Maternal Immune activity during pregnancy and socioeconomic disparities in children's self-regulation.

Maternal immune activity during pregnancy has been associated with risk for psychiatric disorders in offspring, but less is known about its implications for children's emotional and behavioral development. This study examined whether concentrations of five cytokines assayed from prenatal serum were associated with socioeconomic status (SES) and racial disparities in their offspring's self-regulation abilities. Participants included 1628 women in the Collaborative Perinatal Project (CPP). Seven behavioral items conceptually related to self-regulation were rated by CPP psychologists when children were 4 years old. Concentrations of interleukin (IL)-1ß, IL-6, IL-8, tumor necrosis factor (TNF)-α, and IL-10 were assessed. Covariates included child sex and mother's age, psychiatric disorders, and medical conditions during pregnancy. There were significant SES differences in child self-regulation, with higher SES children scoring higher on self-regulation (ß = 0.18, 95% CI [0.11, 0.25]), but no racial differences. The concentration of IL-8 in maternal serum was associated with higher child self-regulation, ß = 0.09, 95% CI [0.02, 0.16]. In mediation analyses, variation in maternal IL-8 contributed to the association between family SES and child self-regulation (ß = 0.02, 95% CI [0.003, 0.030]), explaining about one-tenth of the SES disparities. This study suggests pregnancy as an early sensitive period and maternal immune activity as an important context for child development.

Income inequality among American states and the conditional risk of post-traumatic stress disorder.

PURPOSE: Vulnerability to post-traumatic disorder (PTSD) following a traumatic event can be influenced by individual-level as well as contextual factors. Characteristics of the social and economic environment might increase the odds for PTSD after traumatic events occur. One example that has been identified as a potential environmental determinant is income inequality. The purpose of this study is to investigate the association between State-level income inequality and PTSD among adults who have been exposed to trauma. METHODS: We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,653). Structured diagnostic interviews were administered at baseline (2001-2002) and follow-up (2004-2005). Weighted multi-level logistic regression was used to determine if US State-level income inequality, as measured by the Gini coefficient, was associated with incident episodes of PTSD during the study's 3-year follow-up period adjusting for individual and state-level covariates. RESULTS: The mean Gini coefficient across states in the NESARC was 0.44 (SD = 0.02) and ranged from 0.39 to 0.53. Of the respondents, 27,638 reported exposure to a traumatic event. Of this sample, 6.9 and 2.3% experienced persistent or recurrent and incident PTSD, respectively. State-level inequality was not associated with increased odds for persistent or recurrent PTSD (OR = 1.02; 95% CI 0.85, 1.22), but was associated with incident PTSD (OR = 1.30, 95% CI 1.04, 1.63). CONCLUSION: The degree of income inequality in one's state of residence is associated with vulnerability to PTSD among individuals exposed to traumatic events. Additional work is needed to determine if this association is causal (or alternatively, is explained by other socio-contextual factors associated with income inequality), and if so, what anxiogenic mechanisms explain it.

Association of respondent psychiatric comorbidity with family history of comorbidity: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

OBJECTIVE: Substance use disorders and major psychiatric disorders are common, highly comorbid with each other, and familial. However, the extent to which comorbidity is itself familial remains unclear. The purpose of this study is to investigate associations between comorbidity among respondents with family history of comorbidity. METHODS: We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions-III to study the associations of family history (FH) of comorbidity among alcoholism, drug problems, depression, antisocial behavior, and anxiety disorders in parents and maternal and paternal grandparents with corresponding DSM-5 diagnostic comorbidity among respondents. We utilized multivariable multinomial logistic regression models controlling for age, sex, race, education, family income, marital status, and adverse childhood experiences (ACEs). RESULTS: All comorbid associations of any two disorders with FH were statistically significant; almost all adjusted odds ratios (ORs) for respondent comorbidity in the presence of FH of the parallel comorbidity exceeded 10. ORs involving antisocial behavior in relatives and antisocial personality disorder in respondents were consistently larger than those for any other pairs of disorders. After further adjustment for ACEs, most patterns of association were similar but the ORs were reduced twofold to threefold. ACEs may be mediators in relationships between familial and respondent comorbidities. CONCLUSION: Further investigations of relationships among familial comorbidity, ACEs, and respondents' diagnoses may improve understanding of comorbidity.

The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III.

