Daily Levels and Dynamic Metrics of Affective-Cognitive Constructs Associate With Suicidal Thoughts and Behaviours in Adults After Psychiatric Hospitalization.

The period after psychiatric hospitalization is an extraordinarily high-risk period for suicidal thoughts and behaviours (STBs). Affective-cognitive constructs (ACCs) are salient risk factors for STBs, and intensive longitudinal metrics of these constructs may improve personalized risk detection and intervention. However, limited research has examined how within-person daily levels and between-person dynamic metrics of ACCs relate to STBs after hospital discharge. Adult psychiatric inpatients (N = 95) completed a 65-day ecological momentary assessment protocol after discharge as part of a 6-month follow-up period. Using dynamic structural equation models, we examined both within-person daily levels and between-person dynamic metrics (intensity, variability and inertia) of positive and negative affect, rumination, distress intolerance and emotion dysregulation as risk factors for STBs. Within-person lower daily levels of positive affect and higher daily levels of negative affect, rumination, distress intolerance and emotion dysregulation were risk factors for next-day suicidal ideation (SI). Same-day within-person higher rumination and negative affect were also risk factors for same-day SI. At the between-person level, higher overall positive affect was protective against active SI and suicidal behaviour over the 6-month follow-up, while greater variability of rumination and distress intolerance increased risk for active SI, suicidal behaviour and suicide attempt. The present study provides the most comprehensive examination to date of intensive longitudinal metrics of ACCs as risk factors for STBs. Results support the continued use of intensive longitudinal methods to improve STB risk detection. Interventions focusing on rumination and distress intolerance may specifically help to prevent suicidal crises during critical transitions in care.

Nonmedical Prescription Drug Use Among Female Adolescents: The Relative Influence of Maternal Factors, Social Norms, and Perceptions of Risk and Availability.

Increasing understanding of the risk and protective factors for adolescent nonmedical use of prescription drugs (NMUPD) could inform prevention efforts. Several correlates have been identified, including parental factors, perceptions about use and accessibility, social norms, and age. However, these constructs have rarely been simultaneously examined using paired data from parents and adolescents. We aimed to examine the relative influence of these correlates among dyads (N=349) of mothers and adolescent daughters. Using multiple logistic regression, daughters' past NMUPD and inclination for future NMUPD were regressed onto descriptive norms for friend use, perceived drug accessibility and risk of harm from use, daughter age, mothers' disapproval about use, mothers' past NMUPD and inclination for future NMUPD, and the mother-daughter relationship quality. Akaike weights and lasso regressions were also estimated to evaluate the relative importance of each correlate. Higher descriptive norms for friend use, older age, and mothers' inclination for NMUPD were risk factors for daughters' NMUPD, while a closer mother-daughter relationship and mothers' disapproving attitudes towards NMUPD were protective factors. The three analysis approaches were corroborative. Results suggest friend descriptive norms, mother-daughter relationship quality, and mothers' attitudes about NMUPD are important prevention targets.

An investigation of the effects of sensation seeking and impulsivity on extreme sport participation and injury using path analysis.

OBJECTIVE: Extreme sport participation and injury rates have increased in recent decades. This study aimed to investigate sub-dimensions of impulsivity and sensation seeking that contribute to participation and injury risk in extreme sports. PARTICIPANTS: Data included cross-sectional survey responses from 7,109 college students (Mage = 19.68, SD = 2.31). METHODS: This study utilized path analysis to investigate sub-dimensions of sensation seeking and impulsivity as predictors of extreme sport participation and injury across 3 models. RESULTS: Results of the final model identify risk seeking and lack of perseverance as the two strongest predictors of extreme sports injury, risk seeking, experience seeking, and lack of premeditation as the strongest positive predictors of extreme sports participation, and lack of perseverance as the strongest negative predictor of extreme sports participation. CONCLUSIONS: These results will contribute to targeted prevention and intervention efforts for extreme sports injury among young adults based on identified individual personality factors.

Personality and emotion dysregulation profiles predict differential engagement in a wide range of health-risk behaviors.

OBJECTIVE: Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies. PARTICIPANTS: 2077 college students completed a cross-sectional survey. METHODS: Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes. RESULTS: Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors. CONCLUSIONS: Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex.

Heavy episodic drinking in adolescence and alcohol-related problems in adulthood: A developmental approach to alcohol use across the life course.

