Exploring the structure of fearlessness using self-report measures.

OBJECTIVE: The present study examined the hierarchical structure of self-reported fearlessness and compared this structure to external criterion measures. BACKGROUND: Fearlessness is often discussed in relation to clinical and personality research. However, there is a paucity of research focusing on its empirical structure, in particular with self-report measures. METHOD: Using a preregistered analytical approach, we employed Goldberg's 2006 "bass-ackward" factor analysis on self-reported trait fear and fearlessness items to uncover the hierarchical structure of the construct. The final sample consisted of 619 participants and 562 informants. RESULTS: By assessing fit statistics and interpretability of the factors, we found a six-factor model fit the data best. The six-factor solution emerged as comprehensive and included components labeled Assertiveness, Low Anxiety, Sociability, Recklessness, Openness to Action, and Adventurousness. Criterion variables measuring boldness, fear, anxiety, psychopathy, basic personality traits, and impulsivity, were correlated with the factor scores at each factor level of the model. Conclusions The findings from this study elucidate how trait fearlessness unfolds at varying levels and how these factors relate to and diverge from various outcomes.

Momentary assessment of the relations between narcissistic traits, interpersonal behaviors, and aggression.

INTRODUCTION: This study explores the associations among narcissistic traits, interpersonal behaviors, and aggression using repeated, situation-based measurement. We examine narcissism's relations with aggression across three levels of its theorized hierarchy (level 1: narcissism; level 2: grandiose vs. vulnerable narcissism; level 3: antagonism, agentic extraversion, and narcissistic neuroticism). METHODS: Using an experience-sampling approach, the current study examined the effects of narcissism and its finer-grained components on daily affective experiences and aggressive behaviors in the context of interpersonal interactions. Data were collected from 477 undergraduate students who were instructed to complete four prompts a day for ten consecutive days. RESULTS: Narcissism at the global construct level positively predicted multiple indices of episodic aggression (i.e., aggressive temper, aggressive urge, verbal aggression). At the dual-dimension level, grandiose narcissism specifically predicted aggression, and then at the trifurcated level, interpersonal antagonism predicted aggression by itself and in interaction with event-level negative affect. Negative affect consistently exhibited both within- and between-person effects on aggression. CONCLUSION: In real-life social interactions, narcissism dimensions differentially affect the way individuals experience social interactions and process negative affect, and thus in both research and clinical practice, narcissism is best assessed as a heterogeneous, multidimensional construct.

Comparing Brief Measures of Narcissism-Internal Consistency, Validity, and Coverage.

Many measures, varying in breadth and length, have been constructed to measure narcissism. In recent years, super-short forms have become popular in research settings. Although brief measures hold some advantages, their brevity can come at psychometric costs. Participants recruited from Amazon's Mechanical Turk (N = 473) completed long and brief narcissism measures and criterion measures in a randomized order. Short forms were examined and compared to long forms in terms of their completion times and psychometric properties. Generally, the short forms demonstrated adequate internal consistency, variable convergence with each other, mostly moderate to strong convergence with long forms, and appropriate convergence with external criteria. These findings suggest that some short forms may be used when efficiency of survey administration is particularly important without significant psychometric cost. We discuss the advantages and disadvantages of the brief measures and make recommendations for which to use depending on the priorities of a given study.

Associations between food insecurity and child and parental physical, nutritional, psychosocial and economic well-being globally during the first 1000 days: A scoping review.

Food insecurity affects billions of individuals annually and contributes to myriad poor health outcomes. Experiences of food insecurity may be particularly harmful during the first 1000 days, but literature on the topic has not been synthesized. We therefore aimed to characterize all available studies examining associations between food insecurity and nutritional, psychosocial, physical and economic well-being among parents and children during this period. We implemented a standardized search strategy across 11 databases. Four researchers screened 10,257 articles, 120 of which met the inclusion criteria. Most studies were conducted in Sub-Saharan Africa (43.3%), followed by North America (20.8%). Studies were primarily quantitative (95.8%), cross-sectional (70.0%) and focused on women (pregnant or post-partum, 48.3%) or women and children (15.8%). Physical health outcomes were the most investigated (n = 87 studies), followed by nutritional (n = 69), psychosocial (n = 35) and economic well-being (n = 2). The most studied associations were between food insecurity and stunting (n = 15), maternal depression (n = 12), child dietary diversity (n = 7) and maternal body mass index (n = 6). The strength of evidence for the observed associations varied across populations as well as within and between examined outcomes. We recommend that future studies recruit more diverse study populations, consider temporality of relationships, use instruments that facilitate cross-site comparisons, measure individual-level food insecurity and outcomes most likely to be impacted by food insecurity, evaluate contextual factors that may modify the effects of food insecurity and employ analytic techniques that permit assessment of causal pathways.

