The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: a family history study

Incidence Trajectories of Psychiatric Disorders After Assault, Injury, and Bereavement

Importance

Traumatic events have been associated with elevated risks of psychiatric disorders, while the contributions of familial factors to these associations remain less clear.

Objective

To determine the contribution of familial factors to long-term incidence trajectories of psychiatric disorders following potentially traumatic events.

Design, Setting, and Participants

This cohort study evaluated 3 separate cohorts of individuals residing in Sweden who were free of previous diagnosed psychiatric disorders when first exposed to assault (n = 49 957), injury (n = 555 314), or bereavement (n = 321 263) from January 1987 to December 2013, together with their unexposed full siblings, and 10 age-, sex-, and birthplace-matched unexposed individuals (per exposed individual). Cohorts were created from the Swedish Total Population Register linked to health and population registers. Data were analyzed from March 2022 to April 2023.

Exposures

Potentially traumatic events, including various types of assault, injuries, and bereavement (death of a child or of a spouse or partner), were ascertained from the Swedish national registers.

Main Outcomes and Measures

Incident psychiatric disorders were ascertained from the Swedish Patient Register. Flexible parametric and Cox models were used to estimate associations of potentially traumatic events with incident psychiatric disorders after multivariable adjustment.

Results

The median (IQR) age at exposure to assault, injury, and bereavement was 22 (18-31), 19 (8-40), and 60 (51-68) years, respectively. During a median (IQR) follow-up of 4.9 (2.2-8.2), 9.1 (4.1-15.6), and 8.1 (3.4-14.8) years, the incidence rates of any psychiatric disorder were 38.1, 13.9, and 9.0 per 1000 person-years for the exposed groups of the 3 cohorts, respectively. Elevated risk of any psychiatric disorder was observed during the first year after exposure to any assault (hazard ratio [HR], 4.55; 95% CI, 4.34-4.77), injury (HR, 3.31; 95% CI,3.23-3.38), or bereavement (HR, 2.81; 95% CI, 2.72-2.91) and thereafter (assault HR, 2.50; 95% CI, 2.43-2.56; injury HR, 1.69; 95% CI, 1.68-1.70; bereavement HR, 1.42; 95% CI, 1.40-1.44). Comparable associations were obtained in sibling comparison (first year: assault HR, 3.70; 95% CI, 3.37-4.05; injury HR, 2.98; 95% CI, 2.85-3.12; bereavement HR, 2.72; 95% CI, 2.54-2.91; thereafter: assault HR, 1.93; 95% CI, 1.84-2.02; injury HR, 1.51; 95% CI, 1.48-1.53; bereavement HR, 1.35; 95% CI, 1.31-1.38). The risk elevation varied somewhat by type of traumatic events and psychiatric disorders, with the greatest HR noted for posttraumatic stress disorder after sexual assault (sibling comparison HR, 4.52; 95% CI, 3.56-5.73 during entire follow-up period).

Conclusions and Relevance

In this study, the long-term risk elevation of psychiatric disorders after potentially traumatic events was largely independent of familial factors. The risk elevation observed immediately after these events motivates early clinical surveillance and mental health services for these vulnerable populations.

Intergenerational Transmission of Psychiatric Conditions and Psychiatric, Behavioral, and Psychosocial Outcomes in Offspring

Importance

Psychiatric conditions in parents are associated with many psychiatric and nonpsychiatric outcomes in offspring. However, it remains unknown whether this intergenerational transmission is attributable to broader psychopathology comorbidity or to specific conditions.

Objective

To estimate associations between general and specific psychopathology factors in parents and a wide range of register-based outcomes in their offspring.

Design, Setting, and Participants

This Swedish national register-based cohort study included 2 947 703 individuals born between 1970 and 2000 and followed up with participants through December 31, 2013. Statistical analysis was performed from October 2022 to October 2023.

Exposures

Hierarchical factor model consisting of 1 general and 3 specific psychopathology factors fit to 9 parental psychiatric diagnoses and violent criminal court convictions.

Main Outcomes and Measures

A total of 31 outcomes were measured in offspring and sorted into 6 broad clusters: psychotic-like outcomes, neurodevelopmental outcomes, internalizing outcomes, externalizing outcomes, behavior and accidents, and psychosocial outcomes.

Results

Of 2 947 703 individuals, 1 518 252 (51.5%) were male, and the mean (SD) age at the end of follow-up was 28.7 (8.9) years. The general psychopathology factor in parents was significantly associated with all 31 offspring outcomes (range: odds ratio [OR] for accidents, 1.08 [95% CI, 1.07-1.08] to OR for social welfare recipiency, 1.40 [95% CI, 1.39-1.40]), which means that children whose parents scored 1 SD above the mean on the general psychopathology factor had an 8% to 40% higher odds of different studied outcomes. The specific psychotic factor in parents was primarily associated with all 5 psychotic-like outcomes (range: OR for prescription of antiepileptics, 1.05 [95% CI, 1.04-1.06] to OR for schizophrenia, 1.25 [95% CI, 1.23-1.28]) and the specific internalizing factor in parents was primarily associated with all 6 internalizing outcomes (range: OR for prescription of anxiolytics, 1.10 [95% CI, 1.09-1.10] to OR for depression, 1.13 [95% CI, 1.12-1.13]) and all 6 neurodevelopmental outcomes (range: OR for intellectual disability, 1.02 [95% CI, 1.01-1.03] to OR for autism spectrum disorder, 1.10 [95% CI, 1.09-1.11]) in offspring. The specific externalizing factor in parents was associated with all 6 externalizing outcomes (range: OR for violent crimes, 1.21 [95% CI, 1.19-1.23] to OR for oppositional defiant disorder, 1.32 [95% CI, 1.32-1.33]) and all 6 internalizing outcomes (range: OR for obsessive-compulsive disorder, 1.01 [95% CI, 1.00-1.02] to OR for posttraumatic stress disorder, 1.13 [95% CI, 1.12-1.13]) in offspring.

Conclusions and Relevance

This cohort study of the Swedish population suggests that the intergenerational transmission of psychiatric conditions across different types of spectra may largely be attributable to a parental general psychopathology factor, whereas specific factors appeared to be primarily responsible for within-spectrum associations between parents and their offspring. Professionals who work with children (eg, child psychologists, psychiatrists, teachers, and social workers) might benefit from taking the total number of parental psychiatric conditions into account, regardless of type, when forecasting child mental health and social functions.

Substance Use Disorders and Medication-Assisted Therapies: Current Practices and Implications for Nursing

In the United States, the opioid epidemic and COVID-19-related substance use have exacerbated the overall incidence of substance use disorders (SUDs). Medication-assisted therapy (MAT), or cognitive and behavioral therapy that combines medications that reduce substance use or acute withdrawal symptoms, has dramatically improved outcomes for SUD patients, including preventing mortality. With recent US Congressional funding for MAT, patients presenting for acute care on MAT-related medications will continue to increase. Nurses should be aware of these medications' mechanism of action, typical side effects, and implications on treating acute pain to optimize their care.

Suicidal ideation, attempt and associated factor among secondary school students in Harari regional state, Eastern Ethiopia. A multi-center cross-sectional study

Background

Suicide is a major public health issue across the globe. It is the second leading cause of death in adolescents. Even though the rate of suicide has increased, no study has been conducted to investigate the determinants of suicide in the study area. Therefore, this study aimed to assess the magnitude of suicidal ideation, suicide attempts, and its associated factors among secondary school students in the Harari regional state of Eastern Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among randomly selected 1,666 secondary school students. A structured-self-administered questionnaire was used for data collection. The WHO Composite International Diagnostic Interview (CIDI) was used to assess suicidal ideation and suicide attempts. The Depression Anxiety and Stress Scale (DASS) was also used to assess depression, anxiety, and stress. Data were entered into EpiData version 3.1 and exported to Stata version 14.0 for the analysis. A logistic regression analysis was performed to determine the association between the outcome and independent variables and the statistical significance was declared at a p-value of < 0.05.

