Patterns of experience, expression, and physiology of stress relate to depressive symptoms and self-injurious thoughts and behaviors in adolescents: a person-centered approach.

BACKGROUND: Preliminary evidence shows that discordance in stress experience, expression, and physiology (EEP) in adolescents is linked to depression, suicidal ideation (SI), non-suicidal self-injury (NSSI), and brain functioning. This study employs person-centered analysis to probe the relationship between stress responses, psychopathology, and neural patterns in female adolescents who are oversampled for engagement in NSSI. METHODS: Adolescent females (N = 109, ages 12-17) underwent a social stress test from which self-report measures of stress experience, observer ratings of stress expression, and physiological metrics of stress (via salivary cortisol) were obtained. Multi-trajectory modeling was employed to identify concordant and discordant stress EEP groups. Depressive symptoms, SI and attempt, NSSI engagement, frontal and limbic activation to emotional stimuli, and resting state fronto-limbic connectivity were examined in the EEP groups derived from the multi-trajectory models. RESULTS: Four groups were identified, three of which demonstrated relatively concordant EEP and one which demonstrated discordant EEP (High Experience-High Expression-Low Physiology). Further, replicating past research, the High Experience-High Expression-Low Physiology discordant group exhibited higher depressive symptoms, SI, suicide attempt, and NSSI episodes (only for sensitivity analyses based on past year) relative to other EEP groups. No significant group differences in brain functioning emerged. CONCLUSION: Results indicate that within-person, multi-level patterns in stress responding capture risk for dysfunction including depression and self-injurious thoughts and behaviors. Further interrogating of system-level stress functioning may better inform assessment and intervention efforts.

Clinical Trajectories in Adolescents with and without a History of Non-Suicidal Self-Injury: The BRIDGES Longitudinal Study.

Background: Non-suicidal self-injury (NSSI) is a highly prevalent clinical concern in adolescents and is associated with impaired functioning and suicide risk. The BRIDGES (BRain Imaging Development of Girls' Emotion and Self) study was designed to collect longitudinal clinical and neurobiological data to advance our understanding of NSSI in adolescents. The purpose of this paper is to describe the clinical data collected as part of this study, including psychiatric diagnoses, depression symptoms, episodes of non-suicidal self-injury, suicidal thoughts and behaviors, childhood trauma, and personality domains. Methods: The baseline sample included 164 adolescents aged 12-16 assigned female at birth (Mean age = 14.97, SD = 1.20) with NSSI histories ranging from none to severe. Participants and their parent/guardian were invited to provide data at three time points spaced approximately one year apart. Descriptive analyses were conducted to provide estimates of rates and trajectories of clinical data. Results: Of the 164 study participants, 75.61% and 57.93% completed the second and third time points, respectively. Visual inspection of the data suggests an overall trend of decreasing severity of psychopathology over time, and adolescents with a history of NSSI appeared to have higher rates of psychopathology than those without. Conclusions: This paper describes longitudinal clinical trajectories in adolescents with a range of NSSI histories and presents readers with an overview of the rich, publicly available dataset that we hope will inspire future research to advance the understanding of the neurodevelopmental trajectories associated with NSSI, depression, and suicide risk.

Motion state-dependent motor learning based on explicit visual feedback is quickly recalled, but is less stable than adaptation to physical perturbations.

Recent studies have shown that adaptation to visual feedback perturbations during arm reaching movements involves implicit and explicit learning components. Evidence also suggests that explicit, intentional learning mechanisms are largely responsible for savings-a faster recalibration compared with initial training. However, the extent explicit learning mechanisms facilitate learning and early savings (i.e., the rapid recall of previous performance) for motion state-dependent learning is generally unknown. To address this question, we compared the early savings/recall achieved by two groups of human subjects. One experienced physical perturbations (a velocity-dependent force-field, vFF) to promote adaptation that is thought to be a largely implicit process. The second was only given visual feedback of the required force-velocity relationship; subjects moved in force channels and we provided visual feedback of the lateral force exerted during the movement, as well as the required force pattern based on the movement velocity. Thus, subjects were shown explicit information on the extent the applied temporal pattern of force matched the required velocity-dependent force profile if the force-field perturbation had been applied. After training, both groups experienced a decay and washout period, which was followed by a reexposure block to assess early savings/recall. Although decay was faster for the explicit visual feedback group, the single-trial recall was similar to the physical perturbation group. Thus, compared with visual feedback perturbations, conscious modification of motor output based on motion state-dependent feedback demonstrates rapid recall, but this adjustment is less stable than adaptation based on experiencing the multisensory errors that accompany physical perturbations.NEW & NOTEWORTHY The extent explicit feedback facilitates motion state-dependent changes to motor output is largely unknown. Here, we examined motor adaptation for subjects that experienced physical perturbations and another that made adjustments based on explicit visual feedback information of the required force-velocity relationship. Our results suggest that adjustment of motor output can be based on explicit motion state-dependent information and demonstrates rapid recall, but this learning is less stable than adaptation based on physical perturbations to movement.