Body Composition Trajectories During the First 23 Months of Life Differ by HIV Exposure Among Infants in Western Kenya: A Prospective Study.

BACKGROUND: Infants who are HIV-exposed and uninfected have suboptimal growth patterns compared to those who are HIV-unexposed and uninfected. However, little is known about how these patterns persist beyond 1 year of life. OBJECTIVES: This study aimed to examine whether infant body composition and growth trajectories differed by HIV exposure during the first 2 years of life among Kenyan infants using advanced growth modeling. METHODS: Repeated infant body composition and growth measurements (mean: 6; range: 2-7) were obtained from 6 weeks to 23 months in the Pith Moromo cohort in Western Kenya (n = 295, 50% HIV-exposed and uninfected, 50% male). Body composition trajectory groups were fitted using latent class mixed modeling (LCMM) and associations between HIV exposure and growth trajectories were examined using logistic regression analysis. RESULTS: All infants exhibited poor growth. However, HIV-exposed infants generally grew suboptimally than unexposed infants. Across all body composition models except for the sum of skinfolds, HIV-exposed infants had a higher likelihood of belonging to the suboptimal growth groups identified by LCMM than the HIV-unexposed infants. Notably, HIV-exposed infants were 3.3 times more likely (95% CI: 1.5-7.4) to belong to the length-for-age z-score growth class that remained at a z-score of < -2, indicating stunted growth. HIV-exposed infants were also 2.6 times more likely (95% CI: 1.2-5.4) to belong to the weight-for-length-for-age z-score growth class that remained between 0 and -1, and were 4.2 times more likely (95% CI: 1.9-9.3) to belong to the weight-for-age z-score growth class that indicated poor weight gain besides stunted linear growth. CONCLUSIONS: In a cohort of Kenyan infants, HIV-exposed infants grew suboptimally compared to HIV-unexposed infants beyond 1 year of age. These growth patterns and longer-term effects should be further investigated to support the ongoing efforts to reduce early-life HIV exposure-related health disparities.

The Questionable Practice of Partialing to Refine Scores on and Inferences About Measures of Psychological Constructs.

Partialing is a statistical approach researchers use with the goal of removing extraneous variance from a variable before examining its association with other variables. Controlling for confounds through analysis of covariance or multiple regression analysis and residualizing variables for use in subsequent analyses are common approaches to partialing in clinical research. Despite its intuitive appeal, partialing is fraught with undesirable consequences when predictors are correlated. After describing effects of partialing on variables, we review analytic approaches commonly used in clinical research to make inferences about the nature and effects of partialed variables. We then use two simulations to show how partialing can distort variables and their relations with other variables. Having concluded that, with rare exception, partialing is ill-advised, we offer recommendations for reducing or eliminating problematic uses of partialing. We conclude that the best alternative to partialing is to define and measure constructs so that it is not needed.

A comprehensive item-level examination of Conscientiousness' underlying structure across three large samples.

OBJECTIVE: The present study examined the hierarchical structure of Conscientiousness across three large samples using item-level analyses. BACKGROUND: Conscientiousness is among the strongest predictors of individual differences in major life outcomes. Yet decades of work understanding the optimal lower-order structure of Conscientiousness has not rectified the differences that remain among existing models and measures. To precisely measure its relations to major life outcomes, it is necessary to work toward a comprehensive, replicable conceptualization of the construct's structure. METHODS: The present pre-registered study used three samples (Ns = 446, 406, & 424) to explore the domain's latent structure with item-level "bass-ackward" factor analyses and evaluate the resulting structure's interpretability, parsimony, and replicability. Participants completed self-report measures of Conscientiousness and criteria in its nomological network (e.g., FFM traits, externalizing behavior, disinhibitory traits; informant reports were collected as well). RESULTS: The factor analyses identified five interpretable and replicable factors (i.e., deliberation, order, industriousness, self-discipline, and dependability) using predominant measures of general personality. An additional factor (i.e., traditionalism) was introduced in the six-factor solution when the item pool was expanded to include less widely used measures of general personality. CONCLUSION: The authors discuss the item composition of each factor, their relation to existing models and measures of the domain's structure, their association with relevant criteria, and the general implications of conceptualizing Conscientiousness using flexible, item-level factor analysis.

