Biomarker Profiles of Depression During Young Adulthood: Results From the National Health and Nutrition Examination Survey.

PURPOSE: Cumulative "wear and tear" on physiological systems (allostatic load) may contribute to risk for depression, but there is limited research on allostatic load during young adulthood, which is a peak developmental period for depression onset. This study evaluates profiles of allostatic load and their association with depression in young adults. METHODS: Biomarker and depression data were extracted for 18-24-year-olds (928 females, 932 males) in the National Health and Nutrition Examination Survey from 2015 to 2020. Latent class analysis was used to identify biomarker profiles. Multivariate logistic regression analyses were used to predict depression based on profile membership, controlling for sociodemographic characteristics. RESULTS: Three allostatic load profiles were identified in both females and males-high inflammatory and moderate metabolic dysregulation (immunometabolic dysregulation), high metabolic and moderate inflammatory dysregulation (metaboimmune dysregulation), or low dysregulation. Metaboimmune or immunometabolic dysregulation profiles in females, and metaboimmune dysregulation in males, were associated with 3-3.5 times greater odds of depression compared to low dysregulation profiles. DISCUSSION: Profiles of immune and metabolic dysregulation can be observed during young adulthood. Elevated immunometabolic and metaboimmune profiles were associated with depression risk in young adult females, while elevated metaboimmune profiles were associated with depression risk in young adult males. Detection of depression-related physiological dysregulation in young adults could be used to identify depression phenotypes and apply early interventions.

Lower Socioeconomic Status, Psychological Distress, and Self-reported Hypertension: A Longitudinal Moderated Mediation Analysis.

BACKGROUND: Lower socioeconomic status (SES) has been associated with hypertension; however, the mediators and moderators of this association remain understudied. We examined the mediation effect of psychological distress on the link between lower SES and self-reported hypertension and the racial and sex moderation effects. METHODS: We analyzed the data collected from 2009 to 2019 among adults from the Panel Study of Income Dynamics (PSID). Lower SES was defined as one of 3 indicators: education ≤12 years, unemployed, or individual annual income <$27,800. Psychological distress was assessed using the Kessler K6 scale. Cox proportional hazard regression was conducted. Mediation analyses were performed using the PROCESS macro. RESULTS: In the sample of heads of family who did not have self-reported hypertension in 2009 (N = 6,214), the mean age was 41 years, 30.6% were female, 32.9% were African American. The cumulative incidence of self-reported hypertension was 29.8% between 2009 and 2019. Cox proportional hazard regression analysis showed that after controlling for covariates, lower SES (score > 0 vs. score = 0) was associated with self-reported hypertension (hazard ratio = 1.27, 95% confidence interval = 1.14-1.42). SES had indirect effect on self-reported hypertension through psychological distress and the indirect effect (0.02 in females, 0.01 in males, P < 0.05) was moderated by sex but not by race. CONCLUSIONS: The association of SES and self-reported hypertension was mediated by psychological distress and sex moderated the mediation effect. Interventions focused on reducing contributors to SES and psychological stress should be considered to reduce hypertension risk.

Sleep disorders and relative risk of suicidal ideation and suicide attempts in youth presenting to emergency departments.

OBJECTIVE: Sleep problems predict suicide, which is a leading cause of death in adolescents and young adults, but the relative risk of suicidality in youth with sleep disorders has not been established in nationally representative samples. This study evaluated the relative risk of suicidal ideation and attempt in youth ages 6-24 who presented to United States emergency departments between 2015 and 2017. METHODS: Youths' diagnoses of sleep and psychiatric disorders, and emergency department encounters with suicide attempt and suicidal ideation, were extracted from the Health Care Cost Utilization Project's Nationwide Emergency Department Sample (N = 65,230,478). Relative risk of suicidal ideation and suicide attempt were evaluated through logistic regression and predicted rate ratios after adjustment for history of self-harm and demographic characteristics. RESULTS: Youth with at least 1 sleep disorder had 3 times greater odds of an emergency department encounter involving suicidal ideation compared to those without a sleep disorder (aOR = 3.22, 95% CI: 2.61, 3.98). The predicted probability of suicidal ideation was 46.03% higher in youth with a mood disorder and a sleep disorder, and 47.04% higher in youth with a psychotic disorder and sleep disorder, compared to youth without a sleep disorder. Only 0.32% of youth presenting to emergency departments were diagnosed with a sleep disorder. CONCLUSIONS: Sleep disorders are associated with increased risk for suicidal ideation in youth presenting to emergency departments. Sleep disorders are also underdiagnosed in youth presenting to emergency departments relative to their estimated prevalence in epidemiologic surveys. Research and public health campaigns to prevent suicide in youth should incorporate assessment and intervention for sleep disorders.

