Distinct Symptom Trajectories Research Articles

Patterns and predictors of anxiety and depression symptom trajectories in patients diagnosed with primary brain tumors.

Patients with primary brain tumors (pPBTs) often exhibit heightened distress. This study assesses how symptoms of anxiety and depression change over time in pPBTs and identifies factors that may predict patients' symptom trajectories. Ninety-nine adult pPBTs completed psychosocial assessments at neuro-oncology appointments over 6-18months. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Brain; symptoms of anxiety and depression were assessed with the Patient-Reported Outcomes Measurement Information System short forms. The prevalence of patients with clinically elevated symptoms and those who experienced clinically meaningful changes in symptoms throughout follow-up were examined. Linear mixed-effects models evaluated changes in symptoms over time at the group level, and latent class growth analysis (LCGA) evaluated changes in symptoms over time at the individual level. At enrollment, 51.5% and 32.3% of patients exhibited clinically elevated levels of anxiety and depression, respectively. Of patients with follow-up data (n = 74), 54.1% and 50% experienced clinically meaningful increases in anxiety and depression scores, respectively. There were no significant changes in anxiety or depression scores over time, but better physical, functional, and brain-cancer well-being predicted lower levels of anxiety and depression (p < 0.001). Five sub-groups of patients with distinct symptom trajectories emerged via LCGA. pPBTs commonly experience elevated symptoms of anxiety and depression that may fluctuate in clinically meaningful manners throughout the disease. Routine screening for elevated symptoms is needed to capture clinically meaningful changes and identify factors affecting symptoms to intervene on.

Study Protocol Using Cohort Data and Latent Variable Modeling to Guide Sampling Women With Type 2 Diabetes and Depressive Symptoms.

Depression affects one in three women with Type 2 diabetes, and this concurrence significantly increases the risks of diabetes complications, disability, and early mortality. Depression is underrecognized because of wide variation in presentation and the lack of diagnostic biomarkers. Converging evidence suggests inflammation is a shared biological pathway in diabetes and depression. Overlapping epigenetic associations and social determinants of diabetes and depression implicate inflammatory pathways as a common thread. This article describes the protocol and methods for a pilot study aimed to examine associations between depressive symptoms, inflammation, and social determinants of health among women with Type 2 diabetes. This is an observational correlational study that leverages existing longitudinal data from the Women's Interagency HIV Study (WIHS), a multicenter cohort of HIV seropositive (66%) and HIV seronegative (33%) women, to inform purposive sampling of members from latent subgroups emergent from a prior retrospective cohort-wide analysis. Local active cohort participants from the Bronx study site are then selected for the study. The WIHS recently merged with the Multicenter Aids Cohort Study (MACS) to form the MACS/WIHS Combined Cohort Study. Latent subgroups represent distinct symptom trajectories resultant from a growth mixture model analysis of biannually collected depressive symptom data. Participants complete surveys (symptom and social determinants) and provide blood samples to analyze plasma levels and DNA methylation of genes that encode for inflammatory markers (CRP, IL-6, TNF-α). Correlation and regression analysis will be used to estimate the effect sizes between depressive symptoms and inflammatory markers, clinical indices (body mass index, hemoglobin A1C, comorbidities), and social determinants of health. The study began in January 2022, and completed data collection is estimated by early 2023. We hypothesize that depressive symptom severity will associate with higher levels of inflammation, clinical indices (e.g., higher hemoglobin A1C), and exposure to specific social determinants of health (e.g., lower income, nutritional insecurity). Study findings will provide the basis for future studies aimed at improving outcomes for women with Type 2 diabetes by informing the development and testing of precision health strategies to address and prevent depression in populations most at risk.

Symptom Trajectories Informing Patient Care After Lung Cancer Surgery: A Longitudinal Patient-Reported Outcome Study.

Application of patient-reported outcomes (PROs) in surgical oncology has been limited because of patient heterogeneity. We analyzed symptom trajectories and their associations with recovery outcomes after lung cancer surgery, aiming to profile the heterogeneity of patients' experiences and to identify patients needing extensive care. Symptoms were assessed with the MDASI-LC before surgery, daily after surgery in hospital and weekly within 1 month after discharge. Patients were clustered based on symptoms from post-operative day 1 (POD1) to POD5, using the latent-class-trajectory-model. Functional recovery was compared across the trajectories. Logistic regression was used to explore risk factors for trajectories of more severe symptoms. Based on the five most severe post-surgery symptoms (pain, fatigue, coughing, shortness of breath, and disturbed sleep), we identified three distinct symptom trajectories among 424 patients [mild, N = 225 (53.07%); severe-to-mild, N = 86 (20.28%); severe, N = 104 (24.53%)]. At discharge, more 'severe' patients (73.96%) did not achieve a functional recovery compared with those in mild (32.54%, P < 0.0001) or severe-to-mild (56.96%, P = 0.0274) groups. Factors of significant symptom increase on POD1 were younger-than-55 (OR = 1.94 [95% CI 1.30-2.93], P = 0.001), undergoing open or multi-port video-assisted thoracoscopic surgery (OR = 1.59 [95% CI 1.05-2.41], P = 0.03), and using two chest tubes (OR = 1.72 [95% CI 1.12-2.65], P = 0.01). For patients experiencing dramatic symptom increase on POD1, older age (OR = 2.51 [95% CI 1.40-4.59], P = 0.002) was associated with 'severe' trajectory. This study demonstrated that PRO measures were capable of profiling heterogeneous symptom trajectories after lung cancer surgery. Those in-hospital trajectories were able to differentiate patients' responses to treatments and signal the needs for extensive post-discharge care.

A longitudinal study of post-traumatic stress, depressive, and anxiety symptoms trajectories in subjects with bipolar disorder during the COVID-19 pandemic.

Bipolar disorder (BD) is recognized to be at high risk for developing negative psychopathological sequelae to potentially traumatic events. Nevertheless, scant data are still available about the effects of the COVID-19 emergency on the clinical course of BD. The present study examined prospectively the development and trajectories of post-traumatic stress, depressive, and anxiety symptoms among subjects with BD that were followed in an outpatient psychiatric clinic at the time of pandemic onset. A cohort of 89 subjects with BD was enrolled during the first wave of the COVID-19 pandemic, and assessed at baseline (T0), 2-months (T1), and 6-months (T2) follow-up. A K-means cluster analysis was used to identify distinct trajectories of depressive, anxiety, and post-traumatic stress symptoms during the three time points. We identified three trajectories: the Acute reaction (13.5%); the Increasing severity (23.6%); and the Low symptoms (62.9%) groups, respectively. In the Acute reaction group a significant prevalence of female gender was reported with respect to the Low symptoms one. Subjects in the Increasing severity group reported significantly lower employment rate, and higher rate of relatives at risk for COVID-19 medical complications. Subjects in the Increasing Severity group reported higher rates of previous hospitalization and manic symptoms at baseline than those included in the Low symptoms one. Our results describe three distinct symptom trajectories during the COVID-19 emergency in a cohort of subjects suffering from BD, suggesting the need of a long-term follow-up for detecting the impact of the COVID-19 pandemic in this vulnerable population.

Trajectories of Asthma-Symptoms and Their Association with Family Environmental Factors Among Children in Australia

Background: Asthma is one of the largest health burdens, yet contributors to asthma-symptoms trajectories are understudied in Australian children. We assessed the trajectories of asthma-symptoms and their association with several family environmental factors over the childhood period in Australia. Methods: Asthma-symptoms, family environmental factors and sociodemographic data (2004-2018) were obtained from the ‘Longitudinal Study of Australian Children (