The structure of aggressive personality.

OBJECTIVE: We sought to factor analyze a broad array of aggression measures to identify a comprehensive, coherent factor structure for this construct. BACKGROUND: Measures and models of trait aggression have multiplied to the point of incoherence. METHOD: In Study 1, a diverse sample of 922 undergraduates completed a battery of items acquired from 42 self-report aggression questionnaires. In Study 2, we administered a curated item pool to another diverse sample of 1447 undergraduates, alongside criterion measures. RESULTS: We curated an initial item pool of 734 items down to 289 items that exhibited sufficient variability, were not redundant with other items, and possessed strong loadings onto a central 'trait aggression' factor. These remaining items were best characterized by a six-factor structure, which captured relational, angry, violent, retaliatory, intimate partner, and alcohol forms of aggression. We estimated their hierarchical structure, correlations with their original aggression scales, Five Factor Model trait dimensions, impulsivity facets, and found them to be robust to gender composition and the inclusion of alcohol-naive and intimate-partner-naive participants. CONCLUSIONS: This factor structure mostly supported widely-accepted models of aggressive personality that focus on its overt and relational forms and reactive functions, though proactive aggression only loosely emerged as a distinct entity. We retained the final items as the Comprehensive Aggression Scale (CAS).

Development of a measure of aggressive behavior expectancies in adults: The Aggression Expectancy Questionnaire.

According to sociocognitive theories, aggression is learned and elicited through a series of cognitive processes, such as expectancies, or the various consequences that an individual considers more or less likely following aggressive behavior. The current manuscript describes a measurement development project that ultimately yielded a 16-item measure of positive and negative aggression expectancies suitable for use in adult populations. Across two content generation surveys, two preliminary item refinement studies, and three full studies, we took an iterative approach and administered large item pools to several samples and refined item content through a combination of empirical (i.e., factor loadings, model fit) and conceptual (i.e., content breadth, non-redundancy) considerations. The Aggression Expectancy Questionnaire displays a four-factor structure, as well as evidence of convergent and divergent validity with self-reported aggression and relevant basic (e.g., antagonism, anger) and complex (e.g., psychopathy) personality variables. It is posited that this type of cognitive mechanism may serve as an intermediary link between distal characterological predictors of aggression and its proximal manifestation, which is in line with several prominent theories of personality and may ultimately hold clinical utility by providing a framework for aggression interventions.

Factor Structure of the FFM ATM: Antagonism, Emotional Stability, Impulsivity, and Agency.

The Dark Triad (DT) refers to three socially aversive personality constructs: psychopathy, narcissism, and Machiavellianism. In response to concerns with existing self-report questionnaires measuring these constructs, we created the Five Factor Model Antagonistic Triad Measure (FFM ATM), which uses 46 items to assess multidimensional, faceted versions of the three DT constructs. The current pre-registered study used two large samples (Ns = 600 and 1,247) to explore the structure of the FFM ATM using bass-ackward factor analyses. Participants completed the FFM ATM as well as measures of the five-factor model, aggression, antisocial behavior, and other criteria. A series of factor analyses identified four meaningful and replicable factors (i.e., Antagonism, Emotional Stability, Impulsivity, and Agency). The authors discuss the item composition of each of these factors, their relations to relevant criteria, and implications of conceptualizing the Antagonistic Triad as combinations of elemental traits (factors) as opposed to the multidimensional constructs of psychopathy, narcissism, and Machiavellianism.

Aerobic training reduces pancreatic fat content and improves ß-cell function: A randomized controlled trial using IDEAL-IQ magnetic resonance imaging.

