A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients.

OBJECTIVES: Perioperative mental health of older Black surgical patients is associated with poor surgical outcomes; however, evidence-based perioperative interventions are lacking. Our two study objectives included: first, examine factors affecting perioperative care experiences of older Black surgical patients with mental health problems, and second, ascertain design and implementation requirements for a culturally-adapted perioperative mental health intervention. DESIGN SETTING AND PARTICIPANTS: We conducted six focus groups with older Black patients (n = 15; ≥50 years; surgery within the past 5 years and/or interest in mental health research; history of distress, anxiety, or depression coping with surgery/hospitalization/) from a large academic medical center. We engaged study partners, including interventionists and community members, to gather insights on intervention and implementation needs. We followed a hybrid inductive-deductive thematic approach using open coding and the National Institute on Minority Health and Health Disparities Research Framework. RESULTS: Patients reported that their psychological well-being and long-term mental health outcomes were not appropriately considered during perioperative care. Perceived stressors included interpersonal and structural barriers to using mental healthcare services, clinician treatment biases and ageism in care, and lack of healthcare professional connections/resources. Patients utilized various coping strategies, including talk therapy, faith/spirituality, and family and friends. CONCLUSION: This study offers valuable insights into the experiences of older Black surgical patients and the critical elements for developing a personalized perioperative mental health intervention to support their well-being before, during, and after surgery. Our findings demonstrated a need for a patient-centered and culturally adapted intervention targeting the individual/behavioral and interpersonal levels. Informed by the cultural adaptation framework, we propose a multi-component intervention that integrates psychological and pharmacological components.

A Perioperative Mental Health Intervention for Depressed and Anxious Older Surgical Patients: Results From a Feasibility Study.

OBJECTIVES: The perioperative period is challenging and stressful for older adults. Those with depression and/or anxiety have an increased risk of adverse surgical outcomes. We assessed the feasibility of a perioperative mental health intervention composed of medication optimization and a wellness program following principles of behavioral activation and care coordination for older surgical patients. METHODS: We included orthopedic, oncologic, and cardiac surgical patients aged 60 and older. Feasibility outcomes included study reach, the number of patients who agreed to participate out of the total eligible; and intervention reach, the number of patients who completed the intervention out of patients who agreed to participate. Intervention efficacy was assessed using the Patient Health Questionnaire for Anxiety and Depression (PHQ-ADS). Implementation potential and experiences were collected using patient surveys and qualitative interviews. Complementary caregiver feedback was also collected. RESULTS: Twenty-three out of 28 eligible older adults participated in this study (mean age 68.0 years, 65% women), achieving study reach of 82% and intervention reach of 83%. In qualitative interviews, patients (n = 15) and caregivers (complementary data, n = 5) described overwhelmingly positive experiences with both the intervention components and the interventionist, and reported improvement in managing depression and/or anxiety. Preliminary efficacy analysis indicated improvement in PHQ-ADS scores (F = 12.13, p <0.001). CONCLUSIONS: The study procedures were reported by participants as feasible and the perioperative mental health intervention to reduce anxiety and depression in older surgical patients showed strong implementation potential. Preliminary data suggest its efficacy for improving depression and/or anxiety symptoms. A randomized controlled trial assessing the intervention and implementation effectiveness is currently ongoing.

Identifying the blue patient: preoperative screening for depression.

Preoperative depression is an underappreciated comorbidity that has important implications for postoperative outcomes. Screening for symptoms of depression before surgery can identify patients with or without a previous diagnosis of depression who could benefit from perioperative interventions to improve mood. Preoperative screening programmes are feasible to implement, although care must be taken to ensure that patients who are most likely to benefit are included.

Brain-Hazardous Medications and Potential Subadequate Antidepressant Dosing in Older Surgical Patients Receiving Home Antidepressants: An Observational Study of a Large US Health System.