Result

The overall magnitude of suicidal ideation and attempts was 13.82% at 95% confidence interval (CI): 12.16-15.66 and 7.61% at 95% CI: 6.37-9.07, respectively. Suicidal ideations and suicide attempts were significantly associated with undergoing depressive symptoms (adjusted odds ratio [AOR]: 1.54; 95% CI: 1.08-2.19 and AOR: 2.37; 95% CI: 1.46-3.86, respectively), experiencing anxiety symptoms (AOR: 1.80; 95% CI: 1.25-2.59 and AOR: 1.89; 95% CI: 2.14-10.65, respectively), being exposed to sexual violence (AOR: 3.36; 95% CI: 1.65-6.84), and having a family history of suicidal attempts (AOR: 2.12; 95% CI: 1.21-3.69 and AOR: 4.74; 95% CI: 2.14-10.65, respectively), whereas living in a rural residence (AOR: 1.65 95%, CI: 1.08-2.55) was significantly associated only with suicide attempts.

Conclusion and recommendations

Nearly one in six secondary school students had both suicidal ideation and attempted to take their own life. Suicide is one of the psychiatric emergencies that need immediate action. Therefore, the concerned body from either a governmental or a non-governmental organization should work in setting strategies to minimize sexual violence as well as depressive and anxiety symptoms.

Risk clustering and psychopathology from a multi-center cohort of Indian children, adolescents, and young adults

Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of children, adolescents, and young adults, based on adverse environmental exposure and developmental characteristics, and to examine the association of risk clusters with manifest psychopathology. Participants (n = 8300) between 6 and 23 years were recruited from seven sites in India. We administered questionnaires to elicit history of previous exposure to adverse childhood environments, family history of psychiatric disorders in first-degree relatives, and a range of antenatal and postnatal adversities. We used these variables to generate risk clusters. Mini-International Neuropsychiatric Interview-5 was administered to evaluate manifest psychopathology. Two-step cluster analysis revealed two clusters designated as high-risk cluster (HRC) and low-risk cluster (LRC), comprising 4197 (50.5%) and 4103 (49.5%) participants, respectively. HRC had higher frequencies of family history of mental illness, antenatal and neonatal risk factors, developmental delays, history of migration, and exposure to adverse childhood experiences than LRC. There were significantly higher risks of any psychiatric disorder [Relative Risk (RR) = 2.0, 95% CI 1.8-2.3], externalizing (RR = 4.8, 95% CI 3.6-6.4) and internalizing disorders (RR = 2.6, 95% CI 2.2-2.9), and suicidality (2.3, 95% CI 1.8-2.8) in HRC. Social-environmental and developmental factors could classify Indian children, adolescents and young adults into homogeneous clusters at high or low risk of psychopathology. These biopsychosocial determinants of mental health may have practice, policy and research implications for people in low- and middle-income countries.

Association of Familial Aggregation of Major Depression With Risk of Major Depression

Importance

Major depression (MD) aggregates within families, but how family history of MD confers risk of MD over the life course is unclear. Such knowledge is important to identify and prevent possible depressogenic effects of family environment.

Objective

To examine the association between family MD history and risk of MD including association with age, sex, type of kinship, and age of the affected family member.

Design, Setting, and Participants

This cohort study included all Danish citizens born from 1960 to 2003 with known parental identity followed up from their 15th birthday until time of MD, censoring, or December 31, 2018. Analysis took place between April 2022 and December 2022.

Exposures

Family members with first-time MD using International Classification of Diseases, Eighth Revision codes 296.09, 296.29, 298.09, and 300.49 or 10th Revision codes F32.0-F33.9, family members' age at MD onset, and individuals' age at exposure to family MD.

Main Outcomes and Measures

Multivariable Poisson regression was applied to estimate the incidence rate ratio (IRR) with 95% CI of first-time MD.

Results

Of 2 903 430 individuals (1 486 574 [51.2%] men), 37 970 men (2.6%) and 70 223 women (5.0%) developed MD during follow-up. For men, exposure to maternal, paternal, or full sibling MD were associated with a 2-times higher risk of MD (IRR, 2.10 [95% CI, 2.02-2.19]; IRR, 2.04 [95% CI, 1.94-2.14]; IRR, 2.08 [95% CI, 1.97-2.19]) and the associated risk increased with number of affected family members. This pattern was similar for women. For men, family members' age at MD onset was not associated with MD. For women, maternal MD onset at 69 years or younger was associated with higher IRRs of MD (age <40 years: IRR, 1.64 [95% CI, 1.28-2.10]; age 40-49 years: IRR, 1.62 [95% CI, 1.27-2.07]; age 50-59 years: IRR, 1.56 [95% CI, 1.22-2.00]; and age 60-69 years: IRR, 1.67 [95% CI, 1.28-2.16]) compared with women with maternal MD onset at 70 years or older. For men, exposure to maternal MD younger than 30 years (age <1 year: IRR, 1.95 [95% CI, 1.70-2.25]; age 1 to <12 years: IRR, 2.31 [95% CI, 2.16-2.47]; age 12 to <19 years: IRR, 2.18 [95% CI, 2.03-2.35]; age 19 to <30 years: IRR, 1.42 [95% CI, 1.32-1.53]) was associated with increased IRRs, while exposure to maternal MD at 30 years or older was associated with a lower IRR (0.77 [95% CI, 0.70-0.85]). The findings were similar across type of kinships and for women.

Conclusions and Relevance

In this study, risk of MD was associated with increased numbers of affected family members but did not vary by gender or type of kinship. Exposure to family MD during childhood and adolescence was associated with increased risk.

Stress-related exposures amplify the effects of genetic susceptibility on depression and anxiety

It is unclear whether and to what extent stress-related exposures moderate the effects of polygenic risk scores (PRSs) on depression and anxiety. We aimed to examine such moderation effects for a variety of stress-related exposures on depression and anxiety. We included 41,810 participants with both genome-wide genetic data and measurements of depression and anxiety in the Lifelines Cohort Study. Current depression and anxiety were measured by the MINI International Neuropsychiatric Interview. Stress-related exposures included long-term difficulties, stressful life events, reduced social support, childhood trauma, and loneliness, which were measured by self-report questionnaires. PRSs were calculated based on recent large genome-wide association studies for depression and anxiety. We used linear mixed models adjusting for family relationships to estimate the interactions between PRSs and stress-related exposures. Nine of the ten investigated interactions between the five stress-related exposures and the two PRSs for depression and anxiety were significant (Ps < 0.001). Reduced social support, and higher exposure to long-term difficulties, stressful life events, and loneliness amplified the genetic effects on both depression and anxiety. As for childhood trauma exposure, its interaction with the PRS was significant for depression (P = 1.78 × 10^-05) but not for anxiety (P = 0.32). Higher levels of stress-related exposures significantly amplify the effects of genetic susceptibility on depression and anxiety. With a large sample size and a comprehensive set of stress-related exposures, our study provides powerful evidence on the presence of polygenic risk-by-environment interactions in relation to depression and anxiety.

Validity of Adult Psychopathology Model Using Psychiatric Patient Sample from a Developing Country: Confirmatory Factor Analysis

Objectives. This study is aimed at testing and validating the two-factor measurement model of the Millon Clinical Multiaxial Inventory (MCMI). Specifically, this paper reported construct validity, particularly focusing on convergent and discriminant validities of the internalizing-externalizing MCMI model of adult psychopathology using a psychiatric sample from a developing country, the Republic of Yemen. Methods. MCMI was distributed among 232 outpatients from the Hospital of Taiz City and two private psychiatry clinics in Yemen; data were collected using structured interviews over four months. We used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to explore and confirm the latent structure MCMI and verify the evidence of convergent and discriminant validity. Results. The CFA results indicated that MCMI was a good fit for the internalizing-externalizing two-factor model of adult psychopathology, comparative fit index $\left(\text{CFI}\right)=0.95$ , and $\text{RMSEA}=0.07$ . The results of the CFA provide evidence of convergent and discriminant validity characterized by MCMI with the internalizing-externalizing model. Conclusion. The adult psychopathology of internalizing-externalizing is a valid measurement model of MCMI with ten personality disorders and eight clinical syndromes.

