for mental disorders from the World Health Organization are
between 12 and 49% (WHO 2000) and 12 month prevalence is between 4 and 26% (Demyttenaere et
al 2004). In keeping with these facts estimates of the burden of disease due to neuropsychiatric
disorders is large with nearly three quarters of this substantial burden residing in what have been called
“low” and “middle-income” countries (Lopez et al 2006). In the absence of intervention this burden is
projected to grow dramatically in part due to the demographic and epidemiological transitions in low
and middle-income countries (Mathers and Loncare 2006). Estimates of the low proportion of people
with identified disorders who receive treatment for those disorders indicate an enormous global
10
problem (Wang et al 2007). This burden is almost certainly underestimated in low and middle income
countries because it is based on community surveys which generally omit childhood disorders and late
life disorders and could not reliably measure uncommon severe disorders such as schizophrenia.
Infrastructure for delivering mental health services is often meager leaving many people with severe
problems either untreated or poorly treated (Saxena et al. 2007). Moreover the capacity within high
income countries to partner with countries with fewer resources in joint efforts to address these
problems is underdeveloped.
Drawing on a strong tradition within epidemiology at the Mailman School of Public Health begun by
Susser (Mervyn) and Stein we have expanded our interest and expertise in global mental health. Chair
of the Department of Epidemiology and PET Faculty Member, Sandro Galea is engaged in projects
around the world that examine the mental health consequences of traumatic events induced by war,
terrorism or disaster. He has on-going studies in post-war Liberia, in Ethiopia and among Israelis and
Palestinians exposed to multiple terrorist attacks (see e.g. Galea et al 2010). Richard Neugebauer, a
member of the PET steering committee, studies the mental health and developmental consequences of
the Rwandan Genocide (Neugebauer 2009). He is also actively engaged in an analysis of two
randomized controlled trials of the efficacy of group interpersonal psychotherapy for the treatment of
depression in Sub-Saharan Africa (Bolton et al. 2003).
Ezra Susser, former Department Chair and Co-Director of PET has been involved in the global
mental health field for over 20 years and continues to build on the longstanding connections developed
over that period of time, especially though not only, in Latin America and sub-Saharan Africa. He is
actively involved as a consultant, advisor and mentor on work in Argentina, Brazil, India, South Africa
and elsewhere, and is Chair of the Scientific Advisory Board of Geocode, a European Union funded
collaboration that seeks to build capacity across the globe in birth cohort research, genomics, and
epigenetics, with a key focus being mental disorders. In 2010, Susser and Galea established and colead a Global Mental Health Program at Columbia.
Our interest in global mental health has been matched by a growing interest in this area within
NIMH. The institution of a new Office on Research on Disparities and Global Mental Health is one
strong sign of this interest (and is led by Pamela Collins who was on the PET Steering Committee
before being recruited to that position). In concert with the development of this office a Request for
Applications (RFA-MH-11-070) was released entitled Collaborative Hubs for International Research on
Mental Health (U19). In keeping with our growing interest in this area we responded to this RFA for the
region of Latin American, and under the leadership of Susser (contact PI), Galea (PI), and Chilean
colleagues Rojas and Alvarado (PIs), we received an excellent score that positions us well to become
one of three funded HUBS. In addition, Susser was one of the PIs on an application for sub-Saharan
Africa (contact PI: Crick Lund, UCT), that received a similar score and is well positioned to become
another one of the three funded Hubs. This and the Global Mental Health Program we already have in
place, as well as the broad range of global mental health research of our faculty, provide an
exceptionally strong context for training.
Current PET postdoctoral fellow Joy Noel Baumgartner is strongly integrated into research on
Global mental health through her mentor Ezra Susser. She helped to write and is closely involved in
an R21 (together with a second PI from South Africa) designed to build a platform for the first incidence
study of psychoses in sub-Saharan Africa. Her main interest is in testing, refining and elaborating
measures of social integration that can be used effectively in different cultures and for people with
different types of mental health problems. If they are funded, this work could also be pursued in the
Latin American and Sub-Saharan Hubs. As a starting point, she is refining the widely used World
Health Organization Disability Assessment Schedule (WHODAS 2.0) for African contexts, building on
her dissertation work in Tanzania and her new pilot studies in South Africa.
11
In keeping with the idea that understanding global mental health has direct relevance for
understanding the mental health problems of new immigrants, faculty member Roberto LewisFernandez has a program of research focused on understanding the way culture affects individuals’
experience of mental disorder and their help-seeking expectations (Lewis-Fernandez et al, 2009,
2010). Several other senior faculty members (Brown, Dohrenwend, Hasin, Link, Weissman), though
less centrally involved in global mental health have studies located in other countries and strong
interests in processes pertaining global health such as trauma (Dohrenwend), the provision of
interpersonal psychotherapy (Weissman), gene-environment interaction (Hasin) and stigma (Link).
The strong senior leadership in global mental health is augmented by the interest and expertise of
three junior PET faculty. Lisa Bates is Co-PI of a study that examines women’s health and well-being
in Bangladesh in the context of economic development; she is designated as the PI of a grant in
preparation for a related study in Pakistan, where Dr. Susser and Dr. Atif Rahman will be co-leaders.
Magdalena Cerda is using a quasi-experimental strategy made possible by the introduction of a cable
car to poor isolated communities in Columbia to study the implications of neighborhood change on
violence and mental health; both Galea and Susser are mentors on her K Award and she is part of the
Hub for Latin America. Larry Yang conducts research on schizophrenia in China and currently has a 7
percentile score on an R03 to study the deficit syndrome using a large epidemiological study (Phillips et
al. 2009) of untreated people with schizophrenia. In addition Yang developed a pilot proposal to study
stigma in cross cultural contexts as part of the U19 HUB grant. Of the six main faculty with interest and
expertise in global mental health three (Bates, Cerda and Galea) are new to our faculty since the last
submission indicating a strong growth for this new emphasis. Our emphasis on contexts in general and
global mental health in particular offers fellows at different levels strong training and development
opportunities.
Progress Regarding Expansion “Down” to Biological Factors
Biologic and genetic studies are at the forefront of research in psychiatric disorders, and here too
epidemiology can play a unique and central role (Weissman et al., in press). During the past five year
period we have worked to consolidate and expand training and research opportunities for the fellows in
these areas. We began the last 5 year period of funding with substantial strength in this area as
represented in the research programs of Co-Director Ezra Susser and faculty members Alan Brown,
Susan Hodge, Ruth Ottman and Myrna Weissman. We have added to that strength through the
recruitment of four new faculty -- Cheryl Corcoran a biologically oriented psychiatrist studying the
prodrome for psychosis, Karestan Koenan who has a strong program of research focused on genetic
factors and gene-environment interplay, Kimberly Noble a pediatrician epidemiologist who studies the
biological pathways that link adversity to cognitive functioning and mental health outcomes, and Nicole
Schupf who studies biological and genetic factors in Alzheimer’s Disease. Sandro Galea, the new
chair of epidemiology strengthens several aspects of our program including this one through his studies
of gene-environment interactions in PTSD.
In light of the strong emphasis on neuroscience and its importance for understanding the biology
and genetics of mental illnesses, Weissman et al. (in press) point to the critical role that epidemiology
can play in advancing such understandings. Based on Weissman and colleagues analysis, we identify
four ways in which epidemiology is critical to the advancement of biological and genetic understandings
of mental illnesses.
1) Epidemiology Provides Population-Based Data and Designs. Weissman et al. (in press) make a
compelling case that epidemiological designs and findings can facilitate a partnership with the basic
sciences. Specifically they apply the concept of translational epidemiology to psychiatry and propose
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that “the representative samples, novel designs, and hypotheses offered by epidemiology can be
translated into experimental approaches in the clinical and basic sciences.” As examples they point out
that community studies provide large generalizable samples for collecting genetic information and
biomarkers and can also be used to construct case-control studies targeting biological factors of
interest to basic science investigations.
Furthermore epidemiological studies have spawned
hypotheses like the gateway hypothesis for drug addiction and paternal age as a risk for schizophrenia
and autism. These hypotheses have become the foundation for subsequent animal and genetic
studies. In short, the case is made that epidemiology is critically needed to assist in the full realization
of the tremendous advances that have taken place in the biological sciences over the past decade.
