Full Text PA-95-061

WOMEN'S MENTAL HEALTH RESEARCH

NIH GUIDE, Volume 24, Number 16, May 12, 1995

PA NUMBER:  PA-95-061

P.T.


Keywords: 


National Institute of Mental Health

PURPOSE

The National Institute of Mental Health (NIMH) invites grant
applications from investigators for research on mental disorders,
symptoms, and behavioral, cognitive and social concerns in women
across the lifespan.  Research on women's mental health includes
individual differences in normative behavior, the epidemiology of
specific mental disorders, the etiology and risk factors for their
development; study of the natural and treated course of illness;
prevention; intervention strategies including pharmacokinetics,
pharmacodynamics, efficacy of medications, and psychosocial
interventions; studies of the efficacy and effectiveness of various
prevention and treatment modalities and service use.  The NIMH
encourages research on underserved populations:  minority, rural, and
homeless women and women who are at risk for HIV, who are HIV
positive, and who have AIDS.  This program announcement (PA)
complements the existing PA, Women's Health Over the Lifecourse:
Social and Behavioral Aspects (PA-92-105), by adding the broad
coverage of biologic, pharmacologic, and prevention, treatment, and
services issues and includes earlier developmental periods within its
scope.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting health priority areas.  This
program announcement, Women's Mental Health Research, is related to
the priority areas of women's health, mental health, and mental
disorders.  Potential applicants may obtain a copy of "Healthy People
2000" (Full Report:  Stock No. 017-001-00474-0 or Summary Report:
Stock No. 017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, DC 20402-9325 (telephone
202-783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by foreign and domestic, for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.
Foreign institutions are not eligible for small grants (R03s), First
Independent Research Support and Transition (FIRST) (R29s) awards,
and program project (P01) grants.  Racial/ethnic minority
individuals, women, and persons with disabilities are encouraged to
apply as Principal Investigators.

MECHANISM OF SUPPORT

The mechanisms of support will be the investigator-initiated research
project grant (R01), FIRST award (R29), and small grant (R03).  To
apply for support of a more broadly based multidisciplinary research
program, the research program project (P01) mechanism is suggested.
Policies that govern the research grants programs of the NIH will
prevail.  Details of eligibility for the different funding mechanisms
vary.  Applicants are strongly advised to contact the program
official listed under INQUIRIES for additional information,
particularly related to P01s and other specific application
procedures.

RESEARCH OBJECTIVES

Mental disorders can be recurring or chronic, debilitating, and
life-threatening.  Although no gender difference in the prevalence of
total mental disorders was reported in the NIMH Epidemiologic
Catchment Area study, higher rates for affective and anxiety
disorders were found among women; for example, major depression and
dysthymia affect almost twice as many women as men.  Among disorders
in which there are similar prevalence rates for men and women, gender
differences may be apparent in symptomatology, age of onset, course
of illness, and response to treatment.

Epidemiologic surveys indicate that women are prescribed and use
psychotropic medication at twice the rate of men, yet large gaps
remain in the knowledge base of gender differences in pharmacology.
Historically, this difference is due, in part, to the exclusion of
women of childbearing age from drug-development trials because of
fear of unintended birth defects.  In addition, men have been
considered less complicated research participants because their
levels of sex hormones were assumed to remain relatively constant,
thus reducing the chance of confounding results.  By excluding women,
researchers have not had to concern themselves with questions about
the effects of the menstrual cycle, or whether the women were pre-,
peri-, or post-menopausal or on hormone medications (e.g., oral
contraceptives or estrogen replacement therapy). Unfortunately, this
research strategy has not furthered the understanding of gender
differences in pharmacokinetics and pharmacodynamics of
psychotherapeutic drugs.

