MENTAL HEALTH FOR A LIFETIME: 

RESEARCH FOR THE MENTAL HEALTH NEEDS OF OLDER AMERICANS

Report of the National Advisory Mental Health Council’s 

 Workgroup on Aging Research
i 

Table of Contents 

CHAPTER I. THE AGING RESEARCH WORKGROUP 

 Introduction.....................................................................................................................1 

CHAPTER II. THE WORKGROUP’S PROCESS AND FINDINGS

 Workgroup Composition and Charge.............................................................................3 

 Workgroup Process........................................................................................................3 

 Briefings .........................................................................................................................3 

 Background Reports Reviewed .....................................................................................3 

 Workgroup Findings .......................................................................................................5 

Aging Research Support at NIMH and NIH ...................................................................5 

 Setting the Mark .............................................................................................................6

Exploring the Factors Related to the Paucity of Geriatric Awards.................................8 

Staffing Patterns in Aging at NIMH ................................................................................9 

 Summary of Findings .....................................................................................................9 

CHAPTER III. NIMH AGING RESEARCH: VISION AND RECOMMENDATIONS 

 Introduction ................................................................................................................. 11 

 Public Health and Scientific Vision.............................................................................. 11 

 Workgroup Recommendations ................................................................................... 15 

 Building the Geriatric Mental Health Research Portfolio ............................................ 15 

 Recommendations for Developing Geriatric Researchers ......................................... 16 

 Organizational Recommendations.............................................................................. 17 

 NIMH Staffing Needs .................................................................................................. 18 

 Summary..................................................................................................................... 18 

 

APPENDIX A: National Advisory Mental Health Council .................................................................................. 19

APPENDIX B: National Advisory Mental Health Council Aging Research Workgroup..................................... 21 

APPENDIX C: National Institute of Mental Health Aging Research Consortium.............................................. 22 

APPENDIX D: National Institutes of Health Staff to the Workgroup ................................................................. 23 

TABLE 1: National Institutes of Health Aging Research................................................................................... 24 

TABLE 2: FY 2002 Aging and Child Grant Support Comparison ..................................................................... 25 

TABLE 3: FY 2002 Aging and Child Career Awards and Fellowship Comparisons......................................... 25 

FIGURE 1: Growth Rate-All Level 1 Career Awards......................................................................................... 26 

FIGURE 2: Growth Rate-Aging Level 1 Career Awards ................................................................................... 27

FIGURE 3: Growth Rate- Child Level 1 Career Awards ................................................................................... 28 

TABLE 4: FY 2002 Number of Aging and Child Training Grants Across all NIMH 

 Programs Comparison.................................................................................................................... 29 

TABLE 5: Comparison of Success Rate of Aging and Child Grant Applications by Council 

 Round Comparison........................................................................................................................ 30 

TABLE 6: Success Rate of Aging Grant Applications With New Principal Investigators 

 Across Programmatic Areas by Council Round Comparison........................................................ 31 

TABLE 7: Aging Expertise on Initial Review Groups (IRGs) A Comparison of IRGs 

 Evaluating Aging Applications During Fiscal Year 2001 ................................................................ 32 
1 

 

CHAPTER I 

THE AGING RESEARCH WORKGROUP

INTRODUCTION 

The impetus for “Mental Health for a Lifetime” derives from the well-known 

demographics on aging America. The number of Americans age 65 years and older is 

growing rapidly, and is projected to reach 70.3 million by 2030, or 20 percent of the U.S. 

population.1

 In addition, older Americans include an increasing percentage of racial and 

ethnic minorities,2 which also presents opportunities for research along with new 

challenges to health care and social service systems. At the same time, older 

Americans expect to lead rich lives that include a full range of work, recreational, and 

social activities, and that, in turn, depend on older American remaining mentally as well 

as physically healthy. Recognizing these demographic trends, this report charts a path 

for the National Institute of Mental Health (NIMH) to develop research that will promote 

mental health for the growing proportion of older Americans. In addition, this report 

identifies research required to understand the needs of individuals living with mental 

illness as they move toward later life. 

Fostering an understanding of healthy aging is essential to better care and better living 

for older Americans. All too often, for example, older individuals and their doctors 

accept depression as a normal part of aging when it is not. 3 This belief is especially 

unfortunate for those who first develop depression late in life, when such resignation 

can prevent the individual from receiving effective care.4

 Untreated depression, after 

all, is a deadly disease, and the impact of that is seen in the fact that older Americans 

are disproportionately likely to die by suicide. Representing only 13 percent of the U.S. 

population, individuals age 65 and older accounted for 18 percent of all suicide deaths 

in 2000.5

 Of the nearly 35 million Americans age 65 years and older, an estimated 2 

million have a depressive illness and another 5 million may have depressive symptoms 

that fall short of meeting full diagnostic criteria for a disorder.6

 In short, depression 

among older Americans should be screened for and treated no differently than other 

illnesses that become prevalent later in life, such as diabetes or high-blood pressure. 

One of the goals of NIMH’s aging research portfolio is to fund research that addresses 

the barriers that prevent older Americans from receiving effective treatment for 

1

 U.S. Census Bureau. National Population Projections, available at http://www.census.gov/population/www/projections/natsumT3.html. 2

 Ibid 

3

 Lebowitz B.D., Pearson J.L., Schneider L.S., Reynolds C.F. III, Alexopoulos G.S., Bruce M.L., Conwell Y., Katz I.R., Meyers B.S., 

Morrison M.F., Mossey J., Niederehe G., and Parmelee P. Diagnosis and Treatment of Depression in Late Life. Consensus 

Statement Update. Journal of the American Medical Association, 278(14):1186-1190, 1997. 4

 Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Mental Health. 

Older Adults: Depression and Suicide Facts. NIH Publication No. 03-4593, revised May 2003, available at 

http://www.nimh.nih.gov/publicat/elderlydepsuicide.cfm#8. 5

 Office of Statistics and Programming, NCIPC, CDC. Web-based Injury Statistics Query and Reporting System (WISQARSTM), 

available at http://www.cdc.gov/ncipc/wisqars/default.htm. 6

Conwell Y. “Suicide in Later Life: A Review and Recommendations for Prevention.” Suicide and Life Threatening Behavior, 

31(Suppl): 32-47, 2001. 
2 

 

depression and other mental illnesses. Another is to develop a greater understanding 

of the basic processes underlying these illnesses and to develop more effective 

treatment and preventive interventions. Effective treatment of mental disorders, while 

beneficial in its own right, also can lower the burden and costs of other medical 

conditions, such as cardiovascular disease and diabetes, which occur frequently in 

aging populations. Studies of health care systems indicate that the presence of 

depression raises the costs of overall yearly health care by 50 percent or more, and that 

the magnitude of the added expense grows in proportion to the number of chronic 

medical conditions that are present.7

 

Given the increasing urgency to address the mental health needs of older citizens, 

Dr. Thomas Insel, Director, NIMH, and the National Advisory Mental Health Council 

(NAMHC) (see Appendix A for membership) convened the Aging Research Workgroup 

to assess the Institute’s extramural aging research and training portfolio and to identify 

strategies for developing: (1) promising research areas in mental health and aging; 

(2) researchers who are skilled in aging issues; (3) NIMH program staff expertise in 

aging research; and (4) collaborations with other stakeholders. The Workgroup was 

composed of NAMHC members (see Appendix B for the Workgroup roster) whose 

expertise included minority health, social and behavioral science, HIV/AIDS, genetics, 

epidemiology, public health, health care management, health policy, and geriatric 

mental health. Council member Dr. Charles Reynolds, III, was chosen to chair the 

Workgroup. In addition, the Workgroup was supported by members of the NIMH Aging 

Research Consortium (see Appendix C) and by additional staff at NIMH and the 

National Institute on Aging (NIA) listed in Appendix D. 

 

7

 Unutzer, J., Patrick, D.L., Simon, G., Grembowski, D., Walker, E., Rutter, C., and Katon, W. “Depressive Symptoms and the Cost 

of Health Services in HMO Patients Aged 65 years and Older. A 4-year Prospective Study.” Journal of the American Medical 

Association, 277(20):1618-1623, 1997. 
3 

 

CHAPTER II 

THE WORKGROUP’S PROCESS AND FINDINGS

WORKGROUP COMPOSITION AND CHARGE 

The Council’s Aging Research Workgroup has reviewed the Institute’s current aging 

research portfolio, the status of the field, and the opportunities in science for addressing 

this urgent public health need both within NIMH and at other Federal or private 

agencies. The following pages in this chapter describe the Workgroup’s process and 

findings. These, in turn, guided the Workgroup in developing its final recommendations 

(see Chapter III) regarding promising research areas in mental health and aging, the 

need for researchers skilled in aging issues, an appropriate programmatic structure at 

NIMH to foster the development of the field, and areas of collaboration with other 

stakeholders. 

