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Item Adverse Childhood Experiences and Mental Health Conditions Among Multiracial Adolescents(Taylor & Francis, 2021) Weller, Bridget E.; Conrad, Joseph K.; Wilburn, Victoria G.; Ramamonjiarivelo, Jo; Gladden, Jessica; Occupational Therapy, School of Health and Human SciencesThe relationships between adverse childhood experiences (ACEs) and mental health conditions have received much attention in the literature. A particularly well-documented type of ACE is household dysfunction. However, compared to monoracial youth, little is known about the relationship between this type of ACE and mental health outcomes among multiracial adolescents. Objective The objective of this study was to verify the factor structure of the household dysfunction type of ACE using data from the National Survey of Children’s Health (NSCH), and then examine whether household dysfunction (measured as a latent construct) was associated with mental health conditions among multiracial adolescents. Design We used cross-sectional data collected in 2016 from caregivers who completed the NSCH and analyzed data from a subpopulation of adolescents (12–17) who reported more than one race (n = 1,231). Mplus 8.4 was used to conduct confirmatory factor analysis and probit models from a structural equation modeling framework. Results Results from this study indicated that the household dysfunction type of ACE, as a latent construct, had good model fit and was significantly associated with depression [standardized coefficient [B] = .50, 95% confidence interval [CI] .36, .65], anxiety [B = .61, 95% CI .48, .73], behavior problems [B = .58, 95% CI .44, .72], and ADHD [B = .54, 95% CI .38, .69] for multiracial adolescents. Conclusions Household dysfunction may result in adolescents being separated (physically or emotionally) from their caregivers, which may hinder adolescents’ ability to establish or maintain one of the most important relationships needed to promote racial/ethnic identity development and mental health. Implications for advancements in theory and NSCH are presented.Item Affective and emotional dysregulation as pre-dementia risk markers: exploring the mild behavioral impairment symptoms of depression, anxiety, irritability, and euphoria(Cambridge, 2018-02) Ismail, Zahinoor; Gatchel, Jennifer; Bateman, Daniel R.; Barcelos-Ferreira, Ricardo; Chantillon, Marc; Jaeger, Judith; Donovan, Nancy J.; Mortby, Moyra E.; Psychiatry, School of MedicineBackground: Affective and emotional symptoms such as depression, anxiety, euphoria, and irritability are common neuropsychiatric symptoms (NPS) in pre-dementia and cognitively normal older adults. They comprise a domain of Mild Behavioral Impairment (MBI), which describes their emergence in later life as an at-risk state for cognitive decline and dementia, and as a potential manifestation of prodromal dementia. This selective scoping review explores the epidemiology and neurobiological links between affective and emotional symptoms, and incident cognitive decline, focusing on recent literature in this expanding field of research. Methods: Existing literature in prodromal and dementia states was reviewed, focusing on epidemiology, and neurobiology. Search terms included: “mild cognitive impairment,” “dementia,” “prodromal dementia,” “preclinical dementia,” “Alzheimer's,” “depression,” “dysphoria,” “mania,” “euphoria,” “bipolar disorder,” and “irritability.” Results: Affective and emotional dysregulation are common in preclinical and prodromal dementia syndromes, often being harbingers of neurodegenerative change and progressive cognitive decline. Nosological constraints in distinguishing between pre-existing psychiatric symptomatology and later life acquired NPS limit historical data utility, but emerging research emphasizes the importance of addressing time frames between symptom onset and cognitive decline, and age of symptom onset. Conclusion: Affective symptoms are of prognostic utility, but interventions to prevent dementia syndromes are limited. Trials need to assess interventions targeting known dementia pathology, toward novel pathology, as well as using psychiatric medications. Research focusing explicitly on later life onset symptomatology will improve our understanding of the neurobiology of NPS and neurodegeneration, enrich the study sample, and inform observational and clinical trial design for prevention and treatment strategies.Item Affective traits and adiposity : a prospective, bidirectional analysis of the African American Health study data(Proquest, 2013) Hawkins, Misty Anne; Stewart, Jesse C.; Rand, Kevin L.; Cyders, Melissa A.; Miller, Douglas K.; Grahame, Nicholas J.Research indicates that negative affective traits (e.g., depression) are predictors and consequences of excess adiposity. Given that racial minorities and positive affective traits have been underrepresented in past investigations, more prospective studies are needed which examine multiple affective traits in relation to obesity in these populations. The objective of the current study was to investigate the prospective, bidirectional associations between multiple affective traits and multiple adiposity indicators in African Americans using data from the African American Health (AAH) study. The AAH study is a prospective cohort study of African Americans aged 49-65 years at baseline (N = 998). The longest follow-up period in the current study was 9 years (N = 579). Self-reported and measured body mass index (BMI; kg/m2) and body fat percent (BF%) were used as adiposity indicators. Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies-Depression Scale (CES-D), and anxiety was assessed using the Generalized Anxiety Disorder-2 (GAD-2) scale. Positive affective traits were assessed with the Vitality subscale of the Short Form-36 and Positive Affect subscale from the CES-D. Latent variable path analysis, a structural equation modeling technique, was conducted. Although fit statistics indicated that the models fit the data (RMSEA < .06), examination of the structural paths revealed that the CES-D and GAD-2 were not predictors or consequences of self-reported BMI, measured BMI, or BF% (ps > .05). Likewise, Vitality and CES-D Positive Affect were not related to any adiposity indicator (ps > .05). The results of this prospective cohort study suggest that affective traits are not predictors or consequences of adiposity in middle-aged African Americans and that this group may require obesity prevention or intervention programs with little to no emphasis on affective traits. Possible explanations for the current results include ethnic differences in the mechanistic pathways between affective traits and adiposity.Item Agreement between older adult patient and caregiver proxy symptom reports(Springer, 2022-05) Kroenke, Kurt; Stump, Timothy E.; Monahan, Patrick O.; Medicine, School of MedicineBackground Proxy report is essential for patients unable to complete patient-reported outcome (PRO) measures themselves and potentially beneficial when the caregiver perspective can complement patient report. In this study, we examine agreement between self-report by older adults and proxy report by their caregivers when completing PROs for pain, anxiety, depression, and other symptoms/impairments. Methods Four PROs were administered by telephone to older adults and their caregivers followed by re-administration within 24 h in a random subgroup. The PROs included the PHQ-9 depression, GAD-7 anxiety, PEG pain, and SymTrak multi-dimensional symptom and functional status scales. Results The sample consisted of 576 older adult and caregiver participants (188 patient-caregiver dyads, 200 patients without identified caregiver). The four measures had good internal (Cronbach’s alpha, 0.76 to 0.92) and test–retest (ICC, 0.63 to 0.92) reliability whether completed by patients or caregivers. Total score and item-level means were relatively similar for both patient and caregiver reports. Agreement for total score as measured by intraclass correlation coefficient (ICC) was better for SymTrak-23 (0.48) and pain (0.58) than for anxiety (0.28) and depression (0.25). Multinomial modeling showed higher (worse) patient-reported scale scores were associated with caregiver underreporting, whereas higher caregiver task difficulty was associated with overreporting. Conclusion When averaged over individuals at the group level, proxy reports of PRO scores by caregivers tend to approximate patient reports. For individual patients, proxy report should be interpreted more cautiously for psychological symptoms as well as when patient-reported symptoms are more severe, or caregiver task difficulty is high.Item Anxiogenic CO2 Stimulus Elicits Exacerbated Hot Flash-like Responses in a Rat Menopause Model and Hot Flashes in Menopausal Women(Lippincott, Williams & Wilkins, 2016-11) Federici, Lauren M.; Roth, Sarah Dorsey; Krier, Connie; Fitz, Stephanie D.; Skaar, Todd C.; Shekhar, Anantha; Carpenter, Janet S.; Johnson, Philip L.; Anatomy and Cell Biology, School of MedicineObjective Since longitudinal studies determined that anxiety is a strong risk factor for hot flashes, we hypothesized that an anxiogenic stimulus that signals air hunger (hypercapnic, normoxic gas) would trigger an exacerbated hot flash-associated increase in tail skin temperature (TST) in a rat ovariectomy (OVEX) model of surgical menopause and hot flashes in symptomatic menopausal women. We also assessed TST responses in OVEX serotonin transporter (SERT)+/− rats that models a common polymorphism that is associated with increased climacteric symptoms in menopausal women and increases in anxiety traits. Methods OVEX and sham-OVEX rats (initial experiment) and wildtype and SERT+/− OVEX rats (subsequent experiment) were exposed to a 5 min infusion of 20%CO2 normoxic gas while measuring TST. Menopausal women were given brief 20% and 35%CO2 challenges, and