Heavy episodic drinking (HED) is a major public health concern, and youth who engage in HED are at increased risk for alcohol-related problems that continue into adulthood. Importantly, there is heterogeneity in the onset and course of adolescent HED, as youth exhibit different trajectories of initiation and progression into heavy drinking. Much of what is known about the etiology of adolescent HED and alcohol-related problems that persist into adulthood comes from studies of predominantly White, middle-class youth. Because alcohol use and related problems vary by race/ethnicity and socioeconomic status, it is unclear whether previous findings are relevant for understanding developmental antecedents and distal consequences of adolescent HED for minoritized individuals. In the current study, we utilize a developmental psychopathology perspective to fill this gap in the literature. Using a racially and economically diverse cohort followed from adolescence well into adulthood, we apply group-based trajectory modeling (GBTM) to identify patterns of involvement in HED from age 14 to 17 years. We then investigate developmental antecedents of GBTM class membership, and alcohol-related distal outcomes in adulthood (∼ age 31 years) associated with GBTM class membership. Results highlight the importance of adolescent alcohol use in predicting future alcohol use in adulthood.

Meaning in Life Moderates Relations between Personality and Temperament and Nonsuicidal Self-Injury in Hospitalized Adolescents.

Previous research indicates that sensation seeking, emotion dysregulation, and impulsivity are predictive of non-suicidal self-injury (NSSI). A body of research supports that meaning in life predicts improved mental health and well-being, including fewer suicidal thoughts and attempts, yet no research has examined the moderating effects of meaning in life on the relations between personality and temperament and NSSI. Given the growing incidence rates of NSSI among adolescents and the potential lifelong consequences of NSSI, it is imperative to better understand the factors that reduce the rates at which adolescents in a clinical sample engage in NSSI. The present study investigates if the protective factors of meaning in life moderate the relation between personality and temperament variables and NSSI among 126 adolescents (71% female, Mage = 16.1, SD = 1.1, range 13-18, 80% White) residing in an inpatient psychiatric hospital who endorsed NSSI in the last 12 months. Results from hurdle modeling indicate that two subtypes of meaning in life, presence of meaning in life and search for meaning of life, may serve as robust protective factors against engagement in NSSI among a clinical sample of adolescents. Additionally, results suggest that search for meaning, but not presence of meaning in life, variables moderate the relations between personality and temperament and NSSI. Results provide evidence that meaning in life is an understudied variable of importance in understanding how to prevent or treat NSSI. It also underscores the need to develop, refine, and test meaning-making interventions.

Classification trees identify shared and distinct correlates of nonsuicidal self-injury and suicidal ideation across gender identities in emerging adults.

College students have an elevated risk for self-injurious thoughts and behaviours (SITBs), and there are robust differences in prevalence rates for SITBs across gender identities. Although numerous constructs have been implicated as risk factors, researchers have not significantly improved at predicting SITBs, possibly owing to constraints of confirmatory analyses. Classification trees are exploratory, person-centred analyses that enable joint examination of numerous correlates and their interactions. Thus, classification trees may discern previously unstudied risk factors and identify distinct subpopulations with elevated risk for SITBs. We tested classification trees that evaluated 298 potential correlates of nonsuicidal self-injury and suicidal ideation across self-identified women and men. Data came from 5,131 college students who completed the National College Health Assessment, which assesses a wide range of health-related constructs. Models produced parsimonious decision trees that accounted for a substantial amount of outcome variability (38.3-51.5%). Psychopathology, poorer psychological well-being, and other SITBs emerged as important correlates for all participants. Trauma, disordered eating, and heavy alcohol use were salient among women, whereas alcohol use norms were important correlates among men. Importantly, models identified several constructs that may be amenable to intervention. Results support the use of exploratory analyses to explicate heterogeneity among individuals who engage in SITBs and suggest that gender identity is an important moderator for certain risk factors.

Cannabis Outcome Expectancies, Cannabis Use Motives, and Cannabis Use among a Small Sample of Frequent Using Adults.

Background: Little is known about the factors influencing use among frequent cannabis users, defined here as using at least three times per week. Outcome expectancies and motives for cannabis use have been independently examined in relation to cannabis use, but not among frequent users. Further, the associations among distinct expectancies and motives for cannabis use have yet to be explored. The current study examined whether expectancies influence cannabis use through cannabis use motives among frequent users. Additionally, we examined more nuanced relationships among three cannabis outcome expectancies (relaxation/tension reduction, social, perceptual/cognitive) and four motives (enhancement, social, coping, expansion). Method: Bayesian path analysis with informative priors was used to examine associations among expectancies, motives, and outcomes in a sample of 54 (63% male) young adult frequent users (i.e., at least three times per week; 65% used daily). Participants were recruited from the community and completed self-report questionnaires assessing cannabis use, expectancies, and motives. Results: Findings support hypotheses that cannabis use expectancies were associated with unique motives for frequent cannabis users. Perceptual/cognitive enhancement expectancies were the only expectancy to consistently relate to all four cannabis use motives. Social expectancies were related to enhancement, social, and expansion motives for use, and relaxation/tension reduction expectancies were associated with coping motives. Conclusions: Results extend previous work examining direct and indirect effects of expectancies and motives among frequent using young adults. Findings support the potential clinical utility of exploring the perceived functional benefits of cannabis use for individual frequent users as well as potential alternatives that might serve similar functions with fewer risks and consequences.