2) Epidemiology is Critical to the Identification of Biological Risk Factors. Among the many
examples Weissman et al. provide, several critical findings have emerged from the work of PET faculty.
For example, informed by the nuerodevelopmental approach and the idea that there are critical periods
in which environmental exposures might be particularly important, Brown and Susser have studied
cohorts who were ascertained in utero and have now been followed through adult life. Facilitated by
the collection and storage of maternal sera, these studies provide some of the most convincing
evidence concerning the role of infections in the etiology of schizophrenia (Brown et al 2004; 2005).
The approach also allows the study of environmental toxins and nutrition. For example, evidence is
building that in-utero iron deficiency may play a role in psychosis as a paper from PET fellow Beverly
Insel has indicated (Insel et al. 2008). In keeping with the success of this approach Brown has three
ongoing R01’s focused on schizophrenia, autism (in Finnish cohorts) and bi-polar disorder (in a
California cohort) and Susser is involved with studies in China and Israel forming an excellent context
for discovery and training of fellows. Brown has also demonstrated that in utero infectious exposures
are associated with core phenotypes that have been consistently observed in schizophrenia, including
neurocognitive anomalies (Brown et al, 2009).
3) Epidemiology is Critical for Studying the Interplay Between Genes and Environments. In
describing the rationale for the importance of contextual factors (see above) we argued that a thorough
understanding of contextual factors was critical to understanding the interplay between genes and
environments. Of course the same is true for genetic factors. To the extent that genes modify
environmental exposures such as personally experienced stressful life events or disadvantaged
contextual circumstances (e.g. Koenen el al. 2009) we need to understand genes to understand
environmental exposures. To do so a thorough understanding of informative epidemiological designs
such as high risk and twin studies is required. Additionally, new ideas relating to epi-genetics will likely
deepen the need to understand genetics in relation to environments in the time ahead. The programs
of research of Brown, Galea, Koenen, Susser and Weissman provide superb contexts for training in
these areas.
4) Epidemiology is Important for Understanding Biological Pathways from Adversity to Disorder.
Understanding the role of adversity in the onset and course of mental disorders will be greatly
enhanced and more deeply understood to the extent that the biological pathways linking adversity to
disorder are identified. Recent research strongly suggests the possibility of new understanding in this
area. For example the work of Boyce and colleagues (2005) interrogates the interactive influences of
socioeconomic adversities and neurobiological responses showing that they operate in concert to
induce both physical and mental disorders in childhood. In keeping with this general paradigm, new
faculty member Kim Noble uses imaging (MRI) to understand the neuro-cognitive mechanisms linking
socioeconomic adversity and brain functioning (Nobel et al. 2006; 2007).
All of the PET fellows have benefited from the development of this area of research, but some have
been particularly drawn to it. Fellows recently graduated from PET who focused on biological factors
included Anna Keski-Rahkonen twin studies of eating disorders, James Gangswich, insulin
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dependence and depression, and Beverly Insel iron deficiency and maternal-fetal blood incompatibity
and schizophrenia. Current fellow David Freedman is studying early developmental risks for
neurocognitive dysfunction in schizophrenia and newly admitted postdoctoral fellow Keely CheslackPostava will be working on the development of autism in offspring of mothers exposed to environmental
pollutants both under the mentorship of Alan Brown. In sum we continue to have the capacity to expose
students to and mentor them in cutting edge research that has a biologic focus.
A Life-Course Developmental Perspective.
In addition to an emphasis that focuses “up” to contexts and “down” to biological determinants, our
program strongly emphasizes a developmental psychopathology perspective – what might be
considered a horizontal dimension. Both epidemiologists at large and our faculty have increasingly
recognized the critical importance of understanding individual trajectories through time - ranging from
prenatal and infant periods, through childhood and adolescence, into early, middle, and late adulthood
- and how these trajectories are influenced by biological and social factors. Indeed, this developmental
perspective applies not only to one generation but can be extended to multiple generations and to the
idea that the life trajectory of one generation has impact of the trajectory of another.
Many of the critical questions facing the field can only be answered with data that contain
information collected across the life course (Kuh et al 2003). An appreciation of the power and
necessity of these designs has led many of our program faculty to prospective longitudinal
investigations of mental illnesses spanning multiple life-stages from in utero exposures to adult aging
(e.g., Brown et al 2009) and across more than one generation (e.g.,Weissman 2006). In Brown’s
studies in Finland, data from the early prenatal period through childhood development, adolescent
neurocognition, and adult onset of schizophrenia will be investigated using systematically collected
national registries and records. His team and collaborators in Finland are also leading studies on
developmental trajectories that are associated with development of autism.
A compelling rationale for focusing on a life course approach is evident in considering some obvious
benefits of the approach. First, it allows the study of linkages between circumstances at one time and
circumstances at another thereby deepening the understanding of the outcomes of interest. Second, it
can capture the accumulation of adversity or advantage necessary to examine concepts like allostatic
load (McEwen 1998) and weathering (Geronimus 2001). Third it facilitates the assessment of critical or
sensitive times when specific exposures could have particularly strong impacts on mental health years
or even decades later (Brown 2010). Fourth, when the design involves multiple generations or sibling
pairs it becomes possible to address substantive questions such as the effect of one generation on the
next (Cohen et al. 2006) or to refine causal inference through the use of sibling designs (Susser et al.
2006). Fifth the data structure that life course studies provide allows the use of methodological
approaches such as fixed effects analyses (Allison 2005), latent growth curves, and growth mixture
models that can improve causal inference and facilitate targeted tests of hypotheses. Finally, a life
course approach is particularly congenial with our programs strong emphasis on integration across
multiple levels of influence. Instead of forcing questions about biological or social influence into an
either/or framework it allows us to assess, for example, how a genetic or biological circumstance early
in life might lead to social consequences that then become new risks for the exacerbation of the
condition in question or risks for entirely different disorders. Similarly social adversity can lead to
biological consequences which then become risks for the development of disorder. For all of these
reasons the life course/developmental psychopathology component remains central to our program
and the training it provides.
Over the past five years we have made substantial progress in incorporating an emphasis on the life
course. Co-Director Pat Cohen’s study has continued to be the centerpiece in this regard. The
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“children” in her study were born between 1964 and 1974 and now have children of their own. These
and other data on this cohort are being used to study reciprocal effects of family members on one
another over time. For example, former fellow Deidre Anglin used these data to study the impact of
maternal separation and its duration on schizotypal symptoms much later in life (Anglin, Cohen and
Chen 2008). A particularly novel set of findings from this study addressed Axis II disorders, the long
term course of these disorders and their relationship with Axis I disorders (Crawford et al. 2008;
Johnson et al. 2008). Cohen’s research has also introduced PET fellows to concepts and methods for
studying how individual trajectories are influenced by individual and contextual factors (see Cohen et
al. 2003). Her most recent work incorporates genetic data and will allow tests of the influence of genetic
factors on trajectories of psychiatric disorders.
A growing strength in the Epidemiology Department resides in the Imprints Center Directed by Ezra
Susser and the newly established Life Course Cluster within Epidemiology that is also led by Susser.
These overlapping groups carry out studies in birth cohorts across the globe, with the aim of deepening
our understanding of the origins and unfolding of health and disease. The center brings together
investigators who are conducting studies in 18 birth/pregnancy cohorts from 12 countries. Psychiatric
outcomes over the life course are a primary focus of most of the studies. Past and current fellows have
used these remarkable data to investigate the role of maternal fetal blood incompatibility, iron
deficiency, living conditions and social statuses in the onset of mental disorders (as in the work of PET
fellows Insel, March and Breshnahan). Susser, Brown and Link are each PI’s on separate grants
focused on birth/pregnancy cohorts with psychiatric outcome measures thereby insuring excellent
opportunities for new cohorts of PET fellows in this domain. One cohort of particular interest, and in
which Susser and Bresnahan have played a central role, is the Norwegian MoBa study, a pregnancy
cohort of 109,000 that is arguably the richest extant pregnancy cohort data set. They are collaborating
closely with Norwegian investigators to study diagnostic outcomes such as autism spectrum disorders
and ADHD as well as outcome domains such as cognition and language. A study of schizophrenia in
this cohort is already being planned.