BACKGROUND: Older surgical patients with depression often experience poor postoperative outcomes. Poor outcomes may stem from brain-hazardous medications and subadequate antidepressant dosing. METHODS: This was a retrospective, observational cohort study covering the period between January 1, 2021 and December 31, 2021. Patients ≥60 years of age who underwent inpatient surgery and had an overnight stay at an integrated academic health care system comprising 14 hospitals were eligible. We analyzed the prevalence of home central nervous system (CNS)-active potentially inappropriate medication (PIM) and potential subadequate antidepressant dosing in older surgical patients receiving home antidepressants. Univariable and multivariable regression models were used to identify factors associated with home CNS-active PIM prescribing and potential subadequate antidepressant dosing. Additionally, outcomes were compared among patients receiving and not receiving CNS-active PIMs and patients receiving and not receiving subadequate antidepressant dosing. RESULTS: A total of 8031 patients were included in this study (47% female, mean age = 70 years) of whom 2087 (26%) were prescribed antidepressants. Roughly one-half (49%, 95% confidence interval [CI], 46.5-50.1) of patients receiving home antidepressants were also receiving ≥1 CNS-active PIM and 29% (95% CI, 27.0-29.3) were receiving a potential subadequate dose. Factors associated with an increased likelihood of receiving a home CNS-active PIM included female sex (adjusted odds ratio [aOR], 1.46), anxiety (aOR, 2.43), asthma or chronic obstructive pulmonary disease (aOR, 1.39), and serotonin-norepinephrine reuptake inhibitor use (aOR, 1.54). Patients aged ≥75 years (aOR, 1.57), black race (aOR, 1.48) and those with congestive heart failure (aOR, 1.33) were more likely to be prescribed a potential subadequate antidepressant dose. Patients receiving potential subadequate antidepressant doses were discharged home less often (64% vs 73%), had a longer hospital length of stay (9 days vs 7 days), and a higher mortality rate (18% vs 10%) compared to patients receiving adequate home antidepressant doses (P-value for all <0.01). No differences in these outcomes were found among patients receiving home antidepressants with or without CNS-active PIMs. CONCLUSIONS: Older surgical patients receiving antidepressants are frequently prescribed brain-hazardous medications and potentially subadequate antidepressant doses. Those receiving subadequate antidepressant doses may be at risk for worse postoperative outcomes compared to patients receiving adequate doses. The role of preoperative medication optimization to improve outcomes for older surgical patients should be evaluated.

ICD-10-CM codes infrequently used to document human trafficking in 2019 Nationwide Emergency Department Sample.

INTRODUCTION: People who experience human trafficking (HT) visit emergency departments (ED). The International Classification of Diseases, Clinical Modification (ICD-10-CM) introduced codes to document HT in June 2018. The aim of this study is to identify characteristics of ED patients who experienced forced labor or sexual exploitation as a documented external cause of morbidity in US visits. METHODS: Nationally representative surveillance based on patient visits to 989 hospital-owned EDs in the Nationwide Emergency Department Sample in 2019 became available in 2021. Eight ICD-10-CM codes to classify HT as an external cause of morbidity were combined into one HT variable for analysis in 2021-2022. RESULTS: A weighted count of 517 of 33.1 million ED visits (0.0016%) documented HT as an external cause of morbidity. Of them, sexual exploitation (71.6%) was documented more frequently than labor exploitation (28.4%). Most HT-related codes were visits by females (87.3%) from large metropolitan areas, and identified as white. Approximately 40% of visits were from ZIP codes with a median household income less than $48,000 annually. Relative to all other ED visits, patients with HT as an external cause of morbidity had higher odds of being female (OR = 6.54, 95% CI:3.59, 11.92) and being a minor (OR = 1.76, 95% CI:1.02, 3.04). CONCLUSION: HT was rarely documented as an external cause of morbidity in 989 hospitals' ED visits from a nationally representative sample in 2019. Documentation of recently added HT ICD-10-CM codes does not appear to have been implemented sufficiently to yield an unbiased representation of those who experienced HT and presented in the ED. Efforts to enhance the utility of ICD-10-CM HT codes for surveillance and documentation must first address ED personnel training on identification and response to HT. In doing so, ED personnel also need to address ethical concerns (e.g. stigma, confidentiality, risk of patient harm) and allow for informed consent among trafficked patients in order to be scaled up responsibly.