The Impact of Education on Depression Assessment: Differential Item Functioning Analysis.

A person's level of education can affect their access to health care, and their health outcomes. Increasing rates of depression are another looming public health concern. Therefore, vulnerability is compounded for individuals who have a lower level of education and depression. Assessment of depressive symptoms is integral to many domains of health care including primary care and mental health specialty care. This investigation examined the degree to which education influences the psychometric properties of self-report items that measure depressive symptoms. This study was a secondary data analysis derived from three large internet panel studies. Together, the studies included the Beck Depression Inventory-II, the Center for Epidemiologic Studies Depression Scale, the Patient Health Questionnaire, and the Patient Reported Outcomes Measurement Information System measures of depression. Using a differential item functioning (DIF) approach, we found evidence of DIF such that some items on each of the questionnaires were flagged for DIF with effect sizes ranging from McFadden's Pseudo R2 = .005 to .022. For example, results included several double-barreled questions flagged for DIF. Overall, questionnaires assessing depression vary in level of complexity, which interacts with the respondent's level of education. Measurement of depression should include consideration of possible educational disparities, to identify people who may struggle with a written questionnaire, or may be subject to subtle psychometric biases associated with education.

Normal Aging Affects the Short-Term Temporal Stability of Implicit, But Not Explicit, Motor Learning following Visuomotor Adaptation.

Normal aging is associated with a decline in memory and motor learning ability. However, the exact form of these impairments (e.g., the short-term temporal stability and affected learning mechanisms) is largely unknown. Here, we used a sensorimotor adaptation task to examine changes in the temporal stability of two forms of learning (explicit and implicit) because of normal aging. Healthy young subjects (age range, 19-28 years; 20 individuals) and older human subjects (age range, 63-85 years; 19 individuals) made reaching movements in response to altered visual feedback. On each trial, subjects turned a rotation dial to select an explicit aiming direction. Once selected, the display was removed and subjects moved the cursor from the start position to the target. After initial training with the rotational feedback perturbation, subjects completed a series of probe trials at different delay periods to systematically assess the short-term retention of learning. For both groups, the explicit aiming showed no significant decrease over 1.5 min. However, this was not the case for implicit learning; the decay pattern was markedly different between groups. Older subjects showed a linear decrease of the implicit component of adaptation over time, while young subjects showed an exponential decay over the same period (time constant, 25.61 s). Although older subjects adapted at a similar rate, these results suggest natural aging selectively impacts the short-term (seconds to minutes) temporal stability of implicit motor learning mechanisms. This understanding may provide a means to dissociate natural aging memory impairments from deficits caused by brain disorders that progress with aging.

How Does Narcolepsy Impact Health-Related Quality of Life? A Mixed-Methods Study.

Study Objectives: The purpose of this study was to identify patient-centered issues affecting Health-Related Quality of Life (HRQoL) in people with narcolepsy (PWN) and to evaluate patient-reported outcome measures using a mixed-methods approach. Methods: Twenty-nine adults (93% female, mean age = 31 years) with an established diagnosis of narcolepsy (Type I = 58.6%) completed focus group interviews using live videoconferencing. Additionally, participants completed the Patient-Reported Outcomes Measurement Information System (PROMIS) measures along with legacy measures commonly used in narcolepsy research (Epworth Sleepiness Scale, Patient Health Questionnaire, Short-Form 36). Results: Thematic analysis of qualitative data revealed that HRQoL was impacted by the constancy of sleepiness, unpredictability of narcolepsy symptoms, and negative public perception of narcolepsy. Challenges to accessibility and/or quality of care included dissatisfaction with non-sleep specialists' understanding of narcolepsy, the unpredictability of symptoms, and the cost of health care. There was enthusiasm for developing a psychosocial intervention to improve HRQoL using online access, but there were mixed opinions regarding the format, provider background, and content of the intervention. Elevations (T-score > 60) were found on PROMIS measures of depression, anxiety, fatigue, and sleep impairment. These patterns were consistent with the levels reported on legacy measures. PWN Type I reported lower levels of general health relative to Type II (p < .05). Conclusions: These findings lay the groundwork for more targeted efforts to address areas of diminished HRQoL in PWN. Additionally, PROMIS measures appear to be suitable and efficient instruments for assessing HRQoL in PWN.