OBJECTIVES: To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD). METHODS: Face-to-face interviews with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. RESULTS: Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with

Regularly Drinking Alcohol Before Sexual Activity in a Nationally Representative Sample: Prevalence, Sociodemographics, and Associations With Psychiatric and Substance Use Disorders.

OBJECTIVES: We addressed regular drinking before sex and its associated risk factors. METHODS: From the wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative adult US sample (fielded 2004-2005), we determined the 12-month prevalence of regularly drinking alcohol before sexual activity. Among 17,491 sexually active drinkers, we determined the sociodemographic, psychiatric, and substance use correlates of regularly drinking before sex. RESULTS: Regular presex drinking's 12-month prevalence was 1.8%. Significant bivariate sociodemographic correlates were age, gender, race/ethnicity, education, family income, marital status, and employment status. Generalized anxiety disorder and alcohol dependence were associated with significantly increased odds of being a regular presex drinker after controlling for covariates. CONCLUSIONS: We estimate that 4.3 million American adults are regular presex drinkers. Future research should examine this public health issue at the population level, with particular focus on pathways that link it to psychopathology.

Prevalence and Correlates of Prohibited Questions in Internal Medicine and Pediatrics Fellowship Interviews During One Appointment Year.

PURPOSE: This study sought to investigate how frequently applicants to internal medicine (IM) and pediatrics fellowships are subjected to prohibited questions, how correlates of these interview questions compare between IM and pediatrics fellowship applicants, and which applicant subgroups are most affected. METHOD: The National Resident Matching Program (NRMP) emailed an anonymous survey to all applicants for the 2021 appointment year to the Medical Specialties Matching Program (i.e., IM fellowship Matches) and Pediatric Specialties Fellowship Match who certified rank order lists (ROLs). The survey addressed specific questions regarding the use of legally prohibited questions and questions that violate the NRMP's Match Participation Agreement during interview-related activities. Experiences of respondents were compared by preferred subspecialty and respondent demographics within IM and pediatrics. RESULTS: The final response rates of IM and pediatrics fellowship applicants who certified ROLs, including complete and partial surveys, were 21.7% (1,483/6,847) and 23.4% (385/1,648), respectively. Of the IM and pediatrics respondents, 432/1,296 (33.3%) and 97/366 (26.5%), respectively, reported being asked at least one prohibited demographic question. The most commonly asked prohibited questions pertained to relationship or marital status (IM: 312/1,296, 24.1%; pediatrics: 69/367, 18.8%), national origin (IM: 200/1,296, 15.4%; pediatrics: 30/365, 8.2%), and family planning (IM: 104/1,288, 8.1%; pediatrics: 14/366, 3.8%). Nearly 25% of IM and pediatrics respondents reported being asked to identify other programs they applied to or interviewed with. Most often, these questions came from program faculty (IM: 238/303, 78.5%; pediatrics: 69/88, 78.4%) or program directors (IM: 84/303, 27.7%; pediatrics: 18/88, 20.5%). CONCLUSIONS: Substantial proportions of IM and pediatrics fellowship applicants reported being asked prohibited questions during fellowship interview-related activities. Additional educational efforts are needed to eradicate such questions from the interview process.

Differences in the profiles of DSM-IV and DSM-5 alcohol use disorders: implications for clinicians.

BACKGROUND: Existing information on consequences of the DSM-5 revision for the diagnosis of alcohol use disorders (AUD) has gaps, including missing information critical to understanding implications of the revision for clinical practice. METHODS: Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to compare AUD severity, alcohol consumption and treatment, sociodemographic and health characteristics, and psychiatric comorbidity among individuals with DSM-IV abuse versus DSM-5 moderate AUD and DSM-IV dependence versus DSM-5 severe AUD. For each pair of disorders, we additionally compared 3 mutually exclusive groups: individuals positive solely for the DSM-IV disorder, those positive solely for the DSM-5 disorder, and those positive for both. RESULTS: Whereas 80.5% of individuals positive for DSM-IV dependence were positive for DSM-5 severe AUD, only 58.0% of those positive for abuse were positive for moderate AUD. The profiles of individuals with DSM-IV dependence and DSM-5 severe AUD were almost identical. The only significant (p < 0.005) difference, more AUD criteria among the former, reflected the higher criterion threshold (≥ 4 vs. ≥ 3) for severe AUD relative to dependence. In contrast, the profiles of individuals with DSM-5 moderate AUD and DSM-IV abuse differed substantially. The former endorsed more AUD criteria, had higher rates of physiological dependence, were less likely to be White individuals and men, had lower incomes, were less likely to have private and more likely to have public health insurance, and had higher levels of comorbid anxiety disorders than the latter. CONCLUSIONS: Similarities between the profiles of DSM-IV and DSM-5 AUD far outweigh differences; however, clinicians may face some changes with respect to appropriate screening and referral for cases at the milder end of the AUD severity spectrum, and the mechanisms through which these will be reimbursed may shift slightly from the private to public sector.