AIMS: To explore the effects of six months of moderate-intensity aerobic exercise on pancreatic fat content and its impact on ß-cell function. MATERIALS AND METHODS: A total of 106 patients with type 2 diabetes mellitus were randomized to either a moderate-intensity aerobic training group (three times a week, including 5 min warm-up, 50 min aerobic dancing, and 5 min relaxation, n = 53) or control group (n = 53) with 6-month intervention. The primary endpoint was change in pancreatic fat content. An intention-to-treat analysis was conducted. RESULTS: Eighty-six patients completed the study with 43 patients in the aerobic training group. The average age, HbA1c, and pancreatic fat content for all participants (106 patients) were 66.39 ± 5.59 years, 7.05 ± 1.24%, and 10.35 ± 9.20%, respectively. Nearly half (49.06%) of patients were males. Subjects in the aerobic training group saw a significant reduction in pancreatic fat content when compared to controls (p = 0.001). In logistic regression models containing age, diabetes duration, change in BMI, smoking/drinking status, changes in lipid indices, and other abdominal fat content, only reduction in pancreatic fat content (p < 0.05) was an independent protective factor for ß-cell function and HbA1c. CONCLUSIONS: Six months of moderate-intensity aerobic training significantly reduced the pancreatic fat content. The reduction of pancreatic fat content was an independent protective factor for ß-cell function and HbA1c.

Potential Clinical Applications for Continuous Ketone Monitoring in the Hospitalized Patient with Diabetes.

PURPOSE OF REVIEW: In this review, the authors discuss potential clinical applications for continuous ketone monitoring (CKM) in a broad continuum of clinical settings from pre-hospital care and the emergency department to acute inpatient management and post-discharge follow-up. RECENT FINDINGS: Though in its early stages, the concept of a novel continuous ketone sensing technology exerts great potential for use in the detection and hospital management of DKA, namely to overcome diagnostic barriers associated with ketoacidosis in patients with diabetes and obtain real-time BOHB levels, which may be useful in understanding both patients' response to treatment and DKA trajectory. Peri- and intra-operative use of CKM technology can potentially be applied in a number of urgent and elective surgical procedures frequently underwent by patients with diabetes and in the observation of patients during peri-operative fasting. In transitional care management, CKM technology could potentially facilitate patients' safe transition through levels of care, following hospital discharge from a DKA episode. This evaluation of the literature presents the potential advantages of adopting CKM and integrating this technology into the care algorithm of patients at risk for ketoacidosis.

Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya.

Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.

RESUMEN: El acceso seguro al agua potable en cantidades suficientes (es decir, seguridad hídrica) es importante para la adherencia a la medicación y para limitar la exposición a patógenos; sin embargo, estudios anteriores solo han considerado el papel de la seguridad alimentaria como un determinante social de salud relacionado con el VIH. Por lo tanto, el objetivo de este análisis fue evaluar las relaciones entre la inseguridad hídrica en hogares y los resultados relacionados con el VIH en adultos que viven con VIH en el oeste de Kenia (N = 716). Realizamos un análisis transversal de los datos basales de la iniciativa Shamba Maisha (NCT02815579), un ensayo controlado aleatorio por conglomerados de una intervención multisectorial de créditos para insumos agrícolas. Los datos basales se recopilaron de junio de 2016 a diciembre de 2017. Evaluamos las asociaciones entre la inseguridad hídrica y resultados relacionados con el VIH, ajustando por factores de confusión clínicos y conductuales, incluyendo inseguridad alimentaria. Cada cinco unidades superiores de puntajes de inseguridad hídrica doméstica (rango: 0-51) fue asociado con 1.21 mayores probabilidades de tener una carga viral más alta ≥ 1000 copias / ml (CI 95%: 1,07-1,36) y con 1.26 mayores probabilidades de factores determinantes del SIDA (CI 95%: 1,11-1,42). La inseguridad de hídrica doméstica no se asoció con el recuento de células CD4 (B: −0,27; CI 95%: -13,59-13,05). Los programas de tratamiento y de apoyo al VIH deben considerar evaluar y abordar la inseguridad hídrica además de la inseguridad alimentaria para optimizar los resultados del VIH.

The relation between narcissism and aggression: A meta-analysis.