WORKGROUP PROCESS 

The Workgroup met via conference calls and in-person meetings from March through 

September 2003. To enhance its perspective on ongoing Institute-supported research 

and opportunities for expanded research, the Workgroup received a number of briefings 

and reviewed an extensive array of reports. 

o BRIEFINGS 

1. The NIMH Aging Research Consortium provided an overview on the role of the 

Consortium and on the current NIMH aging research portfolio, with highlights of 

examples and opportunities for future research. 

2. Staff from NIA presented on the NIA research portfolio and discussed past and 

future initiatives. 

3. Dr. Richard Hodes, Director of NIA, attended the Workgroup’s update to the 

NIMH Council and addressed the Council on progress in aging and mental health 

research.8

o BACKGROUND REPORTS REVIEWED

1. The NIMH Aging Research Consortium’s report, “Late-Life Mental Illness at the 

National Institute of Mental Health: An Analysis of Fiscal Year (FY) 2000 Grants, 

Contracts, and Intramural Research Projects” 9

 

2. Abstracts of the NIMH FY 2002 aging portfolio

8

 See http://www.nimh.nih.gov/council/cnclmins_5-03.pdf. 9

 Report available at http://www.nimh.nih.gov/aging/agingreportFY2000.pdf. 
4 

3. NIMH’s and other NIH Institutes’ portfolios in aging research

4. Council’s recent reports:

o “Blueprint for Change: Research on Child and Adolescent Mental Health”

10

o “Racial/Ethnic Diversity in Mental Health Research Careers: An Investment in 

America's Future”

11

o “Translating Behavioral Science into Action: Report of the National Advisory 

Mental Health Council”12

5. Relevant consensus statements: 

o Depression and Bipolar Support Alliance Consensus Statement on the Unmet 

Needs in Diagnosis and Treatment of Mood Disorders in Late Life13

o Institute of Medicine’s report, “Reducing Suicide: A National Imperative”14

6. The variety of programs at NIA targeted at expanding aging research; selected 

examples include: 

o Alzheimer’s Disease Centers: NIA funds 29 centers where investigators 

conduct basic, clinical, and behavioral research and train scientists and health 

care providers. The National Alzheimer’s Coordinating Center (see 

http://www.alz.washington.edu) coordinates data collection and fosters 

research collaboration among the centers. 

o Resource Centers and Coordinating Center for Minority Aging Research 

(RFA-AG-02-004). 

o Human Specimen Repository (see 

http://www.nia.nih.gov/research/repository.asp). 

o Baltimore Longitudinal Study of Aging: America’s longest-running scientific 

study of human aging (see 

http://www.grc.nia.nih.gov/branches/blsa/blsa.htm). 

o Health ABC Study: This study was designed to characterize the extent of 

change in body composition in older men and women, to identify clinical 

conditions accelerating these changes, and to examine the health impact of 

these changes on strength, endurance, disability, and weight-related diseases 

of old age (see 

http://www.nia.nih.gov/research/repository/health_abc_description.htm). 

o Claude D. Pepper Older Americans Independence Centers: These centers 

investigate a range of topics in aging research and have a special mission to 

bring scientists from all disciplines into aging research and train the next 

 

10 Report available at http://www.nimh.nih.gov/childhp/councildesc.cfm. 11 Report available at http://www.nimh.nih.gov/council/diversity.pdf. 12 Report available at http://www.nimh.nih.gov/tbsia/tbsiatoc.cfm. 13 Charney, D.S., Reynolds, C.F. III, Lewis, L., Lebowitz, B.D., et al. “Depression and Bipolar Support Alliance consensus statement 

on the unmet needs in diagnosis and treatment of mood disorders in late life.” Archives of General Psychiatry 60:664-672, 2003. 14 Goldsmith, SK, Pellmar, AM, & Bunney WE (editors). Reducing Suicide: A National Imperative (2002), see 

http://books.nap.edu/books/0309083214/html/index.html. 
5 

generation of investigators in the field (see 

http://www.nia.nih.gov/health/pubs/portfolio/html/reducing.htm#focus). 

o The Healthy Brain Project,15 a useful example of multi-Institute collaboration 

at NIH, providing opportunities to pool data across Institutes and to use 

epidemiological data to better inform the goals and design of clinical trials, 

including the testing of preventive interventions. 

7. Funding initiatives at the Health Resources and Services Administration (HRSA). 

Selected initiatives include: 

o Geriatric Education Centers: As noted on the HRSA Web page (see 

http://bhpr.hrsa.gov/interdisciplinary/gec.html), this program provides grants 

to accredited health professions schools that train physician assistants and 

schools of allied health. Since 1985, 375,000 health professionals have 

received training in geriatrics through the Centers. 

o Geriatrics Faculty Training for Physicians, Dentists and Behavioral Mental 

Health Professionals: This program provides grants that support fellowships 

and other training efforts that assist health professionals who plan to teach 

geriatrics (see http://bhpr.hrsa.gov/interdisciplinary/faculty.html). 

o Geriatric Academic Career Award Program: The awards support career 

development of geriatricians in junior faculty positions who are committed to 

academic careers teaching clinical geriatrics. As noted on the HRSA Web 

site (see http://bhpr.hrsa.gov/interdisciplinary/gaca.html), the program was 

established by Congress in the Health Professions Partnership Act of 1998. 

WORKGROUP FINDINGS 

o AGING RESEARCH SUPPORT AT NIMH AND NIH 

The Workgroup received information on NIMH’s support for aging research. For 

FY 2002, NIMH dedicated 8.5 percent of its research budget to support studies of 

aging. Total funding was approximately $106 million, including support provided via 

grants, contracts, and studies at the Intramural Research Program (IRP) (see Table 

1). This figure represents a 7 percent ($7.0 million) increase in funding over the 

prior fiscal year. In terms of the percentage of its total research budget allocated to 

aging research, NIMH ranked seventh among 23 Institutes and Centers in its 

support for aging research, with NIA providing the highest percentage of support 

(99.9 percent), followed by the National Center for Complementary and Alternative 

Medicine (30.6 percent), the National Eye Institute (19.8 percent), the National 

Institute of Nursing Research (15.2 percent), the National Institute of Neurological 

Disorders and Stroke (12.1 percent), and the National Institute of Arthritis and 

 

15See http://trans.nih.gov/HBI/HBPindex.htm.
6 

 

Musculoskeletal and Skin Diseases (12.0 percent). Overall, the NIH Institutes and 

Centers, excluding NIA, devoted an average of 4.6 percent of their research budgets 

to aging research. 

 

o SETTING THE MARK 

NIMH is clearly above the average in terms of investment in aging research across 

the NIH Institutes, though this is but one measure of sufficiency. The Workgroup 

also wanted to assess how NIMH was investing relative to the perceived public 

health need and scientific opportunity with the goal of ensuring a wise and equitable 

investment for the future. To do so, some reference point or comparison portfolio for 

understanding the NIMH’s investments was needed. 

The Workgroup decided that a helpful reference point would be the support patterns 

and the research development strategies for the NIMH child and adolescent 

research portfolio. These patterns and strategies were outlined in the 2001 Council 

report “Blueprint for Change: Research on Child and Adolescent Mental Health,”16

which contained a careful analysis of the child and adolescent research portfolio and 

recommendations to address some of the same research barriers that face geriatric 

research. The Workgroup felt that this report was particularly germane given that 

sufficient time had passed since the report was written to assess the effectiveness of 

some of its recommendations. 

The child and aging populations comprise similar proportions of the total U.S. 

population, and both have similar rates of mental illness–children and adolescents 

(ages 17 years and younger) make up 26 percent of the total U.S. population and 

older Americans (ages 55 years and older) comprise 21 percent of the population.17 

In terms of rates of mental illness among these age groups, the Methodology for 

Epidemiology of Mental Disorders in Children and Adolescents Study estimated that 

almost 21 percent of U.S. children ages 9-17 had a diagnosable mental or addictive 

disorder associated with at least minimum impairment.18 Data from the 

Epidemiological Catchment Area study show that almost 20 percent of adults age 55 

and older experience specific mental disorders that are not part of “normal” aging.19 

Further, each area has a separate Institute at NIH dedicated to research on these 

populations [(i.e., NIA and National Institute of Child Health and Human 

Development (NICHD)]. NIMH must define its unique role relative to and in 

conjunction with these other Institutes. 

