Impact of a Genetic Diagnosis for a Child's Autism on Parental Perceptions.

Genetic testing is recommended as part of an autism assessment, and most parents support genetic testing for their minor children. However, the impact on parents of receiving a monogenetic/ copy number variant diagnosis for autism in their child is not well understood. To explore this, we surveyed and interviewed parents of children in the SPARK study, a study of autism that includes genetic testing. Surveys were administered one month before and one and 12 months after parents received their child's genetic result. Interviews were conducted approximately one month after results disclosure. A genetic diagnosis (GD) for their child appeared to reduce parents' sense of self-blame and feelings of guilt, and this impact was relatively stable. The data also indicate a modest impact on parents' actions related to the condition, perceptions of themselves, and some aspects of life planning for their child, as measured by quantitative instruments at one month and 12 months after receipt of results. Other measures of parental identity and expectations for their child, in contrast, showed little change following receipt of genetic findings. Overall, parents who were told that no GD was identified showed minimal changes in their responses over time. These results suggest a discernable but relatively limited impact of genetic test results on parents of children with autism. These results should be reassuring to clinicians caring for children with autism and are consistent with studies in other areas of medicine that have suggested that genetic results tend to have fewer effects-negative or positive-than were anticipated.

Effects of age on the relationship between sleep quality and cognitive performance: Findings from the Human Connectome Project-Aging cohort.

BACKGROUND: The association between sleep quality and cognition is widely established, but the role of aging in this relationship is largely unknown. OBJECTIVE: To examine how age impacts the sleep-cognition relationship and determine whether there are sensitive ranges when the relationship between sleep and cognition is modified. This investigation could help identify individuals at risk for sleep-related cognitive impairment. SUBJECTS: Sample included 711 individuals (ages 36.00-89.8359.66 ± 14.9155.7 % female) from the Human Connectome Project-Aging (HCP-A). METHODS: The association between sleep quality (Pittsburgh Sleep Quality Index, PSQI) and cognition (Crystallized Cognition Composite and Fluid Cognition Composite from the NIH Toolbox, the Trail Making Test, TMT, and the Rey Auditory Verbal Learning Test, RAVLT) was measured using linear regression models, with sex, race, use of sleep medication, hypertension, and years of education as covariates. The interaction between sleep and age on cognition was tested using the moderation analysis, with age as both continuous linear and nonlinear (quadratic) terms. RESULTS: There was a significant interaction term between the PSQI and nonlinear age term (age2) on TMT-B (p = 0.02) and NIH Toolbox crystallized cognition (p = 0.02), indicating that poor sleep quality was associated with worse performance on these measures (sensitive age ranges 50-75 years for TMT-B and 66-70 years for crystallized cognition). CONCLUSIONS: The sleep-cognition relationship may be modified by age. Individuals in the middle age to early older adulthood age band may be most vulnerable to sleep-related cognitive impairment.

Investigating the Associations of Sexual Minority Stressors and Incident Hypertension in a Community Sample of Sexual Minority Adults.

BACKGROUND: Sexual minority adults are at higher risk of hypertension than their heterosexual counterparts. Sexual minority stressors (i.e., unique stressors attributed to sexual minority identity) are associated with a variety of poor mental and physical health outcomes. Previous research has not tested associations between sexual minority stressors and incident hypertension among sexual minority adults. PURPOSE: To examine the associations between sexual minority stressors and incident hypertension among sexual minority adults assigned female sex at birth. METHODS: Using data from a longitudinal study, we examined associations between three sexual minority stressors and self-reported hypertension. We ran multiple logistic regression models to estimate the associations between sexual minority stressors and hypertension. We conducted exploratory analyses to determine whether these associations differed by race/ethnicity and sexual identity (e.g., lesbian/gay vs. bisexual). RESULTS: The sample included 380 adults, mean age 38.4 (± 12.81) years. Approximately 54.5% were people of color and 93.9% were female-identified. Mean follow-up was 7.0 (± 0.6) years; during which 12.4% were diagnosed with hypertension. We found that a 1-standard deviation increase in internalized homophobia was associated with higher odds of developing hypertension (AOR 1.48, 95% Cl: 1.06-2.07). Stigma consciousness (AOR 0.85, 95% CI: 0.56-1.26) and experiences of discrimination (AOR 1.07, 95% CI: 0.72-1.52) were not associated with hypertension. The associations of sexual minority stressors with hypertension did not differ by race/ethnicity or sexual identity. CONCLUSIONS: This is the first study to examine the associations between sexual minority stressors and incident hypertension in sexual minority adults. Implications for future studies are highlighted.

