We sought to characterize the ability of large language models to estimate NIMH Research Domain Criteria dimensions from narrative clinical notes of adult psychiatric inpatients, deriving estimate of overall burden of symptoms in each domain. We extracted consecutive admissions to a psychiatric inpatient unit between December 23, 2009 and September 27, 2015 from the electronic health records of a large academic medical center. Admission and discharge notes were scored with a HIPAA-compliant instance of a large language model (gpt-4–1106-preview). To examine convergent validity, the resulting estimates were correlated with those derived using an earlier method; for predictive validity, they were examined for association with length of hospitalization and probability of readmission. The cohort included 3619 individuals, 1779 female (49 %), 1840 male (51 %) with mean age 44 (SD=16.6). We identified modest correlations between LLM-derived RDoC scores and a previously validated scoring method, with Kendall’s tau between from.07 for arousal and 0.27 for positive and cognitive domains (p < .001 for all of these). For admission notes, greater scores on cognitive, sensorimotor, negative, and social domains were significantly associated with longer length of hospitalization in linear regression models including sociodemographic features (p < .01 for all of these); positive valence was associated with shorter hospitalization (p < .001). For discharge notes, social, arousal, and positive valence were associated with likelihood of readmission within 180 days in adjusted logistic regression models (p < .05 for social and arousal, p < .001 for positive valence). Overall, LLM-derived estimates of RDoC psychopathology demonstrated promising convergent and predictive validity, suggesting this approach may make real-world application of the RDoC framework more feasible.

Anxiety disorders are highly comorbid with sleep disturbance and have also been associated with deficits in emotion regulation, the ability to control and express emotions. However, the extent to which specific dimensions of sleep disturbance and emotion regulation are associated with anxiety diagnosis is not well-explored. This study examined dimensions of emotion regulation and sleep disturbance that may predict greater likelihood of anxiety diagnosis using novel machine learning techniques. Participants (Mean(SD) age= 28.6(11.3) years, 62.7% female) with primary anxiety disorders (n = 257), including generalized anxiety disorder (n = 122) and social anxiety disorder (n = 135), and healthy controls (n = 89) completed the Difficulties in Emotion Regulation Scale and Pittsburgh Sleep Quality Index. A conditional inference tree was fit to classify likelihood of current anxiety diagnosis based on predictors. The best model fit included 4 split nodes and 5 terminal nodes. Worse scores on two emotion regulation subscales, strategies directed to manage negative emotions and nonacceptance of negative emotions, were the best predictors of current anxiety diagnosis (99.3% probability of diagnosis). For those with better emotion regulation, poor sleep quality and worse daytime functioning due to sleep were important predictors of anxiety diagnosis. Good emotion regulation and non-disturbed sleep predicted high likelihood of being a non-psychiatric control (88.2%). Limitations include cross-sectional design precluding designating directionality of effects of sleep and emotion regulation on anxiety onset; limited sample size; and self-reported sleep. Facets of emotion regulation and sleep disturbance may be important early targets for brief intervention for anxiety disorders.

BackgroundA developing literature suggests that transcranial magnetic stimulation (TMS) can target anhedonia and suicidal ideation (SI), core symptoms of treatment-resistant depression (TRD). This present naturalistic study extends the existing literature by investigating the connection between changes in anhedonia and suicidal ideation (SI) related to transcranial magnetic stimulation (TMS), independent of any overall changes in depression. MethodsPre and post treatment PHQ-9 and IDS-SR data were collected from 181 TRD patients who received dorsolateral prefrontal cortex ( dlPFC) TMS using the Figure-8 or H1-coil. Changes in overall depression symptoms, anhedonia, and SI were analyzed using chi square tests, repeated measure ANOVAS, and linear regression for repeated measures. ResultsTMS yielded changes in overall depression symptoms (PHQ-9 Cohen’s d = 1.02; IDS-SR Cohen’s d = 1.05), with 23.9% and 41.7% of patients experiencing response as measured by IDS-SR and PHQ-9, respectively. TMS treatment was also associated with large changes in both anhedonia (d = 1.03) and SI (d = 0.88), which were similar in magnitude to changes in all other depression symptoms (d = 0.97). Importantly, changes in anhedonia predicted changes in SI, even after controlling for baseline depression severity and change in other depression symptoms. LimitationsThe lack of a control arm and a neuroimaging measure temper mechanistic conclusion. ConclusionOur results reinforce the effectiveness of TMS in TRD and provide new evidence that anhedonia and SI may belong to a broader symptom cluster potentially undergirded by a shared circuitry accessible to dlPFC TMS.