16 Report available at http://www.nimh.nih.gov/child/blueprin.pdf. 17 U.S. Census Bureau. National Population Projections, available at at http://www.census.gov/population/www/projections/natsumT3.html. 18 When diagnostic criteria required the presence of significant functional impairment, the estimate dropped to 11 percent (Shaffer, 

D., Fisher, P., Dulcan, M.K., Davies, M., Piacentini, J., Schwab-Stone, M.E., Lahey, B.B., Bourdon, K., Jensen, P.S., Bird, H.R., 

Canino, G., and Regier, D.A. “The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, 

Acceptability, Prevalence Rates, and Performance in the MECA Study.” Journal of the American Academy of Child and Adolescent 

Psychiatry 35(7):865-877,1996). 19 Department of Health and Human Services. Mental Health: A Report of the Surgeon General, available at 

http://www.surgeongeneral.gov/library/mentalhealth/home.html.
7 

The child and adolescent research portfolio offers an instructive comparison. Table 

2 indicates that in FY 2002, NIMH supported 246 aging research and training grants 

at a level of $90.25 million, compared with 1,000 grants at a level of $357.77 million 

in the child area—a ratio of approximately 1:4 aging to child grants.20

In addition to funding research projects, NIMH supports career development 

activities, providing salary support so that investigators can devote themselves to 

research. In terms of support for aging and child researchers through Research 

Career Development Awards, support for child researchers far exceeded that for 

aging researchers (see Table 3). Of the total number of career grants awarded by 

NIMH during FY 2002 (N=445), 9.4 percent (n=42) were awarded in the aging area 

compared with 34.6 percent (n=154) in the child area. The pattern was similar with 

fellowships: 4.3 percent (n=16) in the aging area compared with 22.8 percent (n=84) 

in the child area. 

Of special concern to the Workgroup were data on the Level 1 Career Awards in the 

aging area. These career awards are for junior investigators, which affords 

additional mentoring in a research area. Although there has been considerable 

growth in the number of funded Level 1 Career Awards across NIMH, moving from 

32 awards in FY 1997 to 87 awards in FY 2002 (see Figure 1), the number of funded 

aging awards has remained low over the past 6 fiscal years, ranging from 4 

awardees in FY 1997 to 7 awardees in FY 2002 (see Figure 2). It is important to 

note that the number of Level 1 career applications in the aging area also has been 

very low, ranging from 7 applications in FY 1997 to 20 in FY 2002, despite a high 

likelihood of being funded. This trend represents a major threat to the Nation’s 

capacity to do the research necessary to discover, improve, test, and disseminate 

treatments for mental illnesses in old age. 

The situation has been quite different in the child area (see Figure 3). Although the 

likelihood of funding for Level 1 Career Awards in the child area is similar to that for 

the aging area, the number of submissions for child Level 1 Career Awards has 

significantly exceeded the number of submissions in aging. That is, submissions in 

the child area have gone from 14 submissions in FY 1997 to 73 submissions in 

FY 2002, with the largest increase between FY 1999 and FY 2000. The Workgroup 

saw this surge as the effect of the RFA issued in FY 1999 (MH99-002: Research 

Career Development in Mental Disorders of Children, see 

http://grants1.nih.gov/grants/guide/rfa-files/RFA-MH-99-002.html). 

The pattern for training grants is similar to that for career awards, with many more 

awards in the child area as compared with the aging area. As shown in Table 4, 

there were considerably more training grants awarded in the child area than in the 

aging area (a ratio of about 4:1 child to aging training grants). 

 

 

20Figures do not include support provided via contracts or at the NIMH Intramural Research Program. 
8 

o EXPLORING THE FACTORS RELATED TO THE PAUCITY OF GERIATRIC 

AWARDS 

The small number and percentage of geriatric grants are troubling, and the 

Workgroup set about examining the source of the problem. The route from 

submitting an application to receiving funding is difficult, and the initial concern was 

that too many ideas were being lost in the review and funding process. This concern 

was not warranted; as discussed below, once an application in geriatrics is received, 

its chance of funding is as good or better than applications in other programmatic 

areas. Rather, the problem appears to be that not enough geriatric applications are 

submitted. 

Interestingly, aging-related applications tended to score well in comparison with 

applications assigned to several other programs (see Table 5). That is, when 

comparing the applications considered at four consecutive Council meetings that 

occurred from May 2002 to May 2003, the percent of fundable aging applications 

(“fundable” is defined as applications scoring at the 20th percentile or better, or for 

those applications not percentiled, with a priority score of 175 or better) was 

comparable to that for the three comparison groups of applications, with aging 

applications outscoring their counterparts in the developmental risk and clinical 

science programs. However, the number of submitted applications in aging was far 

below the number of submitted applications in the other programmatic areas. 

Delving into this submission problem even further, the Workgroup wondered about 

the likelihood of funding for aging applications submitted by new investigators. But 

as seen in Table 6 and consistent with the pattern noted above, aging applications 

by new investigators scored better, in fact, than applications from new principal 

investigators in other programmatic areas. However, as was the case with all aging 

applications, there were significantly fewer aging applications submitted by new 

investigators as compared to applications submitted in other program areas. 

Concerns over disadvantaged funding were dismissed, but there remained a 

question about the qualification of peer reviewers on review committees. The low 

numbers of geriatric awards may have resulted from a bias or lack of expertise in the 

review groups. The Workgroup considered the adequacy of the peer review of aging 

R01 applications (see Table 7). Sixty-eight R01 applications reviewed during 

FY 2001 were selected for analysis on the basis of having “aging” or related 

keywords in their titles; these were assigned to 28 different Initial Review Groups 

(IRGs) or Special Emphasis Panels (SEPs), depending on the focus of the 

application. Complete reviewer rosters were examined for those IRGs or SEPs that 

reviewed three or more of the selected R01 applications. Each reviewer was 

classified according to whether or not the bulk of his/her research publications for 

the prior 3 years dealt with the elderly or aging issues. Reviewers whose research 

was exclusively or almost exclusively on aging issues were categorized as having a 

“primary interest.” Reviewers who had a clear non-gerontology specialty area (e.g., 

imaging or statistics) but had published several (2-4) papers in their area of interest 
9 

that were devoted to elderly populations were categorized as having a “secondary 

interest.” Based on these criteria, the six IRGs/SEPs that evaluated three or more of 

the selected aging R01 applications were found to have reviewers with adequate 

aging expertise. 

o STAFFING PATTERNS IN AGING AT NIMH 

NIMH established the Aging Research Consortium in January 2002. The 

Consortium’s mission is to: 

o Stimulate research on mental health and mental illness to benefit older adults. 

o Maintain an infrastructure to better coordinate aging research throughout the 

Institute. 

o Provide a linkage to the Institute for researchers, advocates, and the public. 

o Advance research training for the study of late-life mental disorders. 

o Serve as a liaison with other NIH Institutes conducting age-related research. 

Areas of research span the full spectrum of the Institute’s interests, including 

depression, anxiety, Alzheimer’s disease, basic neurobehavioral research, 

schizophrenia, and suicide. In addition, the Consortium is responsible for 

coordinating research, encouraging knowledge transfer and clinical application of the 

findings, and providing research policy leadership. 

The Workgroup found the level of commitment demonstrated by the members of the 

Aging Research Consortium, as well as their understanding of the geriatric portfolio 

at NIMH, to be extraordinary. Nonetheless, their service is over and above that of 

their full-time responsibilities. The Workgroup believed there would be significant 

synergy if these efforts could be coordinated by a full-time aging expert. 

o SUMMARY OF FINDINGS 

1. NIMH devoted 8.5 percent of its FY 2002 portfolio to aging research, which is a 

sizable investment and compares favorably to other NIH Institutes. This rate of 

investment, however, seems unlikely to meet the mental health needs of the 

growing proportion of older Americans. 

2. The NIMH dedicates significantly more of its research budget (all mechanisms) to 

support studies in the child area as compared to that in aging (a ratio of 4:1 in 

terms of funding and number of grants). This is true even though the rates of 

disorder are similar in the two groups and the geriatric segment of the population 

will be growing dramatically. 