High blood pressure (HBP) is a major public health concern in the USA. Sexual minority adults (such as gay/lesbian or bisexual) are at greater risk of HBP than heterosexual adults. However, the reasons for this difference have not been studied. Sexual minority stressors are unique stressors specific to sexual minority individuals. Multiple studies have shown that sexual minority stressors, such as internalized homophobia (defined as someone's internalization of negative societal values towards sexual minority individuals), stigma consciousness (defined as the extent that someone expects to be stereotyped), and experiences of discrimination due to sexual identity, are associated with poor health outcomes. Yet, the relationship between these stressors and HBP has not been studied in this population. In our study, we examined the associations between sexual minority stressors and newly diagnosed HBP among sexual minority adults. Those who reported more internalized homophobia had a higher likelihood of developing HBP within 7 years. There were no significant associations between other sexual minority stressors and HBP. We also found no differences in the associations of sexual minority stressors and HBP by race/ethnicity or sexual identity. Findings highlight the importance of educating healthcare professionals about risk factors for hypertension in sexual minority adults.

Hope for the future protects against suicidal ideation among adolescents and young adults affected by perinatal HIV.

Hope for the future has been found protective against suicidal ideation (SI) in adolescents and young adults (AYA) yet has not been examined in AYA with perinatal HIV-infection (PHIV) or AYA who were perinatally HIV-exposed but uninfected (PHEU), who are at higher risk for SI than general populations. Using data from a New York City-based longitudinal study of AYAPHIV and AYAPHEU enrolled when 9-16 years old, we examined associations between hope for the future, psychiatric disorders, and SI over time using validated measures. Generalized estimating equations were used to estimate differences in mean hope for the future scores by PHIV-status and to estimate adjusted odds ratios for associations between hope for the future and SI. AYA reported high hope for the future scores and low SI across visits, irrespective of PHIV-status. Higher hope for the future scores were associated with lower odds of SI (AOR = 0.48, 95% CI: 0.23, 0.996). Mood disorder was associated with increased odds of SI (AOR = 13.57, 95% CI: 5.11, 36.05) in a model including age, sex, follow-up, PHIV-status, mood disorder, and hope for the future. Understanding how hope can be cultivated and how it protects against SI can help to inform preventive interventions for HIV-affected AYA.

Following Insufficiently Active Adolescents: What Predicts Whether They Meet Adult Activity Guidelines When They Grow Up?

BACKGROUND: We investigated the percentage of insufficiently active adolescents who became young adults meeting moderate to vigorous physical activity (MVPA) guidelines. We also explored adolescent psychosocial and environmental factors that predicted MVPA guideline adherence in young adulthood. METHODS: Participants included N = 1001 adolescents (mean age = 14.1 y) reporting < 7 hours per week of MVPA and followed (8 y later) into young adulthood through Project EAT. We examined mean weekly hours of MVPA, MVPA change between adolescence and young adulthood, and the proportion of participants meeting MVPA guidelines in young adulthood. With sex-stratified logistic regression, we tested 11 adolescent psychosocial and environmental factors predicting meeting MVPA guidelines in young adulthood. RESULTS: Overall, 55% of insufficiently active adolescents became young adults meeting MVPA guidelines. On average, participants reported 3.0 hours per week of MVPA, which improved to 3.8 hours per week in young adulthood. Among female participants, higher MVPA in adolescence and stronger feelings of exercise compulsion predicted greater odds of meeting adult MVPA guidelines (odds ratioMVPA = 1.18; odds ratiocompulsion = 1.13). Among female and male participants, perceived friend support for activity in adolescence predicted greater odds of meeting adult MVPA guidelines (odds ratiofemale = 1.12; odds ratiomale = 1.26). CONCLUSIONS: Insufficiently active adolescents can later meet adult guidelines. Interventions that increase perceived friend support for activity may benefit individuals across development.

HIV and suicide risk across adolescence and young adulthood: an examination of socio-demographic, contextual and psychosocial risk factors for attempted suicide in a longitudinal cohort of ageing adolescents affected by HIV living in the New York City Area.

