Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms.

The objective of this study was to determine whether: (a) cancer-related coping profiles change across time; (b) coping profile transition types predict changes in depressive and physical symptoms. Latent transition analysis was conducted with repeated measures of seven cancer-related coping processes from 460 women recently diagnosed with breast cancer. In multilevel models, coping profile transition groups were entered as predictors of symptoms across 12 months. Three coping profiles emerged at study entry, with two profiles at later assessments. Forty-eight percent of women maintained high-moderate approach-oriented coping over time. Specific factors (e.g., age, acceptance of emotions) differentiated the transition groups. Women who increased and then maintained high-moderate approach-oriented coping had relatively high initial depressive symptoms that declined steeply. When cancer-related acceptance predominated, women experienced increasing physical symptoms. Distinct cancer-related coping patterns are related to the level of and change in depressive and physical symptoms longitudinally. Early intervention to increase approach-oriented coping strategies could yield favorable outcomes.

Individual Differences in Optimum Sleep for Daily Mood During Adolescence.

Efforts to establish an empirical basis for recommended sleep durations during adolescence need to take into account individual differences in optimum sleep, defined as the amount of sleep at which peak functioning is observed. A total of 419 adolescents (Mage = 15.03 years) with Mexican American backgrounds reported their nightly sleep duration and daily mood for a 2-week period at 1 or 2 waves of data collection, 1 year apart. Adolescents also completed an established measure of symptomatology. Multilevel modeling revealed a nonlinear association between sleep duration and next-day mood, whereby both too little and too much sleep were associated with elevated levels of daily distress. Significant individual differences in optimum sleep were observed such that younger adolescents and those with elevated levels of internalizing and total symptomatology evidenced greater sleep durations on nights before they reported their lowest levels of daily distress. Younger adolescents and those with higher internalizing and total symptomatology may need more sleep to reach their peak functioning the next day, at least in terms of daily mood.

Do Treatment Plans Matter? Moving From Recommendations to Action.

We investigated whether a service-planning document outlining recommendations for what providers should address in treatment (i.e., targets) and the associated clinical techniques they should employ (i.e., practices) influenced the targets and practices that providers reported actually implementing during the subsequent treatment episode. Participants included 94 youths ages 4 to 17 (M = 13.57, SD = 3.59) who received community-based mental health services from the Hawai'i Child and Adolescent Mental Health Division. Data on targets and practices were compared across initial Mental Health Treatment Plans and Monthly Treatment and Progress Summaries. Data were analyzed using two-level, generalized mixed effects models with two-way cross-classification or linear mixed effects models. Providers were more likely to report the use of targets and practices in treatment if they were included within the treatment plan. In addition, the more closely targets addressed during treatment followed the recommended targets from the treatment plan, the more closely implemented practices followed the recommended practices listed in the treatment plan. Furthermore, as providers shifted their focus to different targets, a shift in their use of practices was also evident over time. Last, practices for which there is demonstrated efficacy for particular targets were more likely to be used. Service planning documents appear to help organize care; however, results also suggest possible limitations to the current system. These findings highlight potential areas for improvement in planning and care delivery.

Emergent Life Events: An In-Depth Investigation of Characteristics and Provider Responses during Youth Evidence-Based Treatment.

Emergent life events (ELEs), or acute client stressors disclosed within psychotherapy sessions, are not addressed by many evidence-based psychosocial treatments (EBTs). Preliminary provider-report studies suggest that ELEs may interfere with effective EBT implementation. The present study offers a detailed, observational examination of ELEs and their impact on EBT within therapy sessions. Data were observationally coded from 274 sessions with 55 primarily low-income, Latino youth clients (58% male, ages 5-15) in the modular EBT condition (Modular Approach to Therapy for Children [MATCH]) of the Child STEPs California trial. The ELE Coding System-Revised was used to measure ELEs, their characteristics, and provider responses to ELEs, including provider adherence to MATCH. Interrater reliability was generally high. At least one ELE was identified in 13% of randomly selected sessions. ELEs ranged widely in content, and their characteristics did not cluster together. Providers responded more frequently to ELEs with non-EBT content (e.g., information gathering, empathy) than EBT content; use of the ELE as a "teaching moment" for EBT content was the least common response (40% of ELEs). Multilevel regression analyses revealed that compared to sessions without an ELE, ELE sessions were significantly associated with reduced provider adherence to MATCH. Within ELE sessions, higher client distress when discussing the ELE was associated with reduced provider adherence to MATCH, but only when ELE severity was high. Beyond provider report, observational measures indicate that ELEs are prevalent and unpredictable in community settings and disrupt EBT delivery. Findings can inform the development of structured ELE management procedures to enhance existing EBTs.