Using Classification Trees to Examine Predictors of Marijuana Use Among a Wide Range of Variables.

Background: Young adults have elevated risk for negative marijuana use-related outcomes, and there is heterogeneity among users. Identifying risk factors for marijuana user status will improve understanding of different populations of users, which may inform prediction of individuals most likely to experience negative outcomes. Objectives: To identify predictors of marijuana use initiation in young adults. We simultaneously examined a broad range of potential predictors and all their possible interactions, including constructs that have not been previously studied in substance use initiation research. Methods: Data were repeated cross-sectional survey responses from college students in Colorado (N = 4052, 77% White, 61% female, mean age = 22.77). Measures came from the National College Health Assessment, which assesses numerous health and behavioral constructs. We used recursive partitioning and random forest models to identify predictors of ever having used marijuana out of 206 variables. Results: Classification trees identified engagement in increased alcohol use and sexual behavior as salient correlates of marijuana use initiation. Parsimonious recursive partitioning trees explained a substantial amount of variability in marijuana user status (39% in the full model and 24% when alcohol variables were excluded). Random forest models predicted user status with 74.11% and 66.91% accuracy in the full model and when alcohol variables were excluded, respectively. Conclusions: Results support the use of exploratory analyses to explain heterogeneity among marijuana users and non-users. Since engagement in other health-risk behaviors were salient predictors of use initiation, prevention efforts to reduce harm from marijuana use may benefit from targeting risk factors for health-risk behaviors in general.

Associations Between Clinical Evidence of Inflammation and Synovitis in Symptomatic Knee Osteoarthritis: A Cross-Sectional Substudy.

OBJECTIVE: Painful knee osteoarthritis (KOA) has been associated with joint inflammation. There is, however, little literature correlating signs of localized inflammation with contrast-enhanced (CE) magnetic resonance imaging (MRI) of synovium. This study examined the relationship between clinical and functional markers of localized knee inflammation and CE MRI-based synovial scores. METHODS: Patients with symptomatic KOA were enrolled into the randomized, double-blind, Vitamin D Evaluation in Osteoarthritis (VIDEO) trial. In this cross-sectional substudy, associations between validated MRI-based semiquantitative synovial scores of the knee and the following markers of inflammation were investigated: self-reported pain and stiffness, effusion, warmth, joint line tenderness, erythrocyte sedimentation rate, radiographic severity, and functional ability tests. RESULTS: A total of 107 patients satisfied the inclusion criteria of complete data and were included in the analysis. Significant associations were found between the number of regions affected by synovitis and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, effusion, and joint line tenderness. Each additional region affected by synovitis was associated with an increase in WOMAC pain (1.82 [95% confidence interval (95% CI) 0.05, 3.58], P = 0.04), and the association with extent of medial synovitis was particularly strong (3.21 [95% CI 0.43, 5.99], P = 0.02). Extent of synovitis was positively associated with effusion (odds ratio 1.69 [95% CI 1.37, 2.08], P < 0.01) and negatively associated with joint line tenderness (relative risk 0.87 [95% CI 0.84, 0.90], P < 0.01). CONCLUSION: There is a strong positive association between synovitis and self-reported patient pain and clinically detectable effusion. Nonoperative treatments directed at management of inflammation and future trials targeting the synovial tissue for treating KOA should consider these 2 factors as potential inclusion criteria.

Can the publication of guidelines change the management of early rheumatoid arthritis? An interrupted time series analysis from the United Kingdom.

OBJECTIVE: To assess whether publication of national treatment guidelines improved the management of early RA in the UK. METHODS: Incident diagnoses of RA in persons aged over 18 years from 1995 to 2010 were identified from the Clinical Practice Research Datalink. Using a natural experimental study design, interrupted time series analysis was used to assess whether trends in the proportion of patients receiving DMARDs, within 3 and 12 months of diagnosis, changed following publication of British Society for Rheumatology guidelines in 2006. RESULTS: Between 1995 and 2010, 11 772 incident cases of RA were identified. There was a progressive increase in the proportion of patients prescribed any DMARD within 12 months from 43.3% in 1995 to 78.5% in 2010. After publication of the British Society for Rheumatology guidelines, the proportion of patients prescribed any DMARD within 12 months increased by 4.2% (P = 0.053). Prior to the guidance, prescribing was increasing by 1.64% per year, compared with 3.55% per year after publication (P < 0.001). CONCLUSION: Guidelines published by a national body can improve the proportion of patients receiving DMARD treatment in the first year after diagnosis of RA.

Classification of rotator cuff tendinopathy using high definition ultrasound.