3. Overall, there is a need for more geriatric grant applications. There are 

significantly fewer aging applications submitted than in other substantive areas, 

and this is true despite the fact that aging applications tend to score as well, if not 

better, than applications in the comparison program areas. In particular, there is 
10 

an alarming dearth of Level 1 Career applicants in the aging area, again despite 

a high likelihood of funding. 

4. Aging R01 applications are being reviewed by peer review panels with adequate 

expertise in the aging area. 

5. The effort in geriatrics at NIMH appears to require a full-time aging expert to 

coordinate the Institute’s portfolio and development activities. 

 

6. NIMH must make a concerted effort to develop new applications in geriatrics, 

requiring innovative programming, sufficient expert staffing, and coordination 

within NIMH and with stakeholders. 
11 

 

CHAPTER III 

NIMH AGING RESEARCH: VISION AND RECOMMENDATIONS

INTRODUCTION 

The Workgroup’s extensive review of the NIMH portfolio and staffing (see Chapter II) 

yielded a clear picture of the Institute’s current strengths and areas ready for 

development. The Workgroup sought to build upon the accomplishments of NIMH and 

enhance these efforts by identifying successful strategies from other NIMH and NIH 

programs, as well as seeking opportunities with other Federal agencies and private 

foundations. 

PUBLIC HEALTH AND SCIENTIFIC VISION 

As part of its mandate from Dr. Insel and the National Advisory Mental Health Council, 

the Aging Research Workgroup has articulated the principles of an overall scientific 

vision to meet the public health needs of older Americans. The following statements are 

intended to comprise a set of broad, strategic considerations that provide a context for 

the more specific recommendations that follow, which the Workgroup has developed to 

help the Institute meet its goals for late-life research. These principles are based upon 

the work of many individuals, committees, and associations, including but not limited to 

Unmet Needs in the Diagnosis and Treatment of Mood Disorders in Later Life,

Depression and Bipolar Support Alliance21; Reducing Suicide: A National Imperative,

Institute of Medicine (2002)22; the Surgeon General’s Report on Mental Health (1999)23; 

the President’s New Freedom Commission on Mental Health (2003)24; and a research 

summit held at the University of Pittsburgh in September 2002 sponsored by the 

American Association for Geriatric Psychiatry, with participants from the NIMH, the 

Depression and Bipolar Support Alliance, and the National Alliance for the Mentally Ill. 

Principle 1: A life-span approach is vital to understanding mental health 

and illness. A developmental perspective is essential for identifying and 

addressing the special needs of particular populations across the life cycle. 

Changes in the life course include varying patterns of comorbidity, developmental 

disabilities and neurodevelopmental disabilities in early life; substance abuse and 

multiple disorders in mid-life adulthood; and neurodegenerative physical illnesses 

in late life. For example, investigating how the presentation, course, and 

outcome of a mental illness differs between those who had an early and late 

21 Charney D.S., Reynolds, C.F. III, Lewis, L., Lebowitz, B.D, Sunderland, T., Alexopoulos, G.S., Blazer, D.G., Katz, I.R., Meyers, 

B.S., Arean, P.A., Borson, S., Brown, C., Bruce, M.L., Callahan, C.M., Charlson, M.E., Conyell, Y., Cuthbert, B.N., Devanand, D.P., 

Gibson, M.J., Gottlieb, G.L., Krishnan, K.R., Laden, S.K., Lyketsos, C.G., Mulsant, B.H., Niederehe, G., Olin, J.T., Olsin, D.W., 

Pearson, J., Persky, T., Pollock, B.G., Raetzman, S., Reynolds, M., Salzman, C., Schulz, R., Schwenk, T.L., Scolnick, E., Unutzer, 

J., Weissman, M.M., and Young, R.C. “Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in 

Diagnosis and Treatment of Mood Disorders in Late Life.” Archives of General Psychiatry, 60:664-672, 2003. 22 Goldsmith, S.K., Pellmar, A.M., and Bunney W.E. (editors). Reducing Suicide: A National Imperative. The National Academies 

Press, Washington, D.C., 2002, see http://books.nap.edu/books/0309083214/html/index.html. 23Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental 

Health Services, National Institutes of Health, National Institute of Mental Health. Mental Health: A Report of the Surgeon General, 

1999, available at http://www.surgeongeneral.gov/library/mentalhealth/home.html. 24 The Commission’s final report is available at 

http://www.mentalhealthcommission.gov/reports/FinalReport/downloads/downloads.html.
12 

 

onset is likely to provide new, important, and clinically useful information with 

respect to specific risk and protective factors and variability in treatment 

response across the life cycle. 

Principle 2: It is important to understand successful or healthy aging as 

well as the causes, course, and consequences of mental illnesses in later 

life. Additional normative data on the mental health of older people are 

necessary not only to interpret changes in health, functional status, and behavior 

that accompany mental illness, but also to more deeply understand the 

transitions from healthy or normative aging into illness and thereby to define 

rational bases for preventive or early interventions. 

Principle 3: Effective preventive interventions in late-life mental illnesses 

are greatly needed. Preventive interventions should be broadly defined to 

encompass reductions in new cases (incidence), severity, episode duration, 

burden of residual symptoms, and consequence of illness, including excess 

disability, suicide and non-suicide mortality, or progression (conversion) to 

dementing illness. 

Principle 4: Further research on the unique aspects of mental disorders in 

aging populations—such as age- and illness-related changes in 

pharmacokinetic and pharmacodynamic processes, cognition, social 

resources, and medical comorbidities—is needed to understand treatment 

response variability in old age and to improve the care of older people with 

mental illnesses. The hallmarks of mental illnesses in old age are their 

coexistence with multiple medical disorders and the resulting depletion of 

psychosocial and economic resources.25 Changes in the metabolism, 

disposition, and impact of psychotropic medications mean that geriatric-specific 

strategies need development and testing. Simply using conventional treatments 

in the elderly may be as ill advised as using them for treating children. Cognitive 

impairments also are a core feature of mental illnesses in old age, yet they 

require additional focus in intervention studies. The special psychosocial 

challenges of old age–which may include bereavement, transitions to greater 

dependency, and decreased flexibility in problem solving–all merit additional 

study. Further, the needs of depressed suicidal elders have not yet been 

adequately addressed, although promising leads exist from the PROSPECT and 

IMPACT studies.26 27

25 Charney D.S., Reynolds, C.F. III, Lewis, L., et al. “Depression and Bipolar Support Alliance Consensus Statement on the Unmet 

Needs in Diagnosis and Treatment of Mood Disorders in Late Life.” Archives of General Psychiatry, 60:664-672, 2003. 26 Alexopoulos G.S. and PROSPECT Group. “Interventions for Depressed Elderly Primary Care Patients.” International Journal of 

Geriatric Psychiatry 16:553-9, 2001. 27 Unutzer, J., Katon, W., Callahan, C.M., Williams J.W. Jr., Hunkeler, E., Harpole, L., Hoffing, M., Della Penna, R.D., Noel, P.H., 

Tang, L., Belin, T.R., Oishi, S., Langston, C., for the IMPACT Investigators. “Collaborative Care Management of Late-Life 

Depression in the Primary Care Setting. A Randomized Controlled Trial.” Journal of the American Medical Association, 288 

(22):2836-2845, 2002. 
13 

 

Principle 5: The aging brain presents unique opportunities for scientific 

research on mental illness and mental health. The aging brain provides clues 

to the risk and protective factors that may operate across the life cycle. For 

example, on average, women have a later onset of schizophrenia when 

compared to men,28 raising the question of what factors protect some women 

from the onset of schizophrenia until later in the life cycle. Another intriguing 

question pertains to a potential lifespan finding in individuals with bipolar 

disorder: Could there be neuroprotective factors that are associated with this 

illness or its long-term treatment? Studies of neurocognitive function and the use 

of the tools of neuropathology could test several intriguing hypotheses that derive 

from important studies in basic science.29 Also, most older patients with unipolar 

depression show some level of cognitive impairment.30 Both affective and 

cognitive disturbances may be associated with a range of neuropathologies 

including cerebrovascular and neurodegenerative disease. 

These examples illustrate a few of the many opportunities provided by the aging 

brain to understand the pathophysiologies of the brain from a developmental or 

lifespan perspective. They also illustrate the inseparability of mental and 

physical health. 

Principle 6: The NIMH portfolio of psychogeriatric research must 

effectively address the need for better prevention and treatment 

interventions in mental disorders of late life. To meet its mandate to address 

the Nation’s public health needs, NIMH must tailor its research and training 

mission to address the large gaps in the current knowledge base about the 

prevention and treatment of severe and persistent mental illnesses in later life. 

