Derek B. Kosty

MomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results

Background Postpartum depression (PPD)—the most common complication of childbirth—is a significant and prevalent public health problem that severely disrupts family interactions and can result in serious lasting consequences to the health of women and the healthy development of infants. These consequences increase in severity when left untreated; most women with PPD do not obtain help due to a range of logistical and attitudinal barriers. Objective This pilot study was designed to test the feasibility, acceptability, and potential efficacy of an innovative and interactive guided Web-based intervention for postpartum depression, MomMoodBooster (MMB). Methods A sample of 53 women who satisfied eligibility criteria (<9 months postpartum, ≥18 years of age, home Internet access and use of personal email, Edinburgh Postnatal Depression Survey score of 12-20 or Patient Health Questionnaire score from 10-19) were invited to use the MMB program. Assessments occurred at screening/pretest, posttest (3 months following enrollment), and at 6 months follow-up. Results All six sessions of the program were completed by 87% (46/53) of participants. Participants were engaged with the program: visit days (mean 15.2, SD 8.7), number of visits (mean 20.1, SD 12.2), total duration of visits in hours (mean 5.1, SD 1.3), and number of sessions viewed out of six (mean 5.6, SD 1.3) all support high usage. Posttest data were collected from 89% of participants (47/53) and 6-month follow-up data were collected from 87% of participants (46/53). At pretest, 55% (29/53) of participants met PHQ-9 criteria for minor or major depression. At posttest, 90% (26/29) no longer met criteria. Conclusions These findings support the expanded use and additional testing of the MMB program, including its implementation in a range of clinical and public health settings. Trial Registration Clinicaltrials.gov NCT00942721; http://clinicaltrials.gov/ct2/show/NCT00942721 (Archived by WebCite at http://www.webcitation.org/6KjYDvYkQ).

Predictors of First Lifetime Onset of Major Depressive Disorder in Young Adulthood

The first onset of major depressive disorder (MDD) most frequently occurs in young adulthood. However, few studies have examined predictors of first lifetime MDD during this high-risk period. The present study examined a broad range of demographic, clinical, and psychosocial variables as prospective predictors of first onset of MDD in a large community sample of young adults (N = 502) from the Oregon Adolescent Depression Project. Between ages 19-31, 35.3% of the sample had a first lifetime MDD episode. Female gender, familial loading of mood disorders, history of childhood sexual abuse, prior history of anxiety disorder, poor self-reported physical health, and subthreshold depressive symptoms significantly predicted MDD onset. In a multivariate model, female gender, familial loading of mood disorders, and subthreshold depression each contributed unique variance in predicting first lifetime MDD. This model had a moderate-to-large effect in predicting MDD onset. Gender did not moderate the other predictors, and the magnitude of the effects did not diminish over the course of the follow-up. These findings indicate that a number of risk factors significantly predict first lifetime MDD in young adulthood, and that simple multivariate risk models may be useful for identifying individuals at high risk for MDD.

Development and Preliminary Evaluation of an Integrated Treatment Targeting Parenting and Depressive Symptoms in Mothers of Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE More than 50% of mothers of children with attention-deficit/hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. METHOD Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. RESULTS The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. CONCLUSIONS This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

The modeling of internalizing disorders on the basis of patterns of lifetime comorbidity: associations with psychosocial functioning and psychiatric disorders among first-degree relatives.

Two broadband latent factors--internalizing and externalizing--have frequently been identified in studies of the hierarchical structure of psychopathology. In the present research, 3 competing measurement models of putative internalizing disorders (i.e., a parsimonious single-factor model, a model based on the Diagnostic and Statistical Manual of Mental Disorders [4th ed., American Psychiatric Association, 1994], and an alternative model proposed by Krueger, 1999, and Watson, 2005) were evaluated in terms of their ability to account for lifetime patterns of diagnostic comorbidity. Four diagnostic assessments were performed on an age-based cohort of 816 persons over a 15-year interval. Each of the 3 measurement models demonstrated adequate or good fit to the data and similar approximating abilities. Additional analyses, however, suggested that nonspecific aspects of lifetime mood/anxiety or distress/fear disorders (i.e., general negative affect) largely accounted for indicators of psychosocial functioning at age 30 as well as densities of specific psychiatric disorders among the 1st-degree relatives of probands. The relevance of these findings for theoretical and descriptive models of internalizing disorders is discussed.

Refinements in the hierarchical structure of externalizing psychiatric disorders: Patterns of lifetime liability from mid-adolescence through early adulthood.

Research on hierarchical modeling of psychopathology has frequently identified 2 higher order latent factors, internalizing and externalizing. When based on the comorbidity of psychiatric diagnoses, the externalizing domain has usually been modeled as a single latent factor. Multivariate studies of externalizing symptom features, however, suggest multidimensionality. To address this apparent contradiction, confirmatory factor analytic methods and information-theoretic criteria were used to evaluate 4 theoretically plausible measurement models based on lifetime comorbidity patterns of 7 putative externalizing disorders. Diagnostic information was collected at 4 assessment waves from an age-based cohort of 816 persons between the ages of 14 and 33. A 2-factor model that distinguished oppositional behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder) from social norm violation disorders (conduct disorder, adult antisocial behavior, alcohol use disorder, cannabis use disorder, hard drug use disorder) demonstrated consistently good fit and superior approximating abilities. Analyses of psychosocial outcomes measured at the last assessment wave supported the validity of this 2-factor model. Implications of this research for the theoretical understanding of domain-related disorders and the organization of classification systems are discussed.

