Increasing AIP Macrocycle Size Reveals Key Features of agr Activation in Staphylococcus aureus

The agr locus in the commensal human pathogen, Staphylococcus aureus, is a two-promoter regulon with allelic variability that produces a quorum-sensing circuit involved in regulating virulence within the bacterium. Secretion of unique autoinducing peptides (AIPs) and detection of their concentrations by AgrC, a transmembrane receptor histidine kinase, coordinates local bacterial population density with global changes in gene expression. The finding that staphylococcal virulence can be inhibited through antagonism of this quorum-sensing pathway has fueled tremendous interest in understanding the structure-activity relationships underlying the AIP-AgrC interaction. The defining structural feature of the AIP is a 16-membered, thiolactone-containing macrocycle. Surprisingly, the importance of ring size on agr activation or inhibition has not been explored. In this study, we address this deficiency through the synthesis and functional analysis of AIP analogues featuring enlarged and reduced macrocycles. Notably, this study is the first to interrogate AIP function by using both established cell-based reporter gene assays and newly developed in vitro AgrC-I binding and autophosphorylation activity assays. Based on our data, we present a model for robust agr activation involving a cooperative, three-points-of-contact interaction between the AIP macrocycle and AgrC.

Parenting behaviours associated with the development of adaptive and maladaptive offspring personality traits

OBJECTIVES

To investigate the associations of beneficial parenting behaviours with adaptive and maladaptive offspring personality traits that persist into adulthood among individuals in the community.

METHODS

Families (n = 669) participating in the Children in the Community Study were interviewed during the childhood, adolescence, emerging adulthood, and adulthood of the offspring at the mean ages of 6, 14, 16, 22, and 33 years.

RESULTS

Twelve types of beneficial maternal and paternal child-rearing behaviour, reported by offspring at the mean age of 16 years, were associated with elevated offspring personality resiliency, at the mean ages of 22 and 33 years, and with low offspring personality disorder trait levels. These longitudinal associations remained significant when histories of childhood behaviour problems and parental psychiatric disorder were controlled statistically. Similar linear (that is, dose-dependent) associations were observed between the number of beneficial parenting behaviours during childhood and adaptive and maladaptive offspring traits at the mean ages of 22 and 33 years. Maternal and paternal behaviours were independently associated with both adaptive and maladaptive offspring traits.

CONCLUSIONS

Beneficial maternal and paternal child-rearing behaviours may promote the development of adaptive offspring personality traits that endure into adulthood, and they may be prospectively associated with reduced levels of maladaptive offspring traits. These associations may not be attributable to childhood behaviour problems or parental psychiatric disorders, and they may be equally evident during early and middle adulthood.

Depressed parents' treatment needs and children's problems in an urban family medicine practice

OBJECTIVE

The study examined interest in treatment and treatment preferences and obstacles of low-income depressed parents.

METHODS

A total of 273 primarily low-income, Hispanic parents of children aged seven to 17 attending an urban family medicine practice agreed to complete a survey by interview or self-report, including screening diagnoses and treatment history. Three groups were compared: major, subthreshold, and no depression.

RESULTS

Nearly one-third had major (9%) or subthreshold depression (23%), and many in the depressed groups reported recent treatment (50% and 31%, respectively). Parents with any depression were significantly more likely than nondepressed parents to report interest in receiving help, endorse treatment obstacles, and report children's problems.

CONCLUSIONS

High rates of personal and child problems, interest in treatment, and treatment obstacles among low-income, depressed parents highlight the need to develop acceptable mental health services for them and their children, even when parents do not meet full diagnostic criteria for depression.

Patient and clinician perceptions of therapeutic alliance as predictors of improvement in depression

BACKGROUND

Meta-analyses have consistently concluded that a positive therapeutic alliance is associated with better clinical outcomes and progress. To date, however, very few studies have focused on sociodemographic or clinical patient characteristics as moderators of alliance.

METHOD

A multicenter longitudinal treatment outcome study was conducted to investigate the associations of patient and clinician perceptions of the therapeutic alliance with improvement in depression, and to investigate whether these associations were influenced by sociodemographic or clinical characteristics of the patient. Clinician-rated Montgomery Åsberg Depressive Rating Scale scores and both patient- and therapist-rated Helping Alliance Questionnaire (HAQ-I) scores were obtained from 567 outpatients with major depressive disorder who received 6 months of combined psycho- and pharmacotherapy.

RESULTS

Multilevel repeated-measures analyses indicated that patient- and therapist-rated HAQ-I scores, 4 weeks after treatment began, positively predicted subsequent clinical change, controlling for the effect of early improvement and a range of patient characteristics. Next to alliance, early improvement, initial depressive symptom severity, a history of psychiatric disorders, and occupational status affected the rate of clinical improvement. Personality pathology comorbidity, marital and occupational status, and the atypical character of the major depressive episode (MDE) moderated the alliance-outcome relationship, depending on the informant (patient or therapist) of therapeutic alliance.

CONCLUSIONS

The present findings suggest that therapist and patient ratings of therapeutic alliance predict therapeutic progress, and that this relation may be moderated by client characteristics, including personality pathology comorbidity, marital status, occupational status, and the atypical character of the MDE.

Suicidality, depression, major and minor negative life events: a mediator model

Background: Major negative life events are associated with higher suicidality. In this association, two mediating paths were hypothesized: (a) via minor negative life events and (b) via depression.

Methods: Ninety-six adolescent primary care patients were recruited in clinics, a physician’s office, and school nurses’ offices.

Results: (1) Minor negative life events were associated with depressive symptoms and suicidality. (2) Depressive symptoms were associated with suicidality. (3) Depressive symptoms mediated the association of minor negative life events with suicidality.

Conclusions: Findings suggest that minor negative life events may be associated with suicidal ideation among adolescent primary care patients, and that depressive symptoms may mediate the association of minor negative life events with suicidality.

School climate and continuity of adolescent personality disorder symptoms

BACKGROUND

Schools are key social contexts for shaping development and behavior in youths; yet, little is known of their influence on adolescent personality disturbance.