As emphasized by the 2002 report of the NIMH Aging Consortium,31 further 

research into the treatment of elderly suicidal patients, treatment-resistant 

depressions in old age, bipolar illness in the elderly, late-onset schizophrenia, 

anxiety disorders, and mood/behavioral disturbances in people with 

neurodegenerative disorders is greatly needed to reduce the public health 

burden of mental illnesses in old age, both for individual patients and their 

caregivers. 

Principle 7: Knowledge born of NIMH-sponsored psychogeriatric research 

must be broadly disseminated to the benefit of all older Americans and 

their caregivers. Recent studies, such as PROSPECT and IMPACT, have 

demonstrated that collaborative care models do improve the recognition, 

treatment, and outcomes of depressive illnesses in older people attending 

primary care clinics. It is enormously good news that scientifically based 

28 Robins, L.N. and Regier, D.A. Psychiatric Disorders in America. Free Press, New York, 1991. 29 Chuang, D.M., Chen, R.W., Chalecka-Franaszek, E., Ren, M., Hashimoto, R. Kanal, H., Hough, C., Hiroi, T., and Leeds, P. 

“Neuroprotective effects of lithium in cultured cells and animal models of diseases.” Bipolar Disorders 4(2):129-136, 2002. 30 Nebes R.D., Pollock B.G., Houck P.R., Butters M.A., Mulsant B.H., Zmuda M., and Reynolds, C.F. III. “Persistence of Cognitive

Impairments in Geriatric Patients Following Treatment: A Randomized, Double-Blind Clinical Trial with Nortriptyline and Paroxetine. 

Journal of Psychiatric Research 37 (2):99-108, 2003. 31 The report is available at http://www.nimh.nih.gov/aging/agingreportFY2000.pdf. 
14 

 

depression treatment guidelines, such as those formulated by the former Agency 

on Healthcare Policy and Research,32 can be successfully implemented in 

general medical settings to help older people. As these works show, the 

acceptability and credibility of mental health services for older Americans are 

much enhanced when integrated into primary care.33 

 

Unfortunately, integrated case management for mental illness in old age is 

unlikely to be implemented until the factors that affect its adoption are 

understood. For example, research must determine if a particular intervention 

can be adapted to be maximally effective in a nursing home or assisted living 

facility. Studies are needed to determine if beliefs and attitudes in some 

segments of the geriatric population impact how and whether an intervention will 

be used. Dissemination and implementation research to address these issues 

and many others is needed to bridge the gap between clinical research and 

everyday practice by building a knowledge base about how mental health care 

information and new practices are transmitted and translated for health care 

service use in specific settings. 

Similarly, an effective intervention is not likely to be sustainable without 

understanding how financial and structural incentives impede or enable delivery 

of quality care. The complex web of acute and long-term care services, along 

with complex reimbursement policies and insurance benefits, require research to 

understand the implications of these policies and structures for improvement of 

service delivery throughout the life course. 

Additional research should seek to understand why there are disparities in the 

detection and treatment of mental illness across ethnic groups so that 

interventions can be culturally appropriate.34 Research is needed, too, to 

understand how best to maintain functioning in the community among the aged. 

Finally, the Workgroup made an effort to determine how to leverage existing 

resources in order to increase the presence of aging research in the NIMH 

portfolio. Among the many ideas considered, the Workgroup selected 

recommendations based on need, impact, and feasibility. These 

recommendations fell into four categories: (1) organizational changes; 

(2) developing the pool of geriatrics researchers; (3) providing research support 

in geriatrics; and (4) staffing needs. 

32For guidelines on the treatment of depression, see U.S. Agency for Health Care Policy and Research. Depression in Primary 

Care: Volume 2. Treatment of Major Depression (Clinical Practice Guideline Number 5). AHCPR Publication No. 93-0551, April 

1993, available at http://medwebplus.com/obj/5314. 33Charney D.S., Reynolds, C.F. III, Lewis, L., et al. “Depression and Bipolar Support Alliance Consensus Statement on the Unmet 

Needs in Diagnosis and Treatment of Mood Disorders in Late Life.” Archives of General Psychiatry, 60:664-672, 2003. 34 Ruiz, P. “Issues in the psychiatric care of Hispanics.” Psychiatric Services, 48:539-540, 1997. 
15 

WORKGROUP RECOMMENDATIONS 

o BUILDING THE GERIATRIC MENTAL HEALTH RESEARCH PORTFOLIO 

Identifying areas of particular promise in mental health geriatrics research for 

development is easy, as seen in the principles presented in Chapter II of this report. 

Determining how to prioritize among these areas is a more difficult task. One 

essential element is fostering researchers’ inherent interests in exploring a particular 

research question and doing so in expert teams. The Workgroup decided that 

NIMH’s best path is to provide the infrastructure to promote the development of 

interdisciplinary research teams that are formed around investigators’ interests and 

to ensure that rich primary data and samples are efficiently made available to these 

interested researchers. 

Recommendation 1: Issue a Request for Applications (RFA) to 

establish interdisciplinary networks of basic and clinical researchers 

to focus on geriatric mental health questions. The Workgroup was 

impressed by the success of the Behavioral Science and Child Networking 

RFAs and by the Research Units in Pediatric Psychopharmacology in 

building novel interdisciplinary teams and believes the geriatrics area 

would be ripe for such an initiative. Essential to the success of this RFA 

initiative is preliminary developmental activity that may take 1-2 years to 

accomplish. To define substantive areas for the anticipated RFA, the 

Workgroup envisions a series of workshops that would bring together 

geriatric and other researchers to define the richest substantive areas for 

the RFAs and initiate the building of interdisciplinary teams. The 

substantive areas and opportunities, as outlined under the seven 

principles, are valuable places to begin, but the critical objective is to let 

researchers identify the research questions that intrigue them and meet 

this important public health need. 

Recommendation 2: Issue a call for administrative supplements to 

permit the addition of a geriatric sample to current clinical NIMH 

grants. To meet the treatment and service demands of the growing 

proportion of older Americans, inclusion of geriatric samples in research is 

a necessity. Such supplements should be awarded based on the ability of 

proposed supplements to address treatment and service questions 

effectively for the elderly and will require geriatric expertise to do so. 

Recommendation 3: Establish repositories for efficient use of 

geriatric resources. In conjunction with NIA and other Institutes, NIMH 

should expand its efforts in infrastructure support. Just as the NIMH 

Genetics Initiative provides cell lines from well-defined samples in 

schizophrenia, Alzheimer’s, and bipolar disorders, sharing activities in 

geriatrics can spark the field and provide a rich resource to attract 
16 

 

researchers into this high-need area. In particular, the Workgroup was 

interested in seeing: 

A. The NIMH brain banking activities expand collection and distribution of 

 tissues from older brains. 

B. Secondary analyses of data in geriatrics research. 

C. Formation of community-based linkages for research, service, and 

training in geriatrics in conjunction with Health Resources and Services 

Administration’s programs and private foundations. 

o RECOMMENDATIONS FOR DEVELOPING GERIATRIC RESEARCHERS 

As presented in the findings section, the number of geriatric applications submitted 

to NIMH is too low across the board and particularly low in mechanisms directed at 

developing new researchers. It is worth noting that among applications submitted to 

NIMH, geriatric applications do as well or better than other NIMH areas in review 

and funding. The challenge for NIMH seems to be one of renewing interest in the 

area. The recommendations below deal with attracting new researchers into the 

field, which is fully related to the subsequent set of recommendations on developing 

the research portfolio. These sets of recommendations are only separated here for 

clarity of presentation and are expected to augment mutually the number of 

researchers and enhance research initiatives. 

Recommendation 4: Issue a Request for Applications soliciting 

geriatric mentored K awards. To cultivate the field, NIMH must 

proactively recruit new researchers into mental health geriatric research. 

Although there is a clear need for recruiting established researchers into 

geriatrics as well as new researchers, the Workgroup determined that the 

latter would have the greatest long-term benefit. 

Recommendation 5: Promote the availability of the NIH Loan 

Repayment Program.35 The Workgroup felt that the first years of the NIH 

Loan Repayment Program have been a helpful retention tool for clinical 

researchers. By more actively promoting the availability of this program 

among students, the NIH Loan Repayment Program can become an 

effective recruitment tool as well. In conjunction with NIA and other 

Institutes, thought should be given to including additional language about 

geriatric research or perhaps paralleling the separate pediatric notice with 

a separate geriatric notice. 