A Nationally Representative Study of Sexual Orientation and High-Risk Drinking From Adolescence to Young Adulthood.

PURPOSE: To determine whether peer drunkenness, parental knowledge about their adolescent's whereabouts and behaviors, and depressive symptoms contribute to sexual orientation disparities in high-risk drinking behaviors; if they do, they would be potential intervention targets. METHODS: Longitudinal survey data from 2,051 adolescents who participated in the NEXT Generation Health Study were analyzed. Latent growth curve and longitudinal path analyses were used to test for indirect effects linking sexual orientation in 11th grade (3.4% males and 8.4% females were sexual minorities) to past 30-day heavy episodic drinking (HED) over 6 years and past year high-intensity binge drinking at 4 years after high school. RESULTS: Sexual minority males were not more likely to engage in high-risk drinking than heterosexual males. In contrast, sexual minority females were more likely than heterosexual females to engage in HED when they were in 11th grade (Odds Ratio = 2.83, 95% confidence interval = 1.43, 5.61), in part because of lower parental knowledge. Sexual minority females also had higher depressive symptoms during the transition from adolescence to young adulthood, which in turn was associated with greater risk of high-intensity binge drinking in young adulthood. Peer drunkenness was a strong risk factor for HED and high-intensity binge drinking among both males and females. DISCUSSION: Sexual minority females reported lower levels of parental knowledge during adolescence and higher levels of depressive symptoms during the transition to young adulthood than heterosexual females. Both factors were associated with high-risk drinking behavior, suggesting developmentally sensitive opportunities to mitigate sexual orientation disparities in high-risk drinking.

Correlates of recovery from alcohol dependence: a prospective study over a 3-year follow-up interval.

BACKGROUND: Correlates of recovery from alcohol dependence have been identified through a variety of study designs characterized by different strengths and limitations. The goal of this study was to compare correlates of recovery based on a 3-year prospective design with those based on cross-sectional analyses of data from the same source. METHODS: Data from the 2001 to 2002 Wave 1 and 2004 to 2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were used to examine baseline characteristics associated with Wave 2 recovery from alcohol dependence, among those who classified with past-year DSM-IV alcohol dependence at Wave 1 (n = 1,172). RESULTS: Abstinent recovery was significantly associated with Black/Asian/Hispanic race/ethnicity, children <1 year of age in the household at baseline, attending religious services greater than or equal to weekly at follow-up, and having initiated help-seeking that comprised/included 12-step participation within <3 years prior to baseline. Nonabstinent recovery was positively associated with being never married at baseline, having job problems or being unemployed in the year preceding baseline, attending religious services less than weekly at follow-up, baseline smoking and volume of ethanol intake, and having terminated a first marriage within <3 years prior to baseline. Findings, including others of marginal significance (0.05 < p < 0.10), generally supported results from prior pseudo-prospective survival analyses with time-dependent covariates but differed in many ways from cross-sectional analyses of Wave 1 NESARC data. CONCLUSIONS: Various aspects of study design must be considered when interpreting correlates of recovery. Cross-sectional analyses of lifetime correlates of recovery are highly subject to misinterpretation, but pseudo-prospective survival analyses with time-dependent covariates may yield results as valid as those from prospective studies.