Predicting future major depression and persistent depressive symptoms: Development of a prognostic screener and PHQ-4 cutoffs in breast cancer patients.

OBJECTIVE: Create a brief, self-report screener for recently diagnosed breast cancer patients to identify patients at risk of future depression. METHODS: Breast cancer patients (N = 410) within 2 ± 1 months after diagnosis provided data on depression vulnerability. Depression outcomes were defined as a high depressive symptom trajectory or a major depressive episode during 16 months after diagnosis. Stochastic gradient boosting of regression trees identified 7 items highly predictive for the depression outcomes from a pool of 219 candidate depression vulnerability items. Three of the 7 items were from the Patient Health Questionnaire 4 (PHQ-4), a validated screener for current anxiety/depressive disorder that has not been tested to identify risk for future depression. Thresholds classifying patients as high or low risk on the new Depression Risk Questionnaire 7 (DRQ-7) and the PHQ-4 were obtained. Predictive performance of the DRQ-7 and PHQ-4 was assessed on a holdout validation subsample. FINDINGS: DRQ-7 items assess loneliness, irritability, persistent sadness, and low acceptance of emotion as well as 3 items from the PHQ-4 (anhedonia, depressed mood, and worry). A DRQ-7 score of ≥6/23 identified depression outcomes with 0.73 specificity, 0.83 sensitivity, 0.68 positive predictive value, and 0.86 negative predictive value. A PHQ-4 score of ≥3/12 performed moderately well but less accurately than the DRQ-7 (net reclassification improvement = 10%; 95% CI [0.5-16]). INTERPRETATION: The DRQ-7 and the PHQ-4 with a new cutoff score are clinically accessible screeners for risk of depression in newly diagnosed breast cancer patients. Use of the screener to select patients for preventive interventions awaits validation of the screener in other samples.

Adolescent Sleep Duration, Variability, and Peak Levels of Achievement and Mental Health.

To inform public health recommendations for adolescent sleep, the amounts of sleep associated with the highest levels of academic achievement and mental health were examined. The degree to which daily variability in sleep duration represents an underappreciated but functionally significant sleep behavior also was tested. A total of 421 adolescents (Mage  = 15.03 years) with Mexican-American backgrounds reported nightly sleep times for 2 weeks; approximately 80% repeated the same protocol 1 year later. Multilevel modeling indicated that the amount of sleep associated with the lowest levels of internalizing and externalizing symptoms was more than 1 hr greater than the amount associated with the highest levels of academic performance. Greater daily variability in sleep duration predicted greater symptomatology and mixed academic outcomes.

Using Online Images to Teach Quantitative Skills via Comparative Neuroanatomy: Applying the Directives of Vision and Change.

Vision and Change calls for increasing the quantitative skills of biology majors, which includes neuroscience majors. Accordingly, we have devised a module to give students practice at regression analyses, covariance, and ANOVA. This module consists of a quantitative comparative neuroanatomy lab in which students explore the size of the hippocampus relative to the brain in 62 different mammalian species-from an anteater to a zebu. We utilize a digital image library (with appropriate metadata) allowing students to quantify the size of the hippocampus as well as obtain an index of the size of the brain in these various species. Students then answer the following questions: (1) Do brains scale with body size? (2) Does the hippocampus scale with brain size? (3) If we control for body size, does the hippocampus still scale with brain size? (4) How does the hippocampus change as a proportion of brain size? (5) Is the proportional scaling of the hippocampus different among primates, carnivores, and other mammals? (6) Do the data provide evidence for mosaic or concerted evolution? Measures of the pedagogical efficacy showed clear and significant gains on a PreTest vs PostTest assessment of material related to the module. An open ended qualitative measure revealed students' perception of the purposes of the module, which were consistent with the learning goals. This module utilizes open access digital resources and can be performed at any institution. All the materials or links to online resources can be found at https://mdcune.psych.ucla.edu/modules/cna.

Helping Yourself by Offering Help: Mediators of Expressive Helping in Survivors of Hematopoietic Stem Cell Transplant.