35 See http://www.lrp.nih.gov. 
17 

Recommendation 6: Establish an NIMH geriatrics supplement 

program, allowing a current NIMH grantee to add an individual to 

undertake research in geriatrics. Just as NIMH has invested heavily in 

the NIH-wide minority, re-entry, and disability supplement programs, a 

similar investment in geriatrics should be considered. The NIMH geriatrics 

supplement should focus on recruiting new individuals into geriatrics 

mental health research. 

Recommendation 7: Convene professional associations, educators, 

and credentialing authorities to foster the development of training 

models that provide exposure to geriatrics research. This is another 

critical issue for NIMH to address in conjunction with NIA and other 

Institutes. Current clinical training and service demands all too often 

crowd out opportunities for undertaking research. The Workgroup argued 

that exposure to geriatric research was the best recruitment and retention 

tool and hoped that more could be included in training programs. To learn 

more about what attracts new scientists into geriatrics, the meeting should 

consider the merits of developing and fielding a survey of students to 

identify salient decision factors in determining career paths into and out of 

geriatrics research. The results of such a survey can inform future 

recruitment and retention efforts. 

o ORGANIZATIONAL RECOMMENDATIONS 

The NIMH geriatrics portfolio would benefit from an organizational structure that 

provides a focal point for coordinating NIMH’s effort within the Institute and across 

NIH and other Federal agencies, as well as with private and international efforts. 

Although the Aging Research Consortium has been an important avenue for 

coordination, the addition of a full-time staff person dedicated to overseeing the 

Institute’s geriatric portfolio would greatly enhance the Institute’s effort. Regular 

reports to Council and to the field on progress in implementing these 

recommendations will be critical. 

Recommendation 8: Establish a focal point within NIMH to oversee 

and to promote the aging portfolio. The Institute should create a new 

position of Associate Director for Aging Research in the Director’s Office. 

This senior geriatrics expert will direct the Aging Research Consortium as 

well as actively engage other Federal and private entities. As the aging 

portfolio grows, it is likely that geriatric programs within existing branches 

will need to be formed. Staff expertise in aging research will need to be 

increased, and one or more aging branches may be required. 

Recommendation 9: Reinvigorate collaboration across NIH by joining 

with NIA in reconstituting the NIH-wide Aging Coordinating 

Committee. As seen in the resources committed across NIH, many 

Institutes are actively working in aging-related research. By developing 
18 

efforts together, the expertise and resources across NIH can be most 

efficiently deployed. 

o NIMH STAFFING NEEDS 

Recommendation 10: The level of geriatric expertise among the NIMH 

staff should be enhanced through training. The workings of the NIMH 

Aging Research Consortium demonstrate the interest and commitment 

among the staff to geriatrics research. The members asked for additional 

training in geriatrics for interested members of the Consortium and around 

the Institute. Some staff members have aging or geriatric projects in their 

portfolio but may not have sufficient experience in this area. 

Recommendation 11: NIMH should continue to support the Aging 

Research Consortium’s activities of coordination and promulgation 

of NIMH’s geriatric research interests. The Workgroup thought that the 

active involvement of Consortium members at professional meetings was 

an essential element of attracting more researchers into mental health 

geriatrics research. 

SUMMARY

The scientific agenda for mental health and aging research should encompass the 

acquisition of additional normative data to understand the vitality and resilience of 

healthy aging, as well as the causes, course, and consequences of mental illnesses in 

old age. This agenda, accomplished in conjunction with the other NIH Institutes and 

stakeholders, should embrace research on preventive interventions and deepen the 

understanding of age-dependent changes in treatment-relevant factors such as 

pharmacokinetic and pharmacodynamic variables, cognition, psychosocial and 

economic resources, and medical comorbidities. All are important to understanding 

treatment response variability in old age mental illnesses and essential to creating, 

testing, and disseminating better treatment. The NIMH research agenda also should 

recognize that the aging brain presents unique opportunities for scientific research in 

mental health, resiliency and vitality in old age, and mental illnesses of later life. 

Additional disease-focused research should be supported, including research on 

dissemination and uptake of evidence-based practices, to ensure that older Americans 

and their families benefit from the NIMH research mission. 
APPENDIX A 

DEPARTMENT OF HEALTH AND HUMAN SERVICES 

NATIONAL INSTITUTES OF HEALTH 

NATIONAL INSTITUTE OF MENTAL HEALTH 

NATIONAL ADVISORY MENTAL HEALTH COUNCIL 

CHAIRPERSON

Thomas R. Insel, M.D. 

Director 

National Institute of Mental Health 

Bethesda, Maryland 

EXECUTIVE SECRETARY

Jane A. Steinberg, Ph.D. 

Director 

Division of Extramural Activities 

National Institute of Mental Health 

Bethesda, Maryland

 MEMBERS 

Robert O. Boorstin 

Director, WorldView Initiative 

Vietnam Veterans of America Foundation 

Washington, DC 

Javier I. Escobar, M.D. 

Professor and Chairman 

Department of Psychiatry

University of Medicine and Dentistry of New Jersey

Robert Wood Johnson Medical School 

Piscataway, New Jersey

Susan M. Essock, Ph.D. 

Director, Division of Health Services Research 

Department of Psychiatry

Mount Sinai School of Medicine 

New York, New York 

Susan Folkman, Ph.D. 

Professor of Medicine 

Osher Foundation Distinguished Professor in 

 Integrative Medicine 

Director, Osher Center for Integrative Medicine 

University of California San Francisco 

San Francisco, California 

Megan R. Gunnar, Ph.D. 

Distinguished McKnight University Professor of 

 Child Development and Adjunct Professor of Child 

 and Adolescent Psychiatry

Institute of Child Development 

University of Minnesota 

Minneapolis, Minnesota 

Renata J. Henry 

Director, Division of Substance Abuse and Mental 

Health 

State of Delaware 

Delaware Health and Social Services 

New Castle, Delaware 

Henry A. Lester, Ph.D. 

Professor 

Department of Biology

California Institute of Technology

Pasadena, California 

Jeffrey A. Lieberman, M.D. 

Professor and Vice Chairman 

Department of Psychiatry

School of Medicine 

University of North Carolina, Chapel Hill 

Chapel Hill, North Carolina 

James L. McClelland, Ph.D. 

Co-Director 

Center for the Neural Basis of Cognition (CNBC) 

Pittsburgh, Pennsylvania 

James P. McNulty 

President, Depression and Bipolar Support Alliance of 

 Rhode Island 

President, National Alliance for the Mentally Ill (NAMI) 

Providence, Rhode Island 

Eric J. Nestler, M.D., Ph.D. 

Lou and Ellen McGinley Distinguished Professor 

 & Chairman 

Department of Psychiatry

The University of Texas Southwestern Medical Center 

 at Dallas 

Dallas, Texas 

Charles F. Reynolds, III, M.D. 

Professor, Department of Psychiatry, Neurology

 and Neuroscience 

University of Pittsburgh School of Medicine 

Western Psychiatric Institute and Clinic 

Pittsburgh, Pennsylvania 

19 
Elaine Sanders-Bush, Ph.D. 

Professor, Department of Pharmacology

Vanderbilt University School of Medicine 

Nashville, Tennessee 

Larry R. Squire, Ph.D. 

Professor and Research Career Scientist 

Department of Psychiatry

University of California School of Medicine 

Veterans Affairs Medical Center 

San Diego, California 

Ming T. Tsuang, M.D., Ph.D. 

Stanley Cobb Professor of Psychiatry and 

 Psychobiology

Director, Harvard Institute of Psychiatric Epidemiology

 and Genetics 

Department of Psychiatry and Epidemiology

Harvard University

Massachusetts Mental Health Center 

Boston, Massachusetts 

Karen Dineen Wagner, M.D., Ph.D. 

Clarence Ross Miller Professor and Vice-Chair 

Department of Psychiatry and Behavioral Sciences 

Director, Division of Child and Adolescent Psychiatry

University of Texas Medical Branch 

Galveston, Texas

EX OFFICIO MEMBERS 

Office of the Secretary, DHHS

Tommy G. Thompson, J.D. 

Secretary

Department of Health and Human Services 

Washington, DC

National Institutes of Health

Elias A. Zerhouni, M.D. 

Director 

National Institutes of Health 

Bethesda, Maryland

Department of Defense

Elspeth Cameron Ritchie, M.D. 

LTC, MC, USA 

Preventive Psychiatry Fellow

Department of Psychiatry

Uniformed Services University of the Health Sciences 

Bethesda, Maryland 

Department of Veterans Affairs

Robert Freedman, M.D. 