BACKGROUND: ultrasound is a valid cost effective tool in screening for rotator cuff pathology with high levels of accuracy in detecting full-thickness tears. To date there is no rotator cuff tendinopathy classification using ultrasound. The aims of this study are to define a valid high-definition ultrasound rotator cuff tendinopathy classification, which has discriminate validity between groups based upon anatomical principles. METHODS: 464 women, aged 65-87, from an established general population cohort underwent bilateral shoulder ultrasound and musculoskeletal assessment. Sonographer accuracy was established in a separate study by comparing ultrasound findings to the gold standard intra-operative findings. RESULTS: there were 510 normal tendons, 217 abnormal tendons, 77 partial tears, and 124 full-thickness tears. There was no statistical difference in age or the proportion with pain between the abnormal enthesis and partial tear groups, however both groups were statistically older (p<0.001) and had a greater proportion with pain (p<0.001 & p=0.050) than normal tendons. The full-thickness tears were statistically older than normal tendons (p<0.001), but not abnormal/partially torn tendons. The proportion with pain was significantly greater than both groups (p<0.001 & p=0.006). Symptomatic shoulders had a larger median tear size than asymptomatic shoulders (p=0.006). Using tear size as a predictor of pain likelihood, optimum sensitivity and specificity occurred when dividing tears into groups up to 2.5cm and >2.5cm, which corresponds with anatomical descriptions of the width of the supraspinatus tendon. CONCLUSION: the classification system is as follows: Normal Tendons; Abnormal enthesis/Partial-thickness tear; Single tendon full-thickness tears (0-2.5cm); Multi-tendon full-thickness tears (>2.5cm).

Predictors of fracture while on treatment with oral bisphosphonates: a population-based cohort study.

Although oral bisphosphonates (BPs) are highly effective in preventing fractures, some patients will fracture while on treatment. We identified predictors of such fractures in a population-based cohort of incident users of oral BPs. We screened the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) database to identify new users of oral BPs in 2006-2007. SIDIAP includes pharmacy invoice data and primary care electronic medical records for a representative 5 million people in Catalonia (Spain). Exclusion criteria were the following: Paget disease; <40 years of age; and any antiosteoporosis treatment in the previous year. A priori defined risk factors included age, gender, body mass index, vitamin D deficiency, smoking, alcohol drinking, preexisting comorbidities, and medications. Fractures were considered if they appeared at least 6 months after treatment initiation. "Fractures while on treatment" were defined as those occurring among participants persisting for at least 6 months and with an overall high compliance (medication possession ratio ≥80%). Fine and Gray survival models accounting for competing risk with therapy discontinuation were fitted to identify key predictors. Only 7449 of 21,385 (34.8%) participants completed >6 months of therapy. Incidence of fracture while on treatment was 3.4/100 person-years (95% confidence interval [CI], 3.1-3.7). Predictors of these among patients persisting and adhering to treatment included: older age (subhazard ratio [SHR] for 60 to <80 years, 2.18 [95% CI, 1.70-2.80]; for ≥80 years, 2.5 [95% CI, 1.82-3.43]); previous fracture (1.75 [95% CI, 1.39-2.20] and 2.49 [95% CI, 1.98-3.13], in the last 6 months and longer, respectively); underweight, 2.11 (95% CI, 1.14-3.92); inflammatory arthritis, 1.46 (95% CI, 1.02-2.10); use of proton pump inhibitors (PPIs), 1.22 (95% CI, 1.02-1.46); and vitamin D deficiency, 2.69 (95% CI, 1.27-5.72). Even among high compliers, 3.4% of oral BP users will fracture every year. Older age, underweight, vitamin D deficiency, PPI use, previous fracture, and inflammatory arthritides increase risk. Monitoring strategies and/or alternative therapies should be considered for these patients.

Interpopulational variation in the cold tolerance of a broadly distributed marine copepod.

Latitudinal trends in cold tolerance have been observed in many terrestrial ectotherms, but few studies have investigated interpopulational variation in the cold physiology of marine invertebrates. Here, the intertidal copepod Tigriopus californicus was used as a model system to study how local adaptation influences the cold tolerance of a broadly distributed marine crustacean. Among five populations spanning 18° in latitude, the following three metrics were used to compare cold tolerance: the temperature of chill-coma onset, the chill-coma recovery time and post-freezing recovery. In comparison to copepods from warmer southern latitudes, animals from northern populations exhibited lower chill-coma onset temperatures, shorter chill-coma recovery times and faster post-freezing recovery rates. Importantly, all three metrics showed a consistent latitudinal trend, suggesting that any single metric could be used equivalently in future studies investigating latitudinal variation in cold tolerance. Our results agree with previous studies showing that populations within a single species can display strong local adaptation to spatially varying climatic conditions. Thus, accounting for local adaptation in bioclimate models will be useful for understanding how broadly distributed species like T. californicus will respond to anthropogenic climate change.