Conceptual Integration – Dynamic Interplay
Over the past ten years we have worked to incrementally expand our scope of vision “up” to
contexts, “down” to biology and genetics, and “across” the life course. Our emphasis in the next five
years is to further develop and integrate across these multiple levels. Specifically, our aim is to
understand how different levels mutually influence one another. Over the past ten years we have been
recruiting faculty and developing critical connections among them to allow such integration, selecting a
multidisciplinary cohort of faculty and fellows interested in the spectrum of issues and bringing the
people and ideas together in our faculty fellow seminar. Over time, faculty and fellows have come to
recognize the explanatory power of each level of analysis, know enough about each level to identify
instances in which it might be incorporated, and develop relationships with others who have expertise
in these different levels. Over the next five years, we will solidify and integrate what we have learned.
Spurring this integration are biological theories and research that are consistent with our multilevel
framework. For example the work of Michael Meaney and Frances Champagne has shown that
characteristics of the structure of DNA that do not alter the sequence of DNA can nevertheless have
profound effect on the expression of genes through “epigenetic processes” (Meaney 1988; Champagne
2010). In this way environments can be involved in gene expression. Further work in this area is
exploring the possibility of the “inheritance” of environmental effects through a process in which
transmission occurs through a genetic mechanism that involves epigenetic changes to gene expression
(Champagne, 2011). These insights open the possibility for deeper understanding of mutual influence
between genes and stressful events, and between genes and contexts large and small thereby directly
engaging the framework that serves as the basis of our rationale for training.
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Another set of concepts and measures directs attention to the physiological effects of stress. One
example in this domain is the work of McEwen (1998) and his ideas about allostatic load. The theory
as specified by McEwen provides an explanation for how stress and adversity can have untoward
physiological consequences that translate into pathophysiology, disease, and death. As currently
operationalized through multiple biomarkers, measures of this concept have been reliably associated
with low SES, social isolation, and neighborhood disadvantage (Bird et al. 2010, Dowd et al 2009
Seeman et al 2004). In another domain substantial effort has been directed toward investigating
biological aging, weathering and similar concepts. The biomarker of telomere length has begun to
produce a set of associations that is, like the patterns for allostatic load, suggestive of dynamic
interplay between biological and social factors. Studies have found that telomere length is associated
with child abuse, ambient stress in adult life and measures of socioeconomic status (Tyrka et al 2010,
Cherkas 2006). Although these associations are not fully understood, they signal challenging
connections between biology, adversity and context in a life course framework.
These biologic theories, concepts and measures open an enormous opportunity for integration with
social and psychological theories about the stress process (Dohrenwend 1998), social conditions (Link
and Phelan 1995, 2010), child rearing (Johnson et al. 2006) and the timing of all of these factors across
the life course (Susser et al 2006). We have begun to seek this kind of integration in our work.
Sometimes we capitalize on the unusual opportunity afforded when, for example maternal sera have
been stored and can be studied for evidence of fetal exposure to infection, nutritional deficiencies, or
environmental toxins (Brown 2010). In other instances we have collected samples that will allow
investigation of gene-environment interactions, as is the case with respect to the previously mentioned
cohort that Patricia Cohen has been following since the mid 1970’s. In a study funded by NICHD, Link
and Susser are currently collecting blood samples from individuals who are part of a pregnancy cohort
initiated in the late 1950’s and early 1960’s. Influenced by the integrative multidisciplinary approach
valued by PET, this work explicitly seeks to understand the dynamic interplay between social
conditions (like SES), development (social and cognitive) and emerging health over the life course.
Because measurements are available during pregnancy, early childhood, adolescence and now middle
age the mutual influence of multiple levels can be observed over the life course.
Finally, in an effort to advance an eco-epidemiologic approach that considers multiple levels of
organization and how they relate through time, we propose an exploration of the utility of “complex
systems approaches.” While traditional approaches to causal inference have great utility for addressing
many types of causal problems, the dynamic interplay across levels and between individuals can be
hidden by the requirements of standard methods (Galea et al. 2010; Schwartz et al. 2006). New
approaches, grounded in systems thinking and most developed in infectious disease contexts, are
being examined for their potential to overcome this limitation. This perspective relies on a metaphor of
contagion, where the behavior of one individual can influence the behavior and outcomes of others
(Galea 2010). Members of PET faculty are actively engaged in trying to understand the relationship
between these newer methods and current epidemiologic approaches (e.g., Schwartz et al. 2011), and
testing and validating these new methods for understanding population health (Galea et al. 2010). For
example, Galea and colleagues (2009) have applied agent-based modeling, one type of a systems
approach, to understand how environment and social networks shape drug dependence. This work
provides trainees with exposure to and opportunity for research on and with these newly emerging
methods.
Implications of the Framework for Interventions
The framework described above is particularly useful for guiding interventions designed to reduce
the burden of pain and suffering associated with mental illnesses. Focus on multiple levels enhances
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the possibility of developing interventions targeting different levels (contexts, individual behaviors,
biological mechanisms) and, when appropriate, coordinating efforts across levels to achieve maximum
impact. Our focus on life course will facilitate the development of knowledge relevant for determining
the optimal timing of interventions in the life course. Finally our plan for integrating knowledge across
levels will provide information critical to tailoring interventions and maximizing their effectiveness. Thus
our scheme is designed to facilitate the translation of what we learn to effective action.
Methodologies For Addressing Research Questions: Strategic Designs and Innovative Measures
Our training approach stresses both the importance of asking theoretically grounded and important
research questions and the use of rigorous and strategic methods to pursue answers. In what follows
we draw on research conducted by faculty, some of which has already been mentioned above in
regard to their substantive import, to exemplify the broad range of methodological approaches we seek
to encourage. One approach involves testing theories using novel research designs that enhance
causal inference. Prominent examples here are Dohrenwend and colleagues' use of a quasiexperimental strategy to test theoretically derived predictions about the classic social causation-social
selection issue (Dohrenwend et al. 1992); Susser and colleagues (1996) use of the Dutch Famine
Study to investigate the association between in-utero nutritional deprivation among pregnant women
and the development of schizophrenia in their offspring and Schwartz et al.'s (1994) use of data on
parental exposure to the Holocaust to test theories about the non-genetic familial transmission of
mental disorder. This tradition of identifying circumstances that are, or come close to being natural
experiments remains strong within our group. One example is Magdelena Cerda’s study of the
introduction of a cable car to some poor isolated communities in Columbia South America and not to
others. As an exogenous source of neighborhood change, the design allows strong inference with
regard to the implications of such changes for violence and mental health. Similarly Galea harnesses
large scale natural and man made circumstances (war, 9/11, hurricanes and earthquakes) to
understand the role of stressful circumstances on psychopathology and Susser uses sibling designs to
buttress causal inference in studies of the life course influences on mental health sites.
An increasingly important study design entails testing ideas through long term follow-up studies of
informative samples. A prominent example here is Pat Cohen and colleagues' follow-up of a
community sample of over 800 children first assessed 30 years ago at age 6 -10. The maintenance of
this cohort and multiple assessments of a broad range of risks, contexts, and functional measures
provide strong data for illuminating developmental processes. Over 200 publications have resulted
from this study thus far. The unique assessment of personality disorders since early adolescence has
shown the strong risk of early personality disorders for future disorders and dysfunction in a wide range
of areas (Crawford et al. 2008; Johnson et al. 2008). New work includes DNA assessment of genetic
risks identified in other studies, an investigation of contexts that promote adaptive function in
symptomatically vulnerable cohort members, illumination of the origins and meaning of diagnostic
comorbidity, and continuity of problems over three generations. Each of these issues is investigated in
a population-based longitudinal epidemiologic sample, and the availability of such data requires and
enhances the development of novel and sophisticated analytic methods (e.g. Chen and Cohen 2006).