METHOD

A community-based sample of 592 adolescents was assessed for family and school experiences, Axis I psychiatric disorders, and Axis II personality disorder (PD) symptoms, and followed into young adulthood. Multiple regression analysis was used to estimate associations between adolescent-reported school climate and young adult PD symptoms independent of age, sex, family socioeconomic status; childhood maltreatment; Axis I disorder, PD symptoms, academic grades, and parental punishment in adolescence; and four dimensions of school climate.

RESULTS

Schools characterized as high in learning focus were related to cluster B (antisocial, borderline, histrionic, and narcissistic PD) symptom declines, whereas schools characterized as high in opportunities for student autonomy were related to cluster A (paranoid, schizoid, and schizotypal PD) symptom declines. In contrast, schools characterized as conflictual or supporting interpersonal informality/familiarity among students and teachers were related to increases in cluster A symptoms and cluster C (avoidant, dependent, and obsessive-compulsive PD) symptoms.

CONCLUSIONS

Schools may exert both positive and negative influences on continuity of adolescent personality disturbance. The role of the school in guiding young people toward more favorable developmental pathways and alleviating personality disturbance is discussed.

Stigmatization and receptivity to mental health services among recently bereaved adults

Severe grief symptoms, treatment receptivity, attitudes about grief, and stigmatization concerns were assessed in a community-based sample of 135 widowed participants in the Yale Bereavement Study. There was a statistically significant association between the severity of grief symptoms and reported negative reactions from friends and family members. However, more than 90% of the respondents with complicated grief, a severe grief disorder, reported that they would be relieved to know that having such a diagnosis was indicative of a recognizable psychiatric condition, and 100% reported that they would be interested in receiving treatment for their severe grief symptoms.

Minor depression during adolescence and mental health outcomes during adulthood

Data from a community-based prospective longitudinal study were used to investigate the association of minor depressive disorder during adolescence with adverse mental health outcomes during adulthood. Structured diagnostic interviews were administered to a community-based sample of 755 individuals during adolescence and adulthood. Results indicated that minor depressive disorder during adolescence was associated with elevated risk for subsequent psychiatric disorders during adulthood, including major depressive disorder, >or= 1 disruptive disorders and clinically relevant impairment after corresponding and co-occurring disorders were controlled statistically.

Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11

BACKGROUND

Bereavement is a universal experience, and its association with excess morbidity and mortality is well established. Nevertheless, grief becomes a serious health concern for a relative few. For such individuals, intense grief persists, is distressing and disabling, and may meet criteria as a distinct mental disorder. At present, grief is not recognized as a mental disorder in the DSM-IV or ICD-10. The goal of this study was to determine the psychometric validity of criteria for prolonged grief disorder (PGD) to enhance the detection and potential treatment of bereaved individuals at heightened risk of persistent distress and dysfunction.

METHODS AND FINDINGS

A total of 291 bereaved respondents were interviewed three times, grouped as 0-6, 6-12, and 12-24 mo post-loss. Item response theory (IRT) analyses derived the most informative, unbiased PGD symptoms. Combinatoric analyses identified the most sensitive and specific PGD algorithm that was then tested to evaluate its psychometric validity. Criteria require reactions to a significant loss that involve the experience of yearning (e.g., physical or emotional suffering as a result of the desired, but unfulfilled, reunion with the deceased) and at least five of the following nine symptoms experienced at least daily or to a disabling degree: feeling emotionally numb, stunned, or that life is meaningless; experiencing mistrust; bitterness over the loss; difficulty accepting the loss; identity confusion; avoidance of the reality of the loss; or difficulty moving on with life. Symptoms must be present at sufficiently high levels at least six mo from the death and be associated with functional impairment.

CONCLUSIONS

The criteria set for PGD appear able to identify bereaved persons at heightened risk for enduring distress and dysfunction. The results support the psychometric validity of the criteria for PGD that we propose for inclusion in DSM-V and ICD-11. Please see later in the article for Editors' Summary.

Psychiatric disorders during adolescence and relationships with peers from age 17 to age 27

OBJECTIVE

To investigate normative patterns of peer relationships from ages 17 to 27, and to examine the impact of adolescent psychiatric disorders on peer relationships.

METHOD

Psychiatric disorders were measured at a mean age 16 years. At mean age 29, 200 participants completed detailed narrative interviews about their transition to adulthood. Monthly contact and conflict with peers were described in narratives covering ages 17-27.

RESULTS

Adolescent psychiatric disorders did not predict the frequency of peer contact in the young adult period. However, adolescent disruptive disorders predicted greater peer conflict regardless of contact frequency. Adolescents with major depressive or substance abuse disorders and subsequent high frequency of peer contact reported elevated peer conflict during the transition to adulthood. In contrast, among study participants with frequent peer contact during this period, those with adolescent anxiety disorders reported less peer conflict than did those without such a diagnostic history.

CONCLUSIONS

Adolescents with major depressive, disruptive, and substance abuse disorders may be at risk for long-term negative peer relationships, whereas those with anxiety disorders may subsequently avoid peer conflict.

Problematic eating behaviors in adolescents with low self-esteem and elevated depressive symptoms

Previous research has indicated that low self-esteem may be an important risk factor for the development of eating disorders. Few longitudinal studies have examined the relationships between low self-esteem, depressive symptoms, and eating disorders in adolescents. The present study investigated whether low self-esteem was associated with depressive symptoms and problematic eating behaviors. Measures of low self-esteem and problematic eating behaviors were administered to a sample of 197 adolescent primary-care patients. Depressive symptoms and problematic eating behaviors were assessed ten months later. Youths with low self-esteem were at greater risk for high levels of depressive symptoms and eating disorder symptoms. In addition, depressive symptoms mediated the association of low self-esteem with problematic eating behaviors.

Cumulative prevalence of personality disorders between adolescence and adulthood

OBJECTIVE

To investigate the cumulative prevalence of personality disorder (PD) among adults in the community, based on prospective longitudinal data from a series of psychiatric interviews.