OBJECTIVE: Narcissism is a complex, hierarchical construct that can be studied at the one, two, or three factor levels with different components within each level having their own unique nomological networks. The manner in which narcissism-both broadly and narrowly construed-is linked to aggression is important to understand given longstanding clinical and empirical observations of a link between the two and the critical implications of aggression. METHODS: The current preregistered meta-analysis (k = 118) took a novel methodological approach in exploring the association between the three levels of narcissism (i.e., global construct level, dual-dimension level, trifurcated level) and three indices of aggression (i.e., general, proactive, reactive). RESULTS: Results revealed that the global construct of narcissism shows a moderate positive association with different indices of aggression. Vulnerable narcissism associated strongly and positively with reactive aggression and general aggression. At the trifurcated level, interpersonal antagonism associated positively with all indices of aggression, agentic extraversion associated negatively with all indices of aggression, and narcissistic neuroticism associates positively with general and reactive aggression. CONCLUSION: The study highlighted the importance of studying narcissism, and potentially other personality profiles, at a finer-grained level to better understand crucial psychological processes associated with the construct of interest.

Structural brain differences do not mediate the relations between sex and personality or psychopathology.

INTRODUCTION: Males and females tend to exhibit small but reliable differences in personality traits and indices of psychopathology that are relatively stable over time and across cultures. Previous work suggests that sex differences in brain structure account for differences in domains of cognition. METHODS: We used data from the Human Connectome Project (N = 1098) to test whether sex differences in brain morphometry account for observed differences in the personality traits neuroticism and agreeableness, as well as symptoms of internalizing and externalizing psychopathology. We operationalized brain morphometry in three ways: omnibus measures (e.g., total gray matter volume), Glasser regions defined through a multi-modal parcellation approach, and Desikan regions defined by structural features of the brain. RESULTS: Most expected sex differences in personality, psychopathology, and brain morphometry were observed, but the statistical mediation analyses were null: sex differences in brain morphometry did not account for sex differences in personality or psychopathology. CONCLUSIONS: Men and women tend to exhibit meaningful differences in personality and psychopathology, as well as in omnibus morphometry and regional morphometric differences as defined by the Glasser and Desikan atlases, but these morphometric differences appear unrelated to the psychological differences.

The distinction between symptoms and traits in the Hierarchical Taxonomy of Psychopathology (HiTOP).

The Hierarchical Taxonomy of Psychopathology (HiTOP) is an empirically and quantitatively derived dimensional classification system designed to describe the features of psychopathology and, ultimately, to replace categorical nosologies. Among the constructs that HiTOP organizes are "symptom components" and "maladaptive traits," but past HiTOP publications have not fully explicated the distinction between symptoms and traits. We propose working definitions of symptoms and traits and explore challenges, exceptions, and remaining questions. Specifically, we propose that the only systematic difference between symptoms and traits in HiTOP is one of time frame. Maladaptive traits are dispositional constructs that describe persistent tendencies to manifest features of psychopathology, whereas symptoms are features of psychopathology as they are manifest during any specific time period (from moments to days to months). This has the consequence that almost every HiTOP dimension, at any level of the hierarchy, can be assessed as either a trait or a symptom dimension, by adjusting the framing of the assessment. We discuss the implications of these definitions for causal models of the relations between symptoms and traits and for distinctions between psychopathology, normal personality variation, and dysfunction.

An empirically based power primer for laboratory aggression research.

Recent reviews suggest that, like much of the psychological literature, research studies using laboratory aggression paradigms tend to be underpowered to reliably locate commonly observed effect sizes (e.g., r = ~.10-.20, Cohen's d = ~0.20-0.40). In an effort to counter this trend, we provide a "power primer" that laboratory aggression researchers can use as a resource when planning studies using this methodology. Using simulation-based power analyses and effect size estimates derived from recent literature reviews, we provide sample size recommendations based on type of research question (e.g., main effect vs. two-way vs. three-way interactions) and correlations among predictors. Results highlight the large number of participants that must be recruited to reach acceptable (~80%) power, especially for tests of interactions where the recommended sample sizes far exceed those typically employed in this literature. These discrepancies are so substantial that we urge laboratory aggression researchers to consider a moratorium on tests of three-way interactions. Although our results use estimates from the laboratory aggression literature, we believe they are generalizable to other lines of research using behavioral tasks, as well as psychological science more broadly. We close by offering a series of best practice recommendations and reiterating long-standing calls for attention to statistical power as a basic element of study planning.

Annual decline in ß-cell function in patients with type 2 diabetes in China.