INTRODUCTION: As children become adolescents and young adults (AYA), their risk for attempting suicide increases dramatically, with chronic health conditions an important risk factor. This study examined correlates of suicidality across development in AYA living with perinatally acquired HIV (AYALPHIV) and those perinatally HIV-exposed but uninfected (AYAPHEU). METHODS: Data come from an ongoing longitudinal New York City-based study (N = 339) with AYALPHIV and AYAPHEU interviewed every 12-18 months from 2003 to 2019 (mean enrolment age = 12 years; current mean age = 27 years). The Diagnostic Interview Schedule for Children (adolescent or young adult version) assessed psychiatric disorders and first-reported suicide attempt. Generalized estimating equations were used to examine associations between first-reported suicide attempt and socio-demographic, contextual and psychosocial correlates measured concurrently across six timepoints. RESULTS: At enrolment, 51% of participants were female, 72% heterosexual, 60% Black and 50% Latinx. Attempted suicide was significantly higher among AYALPHIV (27%, CI 21-33%) compared to AYAPHEU (16%, CI 10-22%), with an OR of 1.74 (CI 1.04-2.92) in a model adjusting for age. For AYALPHIV, anxiety (OR 2.66, CI 1.46-4.85), mood (OR 3.62, CI 1.49-8.81) and behaviour disorders (OR 5.05, CI 2.15-11.87) and past-year arrest (OR 3.05, CI 1.26-7.4), negative life events (OR 1.27, CI 1.11-1.46), city stress (OR 2.28, CI 1.46-3.57), pregnancy (OR 2.28, CI 1.08-4.81) and HIV stigma (OR 2.46, CI 1.27-4.75) were associated with increased odds of attempted suicide, while identifying as heterosexual (OR 0.27, CI 0.14-0.52), higher personal (OR 0.45, CI 0.26-0.80) and family self-concept (OR 0.36, CI 0.22-0.57) were protective. Interactions by HIV status and age were found: substance use was more strongly associated with attempted suicide among AYAPHEU than AYALPHIV, while negative life events and higher religiosity were more strongly associated with increased odds of attempted suicide among AYA ≥ 19 versus ≤ 18 years. CONCLUSIONS: AYALPHIV compared to AYAPHEU faced unique risks for attempted suicide as they age into adulthood, with the highest risk among AYALPHIV experiencing HIV stigma or pregnancy and the highest risk among AYAPHEU with substance use. Assessing for suicide risk and correlates with attention to ageing can inform preventive interventions tailored to meet AYALPHIV and AYAPHEU needs.

The Role of Amyloid, Tau, and APOE Genotype on the Relationship Between Informant-Reported Sleep Disturbance and Alzheimer's Disease Risks.

BACKGROUND: The association between sleep and Alzheimer's disease (AD) biomarkers are well-established, but little is known about how they interact to change the course of AD. OBJECTIVE: To determine the potential interaction between sleep disturbance and Aß, tau, and APOE4 on brain atrophy and cognitive decline. METHODS: Sample included 351 participants (mean age 72.01 ± 6.67, 50.4%female) who were followed for approximately 5 years as part of the Alzheimer's Disease Neuroimaging Initiative. Informant-reported sleep disturbance (IRSD) was measured using the Neuropsychiatric Inventory (NPI). Changes in magnetic resonance imaging (MRI)-measured AD signature brain regions and cognitive performance and IRSD's interaction with cerebrospinal fluid amyloid-ß (Aß42) and p-Tau depositions and APOE4 status were examined using the linear mixed models. RESULTS: Baseline IRSD was not significantly associated with the rate of atrophy after adjusting for covariates (age, sex, education, total NPI severity score, and sleep medications). However, there was a significant interaction between IRSD and AD biomarkers on faster atrophy rates in multiple brain regions, including the cortical and middle temporal volumes. Post-hoc analyses indicated that Aß and p-Tau/Aß predicted a faster decline in these regions/domains in IRSD, compared with biomarker-negative individuals with IRSD (ps≤0.001). There was a significant IRSD*APOE4 interaction for brain atrophy rate (ps≤0.02) but not for cognition. CONCLUSION: IRSD may increase the future risk of AD by contributing to faster brain atrophy and cognitive decline when combined with the presence of AD biomarkers and APOE4. Early intervention for sleep disturbance could help reduce the risk of developing AD.

Evaluating the Effectiveness of Personalized Medicine With Software.