Adverse Childhood Experiences: Associations with a Blunted Cortisol Stress Response During Pregnancy.

INTRODUCTION: Adverse Childhood Experiences (ACEs) are associated with a range of negative physical and mental health outcomes, yet there is limited research focused on the effect of ACEs on stress responses during pregnancy. Expectant mothers experience an increase in cortisol levels as pregnancy progresses, with this increase having important implications for fetal and early infant development. Little is known about the impact of ACEs on maternal cortisol levels. This study explored the relationship between maternal ACEs and cortisol response among expectant mothers nearing or in the third trimester of pregnancy. METHODS: 39 expectant mothers were exposed to a Baby Cry Protocol via an infant simulator, with salivary cortisol collected at five points in time (N = 181). Stepwise, multilevel model creation resulted in a random intercept and random slope model with an interaction term for total number of ACEs and week of pregnancy. RESULTS: The repeated measures data showed that cortisol levels decreased across collection times, from arrival at the lab, through the Baby Cry Protocol, to recovery. Predictive margins for the interaction term showed that while exposure to a greater number of ACEs was associated with higher cortisol levels early in the third trimester, the expected increase in cortisol late in pregnancy was blunted for expectant mothers who were exposed to a greater number of ACEs. DISCUSSION: These findings findings suggest the importance of ACEs screening and intervention efforts as part of prenatal care.

Latent profiles of biological dysregulation and risk of mortality: time-to-event analysis using the Midlife in the US longitudinal study.

BACKGROUND: There is a well-established relationship between high allostatic load (AL) and increased risk of mortality. This study expands on the literature by combined latent profile analysis (LPA) with survival data analysis techniques to assess the degree to which AL status is associated with time to death. METHODS: LPA was employed to identify underlying classes of biological dysregulation among a sample of 815 participants from the Midlife in the US study. Sex-stratified Cox proportional hazards regression models were used to estimate the association between class of biological dysregulation and time to death while controlling for sociodemographic covariates. RESULTS: The LPA resulted in three classes: low dysregulation, immunometabolic dysregulation and parasympathetic reactivity. Women in the immunometabolic dysregulation group had more than three times the risk of death as compared with women in the low dysregulation group (HR=3.25, 95% CI: 1.47 to 7.07), but that there was not a statistically significant difference between the parasympathetic reactivity group and the low dysregulation group (HR=1.80, 95% CI: 0.62 to 5.23). For men, the risk of death for those in the immunometabolic dysregulation (HR=1.79, 95% CI: 0.88 to 3.65) and parasympathetic reactivity (HR=0.90, 95% CI: 0.34 to 3.65) groups did not differ from the low dysregulation group. CONCLUSION: The findings are consistent with the previous research that demonstrates increased AL as a risk factor for mortality. Specifically, in women, that increased risk may be associated with immunometabolic dysregulation and not simply a generalised measure of cumulative risk as is typically employed in AL research.

Measuring allostatic load: Approaches and limitations to algorithm creation.

OBJECTIVE: Allostatic load literature has proliferated over the past three decades, and a growing body of research demonstrates that higher levels of allostatic load are associated with a wide range of negative physical and mental health outcomes. However, there remain significant challenges with operationalization of the concept. A scoping review of the methods employed to create an allostatic load algorithm was conducted and recommendations for future research with an orientation towards advancing clinical application of the theory are discussed. METHODS: A search of seven electronic databases (PubMed, PsycINFO, Social Work Abstracts, Social Service Abstracts, Social Sciences Citation Index (Web of Science), Sociological Abstracts, Scopus) was completed with the search term "allostatic load." Studies were reviewed, and if they met the inclusion criteria, data was extracted, complied, and presented in the narrative, table, and figures. RESULTS: The initial searches yielded 5280 results with the final sample of 395 non-duplicate articles that met the inclusion criteria. More than half (52.5%) of all included publications employed biomarker cutoffs based on the high-risk quartiles of the sample distribution, 11.1% employed the sum of at-risk clinical scores, and the remainder of studies utilized a range of different algorithms. CONCLUSION: Allostatic load literature has grown at an exponential rate in recent years, but researchers continue to operationalize the concept via algorithms that may have limited utility moving forward. More nuanced statistical approaches are emerging and should be considered, as should a shift towards an approach that can provide additional clinical utility.