A multi- and mixed-method adaptation study of a patient-centered perioperative mental health intervention bundle.

BACKGROUND: Anxiety and depression are common among older adults and can intensify during perioperative periods, but few mental health interventions are designed for older surgical patients' unique needs. As part of the feasibility trial, we developed and adapted a perioperative mental health (PMH) bundle for older patients comprised of behavioral activation (BA) and medication optimization (MO) to ameliorate anxiety and depressive symptoms before, during, and after cardiac, orthopedic, and oncologic surgery. METHODS: We used mixed-methods including workshop studios with patients, caregivers, clinicians, researchers, and interventionists; intervention refinement and reflection meetings; patient case review meetings; intervention session audio-recordings and documentation forms; and patient and caregiver semi-structured interviews. We used the results to refine our PMH bundle. We used multiple analytical approaches to report the nature of adaptations, including hybrid thematic analysis and content analysis informed by the Framework for Reporting Adaptations and Modifications - Expanded. RESULTS: Adaptations were categorized by content (intervention components), context (how the intervention is delivered, based on the study, target population, intervention format, intervention delivery mode, study setting, study personnel), training, and evaluation. Of 51 adaptations, 43.1% involved content, 41.2% involved context, and 15.7% involved training and evaluation. Several key adaptations were noted: (1) Intervention content was tailored to patient preferences and needs (e.g., rewording elements to prevent stigmatization of mental health needs; adjusting BA techniques and documentation forms to improve patient buy-in and motivation). (2) Cohort-specific adaptations were recommended based on differing patient needs. (3) Compassion was identified by patients as the most important element. CONCLUSIONS: We identified evidence-based mental health intervention components from other settings and adapted them to the perioperative setting for older adults. Informed by mixed-methods, we created an innovative and pragmatic patient-centered intervention bundle that is acceptable, feasible, and responsive to the needs of older surgical populations. This approach allowed us to identify implementation strategies to improve the reach, scalability, and sustainability of our bundle, and can guide future patient-centered intervention adaptations. CLINICAL TRIALS REGISTRATION: NCT05110690 (11/08/2021).

Effects of Persistent Exposure to COVID-19 on Mental Health Outcomes Among Trainees: a Longitudinal Survey Study.

BACKGROUND: The rapid spread of the coronavirus disease 2019 (COVID-19) has created considerable strain on the physical and mental health of healthcare workers around the world. The effects have been acute for physician trainees-a unique group functioning simultaneously as learners and care providers with limited autonomy. OBJECTIVE: To investigate the longitudinal effects of physician trainee exposure to patients being tested for COVID-19 on stress, anxiety, depression, and burnout using three surveys conducted during the early phase of the pandemic. DESIGN: Longitudinal survey study. PARTICIPANTS: All physician trainees (N = 1375) at an academic medical center. MAIN MEASURE: Assess the relationship between repeated exposure to patients being tested for COVID-19 and stress, anxiety, depression, and burnout. KEY RESULTS: Three hundred eighty-nine trainees completed the baseline survey (28.3%). Of these, 191 and 136 completed the ensuing surveys. Mean stress, anxiety, and burnout decreased by 21% (95% confidence interval (CI): - 28 to - 12%; P < 0.001), 25% (95% CI: - 36 to - 11%; P < 0.001), and 13% (95% CI: - 18 to - 7%; P < 0.001), respectively, per survey. However, for each survey time point, there was mean increase in stress, anxiety, and burnout per additional exposure: stress [24% (95% CI: + 12 to + 38%; P < 0.001)], anxiety [22% (95% CI: + 2 to + 46%; P = 0.026)], and burnout [18% (95% CI: + 10 to + 28%; P < 0.001)]. For depression, the association between exposure was strongest for the third survey, where mean depression scores increased by 33% per additional exposure (95% CI: + 18 to + 50%; P < 0.001). CONCLUSIONS: Training programs should adapt to address the detrimental effects of the "pileup" of distress associated with persistent exposure through adaptive programs that allow flexibility for time off and recovery.