Maternal symptoms of depression and anxiety during the postpartum period moderate infants' neural response to emotional faces of their mother and of female strangers

Affective exchanges between mothers and infants are key to the intergenerational transmission of depression and anxiety, possibly via adaptations in neural systems that support infants' attention to facial affect. The current study examined associations between postnatal maternal symptoms of depression, panic and social anxiety, maternal parenting behaviours, and infants' neural responses to emotional facial expressions portrayed by their mother and by female strangers. The Negative Central (Nc), an event-related potential component that indexes attention to salient stimuli and is sensitive to emotional expression, was recorded from 30 infants. Maternal sensitivity, intrusiveness, and warmth, as well as infant's positive engagement with their mothers, were coded from unstructured interactions. Mothers reporting higher levels of postnatal depression symptoms were rated by coders as less sensitive and warm, and their infants exhibited decreased positive engagement with the mothers. In contrast, postnatal maternal symptoms of panic and social anxiety were not significantly associated with experimenter-rated parenting behaviours. Additionally, infants of mothers reporting greater postnatal depression symptoms showed a smaller Nc to their own mother's facial expressions, whereas infants of mothers endorsing greater postnatal symptoms of panic demonstrated a larger Nc to fearful facial expressions posed by both their mother and female strangers. Together, these results suggest that maternal symptoms of depression and anxiety during the postpartum period have distinct effects on infants' neural responses to parent and stranger displays of emotion.

Unique prediction of developmental psychopathology from genetic and familial risk

BACKGROUND

Early detection is critical for easing the rising burden of psychiatric disorders. However, the specificity of psychopathological measurements and genetic predictors is unclear among youth.

METHODS

We measured associations between genetic risk for psychopathology (polygenic risk scores (PRS) and family history (FH) measures) and a wide range of behavioral measures in a large sample (n = 5,204) of early adolescent participants (9-11 years) from the Adolescent Brain and Cognitive Development StudySM . Associations were measured both with and without accounting for shared variance across measures of genetic risk.

RESULTS

When controlling for genetic risk for other psychiatric disorders, polygenic risk for problematic opioid use (POU) is uniquely associated with lower behavioral inhibition. Attention deficit hyperactivity disorder (ADHD), depression (DEP), and attempted suicide (SUIC) PRS shared many significant associations with externalizing, internalizing, and psychosis-related behaviors. However, when accounting for all measures of genetic and familial risk, these PRS also showed clear, unique patterns of association. Polygenic risk for ASD, BIP, and SCZ, and attempted suicide uniquely predicted variability in cognitive performance. FH accounted for unique variability in behavior above and beyond PRS and vice versa, with FH measures explaining a greater proportion of unique variability compared to the PRS.

CONCLUSION

Our results indicate that, among youth, many behaviors show shared genetic influences; however, there is also specificity in the profile of emerging psychopathologies for individuals with high genetic risk for particular disorders. This may be useful for quantifying early, differential risk for psychopathology in development.

Familial risk of postpartum depression

OBJECTIVE

Many psychiatric diseases have a strong familial aggregation, but it is unknown whether postpartum depression (PPD) without prior psychiatric history aggregates in families.

METHODS

Based on Danish national registers, we constructed a cohort with information on 848,544 singleton deliveries (1996-2017). Women with an episode of PPD were defined as having used antidepressant medication and/or had a hospital contact for depression within 6 months after delivery. Those with psychiatric history prior to the delivery were excluded. We estimated relative risk (RR) of PPD, comparing women with female relatives with and without PPD history, respectively.

RESULTS

Overall, women with a PPD history in female blood relatives had themselves a higher risk of PPD (RR = 1.64, 95% CI 1.16-2.34). Having the first-degree female relative with PPD history was associated with a more than 2.5 times (RR = 2.65, 95% CI 1.79-3.91) increased risk of PPD. However, having the second/third-degree female relative and/or a female non-blood relative with PPD history did not increase the woman's own risk of PPD (RR = 0.58, 95% CI 0.26-1.28, RR = 1.09, 95% CI 0.83-1.44).

CONCLUSION

Postpartum depression aggregates in families with no other psychiatric history, but the findings do not support a strong genetic trait as a major cause. Other possible mechanisms are shared environment and/or health-seeking behavior in close relationships.

Intergenerational transmission of psychopathology: An examination of symptom severity and directionality

The present study examined the intergenerational transmission of internalizing and externalizing symptom severity, which indexes comorbidity, and symptom directionality, which indicates differentiation toward externalizing versus internalizing problems. Data are from 854 male and female, same-sex adult twin pairs born between 1926 and 1971 (32-60 years old, M = 44.9 years, SD = 4.9 years) from the Twin and Offspring Study in Sweden and their adolescent offspring (11-22 years old, M = 15.7 years, SD = 2.4 years, 52% female). Children-of-twins models revealed additive (9%) and dominant (45%) genetic and nonshared environmental (47%) influences on twins' symptom severity, and additive genetic (39%) and nonshared environmental (61%) influences on twins' symptom directionality. Both comorbid problems and preponderance of symptoms of a particular - internalizing versus externalizing - spectrum were correlated across parent and child generations, although associations were modest especially for directionality (i.e., transmission of specific symptom type). By interpreting findings alongside a recent study of adolescent twins, we demonstrate that the intergenerational transmission of symptom severity and symptom directionality are both unlikely to be attributable to genetic transmission, are both likely to be influenced by direct phenotypic transmission and/or nonpassive rGE, and the intergenerational transmission of symptom severity is also likely to be influenced by passive rGE.

Detecting negative valence symptoms in adolescents based on longitudinal self-reports and behavioral assessments

BACKGROUND

Given the high prevalence of depressive symptoms reported by adolescents and associated risk of experiencing psychiatric disorders as adults, differentiating the trajectories of the symptoms related to negative valence at an individual level could be crucial in gaining a better understanding of their effects later in life.

METHODS

A longitudinal deep learning framework is presented, identifying self-reported and behavioral measurements that detect the depressive symptoms associated with the Negative Valence System domain of the NIMH Research Domain Criteria (RDoC).

RESULTS

Applied to the annual records of 621 participants (age range: 12 to 17 years) of the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA), the deep learning framework identifies predictors of negative valence symptoms, which include lower extraversion, poorer sleep quality, impaired executive control function and factors related to substance use.

LIMITATIONS

The results rely mainly on self-reported measures and do not provide information about the underlying neural correlates. Also, a larger sample is required to understand the role of sex and other demographics related to the risk of experiencing symptoms of negative valence.

CONCLUSIONS

These results provide new information about predictors of negative valence symptoms in individuals during adolescence that could be critical in understanding the development of depression and identifying targets for intervention. Importantly, findings can inform preventive and treatment approaches for depression in adolescents, focusing on a unique predictor set of modifiable modulators to include factors such as sleep hygiene training, cognitive-emotional therapy enhancing coping and controllability experience and/or substance use interventions.

Familial co-aggregation and shared heritability between depression, anxiety, obesity and substance use

Depression, anxiety, obesity and substance use are heritable and often co-occur. However, the mechanisms underlying this co-occurrence are not fully understood. We estimated their familial aggregation and co-aggregation as well as heritabilities and genetic correlations to improve etiological understanding. Data came from the multi-generational population-based Lifelines Cohort Study (n = 162,439). Current depression and anxiety were determined using the MINI International Neuropsychiatric Interview. Smoking, alcohol and drug use were assessed by self-report questionnaires. Body mass index (BMI) and obesity were calculated by measured height and weight. Modified Cox proportional hazards models estimated recurrence risk ratios (λ_R), and restricted maximum likelihood variance decomposition methods estimated heritabilities (h²) and genetic correlations (r_G). All analyses were adjusted for age, age², and sex. Depression, anxiety, obesity and substance use aggregated within families (λ_{R first-degree relative} = 1.08-2.74) as well as between spouses (λ_R = 1.11-6.60). All phenotypes were moderately heritable (from h²_depression = 0.25 to h²_BMI = 0.53). Depression, anxiety, obesity and smoking showed positive familial co-aggregation. That is, each of these traits confers increased risk on the other ones within families, consistent with the positive genetic correlations between these phenotypes (r_G = 0.16-0.94). The exception was obesity, which showed a negative co-aggregation with alcohol and drug use and vice versa, consistent with the negative genetic correlations of BMI with alcohol (r_G = -0.14) and soft drug use (r_G = -0.10). Patterns of cross-phenotype recurrence risk highlight the co-occurrence among depression, anxiety, obesity and substance use within families. Patterns of genetic overlap between these phenotypes provide clues to uncovering the mechanisms underlying familial co-aggregation.