METHOD

Psychiatric interviews were administered to a regionally representative community-based sample of 568 individuals in 1983 (mean age = 14), 1985-1986 (mean age = 16), 1991-1993 (mean age = 22), and 2001-2004 (mean age 33).

RESULTS

The point prevalence of any current DSM-IV PD, including depressive PD and passive-aggressive PD, varied between 12.7% and 14.6% across the four diagnostic assessments. The cumulative prevalence of PD increased at each of the follow-up assessments. At mean age 33, the estimated lifetime prevalence of PD was 28.2%.

CONCLUSION

The cumulative prevalence of PD, based on a series of interviews conducted during adolescence and adulthood, may be substantially higher than the point prevalence of current PD based on a single assessment interview.

The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings

BACKGROUND

Both clinical and population-based studies show that anxiety disorders and substance misuse frequently co-occur in adults, whereas among adolescents, less examination of this association has been done. Adolescence is frequently the time of substance use initiation and its subsequent interaction with anxiety disorders has not been fully explored. It is unknown in adolescents whether anxiety is more related to alcohol abuse versus cannabis abuse. In addition, as depression has been implicated in adolescents with both anxiety and substance misuse, its role in the association should also be considered.

OBJECTIVE

To test the association between current anxiety with alcohol versus cannabis abuse disorders.

METHOD

Cross-sectional, clinician-administered, structured assessment--using the Primary Care Evaluation of Mental Disorders--to evaluate anxiety, mood and substance abuse disorders among 632 adolescents recruited from primary care settings.

RESULTS

Results show a strong association between current anxiety and alcohol [odds ratio = 3.8; 95% confidence interval (CI) 1.2-11.8], but not cannabis (odds ratio = 1.4; 95% CI 0.4-4.7) abuse.

CONCLUSION

This association in adolescents reflects the importance for increased awareness of anxiety symptoms and alcohol use patterns in primary care. The lack of association of anxiety with cannabis abuse in this group may reflect differences in cannabis' anxiolytic properties or that this young group has had less exposure thus far. Given adolescence is a time of especially rapid psychosocial, hormonal and brain development, primary care may provide an opportunity for further investigation and, potentially, early screening and intervention.

Development and validation of a new procedure for the diagnostic assessment of personality disorder: the Multidimensional Personality Disorder Rating Scale (MPDRS)

Data from a community-based prospective longitudinal study were used to investigate the utility of a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder (PD). The Structured Clinical Interview for DSM-IV PDs (SCID-II) was administered to 154 adults. After completing the interview, an experienced clinician assessed the General Diagnostic Criteria for a PD using a structured rating scale. PD diagnoses, based solely on the rating scale data, demonstrated strong agreement with diagnoses obtained using the diagnostic thresholds for specific PDs (Kappa = 0.89). The sensitivity, specificity, predictive power, and internal reliability of the rating scale were satisfactory. PD diagnoses, based on both of the assessment procedures, were associated with substantial impairment and distress. These findings suggest that a structured assessment of the DSM-IV General Diagnostic Criteria for a Personality Disorder may constitute a useful alternative or supplement to standard assessments of the diagnostic thresholds for specific DSM-IV PDs.

Investigation of a developmental model of risk for depression and suicidality following spousal bereavement

Data from a community-based multi-wave investigation were used to examine a developmental model of risk for depression and suicidality following the death of a spouse. Measures of perceived parental affection and control during childhood were administered to 218 widowed adults 11 months after the death of the spouse. Self-esteem, spousal dependency, depression, and suicidality were assessed 9 months later. Dependency on the deceased spouse mediated a significant association between retrospectively reported parental control during childhood and post-loss depressive symptoms. Depressive symptoms mediated significant associations of dependency on the deceased spouse and low self-esteem with suicidal ideation and behavior.

Parental concordance and offspring risk for anxiety, conduct, depressive, and substance use disorders

BACKGROUND

Although parental concordance for any psychiatric disorder is known to be associated with elevated risk for offspring disorder, little evidence is currently available from prospective longitudinal studies regarding the association of parental concordance with offspring risk for anxiety, conduct, depressive, and substance use disorders.

SAMPLING AND METHODS

Psychiatric interviews were conducted with 593 mothers and their biological offspring at mean offspring ages 14, 16, 22, and 33.

RESULTS

Offspring risk for >or=1 psychiatric disorder was significantly greater if both parents had a lifetime history of psychiatric disorder than if only one parent had a lifetime history of disorder. Parental concordance for generalized anxiety disorder (GAD) was associated with a significant increase in offspring risk for anxiety disorders, above and beyond the risk attributable to having one affected parent. In addition, parental concordance for GAD was associated with elevated risk for offspring depressive disorders, and parental concordance for substance use disorders was associated with elevated offspring risk for conduct disorder.

CONCLUSIONS

Parental concordance for GAD may be associated with elevated risk for offspring anxiety disorder, above and beyond the risk associated with having one affected parent.

Extensive television viewing and the development of attention and learning difficulties during adolescence

OBJECTIVE

To investigate the association of television viewing with educational and intellectual outcomes during adolescence and early adulthood.

DESIGN

Prospective epidemiological study.

SETTING

Families participating in the Children in the Community Study, a prospective longitudinal investigation, were interviewed at mean offspring ages 14, 16, and 22 years.

PARTICIPANTS

A community-based sample of 678 families from upstate New York.

MAIN EXPOSURES

Television viewing, attention difficulties, learning difficulties, and educational achievement during adolescence and early adulthood.

MAIN OUTCOME MEASURES

The Disorganizing Poverty Interview and age-appropriate versions of the Diagnostic Interview Schedule for Children.