Ascertaining Design and Implementation Requirements for a Perioperative Neurocognitive Training Intervention for the Prevention of Persistent Pain After Surgery.

BACKGROUND: Persistent postsurgical pain (PPSP) is a common complication that impacts quality of life, often necessitating long-term opioid treatment. Certain neurocognitive factors, including reduced performance on cognitive flexibility tasks, are associated with increased risk of PPSP. We examine the perceptions of surgical patients and clinicians with regard to perioperative pain management activities and needs; patient acceptance and use of a perioperative neurocognitive training intervention; and implementation feasibility. METHODS: We conducted both individual and focus group interviews with patients undergoing thoracic surgery and clinicians in an academic medical center. The Consolidated Framework for Intervention Research guided the development of interview questions related to the adoption and implementation of a neurocognitive intervention to mitigate PPSP. A thematic analysis was used to analyze the responses. RESULTS: Forty patients and 15 clinicians participated. Interviews revealed that there is minimal discussion between clinicians and patients about PPSP. Most participants were receptive to a neurocognitive intervention to prevent PPSP, if evidence demonstrating its effectiveness were available. Potential barriers to neurocognitive training program adoption included fatigue, cognitive overload, lack of familiarity with the technology used for delivering the intervention, and immediate postoperative pain and stress. Implementation facilitators would include patient education about the intervention, incentives for its use, and daily reminders. CONCLUSION: The study identified several guiding principles for addressing patients' and clinicians' barriers to effectively implementing a neurocognitive training intervention to mitigate PPSP after surgery. To ensure the sustainability of neurocognitive interventions for preventing PPSP, such interventions would need to be adapted to meet patients' and clinicians' needs within the perioperative context.

Prevalence and correlates of antisocial personality disorder in older adults.

OBJECTIVES: There is a paucity of research on antisocial personality disorder (ASPD) in the geriatric population and the majority of knowledge on the disorder is drawn from young adult samples. Researchers posit that the prevalence of ASPD as well as other personality disorders (PDs) is underestimated among older adults. Using a nationally representative sample, the present study examines the prevalence and correlates of ASPD in adults ages 50 and older. METHODS: We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions Waves I and III. Multivariate logistic regression analyses were employed to investigate associations between ASPD and sociodemographic characteristics. A series of logistic regression analyses were also conducted to study associations between ASPD and medical conditions (liver and cardiovascular disease, arthritis, and stomach ulcer), major psychiatric disorders (lifetime major depressive disorder, mania, and generalized anxiety disorder), and substance use disorders (lifetime alcohol, marijuana, cocaine, heroin, and nicotine use disorders). RESULTS: Findings indicated that the prevalence of ASPD increases through early adulthood, with a peak at 3.91% in younger adults and decline to 0.78% in adults ages ≥65. Older adults with ASPD are more likely to be diagnosed with a substance use disorder, major depression, mania, and generalized anxiety disorder as well as each medical condition. CONCLUSION: Older adults with ASPD experience increased rates of medical and psychiatric comorbidities. These conditions exacerbate the existing challenges associated with diagnosing and treating this population and may have serious consequences for the patient, their caregivers and society.

Surgical Complications in Older Adults Predict Decline in Self-Perceived Cognitive Function in the Ensuing Year: A Cohort Study.