hot flashes were self-reported and objectively verified. Results Compared to controls, OVEX rats had exacerbated increases in TST, and SERT+/− OVEX rats had prolonged TST increases following CO2. Most women reported mild/moderate hot flashes after CO2 challenges, and the hot flash severity to CO2 was positively correlated with daily hot flash frequency. Conclusions The studies demonstrate that this anxiogenic stimulus is capable of inducing cutaneous vasomotor responses in OVEX rats, and eliciting hot flashes in menopausal women. In rats, the severity of the response was mediated by loss of ovarian function and increased anxiety traits (SERT+/−), and, in women, by daily hot flash frequency. These findings may provide insights into anxiety related triggers and genetic risk factors for hot flashes in thermoneutral environments.Item Automated monitoring of early neurobehavioral changes in mice following traumatic brain injury(Medknow Publications, 2016-02) Qu, Wenrui; Liu, Nai-Kui; Xie, Xin-Min Simon; Li, Rui; Xu, Xiao-Ming; Department of Neurological Surgery, IU School of MedicineTraumatic brain injury often causes a variety of behavioral and emotional impairments that can develop into chronic disorders. Therefore, there is a need to shift towards identifying early symptoms that can aid in the prediction of traumatic brain injury outcomes and behavioral endpoints in patients with traumatic brain injury after early interventions. In this study, we used the SmartCage system, an automated quantitative approach to assess behavior alterations in mice during an early phase of traumatic brain injury in their home cages. Female C57BL/6 adult mice were subjected to moderate controlled cortical impact (CCI) injury. The mice then received a battery of behavioral assessments including neurological score, locomotor activity, sleep/wake states, and anxiety-like behaviors on days 1, 2, and 7 after CCI. Histological analysis was performed on day 7 after the last assessment. Spontaneous activities on days 1 and 2 after injury were significantly decreased in the CCI group. The average percentage of sleep time spent in both dark and light cycles were significantly higher in the CCI group than in the sham group. For anxiety-like behaviors, the time spent in a light compartment and the number of transitions between the dark/light compartments were all significantly reduced in the CCI group than in the sham group. In addition, the mice suffering from CCI exhibited a preference of staying in the dark compartment of a dark/light cage. The CCI mice showed reduced neurological score and histological abnormalities, which are well correlated to the automated behavioral assessments. Our findings demonstrate that the automated SmartCage system provides sensitive and objective measures for early behavior changes in mice following traumatic brain injury.Item Automated Self-management (ASM) vs. ASM-Enhanced Collaborative Care for Chronic Pain and Mood Symptoms: the CAMMPS Randomized Clinical Trial(Springer, 2019-06-21) Kroenke, Kurt; Baye, Fitsum; Lourens, Spencer G.; Evans, Erica; Weitlauf, Sharon; McCalley, Stephanie; Porter, Brian; Matthias, Marianne S.; Bair, Matthew J.; Medicine, School of MedicineBackground Chronic musculoskeletal pain is often accompanied by depression or anxiety wherein co-occurring pain and mood symptoms can be more difficult to treat than either alone. However, few clinical trials have examined interventions that simultaneously target both pain and mood conditions. Objective To determine the comparative effectiveness of automated self-management (ASM) vs. ASM-enhanced collaborative care. Design Randomized clinical trial conducted in six primary care clinics in a VA medical center. Participants Two hundred ninety-four patients with chronic musculoskeletal pain of at least moderate intensity and clinically significant depressive and/or anxiety symptoms. Intervention ASM consisted of automated monitoring and 9 web-based self-management modules. Comprehensive symptom management (CSM) combined ASM with collaborative care management by a nurse-physician team. Both interventions were delivered for 12 months. Main Measures Primary outcome was a composite pain-anxiety-depression (PAD) z-score consisting of the mean of the BPI, PHQ-9, and GAD-7 z-scores: 0.2, 0.5, and 0.8 represent potentially small, moderate, and large clinical differences. Secondary outcomes included global improvement, health-related quality of life, treatment satisfaction, and health services use. Key Results Both CSM and ASM groups had moderate PAD score improvement at 12 months (z = − 0.65 and − 0.52, respectively). Compared to the ASM group, the CSM group had a − 0.23 (95% CI, − 0.38 to − 0.08; overall P = .003) greater decline in composite PAD z-score over 12 months. CSM patients were also more likely to report global improvement and less likely to report worsening at 6 (P = .004) and 12 months (P = .013). Conclusions Two intervention