BACKGROUND: A randomized experiment by Rini et al. (Health Psychol. 33(12):1541-1551, 2014) demonstrated that expressive helping, which involves three expressive writing sessions regarding hematopoietic stem cell transplant, followed by one writing session directed toward helping other stem cell transplant recipients, reduced psychological distress and bothersome physical symptoms among stem cell transplant recipients with elevated survivorship problems, relative to a neutral writing control condition. PURPOSE: The current study evaluated whether word use reflective of emotional expression, cognitive processing, and change in perspective mediates the effects of expressive helping. METHOD: The essays of 67 stem cell transplant recipients with high survivorship problems were analyzed with Linguistic Inquiry and Word Count. Multiple mediation modeling was used to test the hypothesized mechanisms of expressive helping on distress and bothersome physical symptoms. RESULTS: Relative to the control condition, expressive helping produced significant reductions in psychological distress and marginal reductions in physical symptom bother in the analyzed subset of participants from the parent study. Results indicated that positive emotion word use significantly mediated effects of expressive helping on reduced distress, but only for participants who used average (compared to above or below average) rates of negative emotion words. Cognitive processing and change in perspective did not significantly mediate benefits of expressive helping. CONCLUSIONS: Expressive helping carried its positive effects on distress through participants' higher expression of positive emotions when coupled with moderate rates of negative emotions. Findings highlight the benefit of expressing both positive and negative emotions in stressful situations.

Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis.

Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women's physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women's lives.

Dispositional and Situational Avoidance and Approach as Predictors of Physical Symptom Bother Following Breast Cancer Diagnosis.

BACKGROUND: Few studies examine whether dispositional approach and avoidance coping and stressor-specific coping strategies differentially predict physical adjustment to cancer-related stress. PURPOSE: This study examines dispositional and situational avoidance and approach coping as unique predictors of the bother women experience from physical symptoms after breast cancer treatment, as well as whether situational coping mediates the prediction of bother from physical symptoms by dispositional coping. METHOD: Breast cancer patients (N = 460) diagnosed within the past 3 months completed self-report measures of dispositional coping at study entry and of situational coping and bother from physical symptoms every 6 weeks through 6 months. RESULTS: In multilevel structural equation modeling analyses, both dispositional and situational avoidance predict greater symptom bother. Dispositional, but not situational, approach predicts less symptom bother. Supporting mediation models, dispositional avoidance predicts more symptom bother indirectly through greater situational avoidance. Dispositional approach predicts less symptom bother through less situational avoidance. CONCLUSION: Psychosocial interventions to reduce cancer-related avoidance coping are warranted for cancer survivors who are high in dispositional avoidance and/or low in dispositional approach.

Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer.

Depression carries serious psychosocial, physical, and economic consequences for cancer survivors. Study goals were to characterize patterns and predictors of depressive symptoms and major depressive episodes in recently diagnosed breast cancer patients. Consecutively recruited women (N = 460) completed a validated interview (CIDI) and questionnaire measure (CES-D) of depression within 4 months after invasive breast cancer diagnosis and at six additional assessments across 12 months. Outcomes were major depressive episodes, continuous symptom scores, and latent symptom trajectory classes. Across 12 months, 16.6 % of women met criteria for a major depressive episode. Unemployment predicted depressive episodes after other correlates were controlled. Distinct trajectory classes were apparent: an estimated 38 % of women had chronically elevated symptoms (High trajectory), 20 % recovered from elevated symptoms (Recovery), and 43 % had lower symptoms (Low and Very Low trajectories). Although 96 % of episodes occurred in the High or Recovery classes, 66 % of women in the High trajectory did not have an episode. Women in the Low (vs High) trajectory were more likely to be older, retired, more affluent, and have fewer comorbid diseases and briefer oncologic treatment. Women in the Recovery trajectory (vs High) were more likely to be married and more affluent and have fewer comorbid diseases. Assuming available therapeutic resources, assessment of both depressive symptoms and episodes over several months after diagnosis is important. Identification of patients at risk for persistently high depressive symptoms (e.g., younger, longer treatment course) opens targeted opportunities to prevent and promote rapid recovery from depression.

Boys' and girls' weight status and math performance from kindergarten entry through fifth grade: a mediated analysis.

This study tests a mediated model of boys' and girls' weight status and math performance with 6,250 children from the Early Childhood Longitudinal Study. Five data points spanning kindergarten entry (mean age=68.46 months) through fifth grade (mean age=134.60 months) were analyzed. Three weight status groups were identified: persistent obesity, later onset obesity, and never obese. Multilevel models tested relations between weight status and math performance, weight status and interpersonal skills and internalizing behaviors, and interpersonal skills and internalizing behaviors and math performance. Interpersonal skills mediated the association between weight status and math performance for girls, and internalizing behaviors mediated the association between weight status and math performance for both sexes, with effects varying by group and time.

Selection and socialization of risky drinking during the college transition: The importance of microenvironments associated with specific living units.