BACKGROUND: Surgical complications are common among older adults and are potential indicators of poorer long-term outcomes. The authors examined the effects of in-hospital complications on changes in older adults' self-perceived cognitive function in the year after surgery. METHOD: The authors conducted a prospective longitudinal study with 2,155 older adults (age ≥ 65) undergoing surgery, investigating the association between self-reported, in-hospital complications after surgery and Patient-Reported Outcomes Measurement Information System Applied Cognition-Abilities survey (4 items, cognitive function) at 30 days and 1 year after surgery. Surveys were scored on a continuous scale of 0-100, with higher scores representing better self-perceived cognitive functioning. Patient characteristics including demographics, type of complications, surgery type, pain, and activities of daily living were also collected. RESULTS: Having one in-hospital complication was associated with a decrease of 1.79 points (95% confidence interval (CI): -2.78, -0.80), indicating lower self-perceived cognitive functioning at 1 year after surgery; having two or more in-hospital complications was associated with 2.82 point (95% CI: -4.50, -1.15) decrease at 1 year after surgery. Models specific to complication type indicated that respiratory [-3.04, (95% CI: -5.50, -0.57)], neural [-2.11, (95% CI: -3.97, -0.25)], and general complications [-2.39, (95% CI: -3.51, -1.28)] were associated with statistically significant decreases in cognitive function. DISCUSSION: Older surgical patients who suffer in-hospital complications show greater decline in self-perceived cognitive function during the ensuing year. Geriatric specialists may be able to intervene in the immediate perioperative period to reduce complications and possibly mitigate cognitive decline among older adults.

Homicidal Ideation among Children and Adolescents: Evidence from the 2012-2016 Nationwide Emergency Department Sample.

OBJECTIVE: To assess the prevalence and behavioral, sociodemographic, and psychiatric/psychological correlates of homicidal ideation among a sample of children and adolescents. STUDY DESIGN: We employed descriptive and multivariate logit models of homicidal ideation using data from the 2012-2016 Nationwide Emergency Department Sample from the Healthcare Cost and Utilization Project. This study was conducted with data from emergency departments in the US, and we used a sample of (N = 17 041 346) children and adolescents between the ages of 5 and 17 years. RESULTS: Pediatric homicidal ideation is rare with a prevalence estimate of 0.09%; however, its prevalence increases substantially from age 5 years to age 15 years when it peaks, and then declines through the end of adolescence. Conduct disorders conferred 1483% increased odds, attention deficit hyperactivity disorder conferred 616% increased odds, and other behavioral and emotional disorders increased a 2-fold to nearly 4-fold increased liability for homicidal ideation net the effects of sex, age, urban residence, insurance status, and zip code median household income. CONCLUSION: In the wake of homicide tragedies, it is often the case that numerous behavioral and clinical red flags were present in the developmental history of the perpetrator, but these were overlooked. Identifying children and adolescents who present with homicidal ideation is a crucial pediatric and public health matter that can inform prevention and behavioral interventions that forestall lethal violence.

Child and Adolescent Suicidal Ideation and Suicide Attempts: Evidence from the Healthcare Cost and Utilization Project.

OBJECTIVES: To examine the trends associated with child and adolescent suicidal ideation and suicide attempts and to compare these trends to those among the adult population. STUDY DESIGN: A nationally representative sample of administrative billing data was used for the analysis, which included descriptive statistics, trend data, and logistic regression. RESULTS: There were 874 872 (95% CI, 810 574-939 169) children and adolescents and 5 561 197 (95% CI, 5 271 426-5 850 968) adults admitted to an emergency department who experienced suicidal ideation or suicide attempts between 2010 and 2014, representing 1.20% of admissions for children (95% CI, 1.13-1.37) and adolescents and 1.09% of admissions for adults (95% CI, 1.05-1.13). Children and adolescents were more likely to be female (aOR, 1.74; 95% CI, 1.71-1.78) and to have private insurance (aOR, 1.75; 95% CI, 1.68-1.83) as compared with adults. Although the percentage of admissions increased for adults 25 and older (18.95%) the greatest increases were found among children and adolescents (5-11 years of age, 37.87%; 12-14 years of age, 82.03%; 15-17 years of age, 51.59%; and 18-24 years of age, 26.77%). There is a seasonal trend for children and adolescents such that higher rates are associated with the school year, which is not present for adults. CONCLUSION: Practitioners should be cognizant of the fact that suicidal ideation and suicide attempts for youth present differently than they do for the greater population and they should be vigilant in identifying risk factors, especially during seasons where risk of self-harm increases.