There are several cross-cutting issues pertinent to many of the
special topic areas described in this PA.  One is developmental
stage.  Gender differences in age of onset (e.g., schizophrenia) or
age-related differences in course of mental disorders (bipolar
depression) suggest the importance of life stage in the study of
women's mental health and, therefore, the need for both basic and
applied research related to women's mental health across the life
course.  Attention to differences in developmental trajectories
within biological (e.g., pubertal stage, menopausal status) and/or
psychosocial contexts (e.g., rural and urban environments, poverty,
educational status, peer and marital status, history of abuse) is
necessary in research that considers either gender differences in
mental disorder or variation among females.

A second cross-cutting issue relevant to women's mental health
research is limited information available on ethnic minority females.
Knowledge about ethnic minority women's mental health is even more
limited in terms of understanding the etiology and prevalence of
mental disorders, the clinical course, intervention effectiveness,
and service use related to these disorders.  The meaning of ethnic
identity as it pertains to acculturation, social class, and sex-role
socialization requires careful refinement when considering
associations with psychopathology.  Differences in response to high
blood pressure medications among men of different ethnic groups
suggest that there may be possible differences in the
pharmacokinetics and pharmacodynamics of psychotherapeutic drugs
among ethnic groups of women.

Comorbidity, a third cross-cutting issue, is not unique to women's
mental health but reflects current understanding of the etiology and
course of mental disorders.  Increasing evidence indicates a high
likelihood of finding comorbidity among mental disorders, and
comorbidity between mental disorder and substance abuse,
developmental disability, physical disorder, as well as stress,
violence, or other traumas.  Lifetime comorbidity (past history of
mental, physical, and substance abuse disorders and/or history of
trauma or stress) is also of interest in terms of how it may
predispose individuals to certain patterns of  disorder over the life
course.

The genetics of mental disorders constitutes a fourth cross-cutting
area relevant to the mental health of women.  Gender differences in
prevalence rates, onset, and symptom patterns of many mental
disorders have led to a variety of biological theories based at least
partially on genetics: genetic effects of X-linkage, genetic
imprinting, and mitochondrial inheritance of susceptibility genes.
Other explanations proposed include sex differences in the
inheritance of subclinical susceptibility traits or other phenotypes
which may predispose to the development of psychiatric disorders and
to the possible interactions between such genetic factors and other
neuroendocrine factors that are gender specific.  Genetic
epidemiology may help to identify genetic and environmental factors
contributing to mental disorders and suggest promising prevention
strategies.

Special Topic Areas

The following topics highlight research areas needing attention.
They are only illustrative of current research questions and are not
intended to limit in any way the exploration of many underresearched
topics in women's mental health.

Basic Research.  Research that ascertains the relative contributions
of environmental and biological factors to individual differences in
normal behavior is required to understand the etiology of
gender-based differences in prevalence and age of onset of
psychopathology and to shape effective prevention and treatment.
Needed studies include:

o  sexual dimorphism in the cerebral cortex and the mechanisms
regulating developmental events that lead to differences;
methodological approaches to these issues including pharmacological,
physiological, anatomical, functional neuroimaging, molecular, or
genetic techniques

o  mechanisms underlying regulatory behaviors that may be sexually
differentiated, such as ingestion, aggression, exploration, sleep and
chronobiology

o  the nature and development of gender differences in cognition,
including interaction with motivation, stress, emotional reactivity
and regulation, personality, and social interaction

o  the nature and development of gender role, gender identity, and
sexual orientation across the lifespan, with consideration of both
biological and environmental influences

o  ways in which variation in spousal, parental, sibling, peer, and
extra-familial interactions contribute to gender- related risk and
protective factors

o  the impact of women's work force and welfare participation on
parent-child, marital, and overall family adjustment

o  the differential effect of stressors on women, including
sociocultural stressors (e.g., racially, ethnically, or sexually
based discrimination), socioeconomic stressors (e.g., poverty), and
interpersonal stressors (e.g., marital dissolution, conflict between
work force and family obligations).