Psychiatric comorbidity of full and partial posttraumatic stress disorder among older adults in the United States: results from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVES: To present findings on the prevalence, correlates, and psychiatric comorbidity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition posttraumatic stress disorder (PTSD) and partial PTSD in a nationally representative sample of U.S. older adults. DESIGN, SETTING, AND PARTICIPANTS: Face-to-face interviews with 9,463 adults age 60 years and older in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. MEASUREMENTS: Sociodemographic correlates; worst stressful experiences; comorbid lifetime mood, anxiety, substance use, and personality disorders; psychosocial functioning; and suicide attempts. RESULTS: Lifetime prevalences ± standard errors of PTSD and partial PTSD were 4.5% ± 0.25 and 5.5% ± 0.27, respectively. Rates were higher in women (5.7% ± 0.37 and 6.5% ± 0.39) than in men (3.1% ± 0.31 and 4.3% ± 0.37). Older adults with PTSD most frequently identified unexpected death of someone close, serious illness or injury to someone close, and their own serious or life-threatening illness as their worst stressful events. Older adults exposed to trauma but without full or partial PTSD and respondents with partial PTSD most often identified unexpected death of someone close, serious illness or injury to someone close, and indirect experience of 9/11 as their worst events. PTSD was associated with elevated odds of lifetime mood, anxiety, drug use, and borderline and narcissistic personality disorders and decreased psychosocial functioning. Partial PTSD was associated with elevated odds of mood, anxiety, and narcissistic and schizotypal personality disorders and poorer psychosocial functioning relative to older adults exposed to trauma but without full or partial PTSD. CONCLUSIONS: PTSD among older adults in the United States is slightly more prevalent than previously reported and is associated with considerable psychiatric comorbidity and psychosocial dysfunction. Partial PTSD is associated with significant psychiatric comorbidity, particularly with mood and other anxiety disorders.

Medical comorbidity of full and partial posttraumatic stress disorder in US adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: This study examined associations between lifetime trauma exposures, PTSD and partial PTSD, and past-year medical conditions in a nationally representative sample of US adults. METHODS: Face-to-face interviews were conducted with 34,653 participants in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Logistic regression analyses evaluated associations of trauma exposure, PTSD, and partial PTSD with respondent-reported medical diagnoses. RESULTS: After adjustment for sociodemographic characteristics and comorbid Axis I and II disorders, respondents with full PTSD were more likely than traumatized respondents without full or partial PTSD (comparison group) to report diagnoses of diabetes mellitus, noncirrhotic liver disease, angina pectoris, tachycardia, hypercholesterolemia, other heart disease, stomach ulcer, human immunodeficiency virus seropositivity, gastritis, and arthritis (odds ratios [ORs] = 1.2-2.5). Respondents with partial PTSD were more likely than the comparison group to report past-year diagnoses of stomach ulcer, angina pectoris, tachycardia, and arthritis (ORs = 1.3-1.6). Men with full and partial PTSD were more likely than controls to report diagnoses of hypertension (both ORs = 1.6), and both men and women with PTSD (OR = 1.8 and OR = 1.6, respectively) and men with partial PTSD (OR = 2.0) were more likely to report gastritis. The total number of lifetime traumatic event types was associated with many assessed medical conditions (ORs = 1.04-1.16), reducing the magnitudes and rendering some of the associations between PTSD status and medical conditions nonsignificant. CONCLUSIONS: Greater lifetime trauma exposure and PTSD are associated with numerous medical conditions, many of which are stress-related and chronic, in US adults. Partial PTSD is associated with intermediate odds of some of these conditions.

Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior.

OBJECTIVES: To determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents. METHODS: A population-based longitudinal cohort of 1771 adolescents participated in the NEXT Generation Health Study. Participants reported sexual minority status (defined by sexual attraction) in 2010-2011 and retrospectively reported age at onset of suicidality in 2015-2016. RESULTS: Sexual minority adolescents (5.8% of weighted sample) had higher lifetime risk of suicide ideation (26.1% vs 13.0%), plan (16.6% vs 5.4%), and attempt (12.0% vs 5.4%) than heterosexual adolescents. Survival analyses adjusted for demographic characteristics and depressive symptoms revealed positive associations of sexual minority status with time to first onset of suicide ideation (hazard ratio [HR] = 1.77; 95% confidence interval [CI] 1.03-3.06) and plan (HR = 2.69; 95% CI 1.30-5.56). The association between sexual minority status and age at onset of suicide attempt was stronger at age <15 (HR = 3.26; 95% CI 1.25-8.47) than age ≥15 (HR = 0.59; 95% CI 0.21-1.66). The association between sexual minority status and progression from ideation to plan was stronger in the same year of first ideation (HR = 2.01; 95% CI 1.07-3.77) than ≥1 year after first ideation (HR = 1.33; 95% CI 0.26-6.77). CONCLUSIONS: Sexual minority adolescents had earlier onset of suicidality and faster progression from suicide ideation to plan than heterosexual adolescents. The assessment of sexual minority status in routine pediatric care has the potential to inform suicide risk screening, management, and intervention efforts among early sexual minority adolescents.

