Predicting psychosocial risk in pediatric kidney transplantation: An exploratory cluster analysis of a revised Pediatric Transplant Rating Instrument.

BACKGROUND: The Pediatric Transplant Rating Instrument (P-TRI) is a 17-item scale developed to assess psychosocial risk factors for poor outcomes after solid organ transplantation. Research has identified the limitations of the original instrument and proposed revisions to improve clinical utility. This project examined patterns of risk in children being evaluated for kidney transplant using a revised P-TRI. METHODS: A multidisciplinary kidney transplant team revised the P-TRI. A social worker and a psychologist collaboratively completed the modified instrument for 37 children after the psychosocial pretransplant evaluation. Electronic medical records were reviewed for transplant status (transplanted, active waitlist, inactive) 1 year later. Exploratory cluster analyses and chi-square tests examined patterns of risk and correlates with cluster membership. RESULTS: Three clusters were identified. The high-risk group (29.7%) had difficulties with medication and appointment adherence, strained relationships with the medical team, and the presence of parent psychiatric history. The medium-risk group (35.1%) had difficulties with parent knowledge, financial strain, and risk factors for medication nonadherence. The low-risk group (35.1%) demonstrated no difficulties with adherence or financial strain. Clusters were prospectively associated with transplant status, such that those in the high-risk group were less likely to be transplanted within 1 year post-evaluation. CONCLUSIONS: The revised P-TRI demonstrated good construct validity as risk level appeared to be associated with transplant listing status 1 year post-evaluation. These results suggest that standardized pretransplant psychosocial risk assessment tools may have value in optimizing transplant access if they can be paired with targeted, multidisciplinary interventions to address concerns early in the transplant process.

A systematic review of social determinants of health in pediatric organ transplant outcomes.

BACKGROUND: Equitable access to pediatric organ transplantation is critical, although risk factors negatively impacting pre- and post-transplant outcomes remain. No synthesis of the literature on SDoH within the pediatric organ transplant population has been conducted; thus, the current systematic review summarizes findings to date assessing SDoH in the evaluation, listing, and post-transplant periods. METHODS: Literature searches were conducted in Web of Science, Embase, PubMed, and Cumulative Index to Nursing and Allied Health Literature databases. RESULTS: Ninety-three studies were included based on pre-established criteria and were reviewed for main findings and study quality. Findings consistently demonstrated disparities in key transplant outcomes based on racial or ethnic identity, including timing and likelihood of transplant, and rates of rejection, graft failure, and mortality. Although less frequently assessed, variations in outcomes based on geography were also noted, while findings related to insurance or SES were inconsistent. CONCLUSION: This review underscores the persistence of SDoH and disparity in equitable transplant outcomes and discusses the importance of individual and systems-level change to reduce such disparities.

Predictors of latent class trajectories of depressive symptoms in Latina mothers.

Guided by the Family Stress Model (FSM) for minority families, the present study examined culture-specific (i.e., stress responses to anti-immigration actions and news, home-school dissonance) and general (i.e., financial strain, social support) risk and promotive factors as longitudinal predictors of Latina mothers' depressive symptom trajectories. Participants included 271 Latina mothers of early adolescents living in a new immigrant area in the southeast part of the United States, followed prospectively across four time points spanning 2 years. Mothers reported on their depressive symptoms at all four time points; risk and promotive factors were measured at Time 1 (T1). Latent class growth curve models identified three classes of mothers based on their depressive symptom trajectories. Roughly half of mothers reported low and decreasing symptoms, a third indicated moderate and increasing symptoms, and 10% displayed high and increasing symptoms. As expected, higher levels of stress responses to anti-immigration actions and news, home-school dissonance, and financial strain predicted membership in increasing symptom classes, whereas higher social support predicted membership in the decreasing symptom class. By adapting prevention and intervention efforts to the unique cultural and social contexts experienced by Latina mothers in new immigrant areas, practitioners may be better able to protect this segment of the population from experiencing depressive symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The role of executive functioning, healthcare management, and self-efficacy in college students' health-related quality of life.

Objective: Examine how executive functioning (EF), healthcare management, and self-efficacy relate to college students' health-related quality of life (HRQOL). Participants: Undergraduates completed questionnaires at baseline (Time 1; n = 387) and 18-24 months later (Time 2; n = 102). Methods: Participants reported on their EF and healthcare management skills at Time 1 and self-efficacy and mental and physical HRQOL at Time 2. Results: Students with fewer EF problems reported higher mental and physical HRQOL at both timepoints and those with higher healthcare management skills had higher mental and physical HRQOL at Time 1. Higher self-efficacy mediated the relation between EF and mental HRQOL, and the relation between healthcare management and mental HRQOL. Conclusions: Findings illustrate two potential pathways by which self-management, in healthcare settings or daily living, contributes to mental HRQOL during emerging adulthood. Assessing EF and healthcare management could help identify those at risk of low HRQOL and provide information that can inform interventions in college settings.

Predictors of Latent Class Trajectories of Internalizing Symptoms in Latinx Adolescents.