Epidemiology and Psychopathology.  Studies employing epidemiologic
designs have contributed much of what we know about population-based
rates of the incidence, prevalence, and risk factors for mental
disorders in females.  Further research is needed on:

o  factors associated with gender differences in prevalence rates of
various mental disorders in community-defined populations

o  the risk factors for the onset of specific mental disorders in
females at various points in the lifespan, including biological
factors, childhood behavioral/emotional problems, physical illness,
societal-level factors

o  existing data sets such as the Epidemiologic Catchment Area
studies, National Comorbidity Survey, and the Health and Nutrition
Surveys, to further explore how risk factors may uniquely affect men
and women

o  cohort effects that may have differential influence on the
prevalence rates of mental disorders for males and females

o  gender differences in rates of suicide attempts and completions
and their risk factors

o  rates of comorbidity in females, including Axis I mental disorders
with addictive disorders and with Axis II disorders, and the factors
associated with comorbidity in the community

o  genetic epidemiologic approaches to studying mental disorders in
females, including gene-environment interaction models, family
studies, and population-based linkage studies

o  assessment of reliability and validity of current diagnostic
classification systems and instruments in female populations,
including ethnic and racial subpopulations.

Mood, Anxiety, and Personality Disorders.  Mood disorders affect
almost twice as many women as men.  Panic disorder and phobias also
affect two to three times as many women as men.  Clinical studies are
needed on:

o  the development and course of mood, anxiety, and personality
disorders that have significant gender differences in prevalence,
including the exploration of possibly distinct subtypes

o  the biological and psychosocial gender-related variables related
to the development, onset (including childhood), course, treatment,
and relapse of mood and anxiety disorders

o  gender differences in cognitive and/or personality variables as
they predispose to onset or recurrence of disorders

o  the role of gender in suicide attempts and completions across the
life course, including psychological and biological factors

o  gender differences in grief reactions and depression following
bereavement

o  gender differences in the development of phobic avoidance for
social and specific phobias and agoraphobia

o  the role of genetic factors in gender differences in mood,
anxiety, and personality disorders

o  gender differences in somatization disorder as related to
affective and anxiety disorders

o  gender differences in etiology and symptoms in dissociative
disorder with regard to early developmental history, including sexual
and physical abuse

o  the role of shared and distinctive genetic and environmental
factors in patterns of comorbidity between Axis I and Axis II
disorders in women.

Psychiatric Disorders and Reproductive Health.  Differences between
male and female reproductive systems are often correlated with gender
differences in rates of affective disorder.  Changes in women's
reproductive systems are also purported to account for differences in
mood disorders among women.  Research is needed on:

o  the role of menarche in onset and course of mental disorders

o  the role of menstrual cycle variables in the onset and maintenance
of chronic depression, or in the exacerbation of an existing episode;
the relationship between premenstrual depressive disorder and prior
psychopathology

o  the clinical significance of variables related to prepubertal,
menstrual cycle, and menopausal status in biological studies of
psychopathology and pharmacological treatment studies

o  the spectrum of postpartum mood changes, including psychotic
disorders, nonpsychotic depression, and transient blues with
implications for the development of efficacious and safe treatments

o  the relation between endocrine and social changes of the
postpartum period, including that of women with individual and/or
family histories of mood disorder

o  the interactions among the hypothalamic pituitary adrenal and
thyroid axes and gonadal steroids in pre- and post- menopausal women,
and the relation of these hormonal interactions to susceptibility to
psychiatric disorders

o  mood disorder in the perimenopause and menopause, especially in
relation to prior history of disorder, psychosocial stressors,
somatic symptoms of menopause, and estrogen replacement treatments
(ERT)

o  the long-term effects of chronic ERT use on the onset and course
of mental disorders in later life such as dementia, depression, and
anxiety

o  potential nonpharmacological somatic treatments, such as light
therapy, which may be effective for the treatment of behavioral and
physiological symptoms of perimenopause

o  the development of psychiatric disorders secondary to gynecologic
illnesses (e.g., pelvic inflammatory disease), medical procedures
(e.g., genetic counseling, oophorectomy, breast cancer, and other
treatments), miscarriage, treatments, and outcomes (e.g.,
infertility)

o  the effects of reproductive disorders on the psychological status
of patients' daughters and other family members.

