Charles R. Jonassaint

Vulnerability genes or plasticity genes

The classic diathesis–stress framework, which views some individuals as particularly vulnerable to adversity, informs virtually all psychiatric research on behavior–gene–environment (G × E) interaction. An alternative framework of ‘differential susceptibility’ is proposed, one which regards those most susceptible to adversity because of their genetic make up as simultaneously most likely to benefit from supportive or enriching experiences—or even just the absence of adversity. Recent G × E findings consistent with this perspective and involving monoamine oxidase-A, 5-HTTLPR (5-hydroxytryptamine-linked polymorphic region polymorphism) and dopamine receptor D4 (DRD4) are reviewed for illustrative purposes. Results considered suggest that putative ‘vulnerability genes’ or ‘risk alleles’ might, at times, be more appropriately conceptualized as ‘plasticity genes’, because they seem to make individuals more susceptible to environmental influences—for better and for worse.

Facets of openness predict mortality in patients with cardiac disease

Objective: To examine the NEO Personality Inventory (NEO PI) Openness to Experience (O) domain and its facets as predictors of cardiac deaths and all-cause mortality. Methods: The NEO PI was administered to a sample of 977 coronary catheterization patients with significant coronary artery disease. Over an average 15-year follow-up period, 266 cardiac deaths and 463 total deaths occurred. The relationships of O scores to mortality were examined with Cox proportional hazard models. Each model included age, left ventricular ejection fraction, severity of congestive heart failure, and number of diseased vessels as covariates. Results: The O domain score was not associated with all-cause mortality and only approached significance for decreased cardiac deaths (p = .055). However, a higher score for Openness to Feelings was associated with a decreased risk of cardiac death (p < .01) and all-cause mortality (p < .01). High Openness to Actions was also associated with decreased cardiac mortality (p < .01) and all-cause mortality (p = .03) risk. Higher Openness to Aesthetics and Ideas were only associated with decreased cardiac death risk (both p values <.04). In contrast, Openness to Fantasy and Values were not associated with longevity. Previous evidence suggested that educational achievement may account for the effects of Openness to Experience on mortality; however, controlling for educational achievement did not change the results. Conclusion: These findings suggest that greater emotional awareness and high curiosity, as indicated by the NEO PI Feelings and Actions facets, are associated with increased patient longevity independently of other risk factors and educational achievement. CAD = coronary artery disease; FFM = Five-Factor Model; O = Openness to Experience domain

The Effects of Race-related Stress on Cortisol Reactivity in the Laboratory: Implications of the Duke Lacrosse Scandal

BackgroundThe experience of race-related stressors is associated with physiological stress responses. However, much is unknown still about the complex relationship between how race-related stressors are perceived and experienced and potential moderators such as strength of racial identity.PurposeThis research examines the impact of a real-life stressor and strength of race identity on physiological responses to a social evaluative threat induced in the laboratory.MethodsSalivary cortisol measures were collected throughout a stressor protocol. African-American participants were also randomized to one of two conditions designed to promote either racial identification or student identification, before the experimental task. Unexpectedly, a highly publicized real-life racial stressor, the Duke Lacrosse (LaX) scandal, occurred during the course of the data collection. This allowed for pre–post LaX comparisons to be made on cortisol levels.ResultsThese comparisons showed that across both priming conditions, participants post-LaX had highly elevated cortisol levels that were nonresponsive to the experimental stress task, while their pre-LaX counterparts had lower cortisol levels that exhibited a normal stress response pattern. Furthermore, this effect of LaX was significantly moderated by gender, with women having lower mean cortisol levels pre-LaX but significantly greater cortisol levels than all other groups post-LaX.ConclusionsThese results suggest that recent exposure to race-related stress can have a sustained impact on physiological stress responses for African Americans.

Low Life Course Socioeconomic Status (SES) is Associated with Negative NEO PI-R Personality Patterns

BackgroundLow socioeconomic status (SES) is associated with poor health. One potential pathway accounting for this relationship may be an association between low SES and personality characteristics that affect health.MethodsAssociations among parents education, current SES (education and income), and personality were examined among 233 African Americans and Caucasian, male and female community volunteers.ResultsUsing multivariate analysis of variance (MANOVA) to model neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness simultaneously, participants education, household income, and fathers and mothers education each had significant main effects on personality. When examining the life course—the combination of both current and childhood SES—distinctive patterns emerged for each domain, depending upon whether mothers or fathers education was used to index childhood SES. When using mothers education as a childhood SES index, a high life course SES (high participants SES/high mothers education) was associated with high extraversion and openness. Using fathers education as a childhood SES index, a low life course SES (low participants SES/low fathers education) was associated with disproportionately high neuroticism and low conscientiousness. These effects did not differ by race or sex.ConclusionThe implications of these findings for the role of personality in the SES–health relationship are discussed.