Associations between Allostatic Load and Posttraumatic Stress Disorder: A Scoping Review.

Traumatic events may lead to the development of PTSD or PTSD symptomology that can negatively impact health outcomes. Allostatic load, which represents the cumulative biological wear and tear of exposure to stress, can be employed to better understand the physiological etiology of PTSD. A scoping review, informed by the PRISMA Extension for Scoping Reviews, was completed to identify published and unpublished empirical studies that explored the relationship of allostatic load and PTSD. Eight databases were searched yielding four studies, with the results summarized narratively and in tabular form. Findings were mixed as to the association between allostatic load and PTSD. Allostatic load was positively associated with PTSD diagnosis; however, studies measuring only PTSD symptomatology found no relationship. Few PTSD researchers have tested the relationship of a comprehensive measure of allostatic load to PTSD. Among those who have, studies show that allostatic load can be a beneficial tool and applicable theoretical framework for understanding the biological changes associated with PTSD. Future research should focus on standardizing measures of both allostatic load and PTSD and identifying potential confounders. A better understanding of the physiological changes associated with PTSD could lead to more effective prevention and treatment efforts.

Emergency Department Admissions for Physical Child Abuse: Evidence from the 2006-2017 Nationwide Emergency Department Sample.

Physical child abuse continues to be a serious public health issue in the United States. This study expands on previous research by exploring trends in physical child abuse diagnoses among children admitted to emergency departments (EDs) across the United States. The analysis aimed to explicate the association between physical child abuse and both sociodemographic and behavioral health covariates to better inform and identify risk factors associated with ED admissions for abuse. The study also explicated differences between confirmed and suspected physical child abuse cases. The study utilized a nationally representative sample of hospital-owned EDs that included 319,676,625 ED admissions between 2006 and 2017 for children under 18-years-old. The analysis included a trend analysis, bivariate descriptive statistics, and multivariate logistic regression models were employed. Children with a physical child abuse diagnosis were less likely to be from higher income communities (aOR = 0.61, 95% CI [0.53, 0.71]), less likely to be female (aOR = 0.93, 95% CI [0.90, 0.96]), and more likely to be uninsured (aOR = 1.65, 95% CI [1.48, 1.84]). Children with attention-deficit hyperactivity disorder (aOR = 1.36, 95% CI [1.14, 1.62]) and a conduct disorder (aOR = 1.28, 95% CI [1.04, 1.58]) were more likely to have a physical abuse diagnosis. The sex-stratified analyses found that the higher rates of physical abuse among children with attention-deficit hyperactivity disorder were driven by the male subsample, while higher rates of abuse for those with conduct disorders were the result of the female subsample. A supplemental analysis of suspected versus confirmed physical child abuse for the fourth quarter of 2015 through 2017 also revealed sociodemographic and behavioral health differences. This study supports the need to consider sociodemographic and behavioral risk factors associated with physical child abuse to inform treatment and potential reoccurrence of abuse.

Housing Unit Type and Perceived Social Isolation Among Senior Housing Community Residents.

BACKGROUND AND OBJECTIVES: Social isolation, and its associated health implications, is an important issue for older adults in the United States. To date, there has been limited study of the pathways that connect these 2 factors. The present study expands on previous models by linking factors related to the built environment-in the form of housing unit type-to perceived social isolation among those living independently in dedicated senior housing. RESEARCH DESIGN AND METHODS: The causal inference technique of inverse probability weighting with regression adjustment was employed to assess the impact of living in a townhome-style unit, as opposed to in an apartment building, on self-reported perceived social isolation (N = 1,160). RESULTS: Individuals who lived in townhome-style housing reported a 10.4% lower probability of experiencing social isolation as a result of living in a townhome-style unit as opposed to an apartment building-style unit. DISCUSSION AND IMPLICATIONS: The findings provide evidence for the conceptual model that characteristics specific to a given housing unit type may create conditions that exacerbate or buffer individuals from experiencing social isolation. This, in turn, has important implications for the targeting of interventions for social isolation. Policy considerations related to the type of affordable senior housing being built should also be informed by these findings. Additionally, future research should better explicate the role of housing unit type on mental and emotional health outcomes.

Childhood adversity, suicidality, and non-suicidal self-injury among children and adolescents admitted to emergency departments.