Eating Disorders.  Eating disorders, including anorexia nervosa,
bulimia nervosa, and binge-eating disorder, are more common among
young women compared to older women or males in clinic population
groups.  Research is needed on:

o  the community incidence and prevalence of eating disorders and
their comorbidity with physical, mental, and substance abuse
disorders

o  etiologic factors including psychosocial, biologic, and genetic
risks

o  course of illness and long-term impact of psychosocial and
pharmacologic treatments

o  impact of comorbidity on etiology and treatment response.

Alzheimer's Disease and Related Dementias (AD).  Women outnumber men
with increasing age, and risk of dementia increases with age.  Older
women (aged 85+) have a one in four chance of being diagnosed with AD
on average.  Further study is needed on:

o  gender-related risk and protective factors for AD, including the
potential protective effect of estrogen replacement therapy

o  the relation between late onset depression and dementia

o  factors that place middle-aged and older women caregivers of
family members with AD at risk for depression and exacerbated
physical disorders (e.g., compromised immune functioning,
cardiovascular disease)

o  improvement of quality of life among women in nursing homes, where
depression has been associated with greater morbidity and mortality.

Schizophrenia.  Persons with an early adulthood onset of
schizophrenia are more likely to be male, while late-onset (aged 45+)
schizophrenia occurs more frequently among females.  In addition to
studying the gender-by-age effects on onset patterns, more research
is needed on:

o  gender differences in the development, clinical course, and
symptoms of schizophrenia, and response to treatment with
antipsychotic medications and psychosocial rehabilitation therapies
and long-term outcomes

o  the possible role of estrogen in modulating gender differences in
symptoms and medication side effects, such as tardive dyskinesia

o  gender differences in cerebral and limbic system brain morphology
detectable by postmortem and brain imaging techniques

o  gender differences in suicide attempts and completions among
persons with schizophrenia, and clinical profiles of attempters and
completers.

AIDS and Other Sexually Transmitted Diseases (STDs).  The incidence
of HIV in women is increasing at a rate four times that of men in
this country.  AIDS is the leading cause of death among women between
ages 25 and 44.  African-American women face between 10 and 15 times
the risk of AIDS compared with White women.  Studies are needed on:

o  the use of both qualitative and quantitative methods to better
describe women who are at risk for HIV infection or who are
seropositive in order to develop successful, cost-effective
prevention and treatment efforts

o  relation of the HIV stigma among women to: coping, their potential
role as health educator and health caretaker in the family, family
awareness of HIV and provision of support, mental health
consequences, and use of services

o  the individual and family factors that contribute to high-risk
sexual behavior in adolescent girls

o  the acceptance and implementation of effective female- controlled
methods of reducing or preventing STDs or HIV

o  the prevalence of comorbid STDs with chronic mental illness,
personality disorders, mood and anxiety disorders, and past sexual
abuse

o  the way infected women make decisions about reproductive options,
place children in caretaking contexts, and prepare for their own
deaths and/or their children's deaths.

Comorbidity with Physical Illness.  Little is known about the gender
differences in psychiatric comorbidity with physical illnesses;
further, testing for and identification of risk for physical illness
(e.g., genetic testing for breast cancer) as well as the diagnosis
and treatment of physical illness may have unique, adverse behavioral
and psychological consequences for women.  Research is needed on the
gender differences in:

o  psychiatric comorbidity with physical illness and how to best
develop appropriate interventions

o  behavioral and psychological risks of genetic testing and disease
diagnosis and the development of gender-appropriate counseling and
educational procedures to reduce adverse consequences

o  the adverse behavioral and psychological consequences of
treatments for physical illness and methods for reducing such
consequences.

