Rashelle J. Musci

Latent classes of childhood trauma exposure predict the development of behavioral health outcomes in adolescence and young adulthood

BACKGROUND To develop latent classes of exposure to traumatic experiences before the age of 13 years in an urban community sample and to use these latent classes to predict the development of negative behavioral outcomes in adolescence and young adulthood. METHOD A total of 1815 participants in an epidemiologically based, randomized field trial as children completed comprehensive psychiatric assessments as young adults. Reported experiences of nine traumatic experiences before age 13 years were used in a latent class analysis to create latent profiles of traumatic experiences. Latent classes were used to predict psychiatric outcomes at age ⩾13 years, criminal convictions, physical health problems and traumatic experiences reported in young adulthood. RESULTS Three latent classes of childhood traumatic experiences were supported by the data. One class (8% of sample), primarily female, was characterized by experiences of sexual assault and reported significantly higher rates of a range of psychiatric outcomes by young adulthood. Another class (8%), primarily male, was characterized by experiences of violence exposure and reported higher levels of antisocial personality disorder and post-traumatic stress. The final class (84%) reported low levels of childhood traumatic experiences. Parental psychopathology was related to membership in the sexual assault group. CONCLUSIONS Classes of childhood traumatic experiences predict specific psychiatric and behavioral outcomes in adolescence and young adulthood. The long-term adverse effects of childhood traumas are primarily concentrated in victims of sexual and non-sexual violence. Gender emerged as a key covariate in the classes of trauma exposure and outcomes.

Smoking quit success genotype score predicts quit success and distinct patterns of developmental involvement with common addictive substances

Genotype scores that predict relevant clinical outcomes may detect other disease features and help direct prevention efforts. We report data that validate a previously established v1.0 smoking cessation quit success genotype score and describe striking differences in the score in individuals who display differing developmental trajectories of use of common addictive substances. In a cessation study, v1.0 genotype scores predicted ability to quit with P=0.00056 and area under receiver-operating characteristic curve 0.66. About 43% vs 13% quit in the upper vs lower genotype score terciles. Latent class growth analyses of a developmentally assessed sample identified three latent classes based on substance use. Higher v1.0 scores were associated with (a) higher probabilities of participant membership in a latent class that displayed low use of common addictive substances during adolescence (P=0.0004) and (b) lower probabilities of membership in a class that reported escalating use (P=0.001). These results indicate that: (a) we have identified genetic predictors of smoking cessation success, (b) genetic influences on quit success overlap with those that influence the rate at which addictive substance use is taken up during adolescence and (c) individuals at genetic risk for both escalating use of addictive substances and poor abilities to quit may provide especially urgent focus for prevention efforts.

ADHD and suicidal ideation: the roles of emotion regulation and depressive symptoms among college students

Objective: ADHD appears to increase risk for both depression and suicidal ideation, while ADHD and depression are also associated with emotion regulation deficits. Thus, we evaluated the degree to which depression mediated the association between ADHD and suicidal ideation, as well as the degree to which emotion regulation deficits moderated the association ADHD shared with depression and suicidal ideation in a nonclinical sample. Method: Participants were undergraduate psychology students (N = 627; age: M = 20.23, SD = 1.40; 60% female; 47% European American) who completed an online assessment. Results: Results indicated that ADHD indirectly increased suicidal ideation through depression. Emotion regulation deficits of accepting negative emotions, emotional awareness, and goal-oriented behavior moderated the indirect effect of ADHD on suicidal ideation. Conclusion: Depression appears to play an important mediating role in suicidal ideation for college students with ADHD, and specific emotion regulation deficits appear to amplify the effects of ADHD on depression and suicidal ideation.

The role of ethnicity, sexual attitudes, and sexual behavior in sexual revictimization during the transition to emerging adulthood

An experience of child sexual abuse (CSA) substantially increases women’s risk of adult sexual assault (ASA), but the mechanisms underlying this relationship are unclear. Previous research often has not examined the full range of ASA experiences or included the influence of ethnicity, sexual behavior, and sexual attitudes on CSA and severity of ASA. The current study utilized path analysis to explore the relationships among ethnicity, sexual attitudes, number of lifetime sexual partners, CSA, and severity of ASA in emerging adult women. Results indicated a significant relationship between CSA and more severe ASA that was partially explained by having more lifetime sexual partners. Additionally, European American women, relative to Hispanic women, reported more severe victimization, which was fully explained by more positive attitudes toward casual sex and having more lifetime sexual partners. These results have implications in the design and implementation of universal and selective prevention programs aimed at reducing ASA and revictimization among emerging adult women.

The dynamic epigenome and its implications for behavioral interventions: a role for epigenetics to inform disorder prevention and health promotion.

The emerging field of behavioral epigenetics is producing a growing body of evidence that early life experience and social exposure can alter the way by which genes are marked with DNA methylation. We hypothesize that changes in DNA methylation as well as other epigenetic markers could generate stable phenotypes. Early life adversity appears to result in altered DNA methylation of genes in the brain and peripheral tissues, and these changes are associated with adverse phenotypic changes. Although the data are still sparse, early epigenetic studies have provided a proof of principle that experiences and the environment leave marks on genes, and thus suggest molecular and physical mechanisms for the epidemiological concept of gene-environment interaction. The main attraction of DNA methylation for type I (TI) translational prevention science is the fact that, different from genetic changes that are inherited from our ancestors, DNA methylation is potentially preventable and reversible and, therefore, there is a prospect of epigenetically targeted interventions. In addition, DNA methylation markers might provide an objective tool for assessing effects of early adverse experience on individual risks as well as providing objective measures of progress of an intervention. In spite of this great potential promise of the emerging field of social and translational epigenetics, many practical challenges remain that must be addressed before behavioral epigenetics could become translational epigenetics.

How Do School-Based Prevention Programs Impact Teachers? Findings from a Randomized Trial of an Integrated Classroom Management and Social-Emotional Program

A number of classroom-based interventions have been developed to improve social and behavioral outcomes for students, yet few studies have examined how these programs impact the teachers who are implementing them. Impacts on teachers may affect students and therefore also serve as an important proximal outcome to examine. The current study draws upon data from a school-based randomized controlled trial testing the impact of two prevention programs. In one intervention condition, teachers were trained in the classroom behavior management program, PAX Good Behavior Game (PAX GBG). In a second intervention condition, teachers were trained to use an integrated program, referred to as PATHS to PAX, of the PAX GBG and a social and emotional learning curriculum called Promoting Alternative Thinking Strategies (PATHS©). This study aimed to determine whether both interventions positively impacted teachers, with a particular interest in the teachers’ own beliefs and perceptions regarding self-efficacy, burnout, and social-emotional competence. The sample included 350 K-5 teachers across 27 schools (18 schools randomized to intervention, 9 to control). Multilevel latent growth curve analyses indicated that the PATHS to PAX condition generally demonstrated the most benefits to teachers, relative to both the control and PAX GBG conditions. These findings suggest that school-based preventive interventions can have a positive impact on teachers’ beliefs and perceptions, particularly when the program includes a social-emotional component. Several possible mechanisms might account for the added benefit to teachers. Additional research is needed to better understand how these programs impact teachers, as well as students.

Teacher, parent, and peer reports of early aggression as screening measures for long-term maladaptive outcomes: Who provides the most useful information?

OBJECTIVE This study compared the ability of teacher, parent, and peer reports of aggressive behavior in early childhood to accurately classify cases of maladaptive outcomes in late adolescence and early adulthood. METHOD Weighted kappa analyses determined optimal cut points and relative classification accuracy among teacher, parent, and peer reports of aggression assessed for 691 students (54% male; 84% African American and 13% White) in the fall of first grade. Outcomes included antisocial personality, substance use, incarceration history, risky sexual behavior, and failure to graduate from high school on time. RESULTS Peer reports were the most accurate classifier of all outcomes in the full sample. For most outcomes, the addition of teacher or parent reports did not improve overall classification accuracy once peer reports were accounted for. Additional gender-specific and adjusted kappa analyses supported the superior classification utility of the peer report measure. CONCLUSION The results suggest that peer reports provided the most useful classification information of the 3 aggression measures. Implications for targeted intervention efforts in which screening measures are used to identify at-risk children are discussed.

DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF CONSISTENT AND INCONSISTENT LONGITUDINAL REPORTERS OF LIFETIME SUICIDE ATTEMPTS IN ADOLESCENCE THROUGH YOUNG ADULTHOOD

Within the context of the recent release of the 2012 National Suicide Prevention Strategy, and as the third leading cause of death for individuals 10‐ to 24‐years‐old, suicide prevention is a national priority. A consistently reported and robust risk factor for suicide is a prior suicide attempt; however few studies have investigated the consistency of self‐reported lifetime suicide attempts. The goal of this study is to describe the prevalence and characteristics of inconsistent reporting of suicide attempt in a longitudinal cohort of participants annually assessed in 12 waves of data collected from middle school (age 12) to early adulthood (age 22).

Video gaming in a hyperconnected world: A cross-sectional study of heavy gaming, problematic gaming symptoms, and online socializing in adolescents

AIMS Examining online social interactions along with patterns of video gaming behaviors and game addiction symptoms has the potential to enrich our understanding of disorders related to excessive video game play. METHODS We performed latent class analysis in a sample of 9733 adolescents based on heavy use of games, social networking and instant messaging, and game addiction symptoms. We used latent class regression to determine associations between classes, psychosocial well-being and friendship quality. RESULTS We identified two types of heavy gaming classes that differed in probability of online social interaction. Classes with more online social interaction reported fewer problematic gaming symptoms than those with less online social interaction. Most adolescents estimated to be in heavy gaming classes had more depressive symptoms than normative classes. Male non-social gamers had more social anxiety. Female social gamers had less social anxiety and loneliness, but lower self-esteem. Friendship quality attenuated depression in some male social gamers, but strengthened associations with loneliness in some male non-social gamers. CONCLUSIONS In adolescents, symptoms of video game addiction depend not only on video game play but also on concurrent levels of online communication, and those who are very socially active online report fewer symptoms of game addiction.

Data Linkage Strategies to Advance Youth Suicide Prevention: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.

In 2014, suicide was the second leading cause of death in the United States among persons between the ages of 15 to 19 and 20 to 29 years (1). Suicide rates increased by 24% from 1999 through 2014, and the percentage increase in suicide rates was greatest for females aged 10 to 14 years (2). It is difficult to evaluate the longer-term effect of prevention efforts that may be applied years before the peak period of risk for suicidal behaviors. Unanswered questions remain about the effectiveness of youth suicide prevention efforts, in part because of the difficulty associated with long-term follow-up of large populations. Data systems comprise collections of information plus the information technology infrastructure required to operate, maintain, and access the systems. They can be organized in various forms and include electronic health records, payer claims databases, vital records, periodic population surveys, and health information exchanges. Data systems exist for various purposes, including surveillance, billing, and administration of services. The linkage of existing data from prevention studies to data systems that include suicidal behavior outcomes could help identify which interventions are most effective in preventing suicide. The aim of this project was to provide an objective description of the state of the science on data linkage strategies in suicide prevention research, as well as a systematic summary of ongoing research limitations, barriers, gaps, and opportunities for future data linkage approaches to enhance suicide prevention efforts. Methods Detailed methods, including the full set of key questions, analytic framework, search strategies, inclusion criteria, and study data extraction, are available in the full Evidence-based Practice Center report (3). A protocol was developed in September 2015 and is provided in Supplement 1. This article addresses the following question: What national, state, and community data systems can be linked to existing data from prevention efforts in order to add possible value for stakeholders? Supplement 1. Evidence-based Practice Center Systematic Review Protocol Data Sources and Searches We conducted 3 parallel searches to identify suicide prevention studies and relevant data systems. We performed a systematic review of published literature to identify prevention studies, existing suicide data systems, and publications in which the two had been linked; we conducted an environmental scan to identify suicide data systems not reported in the published literature; and we performed a targeted search to identify suicide data systems used in selected states, cities, and communities. Systematic Review of Prevention Studies We searched PubMed, the Cochrane Library, the Campbell Collaboration Library of Systematic Reviews, CINAHL, PsycINFO, and ERIC (Education Resources Information Center) for articles published from January 1990 to December 2015. The search strategies we used are provided in Appendix Table 1. Appendix Table 1. Detailed Search Strategies Data Systems We scanned all studies identified in the systematic literature search for data systems. We then conducted an environmental scan to identify additional data systems not reported in the published literature. Because data systems are usually developed and maintained for operational rather than research purposes, they are often not described in peer-reviewed publications that are the subject of systematic reviews. Finding data systems requires environmental scans, also known as searching the gray literature, which comprises preprints, preliminary progress and advanced reports, technical reports, statistical reports, memoranda, state-of-the-art reports, market research reports, theses, conference proceedings, technical specifications and standards, noncommercial translations, bibliographies, technical and commercial documentation, and official documents not published commercially (primarily government reports and documents) (4). We used the advanced search functions of 3 search engines (Google, Yahoo, and Bing [Microsoft]) to execute the search. We also searched the Web sites of the American Foundation for Suicide Prevention, the American Association of Suicidology, and the Suicide Prevention Resource Center. Targeted Search We conducted a targeted search in 6 states (California, Delaware, Oregon, Illinois, Maryland, and Wisconsin), 2 cities (Baltimore, Maryland, and Wilmington, Delaware), and 1 tribal community (the Menominee Reservation in Wisconsin) for data systems that provided information about our primary outcomes (suicidal ideation, suicide attempt, and suicide) and that were maintained by a state-, city-, or community-level entity. We contacted (via e-mail and telephone) persons in each target area who were responsible for suicide prevention and other public health efforts to request information on state- and community-level sources or systems that included data on suicidal ideation, suicide attempt, and suicide among persons younger than 26 years. Study Selection Systematic Review of Suicide Prevention Studies Two investigators independently reviewed titles and abstracts and then full-text articles using prespecified eligibility criteria. We included studies of humans aged 0 to 25 years with at least 1 intervention and at least 1 outcome of interest (suicide, suicide attempt, or suicidal ideation). Meeting abstracts, articles without original data, and studies conducted outside the United States and not written in English were excluded. We did not limit inclusion by population size or design. Studies published before 1990 were not included; according to the National Action Alliance for Suicide Prevention, suicide became a central issue in the United States in the mid-1990s with the publication by the U.S. Department of Health and Human Services of the Report of the Secretarys Task Force on Youth Suicide in 1989 and the Surgeon Generals Call to Action to Prevent Suicide in 1999 (5). In addition, the amount of abstractable data is significantly limited before 1990. Disagreements about article eligibility that could not be resolved by the 2 reviewers were resolved by the domain experts on the team. Data Systems Two independent experts reviewed the results of the systematic review and environmental scan and determined whether identified data systems met the same eligibility criteria as those applied in the systematic review (other than having to include data about an intervention) and whether they fulfilled the minimum requirements of a data system that can be useful for linkage to suicide prevention studies. We excluded data systems that did not meet all of the following requirements: 1) the data system still exists, and underlying data are available and accessible in digital format; 2) the data system can be shared and acquired by others for research purposes; 3) the data system collects and contains information on at least 1 of the primary outcomes; and 4) the data system is not a duplicate. Data Extraction and Quality Assessment Systematic Review of Suicide Prevention Studies We abstracted data on study, participant, and intervention characteristics as well as suicide outcomes to Microsoft Excel tables. We also abstracted the primary analytic method used by the study, linkage to data systems (if present), and statistical tests used in the study and controlled for covariates. We identified and abstracted data system information (for example, location of the database) and how the data were linked to other sources. Data Systems A coding and classification schema previously used for evaluating community-based data systems was used to classify data system quality and accessibility, including whether data dictionaries and data were readily available (6). We sought additional information about the data systems by searching the Internet for data dictionaries and documentation associated with the data system, downloading a sample data set from the data system, and searching for additional reports that may have described the data system in more detail. Role of the Funding Source The Agency for Healthcare Research and Quality (AHRQ) funded the review, and a working group convened by the National Institutes of Health assisted in developing the scope of the review and the key questions. Neither organization had a role in study selection, quality assessment, or synthesis. The investigators are solely responsible for the content. Results Suicide Prevention Studies The literature search identified 47 studies (reported in 59 articles) (Figure 1). Study population size was highly variable, ranging from 32 to 2100. Twenty-nine of the studies (62%) had 500 or fewer participants. One third (34%) of the prevention intervention studies we identified reported on outcomes more than 1 year after the intervention. Ten studies (21%) focused on special populations, including military personnel (710), incarcerated persons (1113), survivors of sexual trauma (14), persons with major depressive disorder (15), and high-risk youth (16). The 47 studies used various interventions and prevention approaches, and many applied more than 1 prevention approach, such as behavioral and skill building (17 studies), medication or pharmaceutical (7 studies), psychotherapy (10 studies), educational and skill building (12 studies), policy (3 studies), screening (5 studies), and other approaches (9 studies) (Appendix Table 2). Figure 1. Summary of evidence search and selection. ERIC= Education Resources Information Center. * Searched simultaneously through the EBSCO database. Sum of individual reasons exceeds total number of exclusions because reviewers were not required to agree on reason for exclusion. Appendix Table 2. Summary of Intervention Characteristics Data Systems Our literature search, environmental scan, and targeted geographic searches identified 153 unique data systems (Figure 2; Supplement 2). Seven data systems were found in articles