Guided by ecodevelopmental theories, the present study examined how both culture-specific and general risk and protective factors across contexts predicted trajectories of Latinx youth's internalizing symptoms during early and middle adolescence. Participants included 547 Latinx youth (M age = 12.80; 55% females) recruited in middle school and followed prospectively across four time points spanning two years. Youth reported on their internalizing symptoms at all four time points, and risk and protective factors were measured at Time 1 (T1). Latent class growth curve modeling was used to examine heterogenous trajectories of change in internalizing symptoms separately for females and males, and risk and protective factors were examined as predictors of class membership. Three classes based on symptom trajectories emerged for both females and males, with most adolescents falling into classes characterized by low symptoms that remained stable or decreased over time. Risk and protective factors were predictive of class membership in theoretically meaningful ways. Some predictors of internalizing symptom trajectories differed between females and males. Findings inform our understanding of factors that influence developmental trajectories in Latinx youth and can contribute to the refinement of prevention and intervention efforts to help ensure the well-being of this population.

Preschoolers' dynamic respiratory sinus arrhythmia (RSA) change during a challenging parent-child interactive task: Relations with preschoolers' socioemotional health.

Respiratory sinus arrhythmia (RSA) is a biomarker of physiological functioning that has been implicated in self-regulatory processes and shown to relate to children's socioemotional health. RSA is a dynamic process reflecting an individual's response to their environment; thus, temporally sensitive methods are critical to better understanding this self-regulatory process in different contexts. Prior work has studied young children's RSA change in the context of emotion clips and interactions with a stranger. The present study meaningfully expanded upon this work by examining: (a) preschoolers' dynamic RSA change during a challenging task with their mothers, and (b) factors that may explain variability in children's dynamic RSA change. Preschoolers (N = 108; Mage  = 3.56 years) and their mothers from diverse backgrounds completed a challenging activity together while children's physiological activity was monitored. Mothers reported on children's positive affect, parent emotional support, and family cohesion and indicators of socioemotional health. Children's positive affect and family cohesion explained variability in children's dynamic RSA change, which concurrently related to better socioemotional health. This study advances research and theory on biological correlates implicated in the development of children's self-regulation and furthers our understanding of factors that may support children's developing self-regulation at the physiological level.

Synchrony of Respiratory Sinus Arrhythmia in Parents and Children with Autism Spectrum Disorder: Moderation by Interaction Quality and Child Behavior Problems.

Parent-child physiological synchrony, the matching of physiological states between parents and children, is theorized to be important for typically developing (TD) children, but less is known about this process in families of children with autism spectrum disorder (ASD). In a sample of 29 children (M age = 8.00 years, SD = 1.51 years) with ASD and 39 TD-matched children (M age = 7.32 years, SD = 1.36 years) and their primary caregivers (n = 68), we examined whether parent-child dyads showed physiological synchrony indexed by respiratory sinus arrhythmia (RSA) during an interaction, and whether RSA synchrony differed by parent-child interaction quality and child behavior problems. Results indicated that dyads with TD children showed stronger positive RSA synchrony than dyads with children with ASD. Furthermore, for families of children with ASD, RSA synchrony was stronger in families with higher interaction quality and fewer child internalizing problems. These results provide preliminary evidence of parent-child RSA synchrony in families of children with ASD and identify factors that may influence this physiological process. Implications of these findings for social and emotional development in children with ASD are discussed. LAY SUMMARY: Parents and children can get "in tune" with one another at the biological level - a process called physiological synchrony. We studied physiological synchrony in families of children with autism spectrum disorder (ASD) in comparison to same-aged children who had no mental health disorders. We also examined how physiological synchrony might be associated with parent-child interaction quality and child behavior problems. We found that families with a child with ASD showed weaker physiological synchrony than families with a child who was typically developing. Further, we found that physiological synchrony was stronger when parents and children with ASD showed higher interaction quality and when children with ASD had lower internalizing problems. These findings contribute to our understanding of family functioning in the context of ASD and have potential implications for future work.

Maternal depression and preadolescent symptoms: An examination of dyad-level moderators in an economically impoverished sample.

This cross-sectional study examined behavioral and physiological indicators of the parent-child relationship as moderators of the link between maternal depressive and child psychopathology symptoms. Ninety-seven mothers (M age = 35.38 years) and their 9- to 12-year-old children (M age = 10.32 years, 53.7% girls, 78.1% African American) from economically impoverished backgrounds participated. Mothers reported on their own depressive symptoms using the Beck Depression Inventory-2 (BDI-2) and their child's emotional and behavioral problems using the Child Behavior Checklist (CBCL). Physiological activity (i.e., respiratory sinus arrhythmia) of both mother and child was collected during a dyadic conflict discussion task, and interactions were coded independently for mother and child positivity, negativity, and engagement. Physiological synchrony was computed using multilevel modeling, and dyad-level behavioral indicators (i.e., dyadic positivity, negativity, and engagement) were created by averaging individual mother and child behavioral codes. Moderation analyses indicated that the link between mother and child symptoms was exacerbated for dyads who displayed low levels of positivity and low levels of engagement, as well as in the context of positive physiological synchrony. In contrast, high levels of positivity and engagement and negative physiological synchrony buffered the link between symptoms. Findings have implications for conceptual models of intergenerational risk for psychopathology and for clinical prevention and intervention efforts that target the parent-child relationship. (PsycInfo Database Record (c) 2020 APA, all rights reserved).