Medical Director, Center for Basic and 

 Clinical Studies in Schizophrenia 

Colorado Veterans Administration Hospital 

Professor of Psychiatry/Pharmacology

University of Colorado Health Sciences Center 

Denver, Colorado

20 
APPENDIX B 

NATIONAL ADVISORY MENTAL HEALTH COUNCIL 

AGING RESEARCH WORKGROUP 

 MEMBERS

Charles F. Reynolds, III, M.D. (Chairperson) 

Professor, Department of Psychiatry, Neurology and 

 Neuroscience 

University of Pittsburgh School of Medicine 

Western Psychiatric Institute and Clinic 

Pittsburgh, Pennsylvania 

Javier I. Escobar, M.D. 

Professor and Chairman 

Department of Psychiatry

University of Medicine and Dentistry of New Jersey

Robert Wood Johnson Medical School 

Piscataway, New Jersey

Susan Folkman, Ph.D. 

Professor of Medicine 

Osher Foundation Distinguished Professor in 

 Integrative Medicine 

Director, Osher Center for Integrative Medicine 

University of California San Francisco 

San Francisco, California 

Norwood W. Knight-Richardson, M.D. 

President and CEO 

The Richardson Group 

Portland, Oregon 

(Dr. Knight-Richardson moved to NIMH

as a consultant in the summer of 2003)

Ming T. Tsuang, M.D., Ph.D. 

Stanley Cobb Professor of Psychiatry and 

 Psychobiology

Director, Harvard Institute of Psychiatric Epidemiology

 and Genetics 

Department of Psychiatry and Epidemiology

Harvard University

Massachusetts Mental Health Center 

Boston, Massachusetts 

21 
APPENDIX C 

NATIONAL INSTITUTE OF MENTAL HEALTH 

AGING RESEARCH CONSORTIUM 

Debra J. Babcock, M.D., Ph.D. 

Chief, Integrative Neuroscience of Schizophrenia, 

 Mood, and other Brain Disorders Program 

Clinical Neuroscience Research Branch 

Division of Neuroscience and Basic Behavioral 

 Science 

Alison W. Bennett 

Senior Program Analyst 

Office of Constituency Relations and 

 Public Liaison 

Timothy Cuerdon, Ph.D. 

Chief, Adherence and Behavior Change 

 Research Program 

Health and Behavioral Science Research Branch 

Division of Mental Disorders, Behavioral Research 

 and AIDS 

Bruce N. Cuthbert, Ph.D. 

Chief, Adult Psychopathology and Prevention 

 Research Branch 

Division of Mental Disorders, Behavioral Research 

 and AIDS 

 

Denise M. Juliano-Bult, M.S.W.

Chief, Systems Research Program 

Services Research and Clinical Epidemiology Branch 

Division of Services and Intervention Research 

Kelly S. Linthicum 

Grants Program Specialist 

Adult Psychopathology and Prevention 

 Research Branch 

Division of Mental Disorders, Behavioral Research 

 and AIDS 

Enid Light, Ph.D. 

Chief, Rehabilitative Intervention Program 

Adult and Geriatric Treatment and Preventive Intervention 

 Research Branch 

Division of Services and Intervention Research 

George T. Niederehe, Ph.D. 

Chief, Geriatric Psychotherapy Program 

Adult and Geriatric Treatment and Preventive Intervention 

 Research Branch 

Division of Services and Intervention Research 

Jason T. Olin, Ph.D. 

Chief, Geriatric Pharmacology Program 

Adult and Geriatric Treatment and Preventive Intervention 

 Research Branch 

Division of Services and Intervention Research 

(moved to Forest Pharmaceuticals in May 2003) 

Karen A. Oliver, Ph.D. 

Chief, Clinical Epidemiology Program 

Services Research and Clinical Epidemiology Branch 

Division of Services and Intervention Research 

Mary Ellen Oliveri, Ph.D. 

Chief, Behavioral Science Research Branch 

Division of Neuroscience and Basic Behavioral Science 

Emeline M. Otey, Ph.D. 

Chief, Neuropsychiatric and Late-Life Disorders Program 

Chief, Social and Cultural Factor Program in Adult 

 Psychopathology and Prevention Research Branch 

Acting Chief, Health Services Behavior Program in Health and 

 Behavioral Science Research Branch 

Division of Mental Disorders, Behavioral Research 

 and AIDS 

Jane L. Pearson, Ph.D. 

Associate Director, Preventive Interventions 

Adult and Geriatric Treatment and Preventive Intervention 

 Research Branch 

Division of Services and Intervention Research 

Shelly Poma 

Psychologist 

Office of Science Policy and Program Planning 

Robert M. Silberfarb, M.A., M.P.A. 

Social Science Analyst 

Office of Science Policy and Program Planning 

P. Trey Sunderland, M.D. 

Chief, Geriatric Psychiatry Branch 

Division of Intramural Research Programs 

David M. Stoff, Ph.D. 

Chief, Neuropsychiatry of HIV/AIDS Program 

Center for Mental Health Research on AIDS 

Division of Mental Disorders, Behavioral Research and 

 AIDS 

22 
23

APPENDIX D 

NATIONAL INSTITUTES OF HEALTH 

STAFF TO THE WORKGROUP 

Staff Director

Jane A. Steinberg, Ph.D. 

Director, Division of Extramural Activities, NIMH 

Assistant Staff Director

Susan Matthews 

Associate Director for Special Projects 

Division of Extramural Activities, NIMH

Consultants

Debra Babcock, M.D., Ph.D. 

Chief, Integrative Neuroscience of Schizophrenia, 

 Mood and other Brain Disorders Program 

Clinical Neuroscience Research Branch 

Division of Neuroscience and Basic Behavioral 

 Science, NIMH 

Neil Buckholtz, Ph.D. 

Chief, Dementias of Aging 

Neuroscience and Neuropsychology of Aging 

 Program, NIA 

Bruce Cuthbert, Ph.D. 

Chief, Adult Psychopathology and Prevention 

 Research Branch 

Division of Mental Disorders, Behavioral Research 

 and AIDS, NIMH 

Barry D. Lebowitz, Ph.D. 

Chief, Adult and Geriatric Treatment and Preventive 

 Intervention Research Branch 

Division of Services and Intervention Research, NIMH 

Marcelle Morrison-Bogorad, Ph.D. 

Associate Director, Neuroscience and 

 Neuropsychology of Aging Program, NIA 

Karen Oliver, Ph.D. 

Chief, Clinical Epidemiology Program 

Services Research and Clinical Epidemiology Branch 

Division of Services and Intervention Research, NIMH 

Technical Support

Jeffrey Blehar 

Grants Technical Assistant, Extramural 

 Review Branch 

Division of Extramural Activities, NIMH 

Debra Dabney 

Program Assistant, Office for Special Projects 

Division of Extramural Activities, NIMH 

Sara Evans 

Health Scientist Administrator, Extramural 

 Review Branch 

Division of Extramural Activities, NIMH 

 

Kelly Linthicum 

Grants Program Specialist, Adult Psychopathology 

 and Prevention Research Branch 

Division of Mental Disorders, Behavioral Research 

 and AIDS, NIMH 

Karen L.T. Shangraw 

Supervisory Social Science Analyst 

Office of Science Policy and Program Planning, NIMH 

Robert M. Silberfarb, M.A., M.P.A. 