Resilience Factors in the Association Between Depressive Symptoms and Suicidality.

PURPOSE: To investigate whether life satisfaction and optimism might reduce the risk of suicidal thoughts and behaviors among adolescents with depressive symptoms. METHODS: Participants were 1,904 youth from the NEXT Generation Health Study, a national sample of U.S. adolescents, followed over 7 years from 2009/2010 to 2015/2016. Longitudinal latent profile analysis and logistic regressions were conducted. RESULTS: We identified three subgroups of adolescents with different patterns of depressive symptoms across the first six waves: "Low" (40%), "Mild" (42%), and "Moderate to Severe" (18%). The Moderate to Severe (OR = 14.47, 95% CI [6.61, 31.66]) and Mild (OR = 3.90, 95% CI [2.22, 6.86]) depression profiles had significantly higher odds of developing suicidality than the Low depression profile. Both life satisfaction and optimism moderated the association between depressive symptom profile and suicidality. The difference in suicidality risk between the Mild and Low depression profiles was significantly attenuated at high versus low levels of life satisfaction, with a difference of -.08, 95% CI [-.14, -.03]. In addition, the difference in suicidality risk between the Moderate to Severe and Low depression profiles was attenuated at high versus low levels of optimism, with a difference of -.11, 95% CI [-.21, -.01]. CONCLUSIONS: For adolescents transitioning to young adulthood, resilience factors such as life satisfaction and optimism may buffer against suicidality risk in the face of mild or moderate to severe depressive symptoms.

Antisocial Behavioral Syndromes in Adulthood and Alcohol Use Disorder Treatment over Three-Year Follow-Up: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.

BACKGROUND: Antisocial personality disorder (ASPD) is associated with poorer treatment outcomes, but more help seeking, for alcohol use disorders (AUDs); however, associations of ASPD with AUD treatment in the general population have not been studied prospectively. OBJECTIVE: To examine prediction of treatment over 3-year follow-up among adults with AUDs by baseline ASPD and syndromal adult antisocial behavior without conduct disorder before age 15 (AABS). METHOD: Face-to-face interviews with 34,653 respondents to the National Epidemiologic Survey on Alcohol and Related Conditions, of whom 3875 had prevalent AUDs between Waves 1 and 2 and ASPD, AABS, or no antisocial syndrome at Wave 1. RESULTS: In unadjusted analyses, baseline ASPD predicted AUD treatment but AABS did not. After adjustment for additional need, predisposing, and enabling factors, antisocial syndromes did not predict treatment. Baseline predictors of treatment included more past-year AUD symptoms, and past-year nicotine dependence and AUD treatment. CONCLUSIONS: That baseline antisocial syndrome did not predict AUD treatment may reflect strong associations of antisociality with previously identified predictors of help seeking.

Antisocial behavioral syndromes and additional psychiatric comorbidity in posttraumatic stress disorder among u.s. Adults: results from wave 2 of the national epidemiologic survey on alcohol and related conditions.

BACKGROUND: Despite the relatively high prevalence of antisocial personality disorder (ASPD) in individuals with posttraumatic stress disorder (PTSD), associations of ASPD with clinical presentation of PTSD, including additional comorbidity, have not been investigated. OBJECTIVE: To present nationally representative findings on associations of DSM-IV ASPD versus syndromal adult antisocial behavior without conduct disorder before age 15 with additional psychiatric disorders among U.S. adults with PTSD. METHOD: Face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version in the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (n=34,653). RESULTS: After adjustment for sociodemographics and additional comorbidity, both antisocial syndromes were significantly associated with bipolar I, attention-deficit/hyperactivity, substance use, and paranoid, schizoid, histrionic, and obsessive-compulsive personality disorders among respondents with PTSD. Odds of major depressive and generalized anxiety disorders were significantly reduced among men with ASPD. CONCLUSIONS: Interventions targeting PTSD may require attention to co-occurring antisociality and additional comorbidity.