BACKGROUND: The aim of this study was to investigate the annual decline of ß-cell function correlated with disease duration in patients with type 2 diabetes in China. METHODS: This cross-sectional study included 4792 adults with type 2 diabetes who were recruited from four university hospital diabetes clinics between April 2018 and November 2018. Baseline data were collected from electric medical records. Participants were divided into 21 groups with 1-year diabetes duration interval to assess the decline rate of ß-cell function. Homeostatic model assessment model (HOMA 2) model was applied to assess ß-cell function. Multiple linear regression model was used to evaluate the association between biochemical and clinical variables and ß-cell function. RESULTS: In Chinese patients with type 2 diabetes, ß-cell function declined by 2% annually. Using angiotensin receptor blockade (ARB) (ß = .048; P = .011), metformin (ß = .138; P = .021), or insulin (ß = .142; P = .018) was associated with increased ß-cell function. However, increased BMI (ß = -.215; P = .022), alcohol consumption (ß = -.331; P < .001), haemoglobin A1c (ß = -.104; P = .027), or increased diabetes duration (ß = -.183; P = .003) was significantly and negatively associated with ß-cell function. CONCLUSIONS: We determined that the annual rate of the ß-cell function decline was 2% in patients with type 2 diabetes in China. Moreover, we confirmed a positive relationship between ARB treatment and ß-cell function, while BMI and alcohol consumption were significantly and negatively associated with the ß-cell function.

Household Water and Food Insecurity Are Positively Associated with Poor Mental and Physical Health among Adults Living with HIV in Western Kenya.

BACKGROUND: Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. OBJECTIVES: We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. METHODS: Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. RESULTS: Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P < 0.001) and 2.92 times greater odds of probable depression (P < 0.001). CONCLUSIONS: Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.

Persistent Food Insecurity, but not HIV, is Associated with Depressive Symptoms Among Perinatal Women in Kenya: A Longitudinal Perspective.

Food insecurity (FI) is an understudied risk factor for depression among perinatal women in sub-Saharan Africa. We therefore explored the longitudinal relationship between FI and depressive symptoms among a cohort of perinatal women of mixed HIV status (n = 371) in Kenya (NCT02974972, NCT02979418). Using longitudinal linear and logistic regressions with random effects, we assessed bivariate and adjusted associations between maternal FI and depressive symptoms. HIV status was also assessed as a potential effect modifier. At baseline, 58% of pregnant women had probable depression (CES-D score > 16) and 84% were severely food insecure. In adjusted analyses, severely food-insecure women had 5.90 greater odds (95% CI 2.32, 15.02, p < 0.001) of having probable depression and scored 4.58 points higher on the CES-D scale (SE: 1.04, p < 0.001) relative to food-secure women. HIV status did not modify the association between FI and depressive symptoms. Interventions to reduce FI may reduce perinatal depression, benefiting mothers and their infants.

RESUMEN: La inseguridad alimentaria es un factor de riesgo del estrés en el periodo de posparto entre mujeres en África Sub-sahariana que es poco estudiado. Por lo tanto exploramos la relación entre la seguridad alimentaria y los síntomas de depresión con un estudio longitudinal entre un cohorte de mujeres en diferentes etapas perinatal y con diferentes estatus de VIH (n=371) en Kenia (NCT02974972, NCT02979418). Se evaluaron asociaciones bi-variadas y asociaciones ajustadas entre la inseguridad alimentaria y las síntomas de depresión usando regresión lineal y logística con efectos aleatorios. El estatus de VIH también se evaluó como modificador de efecto. Al inicio del estudio el 58% de mujeres embarazadas tenían depresión probable (CES-D score >16) y el 84% tenían un nivel de inseguridad alimentaria severa. Mujeres con un nivel de inseguridad alimentaria severa tenían mayores posibilidades del 5.90 (95% IC: 2.32, 15.02, p < 0.001) de depresión probable y una puntuación mas alta del 4.58 en el CES-D (EE: 1.04, p < 0.001) en comparación a las mujeres con un nivel de inseguridad alimentaria seguro. El estatus de VIH no modifico la asociación entre la inseguridad alimentaria y los síntomas de depresión. Intervenciones destinadas para mitigar la inseguridad alimentaria podrían reducir la depresión en el periodo perinatal, proporcionando beneficios a las mamas y sus bebes.