Parental suicide attempt and subsequent risk of pre-enlistment suicide attempt among male and female new soldiers in the U.S. Army

OBJECTIVE

Suicide and suicide attempts among U.S. Army soldiers are a significant concern for public health. This study examined the association of parental suicide attempt prior to age 13 of the soldier with subsequent risk of pre-enlistment suicide attempt.

METHOD

We conducted secondary analyses of survey data from new soldiers who participated in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) (N = 38,396). A series of logistic regression analyses were conducted.

RESULTS

Of all new soldiers, 1.4% reported that they attempted suicide between age 13 and entering the Army, and 2.3% reported a parental suicide attempt prior to age 13. Parental suicide attempt was associated with increased odds of subsequent suicide attempt; however, this association was moderated by gender and was significant only among male soldiers. The association between parental suicide attempt and pre-enlistment suicide attempt among male soldiers was still significant after controlling for socio-demographic characteristics, soldier/parental psychopathology, and childhood adversities.

CONCLUSIONS

These results highlight parental suicide attempt as a unique pre-enlistment risk factor for suicide attempt, especially among male new soldiers. Further studies are needed to separate the genetic and environmental contributions to intra-familial risk for suicidal behavior.

Brain responses during delay discounting in youth at high-risk for substance use disorders

Offspring of parents with substance use disorders (SUD) discount future rewards at a steeper rate on the monetary delay discounting task (DD) than typically developing youth. However, brain activation during DD has yet to be studied in drug naïve youth with a family history (FH) of SUD. Here, we investigate brain activation differences in high-risk youth during DD. We recruited substance naïve youth, aged 11-12, into three groups to compare brain activation during DD: (1) High-risk youth (n = 35) with a FH of SUD and externalizing psychiatric disorders, (2) psychiatric controls (n = 25) who had no FH of SUD, but with equivalent externalizing psychiatric disorders as high-risk youth, and (3) a healthy control group (n = 24) with no FH of SUD and minimal psychopathology. A whole-brain voxel wise analysis of the [Delay > Baseline], [Immediate > Baseline], and [Control > Baseline] contrasts identified functional regions of interest, from which extracted parameter estimates were tested for significant group differences. Relative to control youth, high-risk youth showed stronger activation in the left posterior insula and thalamus when making delayed choices, and stronger activation of the parahippocampal gyrus when making both delayed and control choices (ps < 0.05). Activation in the left posterior insula negatively correlated with both subscales of the Emotion Regulation Checklist, and positively correlated with the Stroop interference effect (ps < 0.05). Our findings suggest possible heritable SUD risk neural markers that distinguish drug naïve high-risk youth from psychiatric and healthy controls.

Identification and Impact Analysis of Family History of Psychiatric Disorder in Mood Disorder Patients With Pretrained Language Model

Mood disorders are ubiquitous mental disorders with familial aggregation. Extracting family history of psychiatric disorders from large electronic hospitalization records is helpful for further study of onset characteristics among patients with a mood disorder. This study uses an observational clinical data set of in-patients of Nanjing Brain Hospital, affiliated with Nanjing Medical University, from the past 10 years. This paper proposes a pretrained language model: Bidirectional Encoder Representations from Transformers (BERT)-Convolutional Neural Network (CNN). We first project the electronic hospitalization records into a low-dimensional dense matrix via the pretrained Chinese BERT model, then feed the dense matrix into the stacked CNN layer to capture high-level features of texts; finally, we use the fully connected layer to extract family history based on high-level features. The accuracy of our BERT-CNN model was 97.12 ± 0.37% in the real-world data set from Nanjing Brain Hospital. We further studied the correlation between mood disorders and family history of psychiatric disorder.

Neurobiology Youth Follow-up Study: protocol to establish a longitudinal and prospective research database using multimodal assessments for current and past mental health treatment-seeking young people within an early intervention service

INTRODUCTION

Approximately 75% of major mental illness occurs before the age of 25 years. Despite this, our capacity to provide effective, early and personalised interventions is limited by insufficient evidence for characterising early-stage, and less specific, presentations of major mental disorders in youth populations. This article describes the protocol for setting up a large-scale database that will collect longitudinal, prospective data that incorporate clinical, social and occupational function, neuropsychological, circadian, metabolic, family history and genetic metrics. By collecting data in a research-purposed, standardised manner, the 'Neurobiology Youth Follow-up Study' should improve identification, characterisation and profiling of youth attending mental healthcare, to better inform diagnosis and treatment at critical time points. The overall goal is enhanced long-term clinical and functional outcomes.

METHODS AND ANALYSIS

This longitudinal clinical cohort study will invite participation from youth (12-30 years) who seek help for mental health-related issues at an early intervention service (headspace Camperdown) and linked services. Participants will be prospectively tracked over 3 years with a series of standardised multimodal assessments at baseline, 6, 12, 24 and 36 months. Evaluations will include: (1) clinician-administered and self-report assessments determining clinical stage, pathophysiological pathways to illness, diagnosis, symptomatology, social and occupational function; (2) neuropsychological profile; (3) sleep-wake patterns and circadian rhythms; (4) metabolic markers and (5) genetics. These data will be used to: (1) model the impact of demographic, phenomenological and treatment variables, on clinical and functional outcomes; (2) map neurobiological profiles and changes onto a transdiagnostic clinical stage and pathophysiological mechanisms framework.

ETHICS AND DISSEMINATION

This study protocol has been approved by the Human Research Ethics Committee of the Sydney Local Health District (2020/ETH01272, protocol V.1.3, 14 October 2020). Research findings will be disseminated through peer-reviewed journals and presentations at scientific conferences and to user and advocacy groups. Participant data will be de-identified.

Engaging in Risky and Impulsive Behaviors to Alleviate Distress Mediates Associations Between Intolerance of Uncertainty and Externalizing Psychopathology

Despite increasing recognition that intolerance of uncertainty is a transdiagnostic dimension of psychopathology, very little research has investigated its relevance for externalizing psychopathology and related risky/impulsive behavior. Ninety-five unselected adults (ages 19-55, 53% men) recruited from the community completed a measure of intolerance of uncertainty, externalizing traits and problems, and risky/impulsive behavior. Higher levels of intolerance of uncertainty were associated with greater endorsement of externalizing symptoms (e.g., aggression, alcohol/marijuana use, problematic impulsivity) and last-month risky and impulsive behaviors. Relations between intolerance of uncertainty and externalizing symptoms/risky behaviors were mediated by a motivation to engage in these behaviors to avoid distress, but not by the motivation to experience pleasurable emotions. Findings suggest that difficulty tolerating uncertainty may confer risk for the externalizing spectrum of psychopathology by increasing the likelihood that an individual will engage in risky behaviors to alleviate distressing or unpleasant emotions.

The Streetlight Effect: Reappraising the Study of Addiction in Light of the Findings of Genome-wide Association Studies

Drug dependence has long been thought to have a genetic component. Research seeking to identify the genetic basis of addiction has gone through important transitions over its history, in part based upon the emergence of new technologies, but also as the result of changing perspectives. Early research approaches were largely dictated by available technology, with technological advancements having highly transformative effects on genetic research, but the limitations of technology also affected modes of thinking about the genetic causes of disease. This review explores these transitions in thinking about the genetic causes of addiction in terms of the "streetlight effect," which is a type of observational bias whereby people search for something only where it is easiest to search. In this way, the genes that were initially studied in the field of addiction genetics were chosen because they were the most "obvious," and formed current understanding of the biological mechanisms underlying the actions of drugs of abuse and drug dependence. The problem with this emphasis is that prior to the genomic era the vast majority of genes and proteins had yet to be identified, much less studied. This review considers how these initial choices, as well as subsequent choices that were also driven by technological limitations, shaped the study of the genetic basis of drug dependence. While genome-wide approaches overcame the initial biases regarding which genes to choose to study inherent in candidate gene studies and other approaches, genome-wide approaches necessitated other assumptions. These included additive genetic causation and limited allelic heterogeneity, which both appear to be incorrect. Thus, the next stage of advancement in this field must overcome these shortcomings through approaches that allow the examination of complex interactive effects, both gene × gene and gene × environment interactions. Techniques for these sorts of studies have recently been developed and represent the next step in our understanding of the genetic basis of drug dependence.