Sleep.  The consequences of sleep disorders, sleep deprivation, and
sleepiness include reduced productivity, lowered cognitive
performance, increased likelihood of accidents, higher morbidity and
mortality, and decreased quality of life.  Although sleep problems in
women are markedly different from those found in men, little
attention has been paid to the assessment of gender differences.
Research is needed on:

o  effects of the menstrual cycle, pregnancy, the postpartum period,
and menopause on sleep

o  reasons for the increase in insomnia in women over 40

o  role of sleep problems in the etiology, clinical course, and
treatment of psychiatric disorders among adolescent girls and women

o  consequences of sleep deprivation resulting from various
combinations of working outside the home, childcare, and caring for
elderly parents.

Violence and Abuse of Women and Girls, Rape, Sexual Assault, Domestic
Violence.  Females disproportionately suffer from domestic violence,
rape, and physical and sexual abuse.  For example, girls are two to
three times more likely than boys to be sexually abused.  Research is
needed on:

o  the psychosocial and biological effects of violence and trauma on
developmental trajectories (with consideration of age of puberty), on
later interpersonal relationships (including marital interactions,
parenting behavior), and on mental health outcomes (including
post-traumatic stress disorder, depression, anxiety)

o  effective psychosocial and pharmacologic treatment strategies for
victims of violence and abuse

o  the prevalence of abuse of elderly women, probable risk factors,
and promising prevention and intervention strategies

o  the impact of violence on the frequency and nature of seeking
health and mental health care-related services (e.g., increased use
of medical emergency room services by women who have been exposed to
violence and trauma)

o  the prevalence of victimization among severely mentally ill women

o  the appropriate recognition and diagnosis of trauma-related
problems by health and mental health treatment providers.

Prevention Research.  Preventive interventions precede clinical
diagnosis and the need for treatment and are aimed at reducing new
cases of mental disorders and related problems.  Promotive
interventions are aimed at a demonstrable development, maintenance,
or enhancement of healthy psychosocial functioning.  Included are
initial tests of efficacy and subsequent tests of the effectiveness
of promising intervention strategies in defined population trials.
Of particular interest are studies on:

o  gender-specific effects of preventive and promotive interventions
aimed at individuals or groups at high risk for depressive and/or
anxiety disorders and related affective problems

o  intervention effects on constellations of risk and protective
factors that may be of particular relevance to the etiology and
development of depression/anxiety in women and girls, including
biological, cultural, and psychosocial factors

o  interventions that target the mental health effects of multiple
role strains experienced by women, including those who are single
parents, who work outside the home, or take care of older and younger
generations simultaneously

o  interventions for women who are at high risk for postpartum
depression, for depression related to loss of a loved one, or for
depression associated with other life events

o  interventions that are aimed at multiple, comorbid outcomes in
women at risk, including mental and substance use disorders

o  interventions which modify gender-specific developmental pathways
to conduct disorder and serious behavior problems in girls, including
comorbid conditions.

Treatment Efficacy.  Treatment efficacy research is the study of
clinical trials of psychopharmacologic and psychosocial treatments
for mental disorders.  Included are the identification of
psychological and biological effects and predictors of outcome.
Studies are needed on:

o  the pharmacokinetics and pharmacodynamics of psychotropic
medications, in particular, receptor populations and enzyme levels
(such as gastric enzymes and hepatic P-450 induction or substrates)
by gender and across age, ethnic, and cultural groups

o  drug-drug interactions, drug clearance in women who are
concomitantly taking various estrogen preparations, and the possible
modulation of responses to psychotherapeutic medications

o  the efficacy of psychosocial and pharmacologic interventions
(singly and in combination), including estrogen replacement therapy
(ERT) as adjunctive treatment for various types of depression in
women in middle and later life

o  the gender differences in potential preferences or expectancies
for treatment modalities, such as a preference for interpersonal
psychotherapy, and implications for treatment efficacy

o  the inclusion of more refined measures of functional impairment in
treatment that can be made more relevant to women and their roles,
including quality of life

o  the implementation of more powerful quantitative techniques for
modeling trajectories of change, including growth-curve analyses,
survival analyses, and mechanisms of change, to better identify
gender differences in the course of illness among persons with mental
disorders.