Natural course of cannabis use disorders

BACKGROUND Despite its importance as a public health concern, relatively little is known about the natural course of cannabis use disorders (CUDs). The primary objective of this research was to provide descriptive data on the onset, recovery and recurrence functions of CUDs during the high-risk periods of adolescence, emerging adulthood and young adulthood based on data from a large prospective community sample. METHOD Probands (n = 816) from the Oregon Adolescent Depression Project (OADP) participated in four diagnostic assessments (T1-T4) between the ages of 16 and 30 years, during which current and past CUDs were assessed. RESULTS The weighted lifetime prevalence of CUDs was 19.1% with an average onset age of 18.6 years. Although gender was not significantly related to the age of initial CUD onset, men were more likely to be diagnosed with a lifetime CUD. Of those diagnosed with a CUD episode, 81.8% eventually achieved recovery during the study period. Women achieved recovery significantly more quickly than men. The recurrence rate (27.7%) was relatively modest, and most likely to occur within the first 36 months following the offset of the first CUD episode. CUD recurrence was uncommon after 72 months of remission and recovery. CONCLUSIONS CUDs are relatively common, affecting about one out of five persons in the OADP sample prior to the age of 30 years. Eventual recovery from index CUD episodes is the norm, although about 30% of those with a CUD exhibit a generally persistent pattern of problematic use extending 7 years or longer.

Examining the Association between Explicit Mathematics Instruction and Student Mathematics Achievement.

Explicit instruction is a systematic instructional approach that facilitates frequent and meaningful instructional interactions between teachers and students around critical academic content. This study examined the relationship between student mathematics outcomes and the rate and quality of explicit instructional interactions that occur during core mathematics instruction in kindergarten classrooms using a multifaceted observation system. A total of 379 observations were conducted in 129 classrooms, involving approximately 2,200 students across a 2-year span. Results suggest that the rate and quality of instructional interactions is related to student mathematics achievement. Implications for instruction and observation research are discussed.

Modeling missing binary outcome data in a successful web-based smokeless tobacco cessation program

AIM To examine various methods to impute missing binary outcome from a web-based tobacco cessation intervention. DESIGN The ChewFree randomized controlled trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants randomized to either an enhanced web-based intervention condition or a basic information-only control condition. SETTING Internet in the United States and Canada. PARTICIPANTS Secondary analyses focused upon 2523 participants in the ChewFree trial. MEASUREMENTS Point-prevalence tobacco abstinence measured at 3- and 6-month follow-up. FINDINGS The results of this study confirmed the findings for the original ChewFree trial and highlighted the use of different missing-data approaches to achieve intent-to-treat analyses when confronted with substantial attrition. The use of different imputation methods yielded results that differed in both the size of the estimated treatment effect and the standard errors. CONCLUSIONS The choice of imputation model used to analyze missing binary outcome data can affect substantially the size and statistical significance of the treatment effect. Without additional information about the missing cases, they can overestimate the effect of treatment. Multiple imputation methods are recommended, especially those that permit a sensitivity analysis of their impact.

Internalizing and externalizing psychopathology as predictors of cannabis use disorder onset during adolescence and early adulthood.

Risk-related liabilities associated with the development of cannabis use disorders (CUDs) during adolescence and early adulthood are thought to be established well before the emergence of the index episode. In this study, internalizing and externalizing psychopathology from earlier developmental periods were evaluated as risk factors for CUDs during adolescence and early adulthood. Participants (N = 816) completed 4 diagnostic assessments between the ages 16 and 30, during which current and past CUDs were assessed as well as a full range of psychiatric disorders associated with internalizing and externalizing psychopathology domains. In unadjusted and adjusted time-to-event analyses, externalizing but not internalizing psychopathology from proximal developmental periods predicted subsequent CUD onset. A large proportion of adolescent and early adult cases, however, did not manifest any externalizing or internalizing psychopathology during developmental periods before CUD onset. Findings are consistent with the emerging view that externalizing disorders from proximal developmental periods are robust risk factors for CUDs. Although the identification of externalizing liabilities may aid in the identification of individuals at risk for embarking on developmental pathways that culminate in CUDs, such liabilities are an incomplete indication of overall risk.

Parental transmission of risk for cannabis use disorders to offspring

AIMS We investigated the risk of cannabis use disorder (CUD) among probands as a function of parental psychopathology and explored parent-offspring gender concordance as a mechanism of parental CUD transmission to offspring. DESIGN Four waves of data collection from a longitudinal epidemiological study of psychopathology among a regionally representative sample. SETTING Participants were selected randomly from western Oregon, USA, and were initially assessed during mid-adolescence. PARTICIPANTS The reference sample included 719 probands and their biological mothers and fathers. MEASUREMENTS CUD episodes among probands were assessed with semistructured diagnostic interviews between mid-adolescence and young adulthood. Life-time psychiatric disorders among parents of probands were assessed when probands were approximately 24 years of age. FINDINGS There was an increased risk for CUD onset among probands with parental histories of CUD [hazard ratio (HR) = 1.93, 95% confidence interval (CI) = 1.30-2.88], hard drug use disorders (HR = 1.96, 95% CI = 1.32-2.90) or antisocial personality disorder (HR = 1.73, 95% CI = 1.06-2.82). A significant parent-offspring gender concordance effect indicated that females with a maternal CUD history were at higher risk for CUD onset compared with females without a maternal CUD (HR = 3.10, 95% CI = 1.52-6.34). Maternal CUD was not associated with CUD onset among males (P = 0.570), nor was there evidence for parent-offspring gender concordance effects for paternal CUD-specific transmission (P = 0.114). CONCLUSIONS Parental histories of antisocial personality and illicit substance use disorders are associated with increased risk for cannabis use disorder onset in offspring, especially among females with maternal cannabis use disorder histories.