Dog bite injuries in the USA: prevalence, correlates and recent trends.

Dog bite-related injuries are associated with high medical costs. The aim of this study was to estimate the prevalence, correlates and recent trends in dog bite injuries among male and female individuals presenting to US emergency departments. The prevalence of dog bites was calculated for years 2010-2014 using the Nationwide Emergency Department Sample. Sex-stratified multivariate logistic regression analyses were conducted with 'dog bite' as the dependent variable and patient and hospital characteristics as independent variables. Overall, the prevalence of dog bite injuries decreased from 2010 to 2014. The prevalence is highest in this sample among male youth. Male individuals diagnosed with an externalising behaviour disorder were more likely to present with a dog bite (OR=1.21, 95% CI 1.27 to 1.30). While the prevalence of dog bites has decreased in recent years, this costly and largely preventable injury remains a concern, especially among youth.

Posttraumatic Stress Disorder Among Low-Income Adolescents Experiencing Family-Neighborhood Income Disparities.

Certain neighborhood factors may increase the risk of exposure to trauma, therefore increasing the risk of posttraumatic stress disorder (PTSD). Other aspects of neighborhoods can be protective, such as neighborhood-based social relationships, which provide social support that buffers the risk of developing PTSD. The strength of these social relationships may not be as dependent on neighborhood conditions as much as they are contingent on socioeconomic similarities between neighborhood residents. Using a nationally representative sample of hospital emergency department admissions in the United States (N = 13,669,251), this study hypothesized that an interaction between family-level income and neighborhood-level income would be associated with adolescent PTSD. The results show that female adolescents who resided in the highest income areas were 1.39 times more likely, 95% CI [1.09, 1.77], to be diagnosed with PTSD than those who lived in the lowest income areas. This association was not statistically significant for male adolescents. Additionally, low-income female youth were nearly one-third more likely than their non-low-income counterparts to be diagnosed, odds ratio (OR) = 1.29, 95% CI [1.12, 1.48], whereas low-income male youth were nearly twice as likely than their non-low-income counterparts to be diagnosed, OR = 1.95, 95% CI [1.62, 2.34]. Furthermore, there was an interaction among both male and female adolescents such that lower-income adolescents living in higher-income areas had higher odds of a PTSD diagnosis compared to their higher-income peers in areas that were in the same median household income quartile.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Trastorno de Estrés Postraumático entre Adolescentes de Bajos Ingresos que Experimentan Disparidades de Ingresos en el Vecindario Familiar FACTORES DEL VECINDARIO Y TEPT EN ADOLESCENTES Ciertos factores del vecindario pueden incrementar el riesgo de exposición al trauma, por tanto, incrementan el riesgo de trastorno de estrés postraumático (TEPT). Otros aspectos del vecindario pueden ser protectores, como las relaciones sociales basadas en la vecindad, lo que provee apoyo social que amortigua el riesgo de desarrollar TEPT. La fuerza de estas relaciones sociales puede no depender tanto de las condiciones del vecindario como depender de las similitudes socioeconómicas entre los residentes del vecindario. Usando una muestra representativa a nivel nacional del departamento de admisiones del hospital de emergencia en los Estados Unidos (N = 13,669,251), este estudio hipotetizó que la interacción entre el nivel de ingreso familiar y el nivel de ingreso del vecindario estaría asociada con el TEPT en adolescentes. Los resultados muestran que adolescentes femeninas que residían en áreas con niveles de ingreso más altos tenian 1.39 veces más probabilidad, 95% IC [1.09-1.77] de ser diagnosticadas con TEPT de las que vivían en áreas con un nivel socioeconómico más bajo. Esta asociación no fue estadísticamente significativa para adolescentes masculinos. Adicionalmente, el nivel de ingreso bajo en jóvenes femeninas tuvo casi un tercio más de probabilidades de ser diagnosticadas que sus contrapartes de ingresos no bajos, odds ratio (OR) = 1.29, IC 95% [1.12, 1.48], mientras que los jóvenes varones de bajos ingresos tenían casi el doble de probabilidades de ser diagnosticados que sus contrapartes que no tenían ingresos bajos, OR = 1.95, 95% IC [1.62, 2.34]. Además, hubo una interacción entre los adolescentes masculinos y femeninos, de tal manera que los adolescentes de bajos ingresos que viven en áreas de mayores ingresos tenían mayores probabilidades de un diagnóstico de TEPT en comparación con sus pares de mayores ingresos en áreas que tenían el mismo ingreso medio familiar.