Intergenerational implications of alcohol intake: metabolic disorders in alcohol-naïve rat offspring

Alcohol drinking may be associated with an increased risk of various metabolic diseases. Rat lines selectively bred for alcohol preference and alcohol avoidance constitute an interesting model to study inherited factors related to alcohol drinking and metabolic disorders. The aim of the present study was to compare the levels of selected laboratory biomarkers of metabolic disorders in blood samples from naïve offspring of Warsaw alcohol high-preferring (WHP), Warsaw alcohol low-preferring (WLP), and wild Wistar rats. Blood samples were collected from 3-month old (300–350 g) alcohol-naïve, male offspring of WHP (n = 8) and WLP rats (n = 8), as well as alcohol-naïve, male, wild Wistar rats. Markers of metabolic, hepatic, and pancreatic disorders were analysed (levels of homocysteine, glucose, total cholesterol, triglycerides and γ-glutamyl transferase (GGT), aspartate (AST), alanine aminotransferase (ALT), and amylase serum activities). Alcohol-naïve offspring of WHP, WLP, and wild Wistar rats differed significantly in the levels of triglycerides, total cholesterol, homocysteine, as well as in the activity of GGT, ALT, AST, and amylase enzymes. Most markers in the alcohol-naïve offspring of WHP rats were altered even thought they were never exposed to alcohol pre- or postnatally. This may suggest that parental alcohol abuse can have a detrimental influence on offspring vulnerability to metabolic disorders.

Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey

We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used weighted data (N = 2317) from NCS-A participants (age: 13-18 years) who did not meet DSM-IV criteria for any lifetime mental disorder. Adolescent mental disorders were assessed with the WHO CIDI. Maternal psychopathology was obtained by self-report. Adolescent mental health service use was assessed with the Service Assessment for Children and Adolescents. Substantial associations between maternal psychopathology and mental health service use in offspring without mental disorders were found between affective disorders and the mental health/medical specialty (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.60-3.90) and any service sector (HR = 2.14, CI = 1.45-3.16), anxiety disorders and any service sector (HR = 1.63, CI = 1.13-2.35), behavior disorders and the school (HR = 3.69, CI = 1.39-9.77) and any service sector (HR = 2.81, CI = 1.12-7.07), substance use disorders and the mental health/medical specialty (HR = 3.75, CI = 1.75-8.03), the school (HR = 3.17, CI = 1.43-7.02), and any service sector (HR = 3.66, CI = 2.00-6.70), and any mental disorder and the mental health/medical specialty (HR = 2.10, CI = 1.34-3.30) and any service sector (HR = 2.03, CI = 1.40-2.92). Results were comparable when restricting analyses to offspring with no indication of suicidality and no more than three life events during the past 12 months. The likelihood of service use was higher among offspring of mothers with mental disorders, compared to mothers without mental disorders. Considering maternal mental disorder status may help to identify subjects at risk of overtreatment.

Mechanisms Through Which a Family Caregiver Coaching Intervention Might Reduce Anxiety Among Children in Military Households

OBJECTIVES

Children of injured or disabled veterans and service members may be at risk for mental health and adjustment problems due to household stress. Yet, there are few widely available interventions to address the needs of this population. Reducing distress and improving coping skills of the parent who cares for the injured or disabled adult may improve child outcomes. This paper examines whether changes in caregiver psychosocial outcomes after a caregiver coaching intervention are associated with decreases in child anxiety.

METHODS

Using programmatic data collected between 2015 and 2019 from participants in a family caregiver coaching intervention (170 caregivers, 294 children), we apply linear mixed models to assess associations between changes in family caregiver well-being, including problem solving, depressive symptoms, burden, health complaints and quality of life, and changes in parent-reported child anxiety.

RESULTS

The baseline median Spence Children's Anxiety Scale-Parent score was 17; children aged 6-11 had slightly higher scores. Child anxiety scores decreased on average 2.8 points (SD 8.4) between baseline and follow-up. In adjusted models, decreases in caregiver depressive symptoms and health complaints were associated with decreases in child anxiety. Caregiver problem-solving skills, quality of life, and subjective burden were not associated with changes in child anxiety.

CONCLUSION

Family caregiver-focused interventions that decrease caregiver stress may positively affect children in the household. Few resources are directed at military children; therefore, practitioners should consider ways to leverage caregiver interventions to address child well-being, such as incorporating information on parenting strategies and addressing issues faced by military children.

The role of pubertal timing in the link between family history of alcohol use disorder and late adolescent substance use

BACKGROUND

Youth who experience puberty earlier than their peers are at heightened risk for substance use during adolescence. However, little is known about whether pubertal timing exacerbates effects of relevant early risk factors, such as family substance use history, as predicted by the "accentuation hypothesis". Using longitudinal data from youth with and without a family history of alcohol use disorder (AUD FHx), we evaluated whether pubertal timing intensifies preexisting familial risk effects on late adolescent substance use.

METHODS

Participants were 568 males and 245 females from the Michigan Longitudinal Study. Pubertal timing was indexed by fitting mixed-effects linear models to repeated measures of self-reported Tanner stage. Multilevel models then tested: (a) whether AUD FHx predicted pubertal timing, and (b) whether AUD FHx, pubertal timing, or their interaction predicted alcohol and marijuana use at ages 16-18.

RESULTS

AUD FHx was unrelated to pubertal timing in either males or females. In males, alcohol and marijuana use in late adolescence were predicted by AUD FHx and timing, but not their interaction. In females, AUD FHx predicted alcohol-related outcomes, but there were no main or interaction effects of timing.

CONCLUSIONS

Pubertal timing does not moderate the link between AUD FHx and late adolescent substance use, in contrast to the accentuation hypothesis. In males, measures of pubertal maturation and familial risk provide unique information for prediction of use. Females displayed no link between pubertal timing and use, which may suggest different risk pathways, or may have been due to the female sample's smaller size.

Psychiatric neuroimaging: Joining forces with epidemiology

Severe mental illnesses such as schizophrenia and mood disorders have a major impact on public health. Disease prevalence and phenotypic expression are the products of environment and gene interactions. However, our incomplete understanding of their aetiology and pathophysiology thwarts primary prevention and early diagnosis and limits the effective application of currently available treatments as well as the development of novel therapeutic approaches. Neuroimaging can provide detailed in vivo information about the biological mechanisms underpinning the relationship between genetic variation and clinical phenotypes or response to treatment. However, the biological complexity of severe mental illness results from unknown or unpredictable interactions between multiple genetic and environmental factors, many of which have only been partially identified. We propose that the use of epidemiological principles to neuroimaging research is a necessary next step in psychiatric research. Because of the complexity of mental disorders and the multiple risk factors involved only the use of large epidemiologically defined samples will allow us to study the broader spectrum of psychopathology, including sub-threshold presentation and explore pathophysiological processes and the functional impact of genetic and non-genetic factors on the onset and persistence of psychopathology.

Opioid use disorder among pregnant women in the 2000-2014 North Carolina state inpatient database

Background: The opioid epidemic's impact reached an increasing portion of the United States population, including pregnant women.Objectives: We sought to determine the prevalence and factors associated with opioid use disorders during pregnancy in North Carolina.Study Design: Using North Carolina's State Inpatient Sample, a retrospective study was conducted to identify pregnancy-related discharges between 2000 and 2014. Hospital discharge records associated with ICD-9-CM diagnoses codes for the use of opioids for all eligible pregnancy-related discharges were extracted. Logistic regression models were used to estimate unadjusted and adjusted bivariate and multivariate relationships.Results: Of 1,937,455 pregnancy-related hospitalization in North Carolina, 6,084 were associated with opioid use, a prevalence of 3.14 cases per 1,000 discharge. Maternal opioid use was associated with an increased odds of early onset delivery, threatened preterm labor, premature rupture of membranes, postpartum depression, stillbirth and poor fetal growth. Women who used opioids during pregnancy had prolonged hospital stays (>5 days) and were 2 times as likely to have more than 4 procedures performed during hospitalization. Compared to other racial groups, non-Hispanic whites had a notably higher prevalence of opioid use disorders (5.8/1,000 pregnancy-related discharges) (P < 0.05 for all).Conclusions: Very few health issues have garnered the attention of such diverse sectors of our society as the opioid epidemic. As the first state-level analysis of opioid use disorders among delivery hospitalizations, these findings suggest the need for a system-wide public health response such as improved funding for Medicaid and child welfare systems to improve the health of the opioid-exposed mother-infant dyad.

