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Item Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design(JMIR Publications, 2021-12-24) Adams, Zachary; Grant, Miyah; Hupp, Samantha; Scott, Taylor; Feagans, Amanda; Phillips, Meredith Lois; Bixler, Kristina; Nallam, Phani Teja; La Putt, Dorothy; Psychiatry, School of MedicineBackground: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.Item Arsenal(2018) Carroll, Brenna; Jefferson, Corey; Baker, Lesley; Robertson, JeanTraumatic experience inspires the human drive for expression. Survivors carry the memory of trauma with them throughout their lives while they struggle to comprehend its impact. They maintain a fragile stability as their capacity to more forward is challenged and their perception of the world around them is altered. The force of memory compels those who have survived a traumatic event to build a defensive arsenal and to search for and to convey an understanding of their experience. My minimalist abstract ceramic sculpture examines the incidence of trauma and explores the transference of concepts and emotions associated with its effects.Item Associations of subjective and objective stress responses with interpersonal trauma, PTSD, stress-induced drinking, and drinking to cope in young adults(American Psychological Association, 2021) Danielson, Carla Kmett; Hahn, Austin M.; Bountress, Kaitlin E.; Adams, Zachary W.; Calhoun, Casey; Amstadter, Ananda B.; Thomas, Suzanne; Psychiatry, School of MedicineObjective: To understand how interpersonal trauma (IPT), stress response, and drinking to cope converge to predict stress-induced drinking, a risk factor for alcohol use disorder. Method: Young adults with no substance use disorder were classified into three trauma history groups: (a) IPT with PTSD (n = 27), (b) IPT without PTSD (n = 35), and (c) Control (no trauma-history/no PTSD; n = 36). Participants completed a baseline assessment, including a structured clinical interview, to confirm PTSD diagnosis, followed by the Trier Social Stressor Task (TSST) and an alcohol use task. Subjective units of distress and blood serum cortisol were collected at standardized timepoints throughout the tasks. Results: In all three groups (PTSD, IPT, control), males consumed more alcohol in the lab than females. Participants in the PTSD group had significantly higher drinking to cope motives, which were associated with greater subjective reactivity; however, neither drinking to cope motives nor subjective reactivity to the TSST predicted post-stressor alcohol consumption for those with PTSD. Conclusions: The interplay among trauma history, stress, and drinking among young adults is nuanced; additional lab-based studies are needed to further clarify the nuanced connection between trauma history, acute stress reactions, and alcohol use.Item The AURORA Study: A Longitudinal, Multimodal Library of Brain Biology and Function after Traumatic Stress Exposure(Springer Nature, 2020-02) McLean, Samuel A.; Ressler, Kerry; Koenen, Karestan Chase; Neylan, Thomas; Germine, Laura; Jovanovic, Tanja; Clifford, Gari D.; Zeng, Donglin; An, Xinming; Linnstaedt, Sarah; Beaudoin, Francesca; House, Stacey; Bollen, Kenneth A.; Musey, Paul; Hendry, Phyllis; Jones, Christopher W.; Lewandowski, Christopher; Swor, Robert; Datner, Elizabeth; Mohiuddin, Kamran; Stevens, Jennifer S.; Storrow, Alan; Kurz, Michael Christopher; McGrath, Meghan E.; Fermann, Gregory J.; Hudak, Lauren A.; Gentile, Nina; Chang, Anna Marie; Peak, David A.; Pascual, Jose L.; Seamon, Mark J.; Sergot, Paulina; Peacock, W. Frank; Diercks, Deborah; Sanchez, Leon D.; Rathlev, Niels; Domeier, Robert; Haran, John Patrick; Pearson, Claire; Murty, Vishnu P.; Insel, Thomas R.; Dagum, Paul; Onnela, Jukka-Pekka; Bruce, Steven E.; Gaynes, Bradley N.; Joormann, Jutta; Miller, Mark W.; Pietrzak, Robert H.; Buysse, Daniel J.; Pizzagalli, Diego A.; Rauch, Scott L.; Harte, Steven E.; Young, Larry J.; Barch, Deanna M.; Lebois, Lauren A. M.; van Rooij, Sanne J. H.; Luna, Beatriz; Smoller, Jordan W.; Dougherty, Robert F.; Pace, Thaddeus W. W.; Binder, Elisabeth; Sheridan, John F.; Elliott, James M.; Basu, Archana; Fromer, Menachem; Parlikar, Tushar; Zaslavsky, Alan M.; Kessler, Ronald; Emergency Medicine, School of MedicineAdverse posttraumatic neuropsychiatric sequelae (APNS) are common among civilian trauma survivors and military veterans. These APNS, as traditionally classified, include posttraumatic stress, postconcussion syndrome, depression, and regional or widespread pain. Traditional classifications have come to hamper scientific