Neighbourhood context and binge drinking from adolescence into early adulthood in a US national cohort.

BACKGROUND: Underage binge drinking is a serious health concern that is likely influenced by the neighbourhood environment. However, longitudinal evidence has been limited and few studies have examined time-varying neighbourhood factors and demographic subgroup variation. METHODS: We investigated neighbourhood influences and binge drinking in a national cohort of US 10th grade students at four times (2010-2014; n = 2745). We estimated odds ratios (OR) for past 30-day binge drinking associated with neighbourhood disadvantage, personal and property crime (quartiles), and number of liquor, beer and wine stores within 5 km, and then evaluated whether neighbourhood associations differ by age, sex and race/ethnicity. RESULTS: Neighbourhood disadvantage was associated with binge drinking before 18 [OR = 1.54; 95% confidence interval (1.14, 2.08)], but not after 18 years of age. Property crime in neighbourhoods was associated with a higher odds of binge drinking [OR = 1.54 (0.96, 2.45)], an association that was stronger in early adulthood [4th vs 1st quartile: OR = 1.77 (1.04, 3.03)] and among Whites [4th vs 1st quartile: OR = 2.46 (1.03, 5.90)]. Higher density of liquor stores predicted binge drinking among Blacks [1-10 stores vs none: OR = 4.31 (1.50, 12.36)] whereas higher density of beer/wine stores predicted binge drinking among Whites [one vs none for beer: OR = 2.21 (1.06, 4.60); for wine: OR = 2.04 (1.04, 4.03)]. CONCLUSIONS: Neighbourhood conditions, particularly those related to economic circumstances, crime and alcohol outlet density, were related to binge drinking among young adults, but associations varied across age and individual characteristics.

Trajectories of Maternal Postpartum Depressive Symptoms.

OBJECTIVES: To identify homogenous depressive symptom trajectories over the postpartum period and the demographic and perinatal factors linked to different trajectories. METHODS: Mothers (N = 4866) were recruited for Upstate KIDS, a population-based birth cohort study, and provided assessments of depressive symptoms at 4, 12, 24, and 36 months postpartum. Maternal demographic and perinatal conditions were obtained from vital records and/or maternal report. RESULTS: Four depression trajectories were identified: low-stable (74.7%), characterized by low symptoms at all waves; low-increasing (8.2%), characterized by initially low but increasing symptoms; medium-decreasing (12.6%), characterized by initially moderate but remitting symptoms; and high-persistent (4.5%), characterized by high symptoms at all waves. Compared with the high-persistent group, older mothers (maximum odds ratio [OR] of the 3 comparisons: 1.10; 95% confidence interval [CI]: 1.05 to 1.15) or those with college education (maximum OR: 2.52; 95% CI: 1.36 to 4.68) were more likely to be in all other symptom groups, and mothers who had a history of mood disorder (minimum OR: 0.07; 95% CI: 0.04 to 0.10) or gestational diabetes mellitus diagnosis (minimum OR: 0.23; 95% CI: 0.08 to 0.68) were less likely to be in other symptom groups. Infertility treatment, multiple births, prepregnancy BMI, gestational hypertension, and infant sex were not differentially associated with depressive symptom trajectories. CONCLUSIONS: One-quarter of mothers in a population-based birth cohort had elevated depressive symptoms in 3 years postpartum. Screening for maternal depression beyond the postpartum period may be warranted, particularly after mood and diabetic disorders.

Prevalence, correlates, disability, and comorbidity of DSM-IV schizotypal personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions.