Another example is Ezra Susser and Alan Brown’s follow-up of the offspring of mothers ascertained
between 1959 and 1967 from the Kaiser Foundation Health plan in Alameda County CA. Using a
nested case control design they conducted assays on the stored sera of mothers to show associations
between indicators of influenza infection, lead exposure, and iron deficiency during gestation and
schizophrenia in the offspring 30 to 38 years later (Brown et al. 2004a, 2004b, 2005). Building on this
work, Susser (with colleague Stephen Buka as co-PI) subsequently led a multisite collaborative same
sex sibling study named the Early Determinants of Health (EDAH). EDAH combined the Alameda
county cohort with another large and comparable US cohort (The New England Family Study,
17
representing the Boston and Providence sites of the Collaborative Perinatal Project, also ascertained
1959 to 1966). EDAH encompassed not only neuropsychiatric outcomes, but also breast cancer and
cardiovascular risk and fertility and other outcomes, and sought to identify common early causes (e.g.
fetal inflammation for depression and cardiovascular disease) as well as differences in effects of early
exposures (e.g. rapid fetal growth may increase risk of breast cancer but decrease risk of
cardiovascular disease and depression) across these health domains. The first publications will appear
later this year in a special issue of the Journal of Developmental Origins of Health and Disease.
Myrna Weissman and colleagues (Weissman et al 2004; 2006, Weissman and Olfson 2009, Warner
et al 2008, Ritsher et al. 2001) combine a family study-high-risk design with a prospective longitudinal
follow-up of three generations of families that were initially identified in 1982. This novel design
provides opportunities to test ideas about the intergenerational transmission of disorders (Weissman et
al. 2004), possible precursors to disorders such as the startle response (Warner et al 2008), the impact
of involvement in treatment in one generation on the depression levels of the next generation assessed
20 years later (Weissman et al 2005) and social causation versus social selection processes with
respect to the relationship between socioeconomic status and depression (Ritsher et al 2001). Notably
none of these factors could have been studied as well outside of this rich design.
Still other design approaches involve the translation of basic social science and epidemiologic
understandings of problems into effective interventions. One example in this regard involves the work
of Dan Herman and Ezra Susser on the Critical Time Intervention (CTI), which is designed to prevent
recurrent homelessness among persons with severe mental illness by enhancing continuity of care
during the transition from institutional to community living. Originally tested in an RCT with adult men
discharged from a shelter-based psychiatry program, the CTI program was found not only to help
people stay housed for longer but also to reduce negative symptoms for at least nine months after the
end of the time limited nine month intervention (Susser et al. 1997; Herman et al. 2000). More recently
Herman and colleagues (in press) evaluated the effectiveness of CTI in an RCT funded by NIMH and
the New York State Office of Mental Health and found that it significantly reduced homelessness after
discharge from hospital, again the effect persisted for at least nine months after the end of the
intervention.) CTI is now being adapted and tested across the US and in many other countries for
persons with mental illness (e.g. Netherlands, Australia, Brazil, UK), and for other kinds of transitions
(e.g., from prison to community, from foster care to unsupported living, for the point of first contact with
mental health services). Other faculty involved in intervention studies include work by Neugebauer and
colleagues evaluating the effect of psychotherapy on women experiencing miscarriage (Neugebauer et
al. 2007) and on youth in war torn Uganda (Bolton et al 2007) and Link and colleagues’ evaluation of
outpatient commitment under Kendra’s law in New York State (Phelan et al. 2010; Link et al. 2011).
We also emphasize the development of new measurement approaches that permit the investigation
of previously intractable research problems. For example, Hasin developed the Psychiatric Research
Interview for Substance and Mental Disorders (PRISM) to overcome difficulties in differentiating
expected intoxication or withdrawal effects from symptoms of psychiatric illnesses. Results have
shown considerably better test-retest reliability for the PRISM than for other widely-used diagnostic
instruments (Hasin et al. 2006). Concerned about the adequacy of measures of environmental stress
and the feasibility of gold standard approaches to capturing it, Dohrenwend and colleagues have
developed narrative based approaches to rating life events and proposed a strategy for testing the
validity of protocols that are less labor intensive (Dohrenwend 2006). The strategy for testing is
currently under way. Finally, Link and Phelan have continued to develop measures related to mental
illness stigma and discrimination in the context of two grants. In the first (an NIMH R21) they translate
insights developed by social psychologists to capture race and gender prejudice (stigma
consciousness, rejection sensitivity) for use among people with mental illnesses. In the second (NSF
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funded), they develop implicit measures of mental illness prejudice in collaboration with “project
implicit” at Harvard University.
As foreshadowed above measures of biologic factors can also provide a rich source of innovative
measurement when such measures are imported from their bench science origins into epidemiologic
studies. When such measures are incorporated into epidemiological studies the capacity to test
previously untestable ideas is greatly enhanced as the work of several faculty demonstrate.
Implications for Training
Clearly, to advance the field of psychiatric epidemiology, future researchers must be well versed in
a broad range of methodologic and substantive issues and equipped with diverse research skills.
These include first and foremost an emphasis on testing ideas through the novel application of
theories, study designs, and measurement innovations as specified above. Doing this requires
knowledge of epidemiologic methods, the construction and psychometric evaluation of measures,
statistical analysis techniques, clinical diagnoses, the fundamentals of genetic, biological, psychological
and sociological theories, concepts, and measures, and the ability to conceptualize these in a multilevel
framework. As detailed below, the training vehicles consist of course work, field placements, and
participation in the faulty-fellow seminar. These are designed to train pre- and post-doctoral fellows
from a variety of disciplines to become conversant in all, and expert in some, of the areas mentioned
above.
Conclusion
PET at Columbia is fortunate to have an exceptionally strong faculty who are pressing knowledge
forward in multiple programs of research that provide superb contexts for training a new generation of
scholars. The PET program organizes this resource via the conceptualization presented above that
seeks to advance knowledge at multiple levels and integrate that knowledge through an understanding
of the dynamic interplay between the levels. As an established program we seek to benefit from the
wisdom that our long history provides but at the same time engage new ideas and flexibly change to
address new pressing questions. As documented above our approach is strongly influenced by new
developments and new emphases and our fellows have been productively situated within that context.
Additionally, we have recruited new faculty both from within Columbia and from outside it to bring new
ideas and new strengths to our program. Below, we describe the structure of our program, indicate
how we adapt and change it over time and provide evidence regarding the strength of the research
context and the success of fellows who have been trained in the program.
3. PROGRAM PLAN
a. Program administration
Program Director
Bruce G. Link has been Director of the program since September 1995. His strong scientific
background, intense involvement in ongoing research projects and commitment to teaching and
mentoring are central to the success of the training program. His guidance and intellectual perspective
permeates all aspects of the program. In addition to mentoring many of the PET students, Dr. Link
provides the fellows’ introduction to the field in his course on Psychiatric Epidemiology. Dr. Link
received his Ph.D. in Sociology from Columbia University in 1980, was trained in the Psychiatric
Epidemiology Training Program at Columbia from 1976-1979, and received a B.S. in biostatistics in
1982 as an NIH funded post-doctoral fellow. He became the Training Coordinator of the Psychiatric
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Epidemiology Training Program when he was appointed an Assistant Professor of Epidemiology in the
School of Public Health at Columbia. He was promoted to Associate Professor of Public Health (with
tenure) in 1988 when he assumed the role of Co-Director of the Training program; he became a full
Professor in 1998. Dr. Link’s excellence in research and mentoring was recognized in 2002 when he
was the recipient of three prestigious awards – the Leonard Pearlin Award for distinguished
contributions to the Sociology of Mental Health, the Presidential Teaching Award at Columbia, and
election to the Institute of Medicine. The multi-disciplinary character of the PET program is enhanced
by Dr. Link’s joint appointments in the Departments of Epidemiology, Psychiatry, Socio-medical
Sciences, and Sociology, and his directorships of the Center for Social Inequalities and Health and the
RWJ Scholars Program. He expends 15% effort in his role as program director.
Administrative structure:
The program is administered by the program director in consultation with the co-directors, training
coordinator and the steering committee.
Co-Directors: Patricia Cohen, Bruce P. Dohrenwend, and Ezra Susser: The Co-Directors play a
critical role in the program in three regards. First, they attend most of the weekly Faculty Fellow
seminars whereas other faculty tend to select the ones in which they are most interested. They know
all of the fellows in the program and are therefore a consistent resource for the fellows. Second, they
each bring particular expertise in areas critical to the program-- Dr. Pat Cohen in design and analysis
issues with a focus on the life course, Dr. Bruce Dohrenwend in theory, study design and the stress
process, and Dr. Ezra Susser in public health interventions and the incorporation of biologic and
genetic variables in a global context. Finally, they inform the program policies through regular meetings
with the Director and Training Coordinator. All of the Co-directors serve as field placement preceptors
and Steering Committee members. The extensive involvement of the co-directors provides breadth and
depth to the available expertise, strengthening the program both intellectually and administratively.