RESULTS

Frequent television viewing during adolescence was associated with elevated risk for subsequent attention and learning difficulties after family characteristics and prior cognitive difficulties were controlled. Youths who watched 1 or more hours of television per day at mean age 14 years were at elevated risk for poor homework completion, negative attitudes toward school, poor grades, and long-term academic failure. Youths who watched 3 or more hours of television per day were the most likely to experience these outcomes. In addition, youths who watched 3 or more hours of television per day were at elevated risk for subsequent attention problems and were the least likely to receive postsecondary education. There was little evidence of bidirectionality in the association of television viewing with attention and learning difficulties.

CONCLUSION

Frequent television viewing during adolescence may be associated with risk for development of attention problems, learning difficulties, and adverse long-term educational outcomes.

Personality disorder and impaired functioning from adolescence to adulthood

BACKGROUND

Little is currently known about functioning and impairment during adulthood associated with the course of personality disorders.

AIMS

To investigate the association of personality disorder stability from adolescence through middle adulthood with measures of global functioning and impairment, using prospective epidemiological data.

METHOD

A community-based sample of 658 individuals was interviewed at mean ages 14, 16, 22 and 33 years.

RESULTS

Individuals with persistent personality disorder had markedly poorer functioning and greater impairment at mean age 33 years than did those who had never been identified as having such disorder or who had a personality disorder that was in remission, after co-occurring Axis I disorders at age 33 years were taken into account. Remitted disorder was associated with mild long-term impairment. Adult-onset personality disorders, however, were also associated with significant impairment.

CONCLUSIONS

Persistent and adult-onset personality disorders are associated with functional impairment among adults in the community. These effects are independent of co-occurring Axis I disorders.

Parental control, partner dependency, and complicated grief among widowed adults in the community

Data from the Yale Bereavement Study, a community-based longitudinal study, were used to investigate the association of 192 widowed individuals' recollections of parenting affection and control during childhood with dependency on the deceased spouse and the development of severe grief symptoms following bereavement. The hypothesis that dependency on the deceased spouse mediates the association of parental affection and control during childhood with the development of severe grief following bereavement was investigated. Findings indicated that a high level of perceived parental control during childhood was associated with elevated levels of dependency on the deceased spouse and with symptoms of complicated grief. Dependency on the deceased spouse mediated the association of perceived parental control with the development of complicated grief following bereavement.

Comorbid personality disorder and treatment use in a community sample of youths: a 20-year follow-up

OBJECTIVE

The impact of comorbid personality disorder (PD) on subsequent treatment and psychotropic drug use was examined in a representative sample of over 700 individuals.

METHOD

Axis I disorders and PD were assessed by self- and mother-report at mean ages 13 and 22 years, and by self-report at mean age 33. Mothers reported treatment use by participants before mean age 33; participants reported treatment and psychotropic drug use at mean age 33.

RESULTS

Individuals with multiple axis I disorders without PD, axis I disorder-PD comorbidity, and single disorders were compared simultaneously to individuals not diagnosed. Overall, odds of subsequent and past year treatment or psychotropic drug use or both were highest when PD co-occurred with a mood, an anxiety, a disruptive, or a substance use disorder.

CONCLUSION

Co-occurring personality pathology may contribute to elevated mental health service use, including use of psychotropic drugs, among young adults in the community.

Personality disorders evident by early adulthood and risk for anxiety disorders during middle adulthood

Data from the Children in the Community Study, a prospective longitudinal investigation, were used to investigate the association of personality disorder (PD) traits, evident by early adulthood, with risk for development of anxiety disorders by middle adulthood. Individuals without a history of anxiety disorders who met diagnostic criteria for >or=1 PD by early adulthood were at markedly elevated risk for agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder by middle adulthood. Antisocial, avoidant, borderline, dependent, depressive, histrionic, obsessive-compulsive, passive-aggressive, and schizotypal PD traits, evident by early adulthood, were associated with elevated risk for >or=1 anxiety disorder during middle adulthood. These associations remained significant after a history of anxiety disorder and co-occurring Axis I psychiatric disorder was controlled statistically. Findings of this study suggest that some types of PD traits that become evident by early adulthood may contribute to increased risk for the development of anxiety disorders by middle adulthood.

Adolescent Cluster A personality disorder symptoms, role assumption in the transition to adulthood, and resolution or persistence of symptoms

Cluster A odd or eccentric personality disorder (PD) symptoms may reflect a schizophrenia spectrum biological vulnerability in at least some persons. Consequently, this symptom pattern may have particularly negative effects on the transition from adolescent to adult roles. A general population sample of 200 young adults was assessed on Cluster A PD at mean ages 17 and 22, and subsequently provided detailed narratives about their monthly experiences and behaviors between these two ages. Adolescent Cluster A PD was related to the developmental trajectories of residential, career, financial, romantic, and family formation roles during this period, and trajectories were related to a change in symptoms over this period. Symptoms were associated with early parenthood and less advanced education, but for other developmental outcomes tended to differ for men and women. These gender differences were attributable, in part, to the differential meaning and consequences of early parenthood for men and women.

Relative impact of young adult personality disorders on subsequent quality of life: findings of a community-based longitudinal study

Little is known about long-term prognostic implications of personality disorder (PD) for quality of life (QOL) in the young adult population not selected for psychiatric treatment. The purpose of this study was to determine the association of PDs with QOL assessed after an 11-year interval. PDs were assessed in 1991-1994 at mean age 22, and indicators of QOL were assessed in 2001-2004 at mean age 33 based on a community sample of 588 young adults. Findings indicated that any PD, or a cluster A, B, or C PD each were independently associated with elevated impairment in overall QOL after adjusting for demographic variables, co-occurring Axis I disorder, and physical illness, and PDs in other clusters. Cluster B PD had a greatest adverse impact on QOL. Symptoms of antisocial, borderline, and schizotypal PD symptoms were independently associated with significant reductions in QOL; avoidant, paranoid, and dependent PD symptoms were associated with smaller reductions, not reaching statistical significance. Symptoms of other individual PDs were not associated with reduced QOL. PDs in young adults in the community have an enduring and adverse impact on subsequent QOL that cannot be attributed to physical illness or Axis I psychiatric disorder.