OBJECTIVE: To present nationally representative findings on the prevalence, correlates, and comorbidity of and disability associated with DSM-IV schizotypal personality disorder (SPD). METHOD: This study used the 2004-2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions, which targeted a nationally representative sample of the adult civilian population of the United States aged 18 years and older and residing in households and group quarters. In Wave 2, attempts were made to conduct face-to-face reinterviews with all respondents to the Wave 1 interview. RESULTS: Lifetime prevalence of SPD was 3.9%, with significantly greater rates among men (4.2%) than women (3.7%) (p < .01). Odds for SPD were significantly greater among black women, individuals with lower incomes, and those who were separated, divorced, or widowed; odds were significantly lower among Asian men (all p < .01). Schizotypal personality disorder was associated with substantial mental disability in both sexes. Co-occurrence rates of Axis I and other Axis II disorders among respondents with SPD were much higher than rates of co-occurrence of SPD among respondents with other disorders. After adjustment for sociodemographic characteristics and additional comorbidity, associations remained significant in both sexes between SPD and 12-month and lifetime bipolar I disorder, social and specific phobias, and posttraumatic stress disorder, as well as 12-month bipolar II disorder, lifetime generalized anxiety disorder, and borderline and narcissistic personality disorders (all p < .01). CONCLUSIONS: Common and unique factors may underlie associations of SPD with narcissistic and borderline personality disorders, whereas much of the comorbidity between SPD and most mood and anxiety disorders appears to reflect factors common to these disorders. Some of the associations with SPD were sex specific. Schizotypal personality disorder and dependent, avoidant, and borderline personality disorders were associated with the occurrence of schizophrenia or psychotic episode. Schizotypal personality disorder is a prevalent, fairly stable, highly disabling disorder in the general population. Sex differences in associations of SPD with other specific Axis I and II disorders can inform more focused, hypothesis-driven investigations of factors underlying the comorbid relationships. Schizotypal as well as borderline, dependent, and avoidant personality disorders may be components of the schizophrenia spectrum.

Association between the Built Environment and Active Transportation among U.S. Adolescents.

INTRODUCTION: As a major determinant of obesity and cardiovascular disease in the United States, decreasing physical activity (PA) has led researchers to study factors influencing daily PA. One opportunity for modifying PA is in relation to transportation to and from school and/or work. We examined the association between characteristics of the built environment of home neighborhoods and transportation-related PA to school or work among youth and emerging adults. METHODS: The data were drawn from Waves 1 and 4 of the NEXT Generation Health Study (n=2780), a nationally representative, longitudinal cohort study starting with 10th grade (Wave 1) in the 2009-2010 school year. Modes of travel to/from school were categorized into three groups: those using active transportation (walking/cycling), public transportation, and passive transportation (being driven or chauffeured/driving). Neighborhood characteristics included land use mix, street connectivity, residence density, park density, recreational density, and walkability. Multinomial logistic regressions and one-way ANOVAs were used to examine multivariate associations between modes of travel to and from work/school and neighborhood characteristics. Analysis accounted for complex survey features including stratification, clustering and sampling weights. RESULTS: After controlling for covariates (i.e., ethnicity, sex, education, and socioeconomic status), more land use diversity, street connectivity, residence density, and walkability were significantly correlated with active transportation in both waves and more park and recreational density were significantly correlated with active transportation in Wave 1, compared with passive transportation. CONCLUSIONS: More mixed land use, greater connected streets as well as higher walkability and density of residence, parks and recreational facilities were associated with active transportation; suggesting city planning officials may consider creating more walkable and liveable communities to promote daily transportation-related PA.

Neighbourhood disadvantage and depressive symptoms among adolescents followed into emerging adulthood.

BACKGROUND: Residents of disadvantaged neighbourhoods report higher levels of depressive symptoms; however, few studies have employed prospective designs during adolescence, when depression tends to emerge. We examined associations of neighbourhood social fragmentation, income inequality and median household income with depressive symptoms in a nationally representative survey of adolescents. METHODS: The NEXT Generation Health Study enrolled 10th-grade students from 81 US high schools in the 2009-2010 school year. Depressive symptoms were assessed with the Modified Depression Scale (wave 1) and the paediatric Patient-Reported Outcome Measurement Information System (waves 2-6). Neighbourhood characteristics at waves 1, 3, 4, and 5 were measured at the census tract level using geolinked data from the American Community Survey 5-year estimates. We used linear mixed models to relate neighbourhood disadvantage to depressive symptoms controlling for neighbourhood and individual sociodemographic factors. RESULTS: None of the models demonstrated evidence for associations of social fragmentation, income inequality or median household income with depressive symptoms. CONCLUSION: Despite the prospective design, repeated measures and nationally representative sample, we detected no association between neighbourhood disadvantage and depressive symptoms. This association may not exist or may be too small to detect in a geographically dispersed sample. Given the public health significance of neighbourhood effects, future research should examine the developmental timing of neighbourhood effects across a wider range of ages than in the current sample, consider both objective and subjective measures of neighbourhood conditions, and use spatially informative techniques that account for conditions of nearby neighbourhoods.