Ankyrin Repeat and Kinase Domain Containing 1 Gene, and Addiction Vulnerability

The TaqIA single nucleotide variant (SNV) has been tested for association with addictions in a huge number of studies. TaqIA is located in the ankyrin repeat and kinase domain containing 1 gene (ANKK1) that codes for a receptor interacting protein kinase. ANKK1 maps on the NTAD cluster along with the dopamine receptor D2 (DRD2), the tetratricopeptide repeat domain 12 (TTC12) and the neural cell adhesion molecule 1 (NCAM1) genes. The four genes have been associated with addictions, although TTC12 and ANKK1 showed the strongest associations. In silico and in vitro studies revealed that ANKK1 is functionally related to the dopaminergic system, in particular with DRD2. In antisocial alcoholism, epistasis between ANKK1 TaqIA and DRD2 C957T SNVs has been described. This clinical finding has been supported by the study of ANKK1 expression in peripheral blood mononuclear cells of alcoholic patients and controls. Regarding the ANKK1 protein, there is direct evidence of its location in adult and developing central nervous system. Together, these findings of the ANKK1 gene and its protein suggest that the TaqIA SNV is a marker of brain differences, both in structure and in dopaminergic function, that increase individual risk to addiction development.

The number of biological parents with alcohol use disorder histories and risk to offspring through age 30

OBJECTIVE

We investigated associations between the number of parents with histories of alcohol use disorder (AUD) and several offspring (proband) variables through age 30: occurrence of AUD and, separately, alcohol dependence; onset age of the initial AUD episode; time to recovery from the first AUD episode; number of distinct AUD episodes; and cumulative duration of AUD across episodes.

METHODS

Offspring data were collected during four assessment waves of a longitudinal epidemiological study of psychiatric disorders with a regionally representative sample. The reference sample included 730 offspring with diagnostic data from at least one parent. Offspring were assessed with semi-structured diagnostic interviews between mid-adolescence and young adulthood and parents were assessed when offspring were approximately 24 years of age.

RESULTS

As the number of parents with AUD increased, offspring risk for AUD and alcohol dependence also increased. Latent growth model results indicated that offspring AUD risk trajectories increase in severity as a function of the number of parents with AUD. This pattern of results was not observed for other AUD course-related features in offspring (i.e., number of distinct episodes; months required for recovery from initial episode; cumulative duration across episodes).

CONCLUSIONS

The number of parents with a history of AUD is associated with overall offspring risk for AUD and alcohol dependence and elevated AUD risk trajectories through age 30. The number of parents with AUD may be a more relevant risk factor for onset-related characteristics of AUD in offspring than for its longitudinal course.

Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology

Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Bidirectional association between alopecia areata and major depressive disorder among probands and unaffected siblings: A nationwide population-based study

BACKGROUND

Alopecia areata (AA) has long been associated with major depressive disorder (MDD). However, most evidence to date has derived from cross-sectional or case-control studies.

OBJECTIVE

To investigate the bidirectional association between AA and MDD among probands and unaffected siblings.

METHODS

Study participants were recruited from the National Health Insurance Research Database in Taiwan. We included 2123 probands with AA, 2298 unaffected siblings, and 9192 matched controls to assess the risk of MDD. We included 16,543 probands with MDD, 17,352 unaffected siblings, and 69,408 matched controls to assess the risk of AA. The Breslow-Cox model was used to calculate the adjusted relative risk.

RESULTS

Compared with controls, AA probands and unaffected siblings had adjusted relative risks of 8.22 (95% confidence interval [CI], 6.41-10.54) and 2.55 (95% CI, 1.91-3.40), respectively, for MDD. MDD probands and unaffected siblings had adjusted relative risks for AA of 1.66 (95% CI, 1.24-2.22) and 1.64 (95% CI, 1.27-2.12), respectively.

LIMITATION

The National Health Insurance Research Database lacked information on disease severity, body mass index, smoking habit, alcohol consumption, and stressful life events.

CONCLUSION

Our study demonstrated a bidirectional association between AA and MDD among probands and unaffected siblings, thus suggesting shared familial mechanisms underlying AA and MDD.

Association Between Brain-Derived Neurotrophic Factor Val66Met Polymorphism and Methamphetamine Use Disorder: A Meta-Analysis

Background: Several studies had examined the association between brain-derived neurotrophic factor (BDNF) Val66Met polymorphism and methamphetamine (METH) use disorder, whereas the results were conflicting. The aim of this study was to conduct a meta-analysis to achieve a pooled effect size of the association between BDNF Val66Met polymorphism and METH use disorder. Methods: Literature searches were conducted in PubMed, EMBASE, and Cochrane Library up to July, 2020. All relevant studies on the relationship of BDNF Val66Met polymorphism and METH addiction were retrieved. Pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated in the dominant, recessive, co-dominant, and allele model to appraise the association. Results: Seven case-control studies with a total of 2,204 subjects (956 METH-dependent cases and 1,248 healthy controls) were included in this meta-analysis. The results showed a significant correlation between BDNF Val66Met polymorphism and METH dependence in overall population under different genetic models. However, subgroup analysis indicated that the association only existed in Han Chinese but not in other Asian populations. Conclusion: Although the current data indicate that BDNF Val66Met polymorphism might be a potential genetic factor for METH use disorder, more researches are needed to prove its role in different populations.

Patterns of polysubstance use and simultaneous co-use in high risk young adults

BACKGROUND

Polysubstance use (PSU) is associated with worse prognosis and poorer physical and mental health compared to single substance use. The current study provides information about PSU patterns by examining a diverse range of alcohol/substance use behaviors ranging from low-level experimentation to indicators of severe abuse. In addition, the current study, for the first time, examines how simultaneous co-use of multiple substances cluster with other more commonly studied PSU behaviors.

METHODS

Latent Class Analysis was used to identify patterns of substance use, in a sample of young-adults (n = 2098), using 25 items from the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA-II) including: items assessing severity of problems with alcohol, cannabis, stimulants, opiates, and sedatives; items assessing # of lifetime uses; items assessing simultaneous co-use of all combinations of substances. Then the association of class membership and age, antisocial and impulsive personality, experience seeking, anxiety, and neuroticism was examined using Multinomial Regression.

RESULTS

Fit indices (i.e. AIC, SSABIC, and entropy) and interpretability of classes supported a five-class solution: "Low Problems" (32% of sample), "Alcohol Primary" (11%), "Alcohol and Cannabis" (25%), "Moderate PSU" (23%), and "Severe PSU" (9%). Simultaneous co-use behaviors discriminated between lower and higher severity groups. Externalizing personality constructs robustly predicted membership in the "Moderate" and "Severe" PSU classes compared to the "Alcohol Primary" class.

CONCLUSIONS

PSU patterns followed an additive pattern of use with lower severity classes using alcohol/cannabis and more severe classes using other illicit substances in addition. Co-use items provided valuable information about PSU severity.

Affective temperaments in Lebanese people with substance use disorder

PURPOSE

To examine these temperaments among patients with substance use disorder (SUD) in the Lebanese population.

DESIGN

Case-control.

METHODS

Fifty-seven controls and 57 patients with SUD were enrolled between April and September 2017.

RESULTS

A significantly higher mean of depressive, irritable, and anxious temperaments was found in addicted patients as compared with the nonaddicts. However, the results of the multivariate analysis showed that anxious, hyperthymic, irritable temperaments would significantly increase the odds of addiction in participants (ORa = 25.20, 1.057, 1.168, 1.241, and 1.275). Cyclothymic temperament would significantly decrease the odds of addiction in participants (ORa = 0.817). Furthermore, suicidality was associated with depressive, anxious, and irritable temperaments.

PRACTICE IMPLICATIONS

Hyperthymic, irritable, and anxious temperaments were the main temperaments found in patients with SUD in Lebanon.