Association of candidate genes with phenotypic traits relevant to anorexia nervosa.

This analysis is a follow-up to an earlier investigation of 182 genes selected as likely candidate genetic variations conferring susceptibility to anorexia nervosa (AN). As those initial case-control results revealed no statistically significant differences in single nucleotide polymorphisms, herein, we investigate alternative phenotypes associated with AN. In 1762 females, using regression analyses, we examined the following: (i) lowest illness-related attained body mass index; (ii) age at menarche; (iii) drive for thinness; (iv) body dissatisfaction; (v) trait anxiety; (vi) concern over mistakes; and (vii) the anticipatory worry and pessimism versus uninhibited optimism subscale of the harm avoidance scale. After controlling for multiple comparisons, no statistically significant results emerged. Although results must be viewed in the context of limitations of statistical power, the approach illustrates a means of potentially identifying genetic variants conferring susceptibility to AN because less complex phenotypes associated with AN are more proximal to the genotype and may be influenced by fewer genes.

Absence of association between specific common variants of the obesity‐related FTO gene and psychological and behavioral eating disorder phenotypes

Extensive population‐based genome‐wide association studies have identified an association between the FTO gene and BMI; however, the mechanism of action is still unknown. To determine whether FTO may influence weight regulation through psychological and behavioral factors, seven single‐nucleotide polymorphisms (SNPs) of the FTO gene were genotyped in 1,085 individuals with anorexia nervosa (AN) and 677 healthy weight controls from the international Price Foundation Genetic Studies of Eating Disorders. Each SNP was tested in association with eating disorder phenotypes and measures that have previously been associated with eating behavior pathology: trait anxiety, harm‐avoidance, novelty seeking, impulsivity, obsessionality, compulsivity, and concern over mistakes. After appropriate correction for multiple comparisons, no significant associations between individual FTO gene SNPs and eating disorder phenotypes or related eating behavior pathology were identified in cases or controls. Thus, this study found no evidence that FTO gene variants associated with weight regulation in the general population are associated with eating disorder phenotypes in AN participants or matched controls.

Neuropsychological effects and attitudes in patients following electroconvulsive therapy

The current study examined the effects of electroconvulsive therapy (ECT) on neuropsychological test performance. Forty-six patients completed brief neuropsychological and psychological testing before and after receiving ECT for the treatment of recalcitrant and severe depression. Neuropsychological testing consisted of the Levin Selective Reminding Test (Levin) and Wechsler Memory Scale-Revised Edition (WMS-R). Self-report measures included the Beck Depression Inventory (BDI), the Short-Term Memory Questionnaire (STMQ), and several other measures of emotional functioning and patient attitudes toward ECT. The mean number of days between pre-ECT and post-ECT testing was 24. T-test revealed a significant decrease in subjective ratings of depression as rated by the BDI, t(45) = 9.82, P < 0.0001 (Pre-BDI = 27.9 ± 20.2; post-BDI = 13.5 ± 9.7). Objective ratings of memory appeared impaired following treatment, and patients’ self-report measures of memory confirmed this decline. More specifically, repeated measures MANOVA [Wilks Lambda F(11,30) = 4.3, p < 0.001] indicated significant decreases for measures of immediate recognition memory (p < 0.005), long-term storage (p < 0.05), delayed prose passage recall (p < 0.0001), percent retained of prose passages (p < 0.0001), and percent retained of visual designs (p < 0.0001). In addition, the number of double mentions on the Levin increased (p < 0.02). This study suggests that there may be a greater need to discuss the intermittent cognitive risks associated with ECT when obtaining informed consent prior to treatment. Further that self-reports of cognitive difficulties may persist even when depression has remitted. However, patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable.