PURPOSE: This population-based study explored the associations between childhood adversity and admission to emergency departments (EDs) with non-suicidal self-injury (NSSI) and with a suicide attempt. METHODS: A nationally representative cross-sectional sample of 5-17-year-olds admitted to EDs (N = 143,113,677) from 2006 to 2015 was utilized to assess the associations between childhood adversities, NSSIs, and suicide attempts. RESULTS: ED admissions with NSSI and admissions with a suicide attempt were associated with greater odds of exposure to individual childhood adversities (aORs: 1.34 to 5.86; aORs: 2.37 to 15.69, respectively). ED admissions with a suicide attempt were associated with greater odds of exposure to childhood adversities that might be perceived as less extreme or harmful (separation or divorce aOR: 15.69) than other adversities (death of a family member aOR: 13.38; history of physical abuse aOR: 9.56) as well as greater odds of exposure to three or more childhood adversities (aOR: 20.98). CONCLUSION: Early detection of childhood adversities is important for identifying potential risk factors for self-harm. ED admission data can provide population-level surveillance to aid in these efforts and lead to more targeted and effective interventions aimed at reducing the negative effects of toxic stress that can result from exposure to childhood adversities.

Coding of Sexual Assault by Emergency Physicians: A Nationally Representative Study.

INTRODUCTION: Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as "alleged." METHODS: This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample. RESULTS: Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault. CONCLUSION: Implications of this coding are discussed.

Neighborhood social integration as a predictor of neighborhood perceptions.

A growing body of literature has established a relationship between neighborhood perceptions and both physical and mental health outcomes, yet there remains a need to further explicate possible psychosocial factors that are predictive of neighborhood perceptions. This study hypothesized that an increase in social integration would result in more positive neighborhood perceptions. Propensity score matching on social integration was employed to strengthen the ability to draw a causal inference about the effect on neighborhood perceptions. When controlling for a range of sociodemographic covariates-including area deprivation index as a measure of objective neighborhood conditions-high social integration accounted for more than a 7% increase in neighborhood perceptions. The findings indicate the role of social integration as a predictor of neighborhood perceptions, revealing the potential importance of interventions and mechanisms aimed at improving neighborhood perceptions via social integration for the purposes of improving physical health and mental wellbeing.

Allostatic load and mental health: a latent class analysis of physiological dysregulation.

This study explored the associations between specific profiles of biological dysregulation and mental health outcomes in a national, community sample of healthy adults in the United States. A latent class analysis of data from the Midlife Development in the United States study (n = 1,757) was conducted to determine classes of biological dysregulation. Multinomial logistic regressions of class membership were employed to determine associations with measures related to depression, including whether or not individuals had sought treatment, Center for Epidemiological Studies Depression Scale, and both the generalized distress and anhedonia subscales of the Mood and Anxiety Symptoms Questionnaire. Four classes of dysregulation emerged: baseline/low dysregulation, metabolic and inflammatory dysregulation, parasympathetic dysregulation, and SAM pathway dysregulation. Individuals who met the criteria for depression measures were more likely to be in the metabolic and immune dysregulation and parasympathetic dysregulation groups as compared to the baseline group. The results suggest that mental health outcomes, such as depression, are differentially associated with specific profiles of biological dysregulation. A more nuanced approach to profiles of dysregulation could better inform treatment decisions.Lay summaryHigher levels of allostatic load, which represents the cumulative wear and tear of exposure to stress, are associated with increased rates of depression and anhedonia. Specifically, parasympathetic dysregulation and immunometabolic dysregulation are associated with negative mental health outcomes.

The mediating effect of allostatic load on the relationship between neighborhood perceptions and depression.

Neighborhood perceptions is an important predictor of both allostatic load in the form of biological dysregulation and major depressive disorder. Furthermore, biological dysregulation is predictive of major depressive disorder. Yet to date, the use of biological dysregulation as one potential causal pathway linking neighborhood perceptions to depression has not been explored. This study examined the relationship between neighborhood perception, biological dysregulation in the form of allostatic load, and depression among individuals who participated in the three waves of the Midlife Development in the United States study (1996-2014). Two-to-one propensity score matching was employed prior the use of causal mediation analyses. Lower neighborhood perceptions at wave one were associated with increased allostatic load at wave two. Allostatic load at wave two is associated with depression at wave three. The mediation analysis shows that 6.0% of the relationship between neighborhood perception and depression is mediated by biological dysregulation. These results can inform future prevention and treatment methods by supporting efforts to integrate individuals and community-level interventions to aid in addressing both the environmental conditions and biological factors associated with depression.

The Population Health OutcomEs aNd Information EXchange (PHOENIX) Program - A Transformative Approach to Reduce the Burden of Chronic Disease.

