Predicting healthcare utilization in youth with type 1 diabetes: The importance of family level variables.

OBJECTIVE: Little is known about how family factors impacting treatment adherence in type 1 diabetes are directly associated with unplanned healthcare utilization (e.g., emergency room visits and hospital admissions). Given the substantial financial burden of diabetes, understanding predictors of healthcare utilization in particular is important to inform behavioral interventions aimed toward improving adherence. RESEARCH DESIGN AND METHODS: The current study examined the relationship between family-level variables and healthcare utilization in a sample of 239 youth with type 1 diabetes and their parents. Healthcare utilization was determined via parent report and chart review. Parent- and youth-reports regarding levels of family conflict, youth autonomy, and parent support related to diabetes management were obtained via questionnaire, and negative reciprocity was obtained by coding observations of parent and youth interactions. Generalized Estimating Equations were used to examine the longitudinal association between healthcare utilization and family-level factors. RESULTS: Higher levels of observed negative reciprocity were associated with more frequent hospital admissions, while higher levels of youth-reported parent involvement in diabetes management were associated with fewer hospital admissions and ED visits. CONCLUSIONS: These findings highlight how family-level factors are directly related to healthcare utilization and point to the continued importance of integrating family-focused behavioral interventions in routine medical care for improving type 1 diabetes outcomes and reducing healthcare costs.

Gender Differences in the Developmental Links Between Conduct Problems and Depression Across Early Adolescence.

Various developmental models have attempted to explain the relationship between antisocial behavior and depressive symptoms in youth, often proposing intermediary processes such as social and academic functioning. However, few studies have tested these developmental models fully, particularly in mixed gender samples. The current study strives to fill this gap in the literature, examining these processes in an early adolescent sample. Results indicated both direct and indirect paths between antisocial behavior and depression. In addition, potentially important gender differences were found. These results underscore the importance of examining direct and indirect links between symptoms of depression and anti-social behavior, and suggest that there may be important developmental differences between girls and boys in the relationship between these symptoms.

Attention bias in youth: associations with youth and mother's depressive symptoms moderated by emotion regulation and affective dynamics during family interactions.

Recent research has highlighted the potential role of attention bias for emotional stimuli as a possible cognitive risk factor for depression in youth. However, differences in youth emotion regulation or maternal affect may moderate the association between maternal and youth depression and youth attention biases. The current study investigated the relationship between maternal and youth depressive symptoms and youth (aged 11-17 years) attention bias for sad and happy faces in 59 mother-youth dyads, examining whether positive and negative maternal affect observed during structured interaction tasks or youth emotion regulation tendencies moderated associations between maternal and youth depression and attention biases. Youth suppression interacted with maternal and youth depression to predict sad attentional biases in youth, while maternal positive affect interacted with maternal depression to predict happy attention biases in youth.

Examining the developmental interface of cortisol and depression symptoms in young adolescent girls.

Despite the substantial amount of data supporting a link between HPA-axis functioning and depression, the ontogeny of this association is not known. The aim of the present study was to contribute data on the developmental interface of HPA-axis functioning and depression in girls by testing associations between repeated measures of depression symptoms and cortisol levels in childhood and early adolescence. Girls (N=232) and their mothers, who were participating in a longitudinal study, were interviewed about depression symptoms annually from ages 9 to 12 years. Cortisol was assayed from saliva at ages 10 and 12 years upon arrival to the lab and following administration of the cold pressor task (CPT). Time of day of collection of saliva and level of pubertal development were included as covariates in model testing. Although most girls did not show an increase in cortisol in response to the CPT, lower levels of output during the CPT were associated with higher levels of depression symptoms. These findings were observed only for cortisol levels assessed at age 12 years. Girls with low levels of cortisol output at age 12, and decreases in output from ages 10 to 12, had stable or slightly increasing depression symptoms from ages 9 to 12 years. We conclude that associations between HPA-axis functioning and depression emerge as early as age 12. However, individual differences in cortisol levels at age 12 also were associated with depression symptoms at earlier ages. The data suggest two possibilities: (1) that childhood depression is associated with HPA-axis dysregulation, but that age related changes in the sensitivity or plasticity of the HPA-axis may result in a delay in the emergence of such an association, or (2) that dysregulation of the functioning of the HPA-axis develops following repeated experience of depression symptoms.

Family Check Up effects on adolescent arrest trajectories: Variation by developmental subtype.

This study examines the effect of the Family Check Up intervention on the probability of arrests from ages 12 to 17 years for youth following heterogeneous developmental trajectories of antisocial behavior. Latent Growth Mixture Modeling results supported the presence of three developmental trajectories of arrests, including a large group of youth with few police contacts, a smaller group of youth showing early onset and chronic arrests, and a group with adolescent-onset arrests. In line with hypotheses, effects of intervention were seen within the adolescent-onset group, but not in the early onset chronic arrest trajectory group, or those youth with little police contact. The trajectory groups were differentiated by peer, family, behavioral and academic risk variables at age 11.