Physical health-related quality of life among older adults with personality disorders.

Objectives: Personality Disorders (PDs) are associated with a multitude of negative consequences. The negative PD effects on health can be even more burdensome for older adults given the physical and social functioning changes that occur with age; however, the majority of research examining the influence of PDs focuses on younger adults. The present study seeks to investigate the relationship between PDs and physical health-related quality of life (PHRQoL) in adults over the age of 50. Methods: Data for 16,884 adults ages 50 and older from the 2001-2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) were analyzed. Multiple linear regression models were analyzed to investigate the relationships of seven PDs and participants' PHRQoL. Results: All PDs except histrionic and avoidant PD had statistically significant negative associations with PHRQoL scores, indicating that respondents diagnosed with PDs were expected to have lower PHRQoL than those without PDs, after controlling for sociodemographic characteristics. When psychosocial covariates were added to the model, only dependent, obsessive-compulsive and paranoid PDs were significantly related to PHRQoL score. Conclusions: For adults ages 50 and older, a diagnosis of PD was weakly associated with lower PHRQoL scores for three PDs, however this is unlikely to be a causal association. The strength of the relationship between PDs and PHRQoL varies by type of PD. Given the higher rates of functional and social changes that occur with age, future research should focus on potential causes of worse physical health among older adults with PDs.

Arthropod Bites and Stings Treated in Emergency Departments: Recent Trends and Correlates.

INTRODUCTION: Despite increasing health effects of arthropod bites and associated costs, research on their frequency is limited, especially at the population level. The aim of this study was to estimate the prevalence, correlates, and recent trends in visits to US emergency departments related to arthropod bites and stings. METHODS: The prevalence of arthropod bites, including information regarding location of the bite, was calculated for years 2010 through 2014 using data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Sex- and age-stratified multivariate logistic regression analyses were conducted with "arthropod bite" as the dependent variable and patient and hospital characteristics as independent variables. RESULTS: Overall, there were significant increases in bites over the study period with higher rates of bites in the summer months (June-August), especially among children. Individuals who seek treatment for arthropod bites in the emergency department are more likely to reside in zip codes with lower median household income and to be without insurance coverage or with Medicaid rather than private insurance. The cost of care related to arthropod bites increased approximately 40% over the study period. CONCLUSIONS: These results provide updated surveillance on the prevalence and correlates of arthropod bites and stings in the US population.

Traumatic Brain Injury and Psychiatric Co-Morbidity in the United States.

The objective of the present study was to provide a nationally representative psychiatric epidemiologic investigation of traumatic brain injury (TBI) and its co-morbid conditions. Data from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC-III) collected between 2012 and 2013 was used. Results indicated that TBI was significantly associated with any lifetime mental health (AOR = 2.32, 95% CI = 1.65-3.70), substance use disorder (AOR = 1.57-1.01-2.42), and violent (AOR = 1.65, 95% CI = 1.03-2.65) and nonviolent (AOR = 1.84, 95% CI = 1.25-2.70) criminal behaviors. In our study, TBI was highly comorbid with psychiatric disorders and especially antisocial behaviors, both violent and non-violent.

Gender differences in the trends and correlates of major depressive episodes among juvenile offenders in the United States.