Training Coordinator: Sharon Schwartz: Dr. Schwartz is responsible for the day to day
administration of the program including scheduling and chairing the weekly Faculty-Fellow Seminar,
coordinating core program courses, advising fellows about courses, field placements and university
resources, preparing administrative reports, conducting program and field placement evaluations,
soliciting and monitoring applications to the program, and interacting with support staff concerning
financial and other administrative issues. She also serves as a member of the Steering Committee and
faculty. Beyond these concrete tasks the Training Coordinator is responsible for integrating the program
components and facilitating connections among faculty and fellows to create and maintain a sense of
identity and a vibrant research community. Dr. Schwartz expends considerable time and effort to
ensure that fellows receive an optimal training experience. She continually monitors for necessary
adjustments to meet the changing needs of each cohort. Her ability to do so is enhanced by
departmental support for her teaching activities. For example, this support allows her to attend
seminars on advances in pedagogy and mentoring to ensure that the program training techniques are
as current and evidence based as the research methods being taught. She is a member of the Glenda
Garvey Teaching Academy and the ASPH/Pfizer Health Academy of Distinguished Teachers. In 2000
she was awarded the Presidential Teaching Award at Columbia.
The Program Director, Co-Directors and Training Coordinator meet on a regular basis to ensure that
the program is running smoothly. They all have long-standing involvement with the program, providing
it with a sense of leadership and continuity.
The Steering Committee:
Alan Brown, Deborah Hasin, Roberto Lewis-Fernandez, Richard
Neugebauer, Myrna Weissman and the director, co-directors and training coordinator will continue to
20
serve on the Steering Committee. These Steering Committee members represent a broad range of
disciplines including epidemiology, genetics, psychiatry, neurobiology and sociology. Karestan
Koenen, a former PET fellow who has just returned to Columbia, will join the Steering Committee. She
will strengthen the representation of genetics and epigenetics in programmatic decision making.
The main functions of the Steering Committee are to help set policy, make admission decisions and
provide program oversight. For example, the training program plan in this current application was
developed in consultation with and with considerable input from the Steering Committee. Members of
the Committee interview prospective candidates and make admissions decisions. They are consulted
concerning such issues as the approval of new courses, the addition of new faculty, and any unusual
difficulties regarding the fellows’ progress. Additionally, they serve as an advisory group suggesting,
and helping to implement, changes in program content and functioning. The Steering committee
almost always makes decisions via consensus. In the few instances when decisions cannot be made
in this way, and routinely for the selection of incoming fellows, the committee members vote with each
Committee member, including the Director and Co-Directors, having one vote.
Support Staff: The program currently employs Brenda Scariff as a part-time administrative assistant.
Her duties include administration of fellow stipend awards, tuition and travel expenses, maintenance of
financial records, arrangement of meetings, interfacing with the university bureaucracy on behalf of the
fellows and general office management. She works closely with the Training Coordinator and
administrative personnel in the Department of Epidemiology to ensure that the program runs smoothly.
The work of Ms. Scariff enhances the fellows experience by buffering them from potentially time
consuming administrative tasks and through their general support.
b. Program Faculty
Table 1 documents the large number of faculty in the participating departments and the number of
these faculty members associated with our training program. All PET program faculty (shown in Table
2) are available to supervise fellows in field placements on an on-going basis and present their work at
seminars throughout the year. Some faculty members also teach courses for the program. Faculty
members continuing in that role since the last grant period (in addition to those serving on the Steering
Committee) are. Mindy Fullilove, Madelyn Gould, Dan Herman, Susan Hodge, Christina Hoven, Denise
Kandel, Mark Olfson, Ruth Ottman, Jo Phelan and J. Blake Turner.
We have also added new members to the faculty to ensure that we have the expertise necessary to
in the areas that we wish to consolidate and develop during the current grant period, as described in
the Background. The new faculty, with their areas of expertise in parentheses, are: Paul Appelbaum
(law and ethics), Lisa Bates (social epidemiology), Magdalena Cerda (global, innovative methods),
Cheryl Corcoran (biological psychiatry), Sandro Galea (global, cross-level, PTSD), Kimberly Nobel
(development, neuro-cognition), Nicole Schupf (genetics, neurobiology), Larry Yang (schizophrenia
prodrome and global).
The faculty members therefore represent the full range of disciplines and expertise necessary for
the integrated approached outlined in the Background section. In selecting PET faculty we have
attempted to consolidate our current strengths while keeping abreast of new developments that need to
be integrated for an “eco-epidemiology” approach. While each fellow cannot gain expertise in all these
areas, they will be exposed to the different frameworks, concepts and terminology to prepare them to
engage in inter-disciplinary work. In the current grant, we have augmented our faculty with an eye to
enhancing representation of more “down-stream” disciplines, especially neurobiology and genetics, and
the upstream global context.
21
As indicated in Tables 3 and 4, the faculty have a wide range of grant and contract support which
provides a rich array of research opportunities for the fellows. As indicated in Tables 5a and 5b the
faculty members have mentored a large number of students from these grants, including trainees on
this T32, indicating their ability to appropriately mentor our trainees. As discussed in the Progress
Report, all of the current trainees are actively engaged in research with faculty.
One measure of the productivity of these research activities is indicated in Tables 6a and 6b which
list the publications for trainees that derived directly from their fellowship research projects. The 15 predoctoral fellows supported by the program over the past 10 years produced almost 70 papers directly
tied to research conducted during their tenure in the program (usually 5 years). Our 25 postdoctoral
fellows have also produced almost 70 papers derived directly from their research in the program,
although their tenure in the program is generally only two or three years. The modal number of papers
is 2 per fellow (including fellows who have not yet completed their tenure in the program). Many of
these papers appear in prestigious journals across a wide range of disciplines, for example the Journal
of Health, Social Behavior, Social Science and Medicine, American Journal of Public Health, American
Journal of Epidemiology, Archives of General Psychiatry and American Journal of Psychiatry. This level
of productivity mirrors the career trajectories of the majority of our fellows most of who go on to have
exceptionally productive research careers (see Progress Report).
Because of the high level of collaboration among the faculty, trainees are afforded varied but
integrated mentoring on their research. For example nearly 20% of the fellows’ publications deriving
from their field placements include more than one PET faculty member as a co-author (these
publications are noted with two asterisks (**).
c. Proposed Training
Program Components
Our program consists of four distinct but interrelated components integrated by a fifth component,
the Faculty-Fellow Seminar. Outlined below are the core elements of the program required of all
fellows. Predoctoral fellows take additional coursework to fulfill the requirements of the Ph.D. program
in epidemiology. The doctoral curriculum has been recently overhauled with the goal of creating more
epidemiologic methods courses offered only to the doctoral students, providing more training in
professional skills (e.g., grant writing, publications) and more emphasis on and time for actual research
projects.
Component I: Coursework in Epidemiology: The goal of this component is to introduce fellows to
key issues and concepts in psychiatric epidemiology. Knowledge in these areas is imparted by
coursework in epidemiologic methods and substantive issues in psychiatric epidemiology.
Epidemiologic methods are covered in a three course sequence - Principles of Epidemiology I, Design
and Conduct of Chronic Disease Epidemiological Studies (Epidemiology II), and Principles of
Epidemiology III. PET faculty members (Galea, Susser) participate in the teaching of Epidemiology I.
The second course is taught by a PET faculty member (Schwartz).
Substantive issues in psychiatric epidemiology are addressed in two courses designed specifically
for PET fellows (although open to all students) and taught by program faculty. The first course,
Psychiatric Epidemiology, is taught by the Program Director, Bruce Link; the second course, Biologic
and Genetic Issues in Psychiatric Epidemiology, is a reading seminar taught by Alan Brown. This
sequence familiarizes the fellows with perspectives on psychiatric disorders from social, through
22
individual, neurologic and genetic factors, to reflect the knowledge base required for our ecoepidemiologic approach.