We present methodological advances in understanding the effectiveness of personalized medicine models and supply easy-to-use open-source software. Personalized medicine involves the systematic use of individual patient characteristics to determine which treatment option is most likely to result in a better average outcome for the patient. Why is personalized medicine not done more in practice? One of many reasons is because practitioners do not have any easy way to holistically evaluate whether their personalization procedure does better than the standard of care, termed improvement. Our software, "Personalized Treatment Evaluator" (the R package PTE), provides inference for improvement out-of-sample in many clinical scenarios. We also extend current methodology by allowing evaluation of improvement in the case where the endpoint is binary or survival. In the software, the practitioner inputs 1) data from a single-stage randomized trial with one continuous, incidence or survival endpoint and 2) an educated guess of a functional form of a model for the endpoint constructed from domain knowledge. The bootstrap is then employed on data unseen during model fitting to provide confidence intervals for the improvement for the average future patient (assuming future patients are similar to the patients in the trial). One may also test against a null scenario where the hypothesized personalization are not more useful than a standard of care. We demonstrate our method's promise on simulated data as well as on data from a randomized comparative trial investigating two treatments for depression.

Yoga practice among ethnically/racially diverse emerging adults: Associations with body image, mindful and disordered eating, and muscle-enhancing behaviors.

BACKGROUND: This study explores cross-sectional associations between yoga and body image, mindful eating, disordered eating, and muscle-enhancing behaviors among a population-based sample of ethnically/racially diverse emerging adults. METHOD: An ethnically/racially diverse population-based sample of 1,568 emerging adults (18-26 years) completed surveys as part of EAT 2010-2018 (Eating and Activity over Time). Models were adjusted for sociodemographic characteristics and body mass index (BMI). RESULTS: Practicing yoga at least 30 min/week was reported by 12.7% (n = 210) of the sample. Yoga practitioners had higher levels of mindful eating than those not practicing yoga. Although effect sizes were small, yoga practitioners were more likely than non-yoga practitioners to use steroids (3.8 vs. 0.7%, p < .001, h = 0.22) or protein powder/shakes (35.1 vs. 25.3%, p < .010, h = 0.21) to increase their muscle size/tone. Body satisfaction, unhealthy weight control behaviors, and binge eating tended to be similar among yoga practitioners and non-yoga practitioners. There was a significant interaction between BMI and yoga in predicting body satisfaction with a trend toward a positive impact among yoga practitioners at higher BMI values. Interactions between yoga practice and all body image attitudes and behaviors across gender and ethnicity/race were not statistically significant. DISCUSSION: Young people from diverse ethnic/racial backgrounds who practice yoga are more likely to engage in mindful eating but have equal or elevated levels of unhealthy body image attitudes and behaviors as compared to non-yoga practitioners. Further research should explore how yoga is best taught and practiced to ensure that it is beneficial for body image and related behaviors.

Nonsuicidal Self-Injury and Suicide: Differences Between Those With and Without Borderline Personality Disorder.

Nonsuicidal self-injury (NSSI) is associated with borderline personality disorder (BPD), but it also occurs in nonclinical samples (Briere & Gil, 1998), inflicting serious harm and serving as a precursor to suicide attempts (Klonsky, May, & Glenn, 2013). Therefore, the DSM-5 proposed a nonsuicidal self-injury disorder (NSSID) and suicidal behavior disorder. Because this addition requires reconciliation with current BPD criteria, the authors' study evaluated type and frequency of NSSI and suicide attempts in 3,795 outpatients. Both were found in those without BPD, although the behaviors increased when some symptoms and full criteria for BPD were met. Wound/skin picking, scratching, and hitting were most common. Cutting was the fifth most common self-injury for those with BPD and the eighth most common for those without the disorder. Therefore, increased clinical attention is warranted for such self-injury, which may go unnoticed but indicate significant distress. Findings suggest that NSSID/suicidal behavior disorder may account for self-injury outside of BPD.

Appraisals of and recommendations for managing intrusive thoughts: An empirical investigation.

The present study investigated strategies for managing intrusive thoughts. Eighty undergraduate students read vignettes of intrusive thoughts - blasphemous, sexual, and violent - which varied in frequency of the thought (high or low) and who experienced the thought (self or other). Appraisal ratings of thoughts were completed and participants completed a response strategy survey where they indicated how much they would endorse various methods for dealing with the thoughts. Some response strategies were theorized to help with intrusive thoughts and some were theorized to be unhelpful. Measures of obsessive-compulsive tendencies were completed to determine relationships between beliefs and appraisals as well as responses to the intrusive thoughts. Results indicated the more distressing a thought was perceived to be, the more likely participants were to recommend unhelpful strategies. Conversely, the less distressing the thought was, the more likely participants were to recommend helpful strategies. Ratings of distress and patterns of responses were related to obsessive-compulsive beliefs as well. Findings are discussed in terms of their relationship to the cognitive behavioral model of OCD, intrusive thoughts, and how future work may serve to educate and reduce stigma related to these common yet distressing experiences.