Error-related neural activity and alcohol use disorder: Differences from risk to remission

Studies suggest that individuals with alcohol use disorder (AUD) display abnormal neural error-processing, measured via the error-related negativity (ERN). The nature of the error-related abnormalities in AUD is unclear, however, as prior research has yielded discrepant findings. In addition, no study to date has attempted to characterize the dispositional nature of the ERN in AUD and directly test to what extent ERN amplitude reflects a risk factor, disease marker, and/or scar of AUD psychopathology. The current study compared ERN amplitude across 244 adult volunteers in the following five groups: 1) current AUD (n = 39), 2) AUD in remission (n = 60), 3) at-risk for AUD (n = 43), 4) psychiatric controls with comparable rates of internalizing psychopathology as the AUD groups (n = 53), and 5) healthy controls with no lifetime history of psychopathology (n = 49). Risk for AUD was defined as a positive, first-degree family history. All participants completed a well-validated flanker task, designed to robustly elicit the ERN, during continuous electroencephalographic (EEG) data collection. Results indicated that individuals with current AUD displayed smaller ERNs compared with individuals at-risk for AUD, with AUD in remission, psychiatric controls, and healthy controls. There were no differences amongst any of the other groups. This suggests that a blunted ERN may be concomitant with current AUD psychopathology and relatedly, a novel neurobiological AUD treatment target and/or objective marker of AUD disease status.

Maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring: A population-based birth cohort study

Epidemiological studies have suggested that maternal diabetes in pregnancy increases the risk of schizophrenia in offspring. A recent cohort study observed that maternal diabetes in early pregnancy is also associated with psychotic experiences in the general adolescent population. However, it remains unclear whether maternal diabetes in early pregnancy is specifically associated with psychotic experiences, or is generally associated with broader mental health problems, including depressive symptoms in adolescence. The present study investigated the longitudinal associations between maternal diabetes in early pregnancy, and psychotic experiences and depressive symptoms in 10-year-old offspring. Our data were derived from the Tokyo Early Adolescence Survey, a population-based survey of early adolescents (N = 4478) and their primary caregivers. Diabetes in early pregnancy was determined by records in the mother's Maternal and Child Health Handbook, documented during the pregnancy. Psychotic experiences and depressive symptoms were established through self-report by the offspring at 10 years of age. Diabetes in early pregnancy was associated with an increased risk of hallucination in the offspring (auditory hallucination [odds ratio {OR} 4.33, 95% confidence interval {CI} 1.12-16.75]; visual hallucination [OR 6.58, 95% CI 1.69-25.66]), even after adjusting for depressive symptoms and other covariates. However, the association between maternal diabetes and delusional thoughts was not significant and diabetes in early pregnancy was not associated with adolescent depressive symptoms. Our investigation suggests that maternal diabetes in early pregnancy may specifically affect the risk of hallucinatory experiences in adolescent offspring.

Association of Maternal and Paternal Depression in the Postnatal Period With Offspring Depression at Age 18 Years

Importance

Paternal depression during the postnatal period has been associated with adverse child outcomes. Family environment has been reported as a pathway for risk transmission from fathers to children. The influence of paternal depression during the postnatal period on offspring depression remains to be clarified.

Objective

To investigate the association between paternal depression in the postnatal period and offspring depression and explore potential mediating and moderating factors that influence any association between paternal and offspring depression.

Design, Setting, and Participants

This prospective study of a UK community-based birth cohort (the Avon Longitudinal Study of Parents and Children) of parents and their adolescent offspring investigated associations between paternal depression during the postnatal period and offspring depression at age 18 years. We tested a hypothesized moderator (ie, sex) and conducted path analysis to examine hypothesized mediators (ie, depression in the other parent, couple conflict, and paternal involvement and emotional problems, conduct problems, and hyperactivity in offspring at age 3.5 years) of the associations between both paternal and maternal depression and offspring depression. Data collection for the Avon Longitudinal Study of Parents and Children began in 1991 and is ongoing. Data analysis for this study was conducted from June 2015 to September 2018.

Exposures

Depression symptoms in fathers at 8 weeks after the birth of their children.

Main Outcomes and Measures

Offspring depression symptoms at age 18 years, using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes.

Results

A total of 3176 father-offspring pairs were analyzed; of the children, 1764 were girls (55.5%) and 1412 (44.5%) were boys. Paternal mean (SD) age at delivery was 29.6 (9.6) years. The offspring of fathers who had depression during the postnatal period were at increased risk of experiencing depression symptoms at age 18 years (β = 0.053 [95% CI, 0.02-0.09]). The association is mediated by maternal depression at 8 months after birth (β = 0.011 [95% CI, 0.0008-0.02]; 21% [0.011/0.053]) and conduct problems at 42 months after birth (β = 0.004; [95% CI , -0.00004 to 0.009]; 7.5% [0.004/0.053]). Couple conflict and paternal involvement do not mediate this association. The increased risk is seen in girls but not boys (interaction β = 0.095; P = .01).

Conclusions and Relevance

The association between paternal depression in the postnatal period and depression in girls at age 18 years is partially explained by maternal depression. Couple conflict and paternal involvement were not found to play a role in the risk of transmission; this contrasts with the role that couple conflict was found to play in the risk of childhood behavior problems. Conduct problems in childhood appear to be a pathway for risk transmission between paternal depression and subsequent depression in offspring at age 18 years.

Maternal psychopathology and mental health treatment delay in adolescents from a national cohort

OBJECTIVE

To investigate whether maternal psychopathology predicts mental health service use and treatment delay in offspring with mental disorders.

DATA SOURCES

Weighted data collected between 2001 and 2004 from NCS-A participants (age: 13-18 years; N = 2939) meeting DSM-IV criteria for any lifetime mental disorder, assessed with WHO CIDI, and from their biological mothers.

STUDY DESIGN

National representative cohort.

DATA COLLECTION

Maternal psychopathology was assessed with self-report, adolescent mental health service use with the Service Assessment for Children and Adolescents.

PRINCIPAL FINDINGS

Maternal psychopathology predicted offspring mental health service use across various service sectors, except for school services. In the mental health specialty sector, estimates were highest for maternal affective (hazard ratio (HR) = 2.17, 95 percent confidence interval (CI) = 1.66-2.82) and any mental disorder (HR = 2.13, 95 percent CI = 1.53-2.97). For offspring use of any mental health services, estimates were highest for maternal behavior (HR = 1.60, 95 percent CI = 1.15-2.21) and substance use disorders (HR = 1.57, 95 percent CI = 1.09-2.24). Treatment delay of offspring mental health service use was predicted by maternal behavior disorders.

CONCLUSIONS

Maternal psychopathology fostered mental health service use in offspring with mental disorders, while maternal behavior disorders might also retard treatment. Considering parental psychopathology may help improving the prevention of unmet offspring service needs.

Is the HPA Axis as Target for Depression Outdated, or Is There a New Hope?

Major depressive disorder (MDD) is a very common stress-related mental disorder that carries a huge burden for affected patients and the society. It is associated with a high mortality that derives from suicidality and the development of serious medical conditions such as heart diseases, diabetes, and stroke. Although a range of effective antidepressants are available, more than 50% of the patients do not respond to the first treatment they are prescribed and around 30% fail to respond even after several treatment attempts. The heterogeneous condition of MDD, the lack of biomarkers matching patients with the right treatments and the situation that almost all available drugs are only targeting the serotonin, norepinephrine, or dopamine signaling, without regulating other potentially dysregulated systems may explain the insufficient treatment status. The hypothalamic-pituitary-adrenal (HPA) axis is one of these other systems, there is numerous and robust evidence that it is implicated in MDD and other stress-related conditions, but up to date there is no specific drug targeting HPA axis components that is approved and no test that is routinely used in the clinical setting identifying patients for such a specific treatment. Is there still hope after these many years for a breakthrough of agents targeting the HPA axis? This review will cover tests detecting altered HPA axis function and the specific treatment options such as glucocorticoid receptor (GR) antagonists, corticotropin-releasing hormone 1 (CRH₁) receptor antagonists, tryptophan 2,3-dioxygenase (TDO) inhibitors and FK506 binding protein 5 (FKBP5) receptor antagonists.