Treatment Effectiveness and Service Use.  Both service system and
clinical services research are needed to understand the impact of
organizational, financing, and management factors on the way in which
women use services; and how well treatments previously shown to work
under controlled conditions (efficacy) perform when applied to women
in real world settings (effectiveness).  Studies are needed on:

o  the barriers to the accurate recognition, diagnosis, and effective
treatment of women with mental disorders who are seen in primary
care, hospital, or nursing home settings

o  the effect gender has on chosen pathways to care, the choice of
care provider (including informal providers and support groups), and
outcomes of care

o  age, gender, and cohort effects on pathways to care (older women
rarely seeking mental health professionals) and how treatment
patterns are affected by age and gender of the patient (e.g.,
inappropriate sedative or hypnotic prescriptions)

o  health care providers' treatment patterns for women and minorities
in primary care settings, hospitals, community mental health centers,
and nursing homes

o  the acceptability and effectiveness of clinically efficacious
treatments for women

o  differences in the relationship between the process of providing
mental health services (e.g., therapeutic alliance) and patient
outcomes across gender as well as other factors, such as personality
type, culture, and type and severity of disorder.

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN
SUBJECTS

It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations), which
have been in effect since 1990.  The new policy contains some
provisions that are substantially different from the 1990 policies.

All investigators proposing research involving human subjects should
read the "NIH Guidelines For Inclusion of Women and Minorities as
Subjects in Clinical Research," which have been published in the
Federal Register of March 28, 1994 (FR 59 14508-14513) and reprinted
in the NIH Guide for Grants and Contracts, Volume 23, Number 11,
March 18, 1994.

Investigators also may obtain copies of the policy from the program
staff listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.

APPLICATION PROCEDURES

Applications are to be submitted on the grant application form PHS
398 (rev. 9/91) and will be accepted at the standard application
deadlines as indicated in the application kit.  Application kits are
available at most institutional offices of sponsored research and may
be obtained from the Office of Grants Information, Division of
Research Grants, National Institutes of Health, 6701 Rockledge Drive,
Bethesda, MD 20892, telephone 301/710-0267.  The title and number of
the program announcement must be typed in Section 2a of the face page
of the application.  Applicants should also specify under which
support mechanism they are applying under.

FIRST (R29) applications must include at least three sealed letters
of reference attached to the face page of the original application.
FIRST applications submitted without the required number of reference
letters will be considered incomplete and will be returned without
review.

Applicants from institutions that have an NIMH Center, or a General
Clinical Research Center (GCRC) funded by the NIH National Center for
Research Resources, may wish to identify the center as a resource for
conducting the proposed research.  If so, a letter of agreement from
either the center program director or principal investigator could be
included with the application.

The completed original application and five legible copies must be
sent or delivered to:

Division of Research Grants
National Institutes of Health
6701 Rockledge Drive, Room 1040-MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for courier/overnight mail service)

REVIEW CONSIDERATIONS

Applications that are complete and responsive to the program
announcement will be evaluated for scientific and technical merit by
an appropriate peer review group convened in accordance with the
standard NIH peer review procedures.  As part of the initial merit
review, all applications will receive a written critique and undergo
a process in which only those applications deemed to have the highest
scientific merit, generally the top half of applications under
review, will be discussed, assigned a priority score, and receive a
second-level review by the appropriate national advisory council.

Review Criteria

The following review criteria apply to research project grants (R01
and R29).  Criteria for other mechanisms vary.  Applicants should
consult specific mechanism announcements and with program staff
(listed under INQUIRIES) for further information.

o  scientific, technical, or medical significance and originality of
proposed research

o  appropriateness and adequacy of the experimental approach and
methodology proposed to carry out the research

o  qualifications and research experience of the principal
investigator and staff, particularly, but not exclusively, in the
area of the proposed research

o  availability of the resources necessary to perform the research

o  appropriateness of the proposed budget and duration in relation to
the proposed research

o  adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
evaluated.

The initial review group will also examine the provisions for the
protection of human and animal subjects and the safety of the
research environment.