Development of personality disorder symptoms and the risk for partner violence

In a community sample (N = 543) followed over 20 years, the authors studied associations among childhood family violence exposure, personality disorder (PD) symptoms, and adult partner violence. PD symptoms (DSM-III-R Clusters A, B, and C) in early adulthood partially mediated the effect of earlier childhood risks on the odds of perpetrating partner violence. The authors tested whether stability of PD symptoms from adolescence to the early 20s differs for individuals who later perpetrated partner violence. Cluster A ("Odd/Eccentric") symptoms declined less with age among partner violent versus nonviolent men and women. Cluster B ("Dramatic/Erratic") symptoms were more stable through late adolescence in partner violent men, compared with nonviolent men and violent women. Cluster C ("Anxious") symptoms were most stable among partner violent men.

Adolescent axis I and personality disorders predict quality of life during young adulthood

PURPOSE

To investigate and compare the prospective association of adolescent Axis I mental disorder and personality disorder (PD) with young adult quality of life (QOL) in the general population.

METHODS

Seven hundred fifty mothers and youths participating in a prospective longitudinal community-based study were interviewed. Mental disorders were measured at a mean age 16 years. QOL as the outcome indicators were assessed at a mean age 22.

RESULTS

Adolescent Axis I disorder predicted elevated negative affect and higher levels of stress some 6 years later. Adolescent PD predicted elevated negative affect and higher levels of stress, and also problems in social support and relationships, and poorer residential, mobility, and financial and health resources in adulthood. Youths with both Axis I disorder and one or more PDs had the worst outcomes with regard to health problems, stressful occupational or educational settings, and resources, net of the effects of adolescent health problems. Nevertheless, some aspects of adult QOL were not significantly related to adolescent disorder, including a positive perspective on the future, own morale in a chosen occupation or educational setting, or the amount of autonomy experienced in that setting.

CONCLUSIONS

Among adolescents in the community, PDs during adolescence may have a more adverse impact on young adult QOL than do Axis I disorders. A combination of Axis I and PD may represent a particular risk for new physical health problems and resource inadequacy, including poor access to health care.

Personality strengths in adolescence and decreased risk of developing mental health problems in early adulthood

The aim of this study was to investigate whether personality strengths during adolescence are associated with decreased risk of developing psychiatric disorders, educational or occupational problems, violent or criminal behaviors, and interpersonal difficulties during early adulthood. A representative community sample of 688 mothers from upstate New York and their offspring was interviewed in the period of 1985-1986 (mean offspring age = 16 years) and in that of 1991-1993 (mean offspring age = 22 years). Results showed that youths with numerous personality strengths at the mean age of 16 years were at a decreased risk of developing psychiatric disorders, educational and occupational problems, interpersonal difficulties, and criminal behaviors at the mean age of 22 years. These associations remained significant after controlling for age, sex, socioeconomic status, verbal intelligence, preexisting psychiatric disorders, and corresponding problems at the mean age of 16 years. Although youths with fewer personality strengths who experienced numerous stressful events were at elevated risk of developing psychiatric disorders during early adulthood, those with a higher number of personality strengths at the mean age of 16 years did not share this vulnerability. We conclude that personality strengths during adolescence may contribute to a decreased risk of developing a wide range of adverse outcomes during early adulthood. Systematic evaluation of character strengths may improve the clinical assessment of adolescents.

Parenting behaviors associated with risk for offspring personality disorder during adulthood

CONTEXT

Research has suggested that some types of parental child-rearing behavior may be associated with risk for offspring personality disorder (PD), but the association of parenting with offspring PD has not been investigated comprehensively with prospective longitudinal data.

OBJECTIVE

To investigate the association of parental child-rearing behavior with risk for offspring PD during adulthood.

DESIGN

The Children in the Community study, a prospective longitudinal investigation.

SETTING AND PARTICIPANTS

A community-based sample of 593 families interviewed during childhood (mean age, 6 years), adolescence (mean ages, 14 and 16 years), emerging adulthood (mean age, 22 years), and adulthood (mean age, 33 years) of the offspring.

MAIN OUTCOME MEASURE

The Structured Clinical Interview for DSM-IV Personality Disorders.

RESULTS

Ten types of parenting behavior that were evident during the child-rearing years were associated with elevated offspring risk for PD during adulthood when childhood behavioral or emotional problems and parental psychiatric disorders were controlled statistically. Parental behavior in the home during the child-rearing years was associated with elevated risk for offspring PD at mean ages of 22 and 33 years. Risk for offspring PD at both assessments increased steadily as a function of the number of problematic parenting behaviors that were evident. Low parental affection or nurturing was associated with elevated risk for offspring antisocial (P = .003), avoidant (P = .01), borderline (P = .002), depressive (P = .02), paranoid (P = .002), schizoid (P = .046), and schizotypal (P<.001) PDs. Aversive parental behavior (eg, harsh punishment) was associated with elevated risk for offspring borderline (P = .001), paranoid (P = .004), passive-aggressive (P = .046), and schizotypal (P = .02) PDs.

CONCLUSIONS

Parental behavior during the child-rearing years may be associated with risk for offspring PD that endures into adulthood. This risk may not be attributable to offspring behavioral and emotional problems or parental psychiatric disorder, and it may not diminish over time. Low parental nurturing and aversive parental behavior during child rearing may both be associated with elevated risk for offspring PDs.

A multiwave multi-informant study of the specificity of the association between parental and offspring psychiatric disorders

The present study was conducted to investigate the specificity of the association between parental and offspring psychiatric disorders using epidemiological data from a series of parent and offspring interviews. A community-based sample of 593 mothers and their offspring from upstate New York were interviewed during the adolescence and early adulthood of the offspring. The children of parents with generalized anxiety disorder were at specifically elevated risk for anxiety disorders when co-occurring psychiatric disorders were controlled. The associations between parental and offspring antisocial, conduct, depressive, and substance use disorders were characterized by modest specificity. Children of parents with externalizing disorders were nearly as likely to develop internalizing disorders as they were to develop externalizing disorders. Children of parents with internalizing disorders were somewhat, but not significantly, more likely to develop internalizing disorders. These findings support the inference that children of parents with generalized anxiety disorder may be more likely to develop anxiety disorders than they are to develop other psychiatric disorders. However, when co-occurring psychiatric disorders are accounted for, the children of parents with depressive, disruptive, and substance use disorders may be as likely to develop other disorders as they are to develop the same type of disorder that their parents have had.