A systematic review of the association between depression and health care utilization in children and adults with sickle cell disease

Patients with sickle cell disease (SCD) experience a disproportionately high use of health care resources. Several studies have examined depression and other negative mood states as risk factors for increased health care utilization; however, there have been no systematic reviews examining and summarizing this evidence in SCD. The aim of this systematic review, therefore, was to determine whether depression or depressive symptoms are associated with health care utilization among children and adults with SCD. We followed a quantitative systematic review protocol based on the Preferred Reporting Items for Systematic Reviews and Meta‐ Analyses guidelines and performed a literature search of records from January 1980 to April 2014 using six databases. Empirical studies were eligible if the sample was primarily composed of patients with SCD and included data on depression, mood disorder diagnosis or depressive symptoms and health care utilization. We included 12 studies involving 54 036 unique participants. The prevalence estimates for depression ranged from 2–57%. Seven studies found a significant, or marginally significant, association between depression and utilization while five did not. Patients reporting depression had an estimated 2·8 times greater relative risk of being a high utilizer, and 2·9 versus 1·8 hospitalizations per year on average compared to patients without depression. Overall, depressive symptoms are common in SCD and may increase risk for poor outcomes including health care utilization. The available studies on depression in SCD, however, are limited by small sample sizes, retrospective designs or short follow‐up. This systematic review found a modest association between depression and health care utilization in SCD.

Usability and Feasibility of an mHealth Intervention for Monitoring and Managing Pain Symptoms in Sickle Cell Disease: The Sickle Cell Disease Mobile Application to Record Symptoms via Technology (SMART)

Abstract Patients with sickle cell disease frequently experience severe pain events that lead to unplanned healthcare utilization. Mobile health tools (mHealth) may help prevent these events by providing remote monitoring and self-management support. This article describes the feasibility of the Sickle cell disease Mobile Application to Record symptoms via Technology (SMART), an mHealth app developed to help sickle cell disease patients monitor and manage their day-to-day symptoms. Fifteen patients recorded their pain intensity using a paper visual analog scale (VAS) and then repeated this measurement using an electronic VAS pain measure on SMART. Patients continued using SMART to record clinical symptoms, pain intensity, location and perceived severity, and treatment strategies for at least 28 days. Patient median age was 29 years (range 16–54); 60.0% were male. There was a high intraclass correlation between pain measurements entered on the paper VAS and SMART on the iPhone and the iPad We found a strong association between patient perceived pain severity and pain intensity entries using SMART (b = 1.71; p < 0.01). Daily compliance with SMART entries was a mean 75.0%, with a high of 85.7% in week 1 and low of 57.9% in week 4; however, one-third (n = 5) of the patients were 100.0% compliant even in week 4. Patients who were over age 35 or used an iPad for the study had the highest compliance rates. This study showed that SMART is a useable and feasible method for monitoring daily pain symptoms among adolescents and adults with sickle cell disease-related pain.

Socioeconomic status moderates the association between John Henryism and NEO PI-R personality domains.

Objective: To investigate associations between John Henryism (JH) and NEO Personality Inventory-Revised (PI-R) personality domains. JH—a strong behavioral predisposition to engage in high-effort coping with difficult psychosocial and economic stressors—has been associated with poor health, particularly among persons in lower socioeconomic (SES) groups. Unfavorable personality profiles have also been frequently linked to poor health; however, no studies have yet examined what global personality traits characterize JH. Methods: Hypotheses were examined, using data from a sample of 233 community volunteers (mean age, 33 years; 61% black and 39% white) recruited specifically to represent the full range of the SES gradient. Personality (NEO PI-R) and active coping (12-item JH scale) measures and covariates were derived from baseline interviews. Results: In a multiple regression analysis, independent of SES, JH was positively associated with Conscientiousness (C) (p < .001) and Extraversion (E) (p < .001), whereas the combination of low JH and high SES was associated with Neuroticism (N) (p = .02) When examining associations between JH and combinations of NEO PI-R domains called “styles,” high JH was most strongly associated with a high E/high C “Go-Getters” style of activity, whereas low JH was associated with the low E/high Openness (O) “Introspectors” style. In facet level data, the most robust associations with JH were found for five C and five E facets. Conclusions: High JH was associated with higher scores on C and E, but the combination of low JH and high SES was associated with higher scores on N. SES = socioeconomic status; JH = John Henryism; N = Neuroticism; C = Conscientiousness; E = Extraversion; A = Agreeableness; O = Openness.