AWARD CRITERIA

Applications will compete for available funds with all other approved
applications.  The following will be considered in making funding
decisions:  quality of the proposed project as determined by peer
review, availability of funds, and program priority.

As part of the NIMH Public-Academic Liaison (PAL) initiative, special
encouragement is given to applications that involve active
collaborations between academic researchers and public sector
agencies in planning, undertaking, analyzing, and publishing research
pertaining to persons with severe mental disorders.  The PAL
initiative is based on the premise that important new advances in
understanding and treatment of severe mental disorders can result
from improved linkages between the Nation's scientific resources and
the public sector agencies and programs in which many persons with
severe mental disorders receive their care.  The scope of the PAL
initiative encompasses public sector agencies of all types that deal
with children, adolescents, adults, and elderly persons with severe
mental disorders.

INQUIRIES

Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Delores Parron, Ph.D.
Associate Director for Special Populations
National Institute of Mental Health
5600 Fishers Lane, Room 17C-14
Rockville, MD  20857
Telephone:  (301) 443-2847
FAX:  (301) 443-8552
Email: delores_parron@nih.gov

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
5600 Fishers Lane, Room 7C-08
Rockville, MD  20857
Telephone:  (301) 443-3065
Email:  delores_parron@nih.gov

The National Institute on Drug Abuse (NIDA) is not participating in
this program announcement, but continues to fund research in the area
of women's health and drug abuse through regular grant application
process.  For more information call or write to:

Cora Lee Wetherington, Ph.D.,
Division of Basic Research
National Institute on Drug Abuse
5600 Fishers Lane, Room 10A-20
Rockville, MD  20857
Telephone:  (301) 443-1263
FAX:  (301) 594-6043
Email:  cw84g@nih.gov

The National Institute of Nursing Research (NINR) is not
participating in this program announcement, but continues to fund
research in the area of women's health as it relates to nursing
practice through the regular grant application process.  For more
information call or write to:

J. Taylor Harden, Ph.D. R.N.
Health Promotion/Disease Prevention Branch
National Institute of Nursing Research
Building 45, Room 3AN-12
Bethesda, MD  20892-6300
Telephone:  (301) 594-5976
FAX:  (301) 480-8260
Email:  tharden@ep.ninr.nih.gov

Although not cosponsoring this program announcement, the National
Institute on Aging (NIA) sponsors a broad range of research
activities on biological, clinical, social and behavioral issues in
women's health as they age.  Many of these topics are relevant to
women's mental health.  Inquiries about NIA's sponsorship of these
activities may be directed to:

Dr. Robin A. Barr
Office of Extramural Affairs
National Institute on Aging
Gateway Building, Suite 2C218
7201 Wisconsin Avenue MSC 9205
Bethesda, MD  20892-9205
Telephone:  (301) 496-9322
FAX:  (301) 402-9245
Email:  barr%nihniagw.bitnet@cu.nih.gov

AUTHORITY AND REGULATION

This program is described in the Catalog of Federal Domestic
Assistance No. 93.242.  Awards are made under authorization of the
Public Health Service Act, Title IV, Part A (Public Law 78-410, as
amended by Public Law 99-158, 42 USC 241 and 285) and administered
under PHS grants and Federal Regulations 42 CFR 52 and 45 CFR Part
74.  This program is not subject to the intergovernmental review
requirements of Executive Order 12372 or Health Systems Agency
review. Awards will be administered under PHS grants policy as stated
in the Public Health Service Grants Policy Statement (April 1, 1994).

As part of PL 102-321 (ADAMHA Reorganization Act of 1992), the NIMH,
through the Associate Director for Special Populations, shall
develop, coordinate, and support programs of basic and applied
biological, pharmacological, social, and behavioral research on the
mental health problems of women.

The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the nonuse of all tobacco
products.  In addition, Public Law 103-227, the Pro-Children Act of
1994, prohibits smoking in certain facilities (or in some cases, any
portion of a facility) in which regular or routine education,
library, day care, health care or early childhood development
services are provided to children.

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