Personality disorder traits evident by early adulthood and risk for eating and weight problems during middle adulthood

OBJECTIVE

The current article investigates the association of personality disorder (PD) with the subsequent development of eating and weight problems.

METHOD

Psychiatric interviews were administered to a community-based sample of 658 individuals at mean ages 14, 16, 22, and 33 years.

RESULTS

Individuals with PD by age 22 were at an elevated risk for eating disorders at mean age 33 years. PDs were associated with risk for onset of binge eating, purging, daily dietary restriction, and obesity among individuals without a history of these problems. Borderline and histrionic PD symptoms were associated with recurrent binging and purging at mean age 33 years. Antisocial and schizotypal symptoms were associated with recurrent binging and obesity at mean age 33 years. Depressive PD symptoms were associated with recurrent binging and dietary restriction at mean age 33 years.

CONCLUSION

PD symptoms, evident by early adulthood, may be associated with the risk for the development of eating and weight problems by middle adulthood.

Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity

OBJECTIVE

To investigate the association of dissociative disorder (DD) with impaired functioning and co-occurring Axis I and personality disorders among adults in the community.

METHOD

Psychiatric interviews were administered to a sample of 658 adult participants in the Children in the Community Study, a community-based longitudinal study.

RESULTS

Depersonalization disorder (prevalence: 0.8%), dissociative amnesia (prevalence: 1.8%), dissociative identity disorder (prevalence: 1.5%), and dissociative disorder not otherwise specified (prevalence: 4.4%), evident within the past year, were each associated with impaired functioning, as assessed by the clinician-administered Global Assessment of Functioning Scale. These associations remained significant after controlling for age, sex, and co-occurring disorders. Individuals with anxiety, mood, and personality disorders were significantly more likely than individuals without these disorders were to have DD, after the covariates were controlled. Individuals with Cluster A (DD prevalence: 58%), B (DD prevalence: 68%), and C (DD prevalence: 37%) personality disorders were substantially more likely than those without personality disorders were to have DD.

CONCLUSIONS

DD is associated with clinically significant impairment among adults in the community. DD may be particularly prevalent among individuals with personality disorders.

Impact of adolescent mental disorders and physical illnesses on quality of life 17 years later

OBJECTIVE

To investigate associations of mental disorders and physical illnesses during adolescence with quality of life (QOL) 17 years later.

DESIGN

The Children in the Community Study, a prospective longitudinal investigation.

SETTING

Upstate New York.

PARTICIPANTS

A community-based sample of mothers and their offspring were interviewed.

MAIN OUTCOME MEASURES

Axis I disorders and Axis II personality disorders and physical illnesses were assessed by self-report and mother report in 1985-1986. Outcome indicators of QOL were assessed in 2001-2004.

RESULTS

Compared with participants without adolescent illness or disorder, those with a history of physical illness reported poorer physical health (mean difference [MD], -4.8); those with a history of an Axis I disorder reported poorer physical health (MD, -8.0) and more problematic social relationships (MD, -4.5); and those with a history of personality disorder reported poorer physical health (MD, -8.2), more problematic social relationships (MD, -5.0), lower psychological well-being (MD, -3.6), and more adversity within their environmental context (MD, -4.6) in adulthood. Comorbid physical illness and mental disorder were associated with all 5 QOL domains (MD, -3.1 to -11.9). After adjusting for all demographic variables and comorbidity, associations remained between physical illness and poor physical health (effect size [ES], -0.33); an Axis I disorder and problematic social relationships (ES, -0.37); and personality disorder and problematic social relationships (ES, -0.36), low psychological well-being (ES, -0.23), impaired role function (ES, -0.24), and an adverse environmental context (ES, -0.50).

CONCLUSIONS

Mental disorders may have more adverse long-term associations with QOL than do physical illnesses. Adolescent personality disorders may have a more adverse impact on adult QOL than do adolescent Axis I disorders.

Gender differences in the age-changing relationship between instrumentality and family contact in emerging adulthood

Data from the Children in the Community Transitions Study were used to examine gender differences in the impact of family contact on the development of finance and romance instrumentality from ages 17 to 27 years. Family contact decreased among both men and women across emerging adulthood, although it decreased more rapidly in men than in women. Both finance and romance instrumentality increased for men and women across emerging adulthood. The growth rate did not differ between men and women in either domain, although men tended to be characterized by higher levels of instrumentality than women. There were noteworthy gender differences in the impact of family contact on the development of instrumentality. At age 17, family contact was negatively associated with instrumentality for both men and women; at age 27, the impact of family contact on instrumentality was less negative for women and was positive for men.

Associations of parental personality disorders and axis I disorders with childrearing behavior

Data from the Children in the Community Study, a community-based longitudinal investigation, were used to investigate the associations of parental anxiety, depressive, substance use, and personality disorders with parental child rearing behavior. Comprehensive psychosocial interviews, including assessments of child rearing, were conducted with 224 women and 153 men (mean age = 33 years; mean off- spring age = 8 years). Findings indicated that parental personality disorders were associated with parental possessiveness, inconsistent parental discipline, low parental communication, and low parental praise and encouragement. These associations remained significant when parental gender, offspring gender, and co-occurring parental disorders were controlled statistically. Parental anxiety disorders were independently associated with parental possessiveness. Parents with personality disorders were substantially more likely than parents without personality disorders to report engaging in multiple problematic child rearing behaviors. This association was not moderated by co-occurring parental disorders. These findings suggest that the presence of a parental personality disorder may be associated with an elevated likelihood of problematic parenting behavior during the child rearing years.