Social Science Analyst 

Office of Science Policy and Program Planning, NIMH 

Katherine West 

Visual Information Specialist 

Office of Communications, NIMH 
24

Table 1 

National Institutes Of Health 

Aging Research 

Dollars in Thousands

FY 2002 Actual

Total 

Aging 

Research 

Aging as % 

of Total 

NCI – Cancer ............................................... 4,176,709 140,403 3.4%

NHLBI – Heart.............................................. 2,569,885 89,736 3.5%

NIDCR – Dental ........................................... 342,293 14,353 4.2%

NIDDK – Diabetes........................................ 1,463,560 101,000 6.9%

NINDS – Neurology ..................................... 1,325,232 160,608 12.1%

NIAID – Allergy ............................................ 2,528,279 79,487 3.1%

NIGMS – General Medical ........................... 1,722,936 0 0.0%

NICHD – Child ............................................. 1,110,472 7,696 0.7%

NEI – Eye..................................................... 580,085 115,142 19.8%

NIEHS – Environmental ............................... 564,086 14,834 2.6%

NIA – Aging.................................................. 891,302 890,816 99.9%

NIAMS – Arthritis ......................................... 447,763 53,588 12.0%

NIDCD – Deafness ...................................... 341,306 15,566 4.6%

NIMH – Mental Health.................................. 1,245,292 106,090 8.5%

NIDA – Drug Abuse ..................................... 885,759 1,981 0.2%

NIAAA – Alcohol .......................................... 383,200 5,475 1.4%

NINR – Nursing............................................ 120,236 18.262 15.2%

NHGRI – Human Genome ........................... 428,294 1,068 0.2%

NIBIB – Bioengineering................................ 111,740 1,649 1.5%

NCRR – Research Resources ..................... 1,010,169 46,272 4.6%

NCCAM – Alternative Medicine ................... 104,338 31,878 30.6%

NCMHD – Minority Health............................ 157,393 2,129 1.4%

FIC – Fogarty............................................... 56,798 443 0.8%

 Subtotal, Institutes & Centers........... 22,567,127 1,898,476 8.4%

NLM – Library .............................................. 275,792 0 0.0%

OD – Office/Director..................................... 234,859 1,905 0.8%

B&F – Bldg. & Fac ....................................... 295,879 0 0.0%

 

 Total, NIH Programs ........................ 23,373,657 1,900,381 8.1%

NIH ICs, Excluding NIA..................................... 21,675,825 1,007,660 4.6%
TABLE 2 

FY 2002 AGING AND CHILD 

GRANT SUPPORT COMPARISON 

Program 

Number of 

Grants 

Percentage of 

Total Grants 

Amount 

(in millions) 

Percentage 

of Total $ 

Aging 246 7.0% $ 90.25 9.1% 

Child 1,000 28.3% 357.77 35.9% 

Other Areas 2,287 64.7% 547.97 55.0% 

Total Extramural 3,533 100% $ 995.99 100% 

TABLE 3 

FY 2002 AGING AND CHILD 

CAREER AWARDS AND FELLOWSHIP COMPARISONS 

Program 

Number of 

Career 

Awards

Percentage of 

Total Career 

Awards 

Number of 

Fellowships 

Percentage of 

Total 

Fellowship 

Awards 

Aging 42 9.4% 16 4.3% 

Child 154 34.6% 84 22.8%

Other Areas 249 56.0% 269 72.9% 

Total Extramural 445 100% 369 100% 

25
26

32 46 56 78 73 87 50

75

91

137 119

171

0

50

100

150

200

250

300

1997 1998 1999 2000 2001 2002

Unfunded

Funded

Figure 1

Growth Rate- all Level 1

Career Awards
27

4 5 8 8 7 7 3

10 9 10 4

13

0

10

20

30

40

50

60

70

80

1997 1998 1999 2000 2001 2002

Unfunded

Funded

Figure 2

Growth Rate- Aging Level 1

Career Awards
28

4

17

8

25 23 26

10

9

18

32 35

47

0

10

20

30

40

50

60

70

80

1997 1998 1999 2000 2001 2002

Unfunded

Funded

Figure 3

Growth Rate- Child Level 1

Career Awards

Introduction of Child RFA/ Staff added 
TABLE 4 

FY 2002 NUMBER OF AGING AND CHILD TRAINING GRANTS 

ACROSS ALL NIMH PROGRAMS COMPARISON

GRANT TYPE AGING CHILD 

New Grants 0 3 

Competing Renewals 1 20 

Non-Competing Continuations* 22 73 

TOTAL 23 96

*Six grants support both aging and child research trainees. 

29
30

TABLE 5 

COMPARISON OF PERCENT FUNDED AGING AND CHILD GRANT APPLICATIONS 

BY COUNCIL ROUND COMPARISON* 

Council Date 

• Program to which 

application 

assigned** 

Number of 

Submitted 

Applications 

Number of 

Scored 

Applications 

Number of 

Fundable 

Applications*** 

Percent Fundable 

of Total Number 

of Submitted 

Applications 

Percent 

Fundable of 

Total Number 

of Scored 

Applications 

May 2002 

• CS*** 

• CT  

• DP** *** 

• Aging

87 

66 

123 

44 

62 

58 

86 

44 

22 

24 

26 

15 

25% 

36% 

21% 

34% 

35% 

41% 

30% 

34% 

October 2002 

• CS 

• CT 

• DP 

• Aging 

70 

43 

81 

29 

50 

33 

48 

24 

19 

15 

14 

11 

27% 

35% 

17% 

38% 

38% 

45% 

35% 

46% 

January 2003 

• CS 

• CT 

• DP 

• Aging 

65 

36 

68 

40 

42 

21 

52 

35 

15 

10 

20 

19 

23% 

28% 

29% 

49% 

36% 

48% 

38% 

54% 

May 2003 

• CS 

• CT 

• DP 

• Aging 

78 

49 

97 

56 

66 

41 

72 

48 

26 

12 

17 

12 

33% 

25% 

18% 

21% 

39% 

29% 

24% 

25% 

TOTAL Across 4 

Council Rounds 

• CS 

• CT 

• DP 

• Aging 

300 

194 

369 

169 

220 

153 

258 

151 

82 

61 

77 

57 

27% 

31% 

21% 

34% 

37% 

40% 

30% 

38% 

 * Includes research grants, fellowships, and institutional training grants 

 ** Program Codes 

 CS: Clinical Neuroscience Branch, Division of Neuroscience and Basic Behavioral Science 

 CT: Child and Adolescent Treatment and Preventive Intervention Research Branch, Division 

 of Services and Intervention Research 

 DP: Developmental Psychopathology and Prevention Research Branch, Division of Mental 

 Disorders, Behavioral Research and AIDS 

 *** Defined as applications scoring at the 20th percentile or better, or, for those applications not percentiled, 

with a priority score of 175 or better
TABLE 6 

PERCENT FUNDED AGING GRANT APPLICATIONS 

WITH NEW PRINCIPAL INVESTIGATORS ACROSS PROGRAMMATIC AREAS 

BY COUNCIL ROUND COMPARISON*

Council Date 

• Program to which 

application 

assigned** 

Number of Submitted 

Applications with 

new PIs 

Percent of Funded 

Applications with new PI 

May 2002 

• CS 

• CT 

• DP 

• Aging 

20 

12 

50 

 5 

20% 

17% 

16% 

20% 

October 2002 

• CS 

• CT 

• DP 

• Aging 

17 

15 

34 

 9 

12% 

33% 

 9% 

22% 

January 2003 

• CS 

• CT 

• DP 

• Aging 

21 

11 

24 

10 

10% 

18% 

38% 

50% 

May 2003 

• CS 

• CT 

• DP 

• Aging 

20 

18 

39 

19 

20% 

17% 

23% 

16% 

TOTAL Across 4 Council 

Rounds 

• CS 

• CT 

• DP 

• Aging 

 78 

 56 

147 

 43 

15% 

21% 

20% 

26% 

 * Includes research grants, fellowships, and institutional training grants 

 ** Program Codes 

CS: Clinical Neuroscience Branch, Division of Neuroscience and Basic Behavioral Science 

 CT: Child and Adolescent Treatment and Preventive Intervention Research Branch, Division 

 of Services and Intervention Research 

 DP: Developmental Psychopathology and Prevention Research Branch, Division of Mental 

 Disorders, Behavioral Research and AIDS 

31
TABLE 7 

AGING EXPERTISE ON INITIAL REVIEW GROUPS (IRGs) 

A COMPARISON OF IRGs EVALUATING AGING APPLICATIONS DURING 

FISCAL YEAR 2001

Initial Review 

Group (IRG) 

Number of 

Aging 

Applications 

Total Number of 

Reviewers 

Reviews with Primary or 

Secondary Interest in Aging 

Number (%) 

BBBP-5 9 46 8 (17%) 

ITV-D 9 71 15 (21%) 

SRV-C 7 60 6 (10%) 

BBBP-4 5 42 13 (31%) 

BDCN-6 3* 42 9 (21%) 

RPHB-2 3* 40 4 (10%) 

*Total over 2 cycles (there are three review cycles each fiscal year) 

BBBP-5: Biobehavioral and Behavioral Processes 5 at CSR 

 ITV-D: Interventions at NIMH 

 SRV-C: Services at NIMH 

BBBP-4: Biobehavioral and Behavioral Processes 4 at CSR 

BDCN-6: Brain Disorders and Clinical Neuroscience 6 at CSR 

RPHB-2: Risk, Prevention and Health Behavior 2 at CSR 

32