For fellows lacking social science training, courses are recommended in Sociology and Social
Psychology in GSAS downtown and in the Department of Socio-medical Sciences at the School of
Public Health. For fellows with minimal biologic training, courses are available in the various
departments of the Graduate School of Arts and Sciences as well as the School of Nursing. In addition,
a consortium agreement allows fellows to take courses at other universities in the New York
Metropolitan area. This has allowed fellows to find courses that meet their specific interests, and to
have contact with experts outside of Columbia.
Component II: Coursework in Clinical Psychiatry: Knowledge in this domain is imparted by a course
designed for fellows without clinical experience. It includes an introduction to the major types of
psychopathology, DSM-IV (soon to be DSM-V) criteria, the clinical interview and a survey of the major
research instruments used to detect disorders in community and patient populations. The course is
taught by Dr. Larry Amsel, a psychiatrist and diagnostician who is the Assistant Director for Education
Training for Columbia Presbyterian Hospital Inpatient Unit. Dr. Amsel has been successfully teaching
this course for the past 10 years; it is exceptionally well received and critically important for
epidemiologists who need to know about the clinical phenomena they study.
Component III: Coursework in Statistics: The goal of this component is to ensure that fellows have
sufficient background in measurement and statistics to conduct quantitative research and to work
productively with biostatisticians. Among the core courses taken are: Introduction to Biostatistics,
Problems in Measurement. Categorical Data Analysis, and Applied Regression Analysis. Courses are
also offered in Statistical Genetics taught by a PET faculty member (Hodge). Fellows are directed to go
beyond these basic courses to master more advanced topics required for their research. Such
coursework can be found in biostatistics and in the Graduate School of Arts and Sciences.
Component IV: Field Placements: This component provides fellows with hands-on supervised
research experience with an established researcher. Fellows participate in field placements for 12 to
30+ hours per week depending on stage in the program and whether the fellow is pre or postdoctoral.
For example, pre-doctoral fellows in the first two years of coursework, average at the lower end of
involvement whereas postdoctoral fellows in their final year typically engage full time in their research.
As mentioned above, time allotted for research will be expanded for predoctoral fellows under the new
curriculum.
The program has developed specific procedures to ensure that fellows are acquainted with the full
range of available field placements and to help them select a research placement that meets their
needs. First, each fellow meets with the training coordinator at the beginning of each semester to
review their short and long term training goals (see Progress Report). The trainees are given guidance
about the types of research experiences that would help them achieve their goals. Second, the fellows
receive a written description of the research conducted by each faculty member that they can use to
familiarize themselves with placement possibilities and use as a basis for asking questions to faculty
about those possibilities. Third, at the beginning of each academic year, a faculty-fellow seminar is set
aside for each faculty member to give a short presentation of the research placement possibilities
he/she can provide. The fellows are encouraged to speak with multiple faculty members before
deciding on a field placement. In order to foster communication with faculty about field placement
expectations, we have developed a detailed set of guidelines outlining areas that fellows and faculty
should discuss to ensure that fellows’ needs are met (see Progress Report and Appendix Item 1). The
protocol includes issues such as the frequency of meetings, method of feedback, project scope, and
authorship. We have developed and revised this set of guidelines over the years to minimize
23
miscommunication and maximize the chances for a productive field placement experience. By all
accounts it has been successful but should this proactive approach fail, input from the Training
Coordinator, Director and Co-Directors can be accessed with respect to any problems that arise.
Typically, fellows formulate and develop their initial research projects using data collected by the
preceptor and his/her team. Fellows are expected to take primary responsibility for the project they
develop in consultation and collaboration with their preceptors and research colleagues. Fellows are
expected to be first author on papers they develop and co-authors when they collaborate on papers
they did not initiate. In addition, fellows participate in staff meetings to develop collegial associations
and to become aware of the full range of substantive and technical issues involved in carrying out
studies in psychiatric epidemiology. As fellows near completion of their training they are encouraged to
develop their ideas into independent grant proposals. Fellows also often augment their central projects
with short-term field placements designed for training in specific skills such as field work and
questionnaire development.
Component V: Faculty-Fellow Seminar: The Faculty-Fellow Seminar serves many functions. It
provides a forum for collegial interactions and the development of professional networks; an arena for
fellows to present results of their research and receive feedback and an opportunity to keep abreast of
recent developments in the field. Perhaps the most important function of the seminar is to integrate the
program by providing a time and place for program participants to meet on a regular basis. The
common experience of hearing and discussing the same material facilitates the development of
intellectual ties between faculty and fellows and among the fellows themselves. The seminars are either
presentations of ongoing research by fellows, faculty or guest speakers or workshops on special topics.
While presentations by faculty and fellows provide the backbone of the Faculty-Fellow Seminar, an
effort is made to recruit speakers and develop workshops on topics and approaches that complement
those fellows are exposed to through program courses and faculty (see Appendix Item 2 for a list of the
seminars for the current grant period).
Recent changes in the structuring of the epidemiology department have enhanced the interdisciplinarity of the seminars and our ability to expose fellows to a broader range of research topics.
The department is now organized into “clusters”, an identified group of researchers with overlapping
research interests. The PET training program is in the Neuro-Psych cluster. This is an attempt to
integrate the neurological sciences most closely relevant to psychiatric disorders into psychiatric
research. One faculty-fellow seminar a month has been designated as a “cluster seminar” where
attendees and topics expand psychiatric disorders to include consideration of disorders that are
considered “neurologic” but that clearly overlap those delineated in the DSM. This cluster seminar
expands the trainees’ exposure to biologic issues.
Additional Training Activities: In the past, the program tried to meet the fellows’ requests for training
in career development skills. The epidemiology department now recognizes this need as well and has
integrated this aspect of training into the departmental doctoral curriculum. For example, there is now a
course devoted to training in giving presentations, writing grants and papers. This changed curriculum
will enhance the experience of the PET pre-doctoral trainees.
Columbia also provides a vast number of seminars and conferences each week on a wide array of
topics of interest to the fellows. Fellows frequently attend Psychiatric Grand Rounds, Child Psychiatry
Rounds, Imprint Center Seminars (lifecourse epidemiology), the Seminar in Socio-medical Sciences
and talks sponsored by the HIV Center, the Robert Wood Johnson Society Scholar’s Program (headed
by Bruce Link), the Center for Social Inequalities in Health (headed by Bruce Link and Jo Phelan) as
well as monthly Epidemiology Grand Rounds and Public Health Grand Rounds. The School of Public
Health recently launched a Research Resources Initiative to provide training, guidance and practical
24
help for faculty and post-doctoral fellows in grant activities. In addition to one-on-one help, they provide
a wealth of seminars, workshops and training programs on issues related to research and grant writing.
Our fellows have been eager participants in all these activities.
Examples of Fellows' Programs
To indicate how the training components are integrated into an individual fellow's program, we
provide three examples (see Table A). The first is typical of a pre-doctoral fellow seeking a Ph.D. in
epidemiology with a specialization in psychiatric epidemiology. The second is typical of a postdoctoral
fellow from a social science discipline who has had considerable training in methodology but no clinical
training. Finally, we offer an example of the program of a post-doctoral fellow who is a psychiatrist with
considerable clinical expertise but little if any methodological training. The main difference between the
program of the social scientist and the psychiatrist is that the social scientist takes the full clinical
sequence while the psychiatrist takes the full methods sequence. The proposed training outlined in
Table A is a reflection of the main training activities of the past 5 years and as well as proposed
changes for the new funding period. These changes are planned in response to trainee suggestions,
faculty interests, developments in psychiatry epidemiology, and the new directions that have evolved
from serious reappraisal of the doctoral program in the department of epidemiology.