Adverse outcomes associated with personality disorder not otherwise specified in a community sample

OBJECTIVE

The authors investigated 1) whether adolescents and adults in the community diagnosed with personality disorder not otherwise specified are at elevated risk for adverse outcomes, and 2) whether this elevation in risk is comparable with that associated with the DSM-IV cluster A, B, and C personality disorders.

METHOD

A community-based sample of 693 mothers and their offspring were interviewed during the offspring's childhood, adolescence, and early adulthood. Offspring psychopathology, aggressive behavior, educational and interpersonal difficulties, and suicidal behavior were assessed.

RESULTS

Individuals who met DSM-IV criteria for personality disorder not otherwise specified were significantly more likely than those without personality disorders to have concurrent axis I disorders and behavioral, educational, or interpersonal problems during adolescence and early adulthood. In addition, adolescents with personality disorder not otherwise specified were at significantly elevated risk for subsequent educational failure, numerous interpersonal difficulties, psychiatric disorders, and serious acts of physical aggression by early adulthood. Adolescents with personality disorder not otherwise specified were as likely to have these adverse outcomes as those with cluster A, B, or C personality disorders or those with axis I disorders.

CONCLUSIONS

Adolescents and young adults in the general population diagnosed with personality disorder not otherwise specified may be as likely as those with DSM-IV cluster A, B, or C personality disorders to have axis I psychopathology and to have behavioral, educational, or interpersonal problems that are not attributable to co-occurring psychiatric disorders. Individuals with personality disorder not otherwise specified and individuals with DSM-IV cluster A, B, or C personality disorders are likely to be at substantially elevated risk for a wide range of adverse outcomes.

The children in the community study of developmental course of personality disorder

The Children in the Community (CIC) Study is an ongoing investigation of the course of psychiatric disorders including personality disorders (PDs) in an epidemiological sample of about 800 youths. In addition to tracking developmental trajectories over 20 years from adolescence into adulthood, the CIC Study has used prospective data to investigate early risks for Axis II disorders and symptoms (including both environmental factors and early characteristics), implications of comorbidity with Axis I disorders, and associated negative prognostic risk of adolescent PDs into adulthood. The substantial independent impact of PD on subsequent Axis I disorders, suicide attempts, violent and criminal behavior, interpersonal conflict, and other problematic adult outcomes confirms the importance of attention to these problems when they manifest in early adolescence. The implications of study findings for potential changes in the DSM are discussed.

Personality disorder traits associated with risk for unipolar depression during middle adulthood

Data from the Children in the Community Study, a prospective longitudinal investigation, were used to investigate the association of personality disorder (PD) traits, evident by early adulthood, with risk for the development of unipolar depressive disorders by middle adulthood. Antisocial, borderline, dependent, depressive, histrionic, and schizotypal PD traits, identified between ages 14 and 22, were significantly associated with risk for dysthymic disorder (DD) or major depressive disorder (MDD) by a mean age of 33 after a history of unipolar depression and other psychiatric disorder was controlled statistically. Individuals without a history of unipolar depression who met diagnostic criteria for > or =1 PD by a mean age of 22 were at elevated risk for DD or MDD by a mean age of 33 years. Individuals identified as having a DSM-IV Cluster A (paranoid, schizoid, or schizotypal) or Cluster C (avoidant, dependent, obsessive-compulsive) PD by a mean age of 22 years were at elevated risk for recurrent or chronic unipolar depression. The findings of this study suggest that some types of PD traits that become evident by early adulthood may contribute to an increased risk for the development or recurrence of unipolar depressive disorders by middle adulthood.

Personality disorder traits during adolescence and relationships with family members during the transition to adulthood

Data from the Children in the Community Transitions Study, a prospective longitudinal investigation, were used to examine the association between adolescent personality disorder (PD) traits and conflict with family members during the transition to adulthood. PD traits at mean age 16 years were associated with elevated contact and conflict with family members between ages 17 and 27 years after Axis I disorders were controlled. There was a significant association between frequent contact and elevated conflict with family members. Both declined gradually during the transition to adulthood. Reduced family contact was associated with reduced family conflict, particularly among individuals who had numerous PD traits during adolescence. Among individuals who had a high level of family conflict during adolescence, reduced family contact between ages 17 and 22 years was associated with a subsequent reduction in conflict with family members between ages 22 and 27 years.

Self-reported personality disorder in the children in the community sample: convergent and prospective validity in late adolescence and adulthood

Approximately 800 youths from the Children in the Community Study (Cohen & Cohen, 1996) have been assessed prospectively for over 20 years to study personality disorders (PDs) in adolescents and young adults. In this article we evaluate the Children in the Community Self-Report (CIC-SR) Scales, which were designed to assess DSM-IV PDs using self-reported prospective data from this longitudinal sample. To evaluate convergent validity, we assessed concordance between the CIC-SR Scales and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1995) in 644 participants at mean age 33. To assess predictive validity, we used CIC-SR Scales at mean age 22 to predict subsequent CIC-SR and SCID-II Personality Questionnaire scores at mean age 33. In these analyses the CIC-SR Scales matched or exceeded benchmarks established in previous comparisons between self-report instruments and structured clinical interviews. Unlike other self-report scales, the CIC-SR did not appear to overestimate diagnoses when compared with SCID-II clinical diagnoses.

Adolescent personality disorders and conflict with romantic partners during the transition to adulthood

Longitudinal data were used to investigate the association of adolescent personality disorders with conflict between romantic partners during the transition to adulthood (i.e., age 17 to 27). Findings indicated that adolescent personality disorders (PDs) assessed at mean age 16 were associated with subsequent elevated partner conflict. Cluster B PD was associated with sustained elevations in partner conflict throughout the transition to adulthood. Cluster A and C PDs were associated with elevated partner conflict before age 23. Paranoid, schizoid, schizotypal, borderline, narcissistic, and obsessive-compulsive PD symptoms were independently associated with sustained elevations in partner conflict.