progress because they artificially fragment APNS into siloed, syndromic diagnoses unmoored to discrete components of brain functioning and studied in isolation. These limitations in classification and ontology slow the discovery of pathophysiologic mechanisms, biobehavioral markers, risk prediction tools, and preventive/treatment interventions. Progress in overcoming these limitations has been challenging because such progress would require studies that both evaluate a broad spectrum of posttraumatic sequelae (to overcome fragmentation) and also perform in-depth biobehavioral evaluation (to index sequelae to domains of brain function). This article summarizes the methods of the Advancing Understanding of RecOvery afteR traumA (AURORA) Study. AURORA conducts a large-scale (n = 5000 target sample) in-depth assessment of APNS development using a state-of-the-art battery of self-report, neurocognitive, physiologic, digital phenotyping, psychophysical, neuroimaging, and genomic assessments, beginning in the early aftermath of trauma and continuing for 1 year. The goals of AURORA are to achieve improved phenotypes, prediction tools, and understanding of molecular mechanisms to inform the future development and testing of preventive and treatment interventions.Item Basic symptoms of schizophrenia are related to symptoms of traumatic stress: A pivotal role of sensitization. An observational study(Wolters Kluwer, 2022-07-15) Pec, Ondrej; Lysaker, Paul H.; Bob, Petr; Psychiatry, School of MedicineIntroduction: Subjective cognitive deficits have been broadly reported in schizophrenia and described by Huber as basic symptoms. It remains unclear however to what extent they may be related to psychosocial stressors including trauma. Methods: We assessed basic symptoms using the Frankfurt Complaint Questionnaire (FCQ) in a sample of 40 patients with schizophrenia. Trauma-related symptoms were assessed concurrently using the Trauma Symptom Checklist-40, symptoms of dissociation using the Dissociative Experiences Scale, and sensitization phenomena using the Complex Partial Seizure-like Symptoms Inventory and Limbic System Checklist-33. Psychotic symptoms were measured by Health of the Nation Outcome Scales. The dosage of antipsychotic medication was assessed in terms of equivalents of chlorpromazine, and antidepressant medication in terms of equivalents of fluoxetine. Spearman correlations were performed to explore the relationship between FCQ and other trauma-related measures. To determine the relative contributions of trauma-related symptoms to basic symptoms a linear regression analysis was performed. Results: The results showed that higher levels of basic symptoms of schizophrenia were associated with greater levels of symptoms of dissociation, traumatic stress, and sensitization or kindling-like processes in schizophrenia. Among the trauma-related variables, sensitization phenomena assessed with Complex Partial Seizure-like Symptoms Inventory were closely associated with basic symptoms. Discussion: These results indicate that basic symptoms measured by FCQ might be related to trauma. The potential of trauma to influence neurodevelopmental hypotheses of schizophrenia is discussed.Item Bilateral trauma case conferences: an approach to global surgery equity through a virtual education exchange(Springer Nature, 2023) Bhatia, Manisha B.; Munda, Beryl; Okoth, Philip; Carpenter, Kyle L.; Jenkins, Peter; Keung, Connie H.; Hunter‑Squires, JoAnna L.; Saruni, Seno I.; Simons, Clark J.; Surgery, School of MedicinePurpose: With increased interest in international surgical experiences, many residency programs have integrated global surgery into their training curricula. For surgical trainees in low- and middle-income countries (LMICs), physical exchange can be costly, and laws in high-income countries (HICs) prevent LMIC trainees from practicing surgery while on visiting rotations. To enrich the educational experience of trainees in both settings, we established a monthly virtual trauma conference between surgery training programs. Methods: General surgery teams from two public institutions, a public university with two surgical training programs in Kenya and a public university with two level I trauma centers in the United States, meet monthly to discuss complex and interesting trauma patients. A trainee from each institution presents a clinical case vignette and supplements the case with pertinent peer-reviewed literature. The attendees then answer a series of multiple-choice questions like those found on surgery board exams. Results: Monthly case conferences began in September 2017 with an average of 24 trainees and consultant surgeons. Case discussions serve to stimulate dialogue on patient presentation and management, highlighting cost-conscious, high-quality care and the need to adapt practice patterns to meet resource constraints and provide culturally appropriate care. Conclusion: Our 5-year experience with this virtual case conference has created a unique and robust surgical education experience for trainees and surgeons who have withstood the effects of the pandemic. These case conferences have not only strengthened the camaraderie between our departments, but also promoted equity in global surgery education and prioritized the learning of trainees from both settings.Item Childhood adversities and risk of posttraumatic stress disorder and major depression following a motor vehicle collision in adulthood(Cambridge University Press, 2023-01-10) Ziobrowski, H. N.; Holt-Gosselin, B.; Petukhova, M. V.; King, A. J.; Lee, S.; House, S. L.; Beaudoin, F. L.; An, X.; Stevens, J. S.; Zeng, D.; Neylan, T. C.; Clifford, G. D.; Linnstaedt, S. D.; Germine, L. T.; Bollen, K. A.; Rauch, S. L.; Haran, J. P.; Storrow, A. B.; Lewandowski, C.; Musey, P. I.; Hendry, P. L.; Sheikh, S.; Jones, C. W.; Punches, B. E.; Kurz, M. C.; Swor, R. A.; Hudak, L. A.; Pascual, J. L.; Seamon, M. J.; Harris, E.; Pearson, C.; Merchant, R. C.; Domeier, R. M.; Rathlev, N. K.; O’Neil, B. J.; Sergot, P.; Sanchez, L. D.; Bruce, S. E.; Miller, M. W.; Pietrzak, R. H.; Joormann, J.; Barch, D. M.; Pizzagalli, D. A.; Harte, S. E.; Elliott, J. M.; Ressler, K. J.; McLean, S. A.; Koenen, K. C.; Kessler, R. C.; Emergency Medicine, School of MedicineAims: Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions. Methods: Data came from n = 999 patients ages 18-75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models. Results: Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31-1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65-2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43-2.87) and bullying (RR = 1.44; 95% CI = 0.99-2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE. Conclusions: Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.Item Childhood Unraveled(2023) Edgerly, Brianna; Setser, Meredith; Petranek, Stefan; Potter, William; Baldner, KarenThrough the exploration of handmade paper with nostalgic imagery I have been transforming the fragments and sorrow of my memories into a cathartic experience shared between the artist and the viewer. I use Van Dyke brown printing to translate photographic imagery that reminds me of my childhood and create my version in the form of an abstracted illustration. This translation from photography to drawing allows for a personal reprocessing of the original memory. I print the illustrations onto handmade cotton paper that together create an aesthetically intriguing collection of objects. They are a physical record of how the artistic process has also been a healing one when it comes to my mental health. It also offers the spectator a moment to slow down and reflect on how they process their memories by witnessing how I have processed my own. As a result, my work creates a stronger empathetic understanding of how someone’s past can affect them in the present moment. The delicately intricate use of the material creates a curiosity in the spectator to further interact with the work. As they move in closer to inspect the work, tears, stains, and other imperfections litter both prints and cast forms alike. By allowing the natural processes of hand papermaking and analog printing to create these imperfections, I can embrace and redefine my own. Through paper making and analog printing, I can embrace my own imperfections, redefine them, and find beauty in them.Item Closing the Gap between School & Community Partnerships, A Needs Assessment in Indianapolis, 2021(MCCY, 2021-01) Education Action Team, Early Intervention Planning CouncilOur children spend a significant amount of time in school – and success in school sets the foundation for successful careers and contribution to our communities. However, in recent decades, we have seen what the disinvestment to public education has done to individual schools and school systems. The past year, during the Covid-19 global pandemic, schools have faced even more challenges, navigating school closures, virtual learning, and hybrid models. Research clearly connects multiple external factors and academic success. With a global pandemic layered onto limited funding and capacity, schools continue