Social Drivers of Mental Health: A U.S. Study Using Machine Learning.

INTRODUCTION: Social drivers of mental health can be compared on an aggregated level. This study employed a machine learning approach to identify and rank social drivers of mental health across census tracts in the U.S. METHODS: Data for 38,379 census tracts in the U.S. were collected from multiple sources in 2021. Two measures of mental health problems-self-reported depression and self-assessed poor mental health-among adults and three domains of social drivers (behavioral, environmental, and social) were analyzed on the basis of the unit of census tracts using the Extreme Gradient Boosting machine learning approach in 2022. The leading social drivers were found in each domain in the main sample and in the subsamples divided on the basis of poverty and racial segregation. RESULTS: The three domains combined explained more than 90% of the variance of both mental illness indicators. Self-reported depression and self-assessed poor mental health differed in major social drivers. The two outcome indicators had one overlapping correlate from the behavioral domain: smoking. Other than smoking, climate zone and racial composition were the leading correlates from the environmental and social domains, respectively. Census tract characteristics moderated the impacts of social drivers on mental health problems; the major social drivers differed by census tract poverty and racial segregation. CONCLUSIONS: Population mental health is highly contextualized. Better interventions can be developed on the basis of census tract-level analyses of social drivers that characterize the upstream causes of mental health problems.

Physical activity levels and correlates in nationally representative sample of U.S. adults with healthy weight, obesity, and binge-eating disorder.

OBJECTIVES: This study compared the patterns of moderate and vigorous physical activity (PA) and health conditions in a nationally representative sample of adults categorized with healthy weight (HW) without eating disorder history, obesity without eating disorder history (OB), or current binge-eating disorder (BED) with obesity (BED+OB). METHOD: We used the third National Epidemiological Survey on Alcohol and Related Conditions to compare PA intensity, duration, and their relationships with health indicators in the three groups: HW (n = 11,635), OB (n = 11,056), and BED+OB (n = 110). RESULTS: Prevalence of physical inactivity was significantly greater in OB (38.1%) and BED (51.4%) than HW (30.3%). Prevalence of vigorous PA was significantly lower in OB (45.5%) and BED (31.7%) than HW (54.0%). Duration of moderate and vigorous activity per week was significantly shorter in BED+OB than HW and duration of vigorous activity was shorter in OB than HW. Regardless of PA intensity, BED+OB reported poorer physical and mental health than OB and HW. Greater PA intensity and duration were associated with better physical health, particularly in OB. DISCUSSION: In this nationally representative study of U.S. adults, obesity was associated with physical inactivity. Comorbid obesity and BED was associated with lower PA levels and poorer health. Particularly among adults with obesity, greater PA intensity was associated with better physical health, and greater duration of PA was associated with better physical and mental health. The findings highlight the importance of screening for BED in addition to obesity status and for promoting PA to improve health in U.S. adults.

Association Between Adverse Childhood Events and Multimorbidity in a Racial and Ethnic Diverse Sample of Middle-Aged and Older Adults.

BACKGROUND AND OBJECTIVES: Adverse childhood events (ACEs) have been associated with increased health risks later in life. However, it is unclear whether ACEs may be associated with multimorbidity among diverse racial/ethnic middle-aged and older adults. We evaluated whether there were racial and ethnic differences in the association between ACEs and the number of somatic and psychiatric multimorbidity in a sample of U.S. middle-aged and older adults. RESEARCH DESIGN AND METHODS: Data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (N = 10,727; ≥55 years) were used to test whether the number of self-reported somatic conditions (i.e., heart disease, hypertension, stroke, diabetes, arthritis, cancer, osteoporosis, and chronic lung problems) as well as DSM-5 psychiatric disorders (i.e., depression) during the past 12 months differed by history of ACEs while stratifying by age (i.e., 55-64 or ≥65) and racial/ethnic group (i.e., non-Hispanic White [NHW; n = 7,457], non-Hispanic Black [NHB; n = 1,995], and Hispanic [n=1275]). RESULTS: The prevalence of reporting more than two somatic conditions and psychiatric disorders was 48.8% and 11.4% for those with a history of ACEs, and 41.1% and 3.3% for those without a history of ACEs. Adjusting for sociodemographic and other health risk factors, ACEs was significantly associated with greater numbers of somatic multimorbidity among racial and ethnic middle-aged adults but this was not the case for older adults. DISCUSSION AND IMPLICATIONS: Our findings suggest that middle-aged adults with a history of ACEs are more likely to suffer from somatic and psychiatric multimorbidity, highlighting the importance of screening for ACEs in promoting healthy aging.