models relying heavily on telecare delivery but differing in resource intensity both produced moderate improvements in pain and mood symptoms. However, the model combining collaborative care led by a nurse-physician team with web-based self-management was superior to self-management alone.Item Carbon Dioxide Challenge and Hot Flashes(Office of the Vice Chancellor for Research, 2013-04-05) Dorsey, Sarah E.; Carpenter, Janet S.Little is known about the pathophysiology of menopausal hot flashes, although there appear to be many similarities between hot flashes and panic attacks. While hot flashes occur at random and are difficult to study, there is a method of testing panic attacks. A Carbon Dioxide (CO2) Challenge is a validated method that has been used to induce panic attacks in a laboratory setting. The aim of this study is to test whether a CO2 Challenge using inhalations of 20% and 35% CO2 can provoke a hot flash in menopausal women. We hypothesize that women who have many hot flashes each day (4+) will have a hot flash when exposed to the increased concentration of CO2 using this challenge. Six healthy women attended a study session lasting ninety minutes. In this placebo controlled, cross-over study, women inhale room air, 20% CO2 for 40 seconds, rest for 15 minutes, and 35% CO2 using a double-breath vital capacity inhalation. Anxiety was measured on a numeric rating scale (NRS) and a State Trait Anxiety Inventory (STAI). Most participants have reported a hot flash within minutes of the CO2Challenge. There have been no significant changes in anxiety during the study. Findings provide evidence of the proposed link between hot flashes and panic.Item Chronic Illness and Internalizing Symptomatology in a Transdiagnostic Clinical Sample of Youth(Oxford, 2020-07) Wolock, Elizabeth; Queen, Alexander; Rodriguez, Gabriela M.; Weisz, John R.; Psychiatry, School of MedicineObjective In research with community samples, children with chronic physical illnesses have shown elevated anxiety and depressive symptoms, compared to healthy peers. Less is known about whether physical illnesses are associated with elevated internalizing symptoms even among children referred for mental health treatment—a pattern that would indicate distinctive treatment needs among physically ill children receiving mental health care. We investigated the relationship between chronic physical illness and internalizing symptomatology among children enrolling in outpatient mental health treatment. Method A total of 262 treatment-seeking children ages 7–15 and their caregivers completed a demographic questionnaire, Child Behavior Checklist, and Youth Self-Report during a pre-treatment assessment. Physical illnesses were identified through caregiver report. Results There was no overall association between the presence/absence of chronic physical illness and parent- or child-reported symptoms. However, number of chronic physical illnesses was related to parent- and child-reported affective symptoms. Children with two or more chronic physical illnesses had more severe depressive symptoms than those with fewer physical illnesses. Conclusion Having multiple chronic illnesses may elevate children’s risk of depression symptomatology, even in comparison to other children seeking mental health care. This suggests a need to identify factors that may exacerbate depression symptoms in physically ill children who are initiating therapy and to determine whether different or more intensive services may be helpful for this group. The findings suggest the potential utility of screening for depression in youth with chronic physical illnesses, as well as addressing mental and physical health concerns during treatment.Item Clinical and Psychological Correlates of Two Domains of Hopelessness in Schizophrenia(2008-12) Lysaker, Paul H.; Salyers, Michelle P.; Tsai, Jack; Spurrier, Linda Yorkman; Davis, Louanne W.Hopelessness is a widely observed barrier to recovery from schizophrenia spectrum disorders. Yet little is known about how clinical, social, and psychological factors independently affect hope. Additionally, the relationships that exist between these factors and different kinds of hope are unclear. To explore both issues, we correlated two aspects of hope, expectations of the future and agency, with stigma, clinical symptoms, anxiety, and coping preferences in 143 persons with a schizophrenia spectrum disorder. Multiple regressions revealed that hope for the future was predicted by lesser alienation, lesser preference for ignoring stressors, and lesser emotional discomfort and negative symptoms, accounting for 43% of the variance. A greater sense of agency was linked to lesser endorsement of mental illness stereotypes, fewer negative symptoms, lesser social phobia, and lesser preference for ignoring stressors, accounting for 44% of the variance. Implications for research and interventions are discussed.
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