Table A
Example of Fellows’ Course Program
Predoctoral Fellow – Ph.D. Candidate in Epidemiology
Spring
Year 1
History of Epidemiology
Publications, Presentations and Grants
Critical Thinking in Epidemiology (Epi IV)
Applications of Epi Research Methods II
Biology and Physiology for Epidemiologists
Applied Regression II
Psychiatric Epidemiology
Clinical Seminar in Psychiatry
Faculty-Fellow Seminar
Faculty-Fellow Seminar
Year 2
Concepts in Causal Inference (Epi V)
Advanced Topics in Epidemiologic Methods (Epi VI)
Biological Aspects of Psychiatric Disorders
Responsible Conduct of Research
Faculty-Fellow Seminar
Faculty-Fellow Seminar
Electives
Electives
Year 3
Qualifying Exams
Proposal
Faculty-Fellow Seminar
Faculty-Fellow Seminar
Years 4&5
Dissertation Work
Fall
Postdoctoral Fellow – Social Scientist
Year 1
Psychiatric Epidemiology
Analysis of Categorical Data
Clinical Seminar in Psychiatric Disorders
Design and Conduct of Epidemiologic Studies
Principles of Epidemiology
Faculty –Fellow Seminar
Faculty-Fellow Seminar
25
Year 2
Principles of Epidemiology (3)
Biological Aspects of Psychiatric Disorders
Faculty-Fellow Seminar
Selected Problems in Measurement
Responsible Conduct in Research
Faculty-Fellow Seminar
Year 3
Faculty-Fellow Seminar
Electives as needed
Faculty-Fellow Seminar
Electives as needed
Postdoctoral Fellow - Psychiatrist
Fall
Spring
Year 1
Psychiatric Epidemiology
Introduction to Biostatistics
Principles of Epidemiology
Faculty-Fellow Seminar
Analysis of Categorical Data
Design and Conduct of Epidemiologic Studies
Faculty –Fellow Seminar
Year 2
Principles of Epidemiology (3)
Applied Linear Regression
Faculty-Fellow Seminar
Social Science Methods as needed
Selected Problems in Measurement
Responsible Conduct in Research
Faculty-Fellow Seminar
Year 3
Faculty-Fellow Seminar
Faculty-Fellow Seminar
Duration of Training
As the sample programs described in Table A indicate, we believe that postdoctoral fellows benefit
most from three years of training whereas pre-doctoral fellows need a minimum of five years to
complete their Ph.D. degrees. While postdoctoral fellows can complete the majority of their coursework
in two years, a third year devoted full-time to their field placement affords them the opportunity to
integrate and consolidate what they have learned. It also provides an opportunity to launch their
research careers by giving presentations at professional meetings, writing papers, developing a
publication record and if appropriate and desired writing a K-Award or other grant. Pre-doctoral fellows
need two to two and one half years to complete course work, six to nine months to complete qualifying
exams and two years to complete a doctoral dissertation.
Guiding Fellows through the Program and Monitoring their Progress
Typically, the process of guiding fellows begins before acceptance into the program. When fellows
first apply they are sent material about course offerings, research opportunities, program requirements
and program rules. During the interviewing process gaps in their academic background (e.g.,
methodology) are discussed with suggestions for appropriate courses. Potential research opportunities
are discussed with faculty members who may serve as future field placement preceptors.
Upon acceptance into the program, fellows meet with the Training Coordinator and the Director to
discuss their goals during their tenure in the program and the combination of courses, field placement
and other training activities that would meet these goals. Field placements are discussed at this initial
meeting and fellows are advised to contact a range of potential preceptors during their first semester in
the program. The Training Coordinator meets formally with each fellow at the beginning of each
26
semester to discuss their progress in the program guided by an assessment tool developed to help the
fellows evaluate their training needs and the program’s ability to meet those needs. Informally, the
location of the Training Coordinator’s office, next to that of the fellows’, facilitates ongoing daily contact
with the fellows.
Once a fellow has chosen his/her program and field placement, progress is monitored in a number
of ways. First, each fellow has a field placement preceptor who takes responsibility for this component
of the fellows program. Any difficulties are brought to the attention of the Training Coordinator;
discussions with fellows are initiated immediately upon detection of any problems. A systematic and
formal review of the field placement is done each spring when fellows and their preceptors complete an
evaluation form designed to assess the fellows' progress in and satisfaction with their field placement
(see Appendix Item 3).
Progress is also monitored through fellows' presentations at the Faculty-Fellow Seminars. These
presentations are perhaps the most direct opportunity that faculty have for monitoring fellows' progress.
Faculty and fellows alike tend to be forthright in identifying problems in the research presented at the
seminar during the discussion section of the seminar. After each presentation, the Training Coordinator
meets with the fellow to debrief. These discussions include substantive issues raised at the seminar as
well as presentation style. The fellow is also advised to meet with the faculty members who had the
most serious difficulties with the research presented.
Academic progress is monitored in part from an assessment of fellows' course grades. For predoctoral fellows, academic progress is also monitored through the advisor system of the fellow's degree
program. Any severe academic difficulties are brought to the attention of the Steering Committee
where a plan can be formulated to attempt to improve the situation. Typically, however, fellows are
exceptionally fine students, so that we rarely have to confront such issues.
Post-doctoral fellows are formally evaluated in the fall semester of their second year in the program.
All fellows write a proposal outlining the research they plan to do in their third year of training. In
January, the Steering Committee meets to evaluate the projects for evidence of progress in the
program and a productive third year plan. Fellows who are not making progress toward developing
research skills are not offered a third year of funding.
d. Training Program Evaluation
In addition to monitoring fellows' progress, we also have procedures for monitoring participants'
satisfaction with the program. Written forms have been developed for evaluating courses, field
placements, and the overall program on a yearly basis (see Appendix Items 3 and 4). The evaluations
are reviewed and summarized by the Training Coordinator, who distributes the results to the faculty and
fellows. The Program Director, Co-Directors and Training Coordinator, in consultation with the fellows,
develop plans to address any difficulties raised in the evaluations. These potential solutions are
distributed to the faculty and fellows for their comments. To augment these formal, anonymous,
evaluations, fellows and faculty are encouraged to offer their opinions and suggestions about all facets
of the program. Where possible, alterations are made in the program to rectify any problems indicated.
27
Table 2. Participating Faculty Members
(Alphabetically by Faculty Member)
Name/Degree(s)
Rank
Primary (& Secondary)
Appointment(s)
Role in
Program
Research Interest
Appelbaum, Paul,
M.D.
Professor
Elizabeth K. Dollard Prof. of Field
Psychiatry, Medicine, and
Placement
Law; Director, Division of
Preceptor
Psychiatry, Law & Ethics,
Psychiatry, P&S,
NYSPI; Director of the Center
for Research on the Ethical,
Legal & Social Implications of
Genetic Research
Legal and ethical issues that
impact psychiatric and
general medical practice and
research. In particular he has
examined involuntary
commitment and treatment;
informed consent and
decisional capacity; prediction
and management of violence
by people with mental illness;
and the ethics of research.
Bates, Lisa,
Assistant
Professor
Epidemiology and Population Field
and Family Health, MSPH
Placement
Preceptor
The effects of social context
on health, especially the
impacts of immigration and
gender both domestically and
internationally
Brown, Alan S., M.D., Professor
M.P.H.
Psychiatry, P&S, NYSPI and Field
Department of Epidemiology, Placement
MSPH
Preceptor;
teaches the
Biological
Psychiatry
Course
Biomarkers and risk of major
psychiatric disorders. His
work focuses on infectious,
inflammatory, nutritional,
hormonal, and toxic
exposures.
Cerda, Magdalena,
Ph.D.
Assistant
Professor
Columbia University, MSPH
The social epidemiology of
risk behaviors and psychiatric
disorders, particularly
violence, substance abuse
and depression. Her current
work looks at individual,
family, peer and
neighborhood influences on
common psychiatric disorders
and substance abuse using
innovative methods.
Corcoran, Cheryl,
M.D.
Assistant
Professor
Dept. of Psychiatry, Columbia Field
University
Placement
Psychiatrist, NYSPI
Preceptor
Field
Placement
Preceptor
Understanding prodromal
conditions of psychiatric
disorders. Focuses on
ascertainment,
characterization and
longitudinal evaluation of
prodromal patients;
biomarkers of risk;
relationship between
cannabis use and
schizophrenia.
28
Name/Degree(s)
Rank
Primary (& Secondary)
Appointment(s)
Role in
Program
Research Interest
Dohrenwend, Bruce,
Ph.D.
Professor
Epidemiology, MSPH;
Department of Psychiatry;
Columbia University &
College of Physicians &
Surgeons; Chief, Div. of
Social Psychiatry, NYSPI
Co-Director
Steering
Committee
Field
Placement
Preceptor
Understanding how adversity
and stress are related to
psychiatric disorders that vary
in rate with social positions
defined by gender,
racial/ethnic status, and
socioeconomic status.