Psychiatric and medical correlates of DSM-5 eating disorders in a nationally representative sample of adults in the United States.

OBJECTIVE: To examine psychiatric and somatic correlates of DSM-5 eating disorders (EDs)-anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED)-in a nationally representative sample of adults in the United States. METHOD: A national sample of 36,309 adult participants in the national epidemiologic survey on alcohol and related conditions III (NESARC-III) completed structured diagnostic interviews (AUDADIS-5) to determine psychiatric disorders, including EDs, and reported 12-month diagnosis of chronic somatic conditions. Prevalence of lifetime psychiatric disorders and somatic conditions were calculated across the AN, BN, and BED groups and a fourth group without specific ED; multiple logistic regression models compared the likelihood of psychiatric/somatic conditions with each specific ED relative to the no-specific ED group. RESULTS: All three EDs were associated significantly with lifetime mood disorders, anxiety disorders, alcohol and drug use disorders, and personality disorders. In all three EDs, major depressive disorder was the most prevalent, followed by alcohol use disorder. AN was associated significantly with fibromyalgia, cancer, anemia, and osteoporosis, and BED with diabetes, hypertension, high cholesterol, and triglycerides. BN was not associated significantly with any somatic conditions. CONCLUSIONS: This study examined lifetime psychiatric and somatic correlates of DSM-5 AN, BN, and BED in a large representative sample of U.S. adults. Our findings on significant associations with other psychiatric disorders and with current chronic somatic conditions indicate the serious burdens of EDs. Our findings suggest important differences across specific EDs and indicate some similarities and differences to previous smaller studies based on earlier diagnostic criteria.

Chronic medical conditions in U.S. adults with incarceration history.

OBJECTIVES: To examine the associations between incarceration history and chronic medical conditions in a nationally representative sample of U.S. adults and whether risk for chronic medical conditions differ by sex and race among those with incarceration history. METHOD: The data were from the 2012-2013 National Survey of Alcohol and Related Conditions III (N = 36,133). Multiple logistic regression was used to compare odds of a self-reported diagnosis for 24 chronic medical conditions by incarceration history, as well as by sex and race within those with incarceration history. RESULTS: 12.4% of adults (SE = 0.35) reported a history of incarceration. When adjusted for sociodemographic characteristics, smoking status, and past year alcohol use, incarceration history was associated with significantly increased odds of most chronic medical conditions (adjusted odds ratio [AORs] range = 1.20-3.41). When additionally adjusted for childhood adversity and stressful life events, odds remained significantly elevated for hypertension, myocardial infarction, minor heart conditions, stomach ulcers, arthritis, sleep problems, anemia, bowel, lung, and nerve problems, liver diseases, HIV/AIDS, and sexually transmitted diseases (AORs range = 1.14-2.78). Relative to men with incarceration history, women with incarceration history reported significantly increased odds of multiple chronic disease conditions (AORs range = 1.22-6.60). Hispanic or non-Hispanic Black individuals with incarceration history showed significantly reduced risk for several chronic medical conditions, relative to their non-Hispanic White counterparts (AORs range = 0.30-0.75). CONCLUSIONS: This study suggests that incarceration may be an important factor when considering health disparities, and also highlights the importance of acknowledging early adversity and ongoing life stressors when providing comprehensive health care for individuals with incarceration history. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Psychosocial and metabolic function by smoking status in individuals with binge eating disorder and obesity.