Risky drinking among college students differs as a function of living types, with living at Greek houses as a major risk factor. Both self-selection based on prior drinking and socialization through living environments have been shown to account for this association. However, it is not clear whether selection and socialization processes occur as a function of specific living units within living types. Multilevel models using a prospective sample of incoming college students (N = 2,392) demonstrated that (1) precollege drinking based selection into specific living units occurred within both fraternity houses and residence halls (beyond selection into the Greek system in general) and (2) socialization of extremely risky drinking among certain fraternity houses was greater than other houses (beyond greater socialization of living at fraternity houses than residence halls in general). Living unit-level precollege correlates (i.e., college attendance motives and cigarette use) and college correlates (i.e., peer drinking norms and alcohol availability) accounted for most of the selection and socialization effects. These findings highlight the importance of micro-environments associated with specific living units in risky drinking during the college transition.

Motivational pathways to alcohol use and abuse among Black and White adolescents.

Using data from a biracial community sample of adolescents, the present study examined trajectories of alcohol use and abuse over a 15-year period, from adolescence into young adulthood, as well as the extent to which these trajectories were differentially predicted by coping and enhancement motives for alcohol use among the 2 groups. Coping and enhancement motivations (M. L. Cooper, 1994) refer to the strategic use of alcohol to regulate negative and positive emotions, respectively. Results showed that Black and White youth follow distinct alcohol trajectories from adolescence into young adulthood and that these trajectories are differentially rooted in the regulation of negative and positive emotions. Among Black drinkers, coping motives assessed in adolescence more strongly forecast differences in alcohol involvement into their early 30s, whereas enhancement motives more strongly forecast differences among White drinkers. Results of the present study suggest that different models may be needed to account for drinking behavior among Blacks and Whites and that different approaches may prove maximally effective in reducing heavy or problem drinking among the 2 groups.

Risky drinking in college changes as fraternity/sorority affiliation changes: a person-environment perspective.

This study aimed to resolve the direction of the relation between Greek affiliation and substance use by taking advantage of the quasi-experimental nature of change in college fraternity/sorority affiliation. Precollege individual differences and college substance use were examined as a function of time-varying Greek status to characterize self-selection (by which heavy substance users opt into Greek systems) and socialization (by which Greek systems foster heavy substance use). Prospective data on continuously enrolled college students (N=2,376), assessed at precollege and in the first 6 semesters of college, were used. Latent class analysis indicated 4 discrete groups of status: constant Greek members (30%), constant nonmembers (64%), late joiners (2%), and droppers (4%). Random coefficient models demonstrated disaffiliation with Greek systems is associated with decreases in risky drinking and alcohol-conducive environmental factors (peer norms and alcohol availability), whereas affiliation is associated with increases, indicating Greek socialization via sociocognitive and physical environments. Future Greeks differed from nonmembers in diverse individual characteristics and heavier substance use at precollege, suggesting multiple selection paths into Greek systems. Findings suggest a reciprocal relation between Greek environment and individuals in determining the trajectories of college drinking and heterogeneity in drinking as functions of changes in Greek affiliation.

Who needs more than standard care? Treatment moderators in a randomized clinical trial comparing addiction treatment alone to addiction treatment plus anxiety disorder treatment for comorbid anxiety and substance use disorders.

INTRODUCTION: Understanding for whom treatments exert their greatest effects is crucial for prescriptive recommendations that can improve overall treatment efficacy. Anxiety and substance use disorder comorbidity is prevalent and a significant public health concern. Little is known about who should receive specialized, integrated treatments to address both problems. This study aimed to examine baseline patient characteristics that predict differential outcome between typical treatment for substance use disorders (UC) compared to that treatment combined with cognitive behavioral therapy for anxiety disorders (UC + CALM ARC). METHODS: We examined several putative treatment moderators in a dataset of community-based participants (N = 75) from a randomized clinical trial at an outpatient community substance use disorder (SUD) specialty clinic. Participants who met criteria for any anxiety disorder and any SUD were randomized to UC (the Intensive Outpatient Program at the clinic) or UC + CALM ARC. Outcome measures included anxiety symptoms, drug use, and alcohol use, and were assessed at pre-treatment, post-treatment, and a 6-month follow-up assessment. RESULTS: Older age and female gender were associated with greater improvement on anxiety outcomes in UC + CALM ARC compared to UC. The presence of an alcohol use disorder was associated with greater improvement in alcohol use in UC + CALM ARC compared to UC. Higher opiate-related withdrawal symptoms and the presence of more SUDs were associated with greater improvement in drug use outcomes in UC + CALM ARC compared to UC. CONCLUSIONS: Several pre-treatment characteristics are associated with a return of symptoms for those who receive only UC, whereas the addition of CALM ARC prevented the return of symptoms. Implications for future research and preliminary clinical recommendations are discussed.