to struggle to provide the supports students and their families need to address the challenges and struggles reflected in the classroom. In 2018, the Education Action Team of Marion County’s Early Intervention Planning Council launched an assessment to identify the issues impeding student success from the perspective of school personnel. Additionally, we sought to identify barriers to building stronger partnerships with community resources. Marion County, Indiana is resource rich but systems poor – our community lacks a cohesive network of community services for schools to tap into, thus teachers and staff navigate a fragmented system. Through an online survey, three community conversations, and key informant interviews, we were able to identify key findings that can inform strategic actions moving forward to strengthen the ability of schools to meet student needs – whether they develop within the classroom or not. Our findings show some of the top issues impacting student success are challenges that all exist outside of the school building: • Social and Emotional Health • Trauma and Violence • Mental Health • Chronic Absenteeism • Social Media and Internet School staff are often left trying to address the symptoms of these complex, adaptive challenges, yet they do not have the capacity to fully tackle the root causes nor should they be expected to do so alone. This emphasizes the need to build strong partnerships with community resources, in addition to building the capacity of school personnel to carry out effective solutions inside the classroom. Moreover, schools realize that family engagement is a proactive strategy to support students and building trust with families is paramount. Stronger school-community partnerships and networks will more effectively work towards the systems change necessary to support learning. The recommendations put forth in this report work across multiple levels to provide holistic solutions to the complex problems discussed in our findings from the assessment. Schools and community organizations can join us in taking the necessary steps to building supportive community networks around our schools and advocating for the investment needed to create safe, healthy learning environments for our children.Item Comparison of Intravenous Lipid Emulsions in Parenteral Nutrition: A Pilot Study(2021-02) McGuigan, Alexis K.; O'Palka, Jacquelynn; Blackburn, Sara; Laughlin, Michelle; Carter, AmyBackground: SMOF lipid™ infusion containing soybean oil, medium-chain triglycerides, olive oil, and fish oil has been approved and recommended for use in adults receiving parenteral nutrition (PN). Research shows that SMOF lipid infusion is safe for use in post-operative and critically ill patients. Improved patient outcomes are linked to SMOF lipid use over traditional soybean oil lipid emulsions. Objective: The purpose of this study was to determine the effect of SMOF lipid infusion on incidence of infection, ICU length of stay, hospital length of stay, and mortality in adult trauma patients as compared to parenteral nutrition utilizing 100% soybean oil emulsion or a lipid-free, dextrose and amino acid administration. Methods and Analysis: A retrospective chart review was conducted for adult trauma patients admitted to Eskenazi Health’s surgical intensive care unit (SICU) that received PN from May 2017 to May 2020. Data were collected from the electronic health record and trauma registry. Results: Twenty-nine patients were included who met study criteria: 17 patients in the traditional lipid cohort and 12 in the SMOF lipid cohort. The length of PN therapy was comparable between the traditional and SMOF ILE groups, 13.9 days (± 11.5) and 13.3 days (± 14.3) respectively. All 12 patients in the SMOF lipid cohort received intravenous lipid emulsion (ILE) compared to 42% (n=7) of traditional lipid group patients (p=0.001). SMOF treatment group were provided 100% of estimated energy needs via PN compared to an average of 94% (± 9.7) of estimated energy needs in the traditional lipid treatment group (p=0.036). Incidence of infection during initial hospitalization was significantly lower in the SMOF treatment group (n=3, 25%) compared to the traditional lipid treatment group (n=13, 76%). Mortality was decreased in the SMOF treatment group (0%) when contrasted to the Intralipid treatment group (23.5%), p=0.04. Conclusion: Patients receiving SMOF lipid emulsion within PN therapy had better clinical outcomes compared to those receiving Intralipid soybean-lipid emulsion or a dextrose and amino acid administration.