Association Between Television Viewing and Sleep Problems During Adolescence and Early Adulthood

BACKGROUND

Although research has suggested that extensive television viewing may be associated with sleep problems, the direction of this association has not yet been determined.

OBJECTIVE

To investigate directional hypotheses regarding the association between television viewing and sleep problems during adolescence and early adulthood.

DESIGN

The Children in the Community Study, a prospective longitudinal investigation.

PARTICIPANTS AND SETTING

A community-based sample of 759 mothers from upstate New York and their offspring were interviewed during the early adolescence (mean age, 14 years), middle adolescence (mean age, 16 years), and early adulthood of the offspring (mean age, 22 years).

MAIN OUTCOME MEASURES

Television viewing and sleep problems during adolescence and early adulthood measured using the Disorganizing Poverty Interview and the age-appropriate versions of the Diagnostic Interview Schedule for Children.

RESULTS

Adolescents who watched 3 or more hours of television per day during adolescence were at a significantly elevated risk for frequent sleep problems by early adulthood. This elevation in risk remained significant after offspring age, sex, previous sleep problems, offspring psychiatric disorders, offspring neglect, parental educational level, parental annual income, and parental psychiatric symptoms were controlled statistically. Adolescents who reduced their television viewing from 1 hour or longer to less than 1 hour per day experienced a significant reduction in risk for subsequent sleep problems. Sleep problems during adolescence were not independently associated with subsequent television viewing when prior television viewing was controlled.

CONCLUSION

Extensive television viewing during adolescence may contribute to the development of sleep problems by early adulthood.

Sexual trajectories of abused and neglected youths

The study objective was to examine whether childhood abuse or neglect is associated with the age of onset of puberty and sexual and romantic behavior. A cohort of children (the Children in the Community study) was randomly selected and studied prospectively from childhood to adulthood. A sample of 816 youths were interviewed in their homes at a mean age of 14, 16, and 22 years in 1983, from 1985 to 1986, and from 1991 to 1994. The outcome measures included age of menarche, signs of male puberty, first being in love, dating, sexual intercourse, and pregnancy reported by youths. Child abuse and neglect were measured by official records and youth reports. A history of two or more incidents of sexual abuse was significantly associated with early puberty and early pregnancy after gender, class, race, paternal absence, and mother's age at the birth of the study child were controlled statistically. Public education regarding risk for premature sexual behavior among youths who have experienced sexual abuse is warranted. Efforts to prevent teenage pregnancy should include monitoring and educating sexually abused children as they enter puberty.

Intergenerational transmission of partner violence: a 20-year prospective study

An unselected sample of 543 children was followed over 20 years to test the independent effects of parenting, exposure to domestic violence between parents (ETDV), maltreatment, adolescent disruptive behavior disorders, and emerging adult substance abuse disorders (SUDs) on the risk of violence to and from an adult partner. Conduct disorder (CD) was the strongest risk for perpetrating partner violence for both sexes, followed by ETDV, and power assertive punishment. The effect of child abuse was attributable to these 3 risks. ETDV conferred the greatest risk of receiving partner violence; CD increased the odds of receiving partner violence but did not mediate this effect. Child physical abuse and CD in adolescence were strong independent risks for injury to a partner. SUD mediated the effect of adolescent CD on injury to a partner but not on injury by a partner. Prevention implications are highlighted.

Intergenerational transmission of partner violence: a 20-year prospective study

An unselected sample of 543 children was followed over 20 years to test the independent effects of parenting, exposure to domestic violence between parents (ETDV), maltreatment, adolescent disruptive behavior disorders, and emerging adult substance abuse disorders (SUDs) on the risk of violence to and from an adult partner. Conduct disorder (CD) was the strongest risk for perpetrating partner violence for both sexes, followed by ETDV, and power assertive punishment. The effect of child abuse was attributable to these 3 risks. ETDV conferred the greatest risk of receiving partner violence; CD increased the odds of receiving partner violence but did not mediate this effect. Child physical abuse and CD in adolescence were strong independent risks for injury to a partner. SUD mediated the effect of adolescent CD on injury to a partner but not on injury by a partner. Prevention implications are highlighted.

Intergenerational transmission of partner violence: a 20-year prospective study

An unselected sample of 543 children was followed over 20 years to test the independent effects of parenting, exposure to domestic violence between parents (ETDV), maltreatment, adolescent disruptive behavior disorders, and emerging adult substance abuse disorders (SUDs) on the risk of violence to and from an adult partner. Conduct disorder (CD) was the strongest risk for perpetrating partner violence for both sexes, followed by ETDV, and power assertive punishment. The effect of child abuse was attributable to these 3 risks. ETDV conferred the greatest risk of receiving partner violence; CD increased the odds of receiving partner violence but did not mediate this effect. Child physical abuse and CD in adolescence were strong independent risks for injury to a partner. SUD mediated the effect of adolescent CD on injury to a partner but not on injury by a partner. Prevention implications are highlighted.

Personality disorders associated with substance use among American and Greek adolescents

A study was conducted to investigate the association between personality disorder (PD) symptomatology and substance use among adolescents in community settings in the United States and Greece. The Structured Clinical Interview for DSM-IV Personality Disorders and the Adolescent Health Behavior Survey were completed by 37 male and 84 female adolescents, ages 15 to 18, who were recruited from an adolescent medical clinic and schools in and near New York City (n = 71) and Heraklion, Greece (n = 50). Results indicated that: (1) adolescents with PDs reported more frequent alcohol consumption during the past year than did those without PDs; (2) adolescents with borderline PD reported more cigarette smoking and heavy alcohol consumption than did those without borderline PD; (3) adolescents with antisocial PD symptomatology reported greater alcohol, cigarette, and illicit drug use than did those without antisocial PD symptomatology; and (4) although more American (30%) than Greek (4%) adolescents reported illicit substance use, differences were not observed in the prevalence of alcohol use, cigarette use, or personality disorders as a function of nationality.