PURPOSE: Although it is well-established that juvenile offenders are at an elevated risk for depression and that, within this group, females have the highest risk, little is known regarding the trends in the prevalence of depression among juvenile offenders in the United States. In the present study, we systematically examine secular trends in major depressive episodes (MDE) and their correlates among male and female juvenile offenders and non-offenders in the United States. METHODS: Data were collected between 2005 and 2014 as part of the National Survey on Drug Use and Health (NSDUH). The NSDUH uses multistage area probability sampling methods to select a representative sample of the civilian, non-institutionalized population in the United States. Participants included 171,118 youth aged 12-17 (159,449 non-offenders and 11,669 offenders). The primary variable of interest was self-reported past year MDE. Logistic regression assessed whether sociodemographic factors and psychosocial and behavioral correlates affected the risk of MDE. RESULTS: Between 2005 and 2014, the prevalence of MDE among female youth increased for both offender and non-offender groups: from 24.4% to 33.0% for the offenders and from 12.4% to 16.7% for the non-offenders. No significant trend changes were observed among male youth. In both male and female juvenile offenders, MDEs were associated with increased risk of illicit drug use (males OR=1.61, 95% CI=1.18-2.18; females OR=1.83, 95% CI=1.45-2.31). Additional correlates include alcohol use among male offenders (OR=1.36, 95% CI=1.01-1.83), and binge drinking in female offenders (OR=1.24, 95% CI=1.02-1.49). CONCLUSIONS: The prevalence of past year major depressive episodes is increasing for female juvenile offenders, highlighting a need for improved efforts to target these populations for prevention and treatment.

Use of self-reported psychopathy assessments with older adults: An update on evaluation of their psychometrics for people over 60 years.

BACKGROUND: Psychometric properties of self-report psychopathy scales have generally been established in samples of people under the age of 40. Personality traits are, however, likely to persist into old age, so it is important to understand the performance of user-friendly self-report psychopathy measures among older people. AIMS: The aims of this study were to find out the extent to which self-reported scales developed for rating psychopathy have been used with people of 60 years or older and the extent of any evidence that the psychometric properties of the scales vary with age. METHODS: A systematic literature review, with searching limited to PubMed, EBSCOhost, and Google Scholar for the years 1990-2017, of studies of the psychometric properties of five prominent self-report psychopathy scales: the Self-Report Psychopathy Scale, Levenson Self-Report Psychopathy Scale, Psychopathic Personality Inventory, Triarchic Psychopathy Measure, and the Elemental Psychopathy Assessment according to age of participants. RESULTS: Fourteen studies were found for the years 1990-2017. Age ranges in these samples are wide, with a typical mean age of approximately 30 years. None of these studies focused solely on adults of 60 years or older or attempted to isolate findings by specific age group. CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH: Studies of the use of self-rated psychopathy tools remain inconclusive about their psychometrics in older people. Further investigations should follow three main paths: first, deriving samples solely of older adults from the general population-to improve the generalisability of their results; second, item response theory methods should be used to detect differential item functioning between younger and older adults; finally, modifications of extant measures with and without items with potential age-bias should be tested.

Antisocial Personality Disorder in Older Adults: A Critical Review.

Antisocial personality disorder (ASPD) has enormous negative impacts on the affected individuals, their loved ones, and society. This burden is intensified by the social and functional changes related to age. The lower prevalence of ASPD in older adults compared to younger adults is well-documented. This discrepancy, often attributed solely to antisocial "burnout," contributes to the lack of attention given to this disorder in older adults and may signify difficulty measuring ASPD in this population. These measurement issues likely stem from problems with the validity of the diagnostic criteria for older adults which may not effectively capture changes that occur with age. This review focuses on the current literature surrounding the validity of ASPD criteria with older adults and relevant concepts, including the connection between criminality and ASPD. Issues with screening tools and the measurement of ASPD caused by problems with the criteria are also discussed. Finally, recommendations for improvement, including use of dimensional models of personality disorders, a potential geriatric subclassification of criteria, and modification of the existing criteria are presented with clinical implications and suggestions for future research.