Alcohol family history moderates the association between evening substance-free reinforcement and alcohol problems

Behavioral economic theories of substance abuse posit that deficits in substance-free reward increase risk for substance misuse, but little research has examined potential moderators of this relationship, including dispositional risk factors. Here, we tested the hypothesis that young adult heavy drinkers with family histories of alcohol misuse would show a stronger association specifically between low evening substance-free reinforcement and alcohol problems compared to those without a family history of alcohol misuse. Participants were 317 college students reporting heavy episodic drinking (Mage = 18.8, SD = 1.1, 61% female, 79% White) who completed a questionnaire about engagement and enjoyment in rewarding activities not involving substance use after 7 p.m., along with measures of personal and parental alcohol use/problems. Evening substance-free reinforcement was negatively associated with typical drinking level for women, but not for men. Family history status did not show a significant association with typical alcohol consumption or evening substance-free reinforcement (operationalized as activity participation × enjoyment), but did show a significant association with alcohol problems. Evening substance-free reinforcement was significantly negatively related to alcohol problems for both men and women. However, the presence of a family history of alcohol misuse moderated this relationship, such that only individuals with familial risk for alcohol misuse who reported lower evening substance-free reinforcement evidenced greater alcohol-related problems. These findings suggest that lower evening substance-free reinforcement is associated with alcohol misuse among young adults, and that this association is exacerbated among individuals with familial risk for developing alcohol problems. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Precision pharmacotherapy: psychiatry's future direction in preventing, diagnosing, and treating mental disorders

Mental disorders account for around one-third of disability worldwide and cause enormous personal and societal burden. Current pharmacotherapies and nonpharmacotherapies do help many patients, but there are still high rates of partial or no response, delayed effect, and unfavorable adverse effects. The current diagnostic taxonomy of mental disorders by the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases relies on presenting signs and symptoms, but does not reflect evidence from neurobiological and behavioral systems. However, in the last decades, the understanding of biological mechanisms underlying mental disorders has grown and can be used for the development of precision medicine, that is, to deliver a patient-tailored individual treatment. Precision medicine may incorporate genetic variants contributing to the mental disorder and the response to pharmacotherapies, but also consider gene ¥ environment interactions, blood-based markers, neuropsychological tests, data from electronic health records, early life adversity, stressful life events, and very proximal factors such as lifestyle, nutrition, and sport. Methods such as artificial intelligence and the underlying machine learning and deep learning approaches provide the framework to stratify patients, initiate specific tailored treatments and thus increase response rates, reduce adverse effects and medical errors. In conclusion, precision medicine uses measurable health parameters to identify individuals at risk of a mental disorder, to improve the diagnostic process and to deliver a patient-tailored treatment.

Expert and self-assessment of lifetime symptoms and diagnosis of major depressive disorder in large-scale genetic studies in the general population: comparison of a clinical interview and a self-administered checklist

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Major depression disorder (MDD) is a complex neuropsychiatric disorder and an increasing number of genetic risk variants are being identified. Investigation of their influence in the general population requires accurate and efficient assessment of depressive symptoms. Here, clinical interviews conducted by clinicians are the gold standard. We investigated whether valid and reliable clinical phenotypes can be obtained efficiently using self-administered instruments. Lifetime depressive symptoms and lifetime MDD diagnosis were assessed in 464 population-based individuals using a clinical interview and a structured, self-administered checklist. Analyses were carried out of the following: (i) intraclass correlations (ICC) between checklist and interview; (ii) sensitivity/specificity of the checklist; and (iii) the association of interview and checklist with a positive family history of MDD (FH-MDD+). The correspondence of the self-administered checklist with the clinical interview was good for most depressive symptoms (ICC=0.60–0.80) and moderate for MDD diagnosis (ICC=0.45). With the consecutive inclusion of MDD diagnostic criteria, sensitivity decreased from 0.67 to 0.46, whereas specificity remained high (0.95). For checklist and interview, strong associations were found between FH-MDD+ and most depressive symptoms and MDD diagnosis (all odds ratio≥1.83). The self-administered checklist showed high reliability for both the assessment of lifetime depressive symptoms and screening for individuals with no lifetime diagnosis of MDD. However, attention is warranted when the aim is to identify MDD cases. The positive association between depressive symptomatology and FH-MDD+ indicates the usefulness of both instruments to assess patients in genetic studies. Our data suggest that the more time-efficient and cost-efficient self-administered instruments also allow for the assessment of depressive symptoms accurate enough to investigate the influence of MDD genetic risk variants in the general population.

Cohesive Neighborhoods Where Social Expectations Are Shared May Have Positive Impact On Adolescent Mental Health

Adolescent mental health problems are associated with poor health and well-being in adulthood. We used data from a cohort of 2,264 children born in large US cities in 1998-2000 to examine whether neighborhood collective efficacy (a combination of social cohesion and control) is associated with improvements in adolescent mental health. We found that children who grew up in neighborhoods with high collective efficacy experienced fewer depressive and anxiety symptoms during adolescence than similar children from neighborhoods with low collective efficacy. The magnitude of this neighborhood effect is comparable to the protective effects of depression prevention programs aimed at general or at-risk adolescent populations. Our findings did not vary by family or neighborhood income, which indicates that neighborhood collective efficacy supports adolescent mental health across diverse populations and urban settings. We recommend a greater emphasis on neighborhood environments in individual mental health risk assessments and greater investment in community-based initiatives that strengthen neighborhood social cohesion and control.

The Addiction-Related Protein ANKK1 is Differentially Expressed During the Cell Cycle in Neural Precursors

TaqIA is a polymorphism associated with addictions and dopamine-related traits. It is located in the ankyrin repeat and kinase domain containing 1 gene (ANKK1) nearby the gene for the dopamine D2 receptor (D2R). Since ANKK1 function is unknown, TaqIA-associated traits have been explained only by differences in D2R. Here we report ANKK1 studies in mouse and human brain using quantitative real-time PCR, Western blot, immunohistochemistry, and flow cytometry. ANKK1 mRNA and protein isoforms vary along neurodevelopment in the human and mouse brain. In mouse adult brain ANKK1 is located in astrocytes, nuclei of postmitotic neurons and neural precursors from neurogenic niches. In both embryos and adults, nuclei of neural precursors show significant variation of ANKK1 intensity. We demonstrate a correlation between ANKK1 and the cell cycle. Cell synchronization experiments showed a significant increment of ANKK1-kinase in mitotic cells while ANKK1-kinase overexpression affects G1 and M phase that were found to be modulated by ANKK1 alleles and apomorphine treatment. Furthermore, during embryonic neurogenesis ANKK1 was expressed in slow-dividing neuroblasts and rapidly dividing precursors which are mitotic cells. These results suggest a role of ANKK1 during the cell cycle in neural precursors thus providing biological support to brain structure involvement in the TaqIA-associated phenotypes.

Cannabis use disorder and male sex predict medical cannabis card status in a sample of high risk adolescents

OBJECTIVE

To examine if a substance use disorder (SUD), especially cannabis use disorder in adolescence, predicts future medical cannabis card status among high-risk youth.

METHODS

Data collection occurred in Denver and San Diego. We recruited adolescents, with or at high risk for SUD and conduct problems (hereafter probands) and their siblings (n=654). Baseline (Wave 1) assessments took place between 1999 and 2008, and follow-up (Wave 2) took place between 2010 and 2013. In initial bivariate analyses, we examined whether baseline DSM-IV cannabis abuse/dependence (along with other potential predictors) was associated with possessing a medical cannabis card in young adulthood (Wave 2). Significant predictors were then included in a multiple binomial regression. Self-reported general physical health was also evaluated at both time points. Finally, within Wave 2, we tested whether card status was associated with concurrent substance dependence.

RESULTS

About 16% of the sample self-reported having a medical cannabis card at follow-up. Though bivariate analyses demonstrated that multiple predictors were significantly associated with Wave 2 card status, in our multiple binomial regression only cannabis abuse/dependence and male sex remained significant. At Wave 2, those with a medical cannabis card were significantly more likely to endorse criteria for concurrent cannabis dependence. There was no significant difference in self-reported general physical health.

CONCLUSIONS

Cannabis abuse/dependence and male sex positively predicted future medical cannabis card holder status among a sample of high risk adolescents. Physicians conducting evaluations for medical cannabis cards should carefully evaluate and consider past and concurrent cannabis addiction.