Particular focus on warrelated post-traumatic stress
disorder.
Fullilove, Mindy
Thompson, M.D.
Professor
Psychiatry, Columbia
University & College of
Physicians & Surgeons;
Socio-Medical Sciences,
MSPH
Field
Placement
Preceptor
Mental health problems of
inner city communities. She
has followed a series of
epidemics, including AIDS,
crack cocaine addiction, and
violence, and has examined a
series of urban processes,
such as displacement
because of urban renewal.
Galea, Sandro, M.D., Professor
MPH, Dr.PH
Anna Cheskis Gelman &
Field
Murray Charles Gelman
Placement
Professor and Chair, Dept. of Preceptor
Epidemiology, CU, MSPH
Psychiatric consequences of
community traumatic events;
epidemiology of drug and
alcohol abuse. Development
of methods that use systems
approaches. Global mental
health.
Gould, Madelyn,
Ph.D.
Professor
Psychiatry, Columbia
University, P&S
Epidemiology: MSPH
Field
Placement
Preceptor
Risk factors for suicidal
behaviors and suicide in
children and adolescents
Hasin, Deborah,
Ph.D.
Professor
Psychiatry, College of
Physicians & Surgeons;
Epidemiology, MSPH
Steering
Committee;
Field
Placement
Preceptor
Epidemiology of alcohol use
disorders. Measurement and
definitional issues and
gene/environment
interactions.
Hatzenbuehler, Ph.D. Assistant
Professor
Sociomedical Sciences,
Columbia University
Field
Placement
Preceptor
Examines the consequences
of social policies that
differentially target gays and
lesbians for social exclusion
(e.g., same-sex marriage
laws, employment policies)
affect the mental health of
lesbian, gay and bisexual
populations.
Hoven, Christina,
Dr.PH, MPH
Psychiatry, College of
Physicians & Surgeons;
Epidemiology, MSPH
Field
Placement
Preceptor
Consequences of WTC
attacks on NYC school
children; psychiatric status of
children of first responders in
NYC and Israel.
Associate
Professor
29
Name/Degree(s)
Kandel, Denise,
Ph.D.
Rank
Professor
Primary (& Secondary)
Appointment(s)
Role in
Program
Research Interest
Socio-medical Sciences,
Field
MSPH; Psychiatry, College of Placement
Physicians & Surgeons;
Preceptor
Epidemiology, MSPH
Risk factors for nicotine
dependence and other
substance use disorders in
adolescents; prenatal
exposures and trajectories.
Keyes, Katherine M., Assistant
Ph.D.
Professor
Epidemiology, Columbia
University
Field
Placement
Preceptor
Life course processes that
influence the development
and chronicity of psychiatric
disorders, with a particular
focus on novel methods to
achieve more robust
inference from observational
epidemiological studies.
Karestan,Koenen
Ph.D.
Associate
Professor
Epidemiology, MSPH
Steering
Committee,
Field
Placement
Preceptor
Epigenetic changes,
specifically methylation, as a
potential mechanism
underlying the association
between the built environment
and racial discrimination and
black-white disparities in
substance dependence.
Lifecourse epidemiologic
approach to examine the
interplay of genetic and
environmental factors in
the production of adverse
health behavior, mental
disorders, PTSD and chronic
physical disease.
Lewis-Fernandez,
Roberto, M.D.
Professor
Psychiatry, Columbia College Steering
of Physicians & Surgeons;
Committee;
NYSPI
Field
Placement
Preceptor
Developing clinical
interventions to help
overcome disparities in the
care of underserved US
cultural groups.
Understanding the way
culture affects individuals’
experience of mental disorder
and their help-seeking
expectations
Epidemiology and Sociomedical Sciences, MSPH;
NYSPI
Causes and consequences of
psychiatric disorders. The
linkages between SES and
physical and mental health
from a “fundamental cause
perspective”; stigma among
people with psychiatric
disorders and the bases for
violent behavior among
people with psychiatric
disorders.
Link, Bruce G., Ph.D. Professor
Program
Director;
Steering
Committee;
Field
Placement
Preceptor
30
Name/Degree(s)
Rank
Primary (& Secondary)
Appointment(s)
Role in
Program
Research Interest
Monk, Catherine E.,
Ph.D.
Associate
Professor
Psychiatry, Obstetrics &
Gynecology, NYS
Psychiatric Institute,
Columbia University
Field
Placement
Preceptor
Research that straddles
developmental neuroscience
and perinatal psychiatry. The
organizing focus of her
research is development and
the transmission of risk for
psychopathology from one
generation to the next
Neugebauer,
Richard, Ph.D.
Research
Scientist
NYSPI
Field
Placement
Preceptor
Posttraumatic stress reactions
among Rwandan children and
adolescents in the early
aftermath of genocide.
Noble, Kimberly,
M.D., Ph.D.
Assistant
Professor
Pediatrics, Sergievsky
Center, Columbia University
Field
Placement
Preceptor
Cognitive neuroscience
approaches to socioeconomic
status influences on child
development; the
neurobiology of reading
impairment in SES diverse
children using functional
magnetic resonance imaging
Olfson, Mark, M.D.,
M.P.H.
Professor
Psychiatry, Columbia College Field
of Physicians & Surgeons
Placement
Preceptor
Developmentally specific and
potentially modifiable
predictors of the onset and
course of psychiatric and
substance use disorders
Ottman, Ruth, Ph.D.
Professor
Epidemiology, Sergievsky
Center, MSPH
Field
Placement
Preceptor
Genetic epidemiology with a
focus on the role of inherited
factors in susceptibility to
complex disorders; etiology of
epilepsy
Phelan, Jo, Ph.D.
Professor
Socio-medical Sciences,
MSPH
Field
Placement
Preceptor
Stigma associated with
mental illness, particularly for
genetic etiologic attributions;
inequalities in psychiatric
disorders
Schupf, Nicole,
Professor
Ph.D., M.P.H., Dr.PH
Taub Institute for Research
Field
on Alzheimer’s Disease & the Placement
Aging Brain, Epidemiology,
Preceptor
MSPH
Etiology of Alzheimer’s
disease; genetic factors,
relationship with Down’s
syndrome
Schwartz, Sharon,
Ph.D.
Epidemiology, MSPH
Impact of methodology on
study results, differences
across disciplines.
Inequalities in health
Professor
Training
Coordinator;
Steering
Committee;
Field
Placement
Preceptor
31
Name/Degree(s)
Rank
Primary (& Secondary)
Appointment(s)
Role in
Program
Research Interest
Susser, Ezra, M.D.,
Dr.P.H.
Professor
Epidemiology, MSPH;
Psychiatry, College of
Physicians and Surgeons;
NYSPI
Co-Director;
Steering
Committee;
Field
Placement
Preceptor
Lifecourse influences on
psychiatric disorders; geneenvironment interplay in
psychiatric disorders, global
mental health
Turner, J. Blake,
Ph.D.
Assistant
Professor
Socio-medical Sciences,
MSPH; Research Scientist,
NYSPI
Field
Placement
Preceptor
Etiology of childhood
psychiatric disorders
Wall, Melanie M.,
Ph.D.
Professor
Biostatistics & Psychiatry,
NYS Psychiatric Institute,
Columbia University
Field
Placement
Preceptor
Modeling complex multilevel
and multivariate data on a
wide array of psychosocial
public health and psychiatric
research projects. She is an
expert in longitudinal data
analysis and latent variable
modeling, including structural
equation modeling focused on
mediating and moderating
(Interaction) effects.
Weissman, Myrna,
Ph.D.
Professor
Chief, Div. of Epidemiology,
NYSPI; Epidemiology,
MSPH; Psychiatry , College
of Physicians and Surgeons
Steering
Committee;
Field
Placement
Preceptor
Etiology and treatment of
depression. Interpersonal
psychotherapy, genetic
epidemiology
Columbia University /
Mailman School of Public
Health
Field
Placement
Preceptor
Effects of culture and stigma
on the etiology and course of
psychiatric disorders; global
mental health; immigrant
status and psychiatric
disorders
Yang, Lawrence H.,
Ph.D.
32
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