Cancer-related coping processes as predictors of depressive symptoms, trajectories, and episodes.

OBJECTIVE: Although numerous studies address the relationships of depression with coping processes directed toward approaching or avoiding stressful experiences, the large majority are cross-sectional in design, assess coping processes at only one timepoint, or solely include prediction of the linear slope of depressive symptoms. In this research, coping processes were investigated as predictors of depressive symptoms, symptom trajectory classes (consistently high, recovery, consistently low), and major depressive episodes (MDEs) over 12 months in the cancer context. METHOD: Women (N = 460) within 4 months of breast cancer diagnosis completed assessments of cancer-related coping processes, depressive symptoms, and MDEs at 7 points across 1 year. RESULTS: Beyond sociodemographic and medical variables, coping through cancer-related avoidance an average of 2 months after diagnosis was associated with likelihood of being in the high depressive symptom trajectory class and occurrence of a MDE during the year. Less decline in avoidant coping over time also predicted poor outcomes. In contrast, high initial engagement in approach-oriented coping, as well as increases in coping through emotional expression and acceptance, were associated with lower depressive symptoms across assessments and higher likelihood of being in the recovery or low trajectory class. CONCLUSIONS: Greater engagement in cancer-related avoidant coping was associated with all three indicators of depression, and greater approach-oriented coping was related to more favorable outcomes (except MDE). Sustained or increasing coping through emotional expression or acceptance predicted recovery from initially high depressive symptoms. Approach- and avoidance-oriented coping processes constitute malleable targets for preventive and ameliorative approaches. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children.

OBJECTIVE: To identify eating and activity factors associated with school-aged children's onset of overweight and persistent overweight. DESIGN: Data were gathered at four time points between kindergarten entry and spring of third grade. Children were directly weighed and measured and categorized as not overweight (<95th percentile of body mass index) or overweight (> or =95th percentile body mass index); parents were interviewed by telephone or in person. SUBJECTS/SETTING: Subjects were participants in the Early Childhood Longitudinal Study-Kindergarten Cohort, a nationally representative sample of children who entered kindergarten during 1998-1999. Children who weighed <2,000 g at birth, received therapeutic services before kindergarten, skipped or repeated a grade, or without complete height and weight data were excluded, resulting in 8,459 participants. Children with intermittent overweight were not examined (n=459); analyses addressed 8,000 children. MAIN OUTCOME MEASURES: Three mutually exclusive groups of children were identified: never overweight, overweight onset, and persistent overweight. STATISTICAL ANALYSES PERFORMED: Multilevel, multivariate logistic regression analyses estimated the effects of eating and activity factors on the odds of overweight onset and persistent overweight above child sex, race, and family socioeconomic status. RESULTS: Children who watched more television (odds ratio [OR] 1.02) and ate fewer family meals (OR 1.08) were more likely to be overweight for the first time at spring semester of third grade. Children who watched more television (OR 1.03), ate fewer family meals (OR 1.08), and lived in neighborhoods perceived by parents as less safe for outdoor play (OR 1.32) were more likely to be persistently overweight. Child aerobic exercise and opportunities for activity were not associated with a greater likelihood of weight problems. CONCLUSIONS: This study supports theories regarding the contributions of television watching, family meals, and neighborhood safety to childhood weight status. When working with families to prevent and treat childhood weight problems, food and nutrition professionals should attend to children's time spent with screen media, the frequency of family mealtimes, and parents' perceptions of neighborhood safety for children's outdoor play.

Using multilevel analyses with sibling data to increase analytic power: an illustration and simulation study.

This study investigates the extent to which analytic power can be increased through the inclusion of siblings in a data set and the concomitant use of random coefficient multilevel models. Analyses of real-world data regarding the predictors of young adult alcohol use illustrate how parallel single-level analyses of a 1-child-per-family data set and multilevel analyses of a data set including all siblings in each family would be conducted. A simulation study, closely based on the illustrative analyses, compares the empirical power to detect main, moderation, and mediation effects under three conditions: (a) single-level analyses of 1-child-per-family data, (b) multilevel analyses of all-siblings data, and (c) single-level analyses of independent data with sample size equivalent to the all-siblings condition. Supplementary analyses are conducted to determine the conditions under which greater analytic power could be achieved with the addition of siblings to a data set than with the addition of a lesser number of independent individuals at equivalent cost.