Individuals with binge eating disorder (BED) report smoking to control appetite and weight. Smoking in BED is associated with increased risk for comorbid psychiatric disorders, but its impact on psychosocial functioning and metabolic function has not been evaluated. Participants were 429 treatment-seeking adults (72.4% women; mean age 46.2±11.0years old) with BED comorbid with obesity. Participants were categorized into current smokers (n=66), former smokers (n=145), and never smokers (n=218). Smoking status was unrelated to most historical eating/weight variables and to current eating disorder psychopathology. Smoking status was associated with psychiatric, psychosocial, and metabolic functioning. Compared with never smokers, current smokers were more likely to meet lifetime diagnostic criteria for alcohol (OR=5.51 [95% CI=2.46-12.33]) and substance use disorders (OR=7.05 [95% CI=3.37-14.72]), poorer current physical quality of life, and increased risk for metabolic syndrome (OR=1.80 [95% CI=0.97-3.35]) and related metabolic risks (reduced HDL, elevated total cholesterol). On the other hand, the odds of meeting criteria for lifetime psychiatric comorbidity or metabolic abnormalities were not significantly greater in former smokers, relative to never smokers. Our findings suggest the importance of promoting smoking cessation in treatment-seeking patients with BED and obesity for its potential long-term implications for psychiatric and metabolic functioning.

A preliminary study on the effect of combined nicotine replacement therapy on alcohol responses and alcohol self-administration.

BACKGROUND AND OBJECTIVES: Limiting alcohol consumption may help prevent alcohol-mediated smoking relapse in heavy drinking smokers. This pilot study examined whether combining a nicotine patch with nicotine nasal spray has stronger attenuating effects on alcohol response and consumption than a nicotine patch alone. METHODS: Twenty-two non-alcohol dependent heavy drinking smokers completed the double-blind cross-over, placebo-controlled study (21 mg nicotine patch + nicotine or placebo nasal spray). Six hours after 21 mg nicotine patch application, subjective and physiological responses to a priming drink (0.3 g/kg) were assessed, followed by two 1-hr alcohol self-administration periods, with possible consumption of up to 4 drinks per period (each 0.15 g/kg). Nasal spray (1 mg [active] or 0 mg [placebo] per dose) was administered 10 min prior to the priming dose and each self-administration period. RESULTS: Active nasal spray did not increase serum nicotine levels, compared with placebo administration. The number of drinks consumed did not differ by the nasal spray conditions. However, positive subjective responses to the priming drink were lower in the active nasal spray condition than the placebo nasal spray condition. During the self-administration period, urge to drink was also lower in the active spray condition than the placebo condition. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Augmenting the nicotine patch with nicotine nasal spray attenuated positive subjective alcohol response and craving and suggests that future studies should investigate whether these findings translate to a clinical setting.

Potential side effects of unhealthy lifestyle choices and health risks on basal and reactive heart rate variability in college drinkers.

OBJECTIVE: Emerging adults often begin making independent lifestyle choices during college, yet the association of these choices with fundamental indicators of health and adaptability is unclear. The present study examined the relationship between health risks and neurocardiac function in college drinkers. METHOD: Heart rate variability (HRV) was assessed at baseline and in reaction to a paced breathing challenge in 212 college drinkers (53.8% women). Basal HRV served as a general indicator of health. Reactive HRV (during paced breathing) was used as a marker of an individual's adaptability to challenge. The relationship of HRV to alcohol use, cigarette use, exercise, sleep, and body mass index (BMI) was assessed. RESULTS: Greater alcohol use and less exercise were associated with lower basal HRV. BMI was unrelated to basal HRV but was negatively associated with reactive HRV during the breathing challenge. CONCLUSIONS: High levels of alcohol use and lack of exercise are negative correlates of cardiovascular and general health, even in apparently healthy college drinkers. The negative relationship between BMI and reactive HRV suggests that overweight individuals have reduced ability to psychophysiologically adapt to challenges; understanding the temporal course of this relationship is needed. This study highlights the importance of examining HRV at baseline and in response to a challenge to capture the active neurocardiac processes that contribute to health and adaptive responding. The suppressive effects of health risks on HRV are modifiable; thus, HRV may be useful in evaluating the health benefits of lifestyle change and in promoting change behaviors in college drinkers.