Maternal depression and the heart of parenting: respiratory sinus arrhythmia and affective dynamics during parent-adolescent interactions.

Maternal depression is associated with problematic parenting and the development of emotional and behavior problems in children and adolescents. While emotional regulatory abilities are likely to influence emotional exchanges between parents and teens, surprisingly little is known about the role of emotion regulation during parent-child interactions, particularly in high-risk families. Respiratory sinus arrhythmia (RSA) has been widely linked to emotion regulatory abilities in recent research, and the current study investigated RSA and maternal depression in relation to dyadic flexibility, as well as mutuality of negative and positive affect displayed during three discussion tasks between 59 mother-adolescent pairs (age 11-17 years). Dyadic flexibility was predicted by the interaction of maternal depression, maternal RSA, and teen RSA, with higher maternal RSA predicting greater dyadic flexibility, particularly in highest risk dyads (i.e., elevated maternal depression and lower teen RSA). Teen RSA interacted with maternal depression to predict mutual negative affect, serving as a protective factor. Finally, maternal and teen RSA interacted to predict mutual positive affect, with maternal RSA buffering against low teen RSA to predict higher mutual positive affect. Results support the role of RSA in affectively laden interactions between parents and adolescents, particularly in the face of maternal depression.

Autobiographical memory as a predictor of depression vulnerability in girls.

Overgeneral autobiographical memory (AM), the tendency to recall categories of events when asked to provide specific instances from one's life, is purported to be a marker of depression vulnerability that develops in childhood. Although early adolescence is a period of risk for depression onset especially among girls, prospective examination of this putative risk factor is lacking. The current study examined the prospective associations between AM recall and depressive symptomatology in an enriched community sample of predominantly African American girls. Girls (n = 195) were interviewed about depressive symptoms at ages 11 and 12 years, and AM recall was assessed at age 11. The findings showed that overgeneral retrieval to positive, but not negative, cue words predicted subsequent depressive symptoms after controlling for age 11 symptoms, race, poverty, and Verbal IQ. A moderating effect of race was also shown, whereby overgeneral AM bias predicted depressive symptoms more strongly among European American girls.

Depression begets depression: comparing the predictive utility of depression and anxiety symptoms to later depression.

BACKGROUND: The high comorbidity between depressive and anxiety disorders, especially among females, has called into question the independence of these two symptom groups. It is possible that childhood anxiety typically precedes depression in girls. Comparing of the predictive utility of symptoms of anxiety with the predictive utility of symptoms of depression from early childhood to early adolescence is needed to test this hypothesis. METHODS: Data from a population-based sample of 2,451 girls were used to examine age-related changes and year-to-year stability within and across symptoms of major depression, separation anxiety, and generalized/social anxiety by maternal report from ages 6 to 12. In addition, the predictive utility of symptoms of major depression, separation anxiety, and generalized/social anxiety at ages 7-10 years of age to depressive disorders at ages 11-13 was tested. RESULTS: Symptoms of separation anxiety demonstrated a linear decrease, depression symptoms a linear increase and symptoms of generalized/social anxiety an increase from 6-8, a plateau 8-10, followed by a decrease from 10-12 years. Year-to-year changes in symptoms of major depression were best predicted by depressive symptoms in the previous year, although a small amount of additional variance was accounted for by separation anxiety symptoms in early childhood and generalized/social anxiety symptoms in mid to later childhood. Age 8 was the earliest age from which depressive disorders in early adolescence could be predicted from symptoms of depression and generalized social anxiety. CONCLUSIONS: Homotypic continuity of depression and anxiety symptoms from early childhood to early adolescence is more common in girls than heterotypic continuity. Some additional information about year-to-year changes in depression symptoms and later depressive disorder is gained by assessing anxiety symptoms. Depressive symptoms themselves, however, appear to be the strongest and most reliable predictor of later depression.

Rubber hands feel the touch of light.

Two experiments involving a total of 220 subjects are reported. The experiments document that "stroking" a false hand with the bright beam of light from a laser pointer can produce tactile and thermal sensations when the hand can be seen as one's own. Overall, 66% of subjects reported somatic sensations from the light. Felt hand location was recalibrated toward the location of the false hand for those subjects who felt the light. Moreover, the proprioceptive recalibration from the laser experience was comparable to that produced by actual coordinated brushing of the false hand and of the unseen real hand after 2 min of stimulation. The illusion may be experienced on one's real hand as well. The results are discussed in terms of multisensory integration.