This concept article introduces a transformative vision to reduce the population burden of chronic disease by focusing on data integration, analytics, implementation and community engagement. Known as PHOENIX (The Population Health OutcomEs aNd Information EXchange), the approach leverages a state level health information exchange and multiple other resources to facilitate the integration of clinical and social determinants of health data with a goal of achieving true population health monitoring and management. After reviewing historical context, we describe how multilevel and multimodal data can be used to facilitate core public health services, before discussing the controversies and challenges that lie ahead.

A skillset and a stance: Program planning for cultural competence and cultural humility in home visitation.

Cultural competence has long been valued in home visitation, with a special focus on adapting home visiting programs to maximize their effects on specific cultures and populations. Critics advocate that traditional cultural competence training focusing on individual, professional skills-building should be replaced by cultural humility approaches that focus on humble engagement of participants. Little is known about how home visiting programs serving broadly diverse populations experience cultural competence and/or cultural humility efforts and initiatives on the ground. Interviews approximately 90-120 min in length were conducted with 34 home visiting program administrators in a large Midwestern state. Interviews were audio-recorded, transcribed, coded thematically, and subjected to content analysis. Two themes were identified from interviews. Respondents emphasized that: 1) cultural competency training was required by home visiting program models, so cultural competency questions were always addressed in home visitation, especially in training for new home visitors; and 2) cultural competence also included many aspects of cultural humility, commitment to continuous self-evaluation and self-reflection on cultural encounters that identified cultural knowledge gaps and sought more information. Respondents did not see cultural competency and cultural humility as oppositional and saw both concepts as important for engaging participants in home visitation.

Collective action among US veterans: Understanding the importance of self-efficacy, collective efficacy, and social support.

The purpose of this study was to examine the relationship between collective action, collective efficacy, self-efficacy, and social support among US veterans who formally volunteered in their communities upon their return from military service. The participants were 323 post-9/11/01-era veterans who completed a national nonprofit administered civic service program. Results from the structural equation model indicate that appraisal social support is negatively, directly associated with collective action, while belonging social support is positively, directly associated with collective action. In addition, appraisal social support is positively, indirectly associated with collective action via self-efficacy and collective efficacy. About 44% of the relationship between self-efficacy and collective action is associated via collective efficacy. The model accounts 19.9% of the variance in self-efficacy, 16.5% of the variance in collective efficacy, and 23.7% of the variance in collective action. The role of social support in the model provides additional evidence for the importance of strong social ties in facilitating collective action as veterans gather to volunteer in programs across the country. Results have implications for how national, nonprofit, and community volunteering programs may want to engage veterans and community members in collective action efforts.

Neighborhood perceptions and allostatic load: Evidence from Midlife in the United States study.

Allostatic load, which represents the cumulative wear and tear on physiological systems resulting from long-term exposure to stress, provides a theoretical framework that can be applied to understand the association between neighborhood conditions and health outcomes. Within allostatic load theory perception plays a key role, as the cognitive appraisal process associated with one's perceptions determines whether external stimuli-such as neighborhood conditions-are deemed threatening or benign. With data from the Midlife Development in the United States, this study employed structural equation modeling to assess the association between neighborhood perceptions and cumulative, systems-level allostatic load scores. The findings demonstrate that neighborhood perception, as operationalized as a combination of perceived trust in neighbors, perceived neighborhood safety, and perceived neighborhood conditions, was inversely associated with allostatic load even when controlling for objective neighborhood conditions.

Homicidal Ideation and Forensic Psychopathology: Evidence From the 2016 Nationwide Emergency Department Sample (NEDS).

Homicide is the most serious and costly criminal offense and better forensic and criminological understanding of homicidal ideation as a potential psychobehavioral precursor to homicidal conduct is critical. Using data from the 2016 Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP) distributed by the Agency for Healthcare Research and Quality (AHRQ), we found 64,910 cases of homicidal ideation among a sample of 25.6 + million-a prevalence of 0.25%. Numerous conditions conferred increased substantially the likelihood of homicidal ideation including antisocial personality disorder (2406%), schizoaffective disorder (1821%), borderline personality disorder (1557%), paranoid personality disorder (1,504%), schizophrenia (1,143%), obsessive-compulsive personality disorder (921%), brief psychotic disorder (771%), unspecified psychosis (737%), avoidant personality disorder (596%), and schizoid personality disorder (571%), delusional disorder (546%), and other psychotic disorder (504%). Homicidal ideation is comorbid with serious psychiatric and behavioral problems and has important implications for offender typologies and homicidality.