ObjectiveEmotion recognition, reactivity, and regulation are important in the development and maintenance of anxiety disorders. Whether and how these processes differentiate between different trajectories in anxiety remain unclear. The current study examined emotional processes as prospective predictors of anxiety symptom trajectories in psychiatrically hospitalized youth. MethodParticipants were 180 adolescents (Mage = 14.89; SD = 1.35) from a psychiatric inpatient unit. At index hospitalization, participants completed a behavioral task assessing facial emotion recognition, and self-report measures of emotion dysregulation and reactivity. They completed a self-report measure on anxiety symptoms at baseline and 3, 6, 12, and 18 months post-discharge. Latent growth curve analysis was conducted to identify subgroups of individuals based upon their trajectory of anxiety symptoms across 18-months. ANOVAs were used to examine subgroup differences in emotional processing variables. ResultsThree distinct trajectories were identified, a stable moderate-to-high anxiety group, a group with moderate-to-high anxiety at baseline with symptom improvement over time, and a group characterized by relatively stable low-to-moderate anxiety throughout the study. The two initially moderate-to-high anxiety groups scored higher for emotion dysregulation and emotion reactivity at baseline compared to the low-to-moderate anxiety group. Emotion regulation difficulties relating to emotional non-acceptance were higher for the stable moderate-to-high anxiety group than for the moderate-to-high anxiety group that experience symptom improvement over time. ConclusionsThese findings may have clinical implications for discharge planning. Future studies should explore emotion regulation with a focus on non-acceptance of one’s emotional experiences as a potential target of intervention in individuals with elevated anxiety.

Alterations in dynamic affective processes are associated with dysregulated affect and depression. Although depression is often associated with heightened inertia (i.e., greater moment-to-moment correlation) and variability (i.e., larger departures from typical levels) of affect in adults, less is known about whether altered affect dynamics are present in youth at risk for depression. This study investigated the association of clinical depression and depression risk with the inertia and variability of positive and negative affect in a sample of youth at varying risk for depression. Our sample included 147 adolescents aged 14 to 17, categorized into three groups: never-depressed lower-risk, never-depressed higher-risk (based on maternal history of depression), and currently depressed adolescents. Adolescents completed ecological momentary assessments of positive and negative affect up to seven times per day for a week. Multilevel models and ANOVAs were used to examine associations of affective inertia and variability with adolescent depression and risk based on maternal history, controlling for average affect. Depressed adolescents showed more inert and diminished positive affect, and more variable and elevated negative affect compared to lower- and higher-risk youth, though associations attenuated after controlling for average affect. No differences were identified between never-depressed higher-risk and lower-risk youth. Additional longitudinal studies are needed to evaluate whether altered affect dynamics in daily life precede depression onset to understand their utility for developing preventive interventions.

Anxiety and impulsivity often co-occur, but due to broad conceptualizations of impulsive behavior, it remains unclear whether anxiety could be positively associated with global impulsivity or specific facets of impulsivity. Negative urgency, or rash behavior that specifically occurs during negative emotional states, may provide common ground to examine the overlap between high anxiety and high impulsivity. Limited work has examined relationships between negative urgency and behavioral processes that are often associated with both anxiety and global impulsivity, such as experiential avoidance. In this study, we examined self-report data collected from a non-clinical sample of adult participants (n = 589) to test relationships between anxiety and experiential avoidance through both negative urgency and global impulsivity. Contrary to hypotheses, we found that negative urgency alone did not alter the relationship between anxiety and experiential avoidance. However, follow-up analyses including data-driven factors of impulsivity revealed that in combination, anxiety and both emotion-based impulsivity (i.e. negative and positive urgency) and hyperactivity were linked to greater experiential avoidance. By contrast, anxiety and non-planning were associated with lower experiential avoidance. These results provide targets for future studies to examine individual differences in profiles of co-occurring anxiety and impulsivity.

BackgroundGeneralized Anxiety Disorder (GAD) is prevalent among people with HIV and is associated with adverse health outcomes. This study investigates the suitability of the Generalized Anxiety Disorder Scale-7 item (GAD-7) screening tool and its 2-item (GAD-2) version for use in young adults with perinatally-acquired HIV (YAPHIV) and young adults perinatally exposed to HIV but uninfected (YAPHEU). MethodsData come from the 7th follow-up interview (FU7) from a longitudinal study of youth with PHIV and PHEU, first recruited when 9–16 years. The GAD-7 was administered along with a diagnostic psychiatric interview (DISC-IV). Receiver Operating Characteristic analysis assessed accuracy, sensitivity, and specificity of the GAD7 and GAD-2. Subgroup analyses considered HIV status, ethnicity, and race. ResultsAt FU7, participants (n = 204) were ages 20–29; 54% female; and the majority African-American and/or Latinx. 12% met diagnostic criteria for GAD. Recommended GAD-7 (>10) and GAD-2 (>3) cut-scores showed suboptimal sensitivity (0.52 and 0.48, respectively) and high specificity (0.91 and 0.90, respectively). Lowering cut-scores (GAD-7 >6 and GAD-2 >2) improved sensitivity (0.76 and 0.80) while sacrificing specificity (0.77 and 0.78). Stratified analyses by HIV status revealed similar accuracy in YAPHIV and YAPHEU. Race/ethnicity did not significantly affect cut-scores. DiscussionAnxiety disorders are common in YAPHIV, and efficient screening is essential. While the GAD-7 and GAD-2 show promise, recommended cut-scores may not be optimal. Lowering cut-scores may enhance sensitivity without losing clinical utility. Further research is needed to refine cut-scores based on demographic characteristics and in global contexts, ensuring effective anxiety screening in this population.

ObjectivesThe rate of suicide increased in members of the United States Army since 2011 after the Iraq and Afghanistan wars and continues to be a major concern. In order to reverse this disturbing trend, it is vital to understand the risk and protective factors for suicide death in servicemembers. MethodsData were obtained from a case-control psychological autopsy study, which compared U.S. Army suicide decedent cases (n = 135) to a probability sample of living controls (n = 255) who are also service members weighted to be representative of the Army. Interviews were conducted with next-of-kin (NOK) and supervisor (SUP) informants. Multivariable logistic regressions models were constructed using predictors significant after controlling for multiple comparisons. ResultsThe most parsimonious multivariable model controlling for deployment status, as reported by SUP predicting suicide death consisted of four significant variables: a spouse or partner left him or her in the past month (OR = 28.5 [95% CI = 1.8, 442.7] χ² = 5.72, p = .0168); a smaller social network (OR = 4.2 [95% CI = 1.0, 17.3] χ² = 3.97, p = .0462), less likely to seek help from a mental health counselor (OR = 3.4 [95% CI = 1.2, 9.7] χ² = 5.35, p = .0207) and more likely to be described as incautious (OR = 3.8 [95% CI = 1.2, 11.7] χ² = 5.42, p = .0199). The AUC = .88 [95%CI = 0.82, 0.94] for this regression model suggests strong prediction. ConclusionsOur findings suggest that recent relationship problems, especially in soldiers who are less likely to seek out support from others, may be warning signs for detection and prevention of imminent risk of suicide and according to supervisor informant surveys, had neither evidence of a mental health disorder, nor disclosed suicidal ideation or self-harm. Implications for suicide prevention are discussed.

Although there is an established link between smaller hippocampal volume and anxiety, the longitudinal relations between hippocampus structure and anxiety in diverse youth are not well understood. The present longitudinal study investigated hippocampal volumes related to anxiety symptoms in a sample of Black 8–14-year-old youth (N = 64), a population historically underrepresented in neuroimaging research. Smaller hippocampal volumes were associated with greater anxiety symptoms independent of age, sex, intracranial volume and trauma exposure. Exploratory longitudinal analyses showed smaller hippocampal volume as a predictor for anxiety symptoms (n = 37) and not a consequence of anxiety symptoms (n = 32), however results were inconclusive as this finding was no longer significant after correcting for baseline anxiety symptoms. Overall, this data increases our understanding of potential neurobiological mechanisms for anxiety in a high-risk sample of Black youth and suggests future directions into studying trajectories of developmental risk.

This study sought to further evaluate an observational measure of rumination that occurs during psychotherapy (i.e., in-session rumination). Specifically, the study aimed to replicate the reliability of an observational rating procedure in new therapy sessions and a new sample, clarify the relationship between in-session rumination and depressive symptoms, and evaluate for the first time the relationship between in-session rumination and self-reported rumination. A team of trained research assistants produced observational ratings of in-session rumination occurring during video-taped sessions of CBT from two separate treatment studies. Thirty-five patients with major depressive disorder (MDD) from one study had their final session rated, and 17 patients with MDD from another study had their first session rated. Results showed that the observational ratings were reliable, and that in-session rumination generally correlated with depressive symptom severity as expected, with higher in-session rumination predicting higher depressive symptom levels both cross-sectionally and longitudinally. Preliminary evidence also found that in-session rumination correlated with self-reported rumination, and exploratory analyses provided preliminary evidence supporting the incremental validity of in-session rumination for predicting depression severity after treatment. The results indicate that in-session rumination can be reliably identified during CBT sessions and consistently predicts higher depressive severity, both of which support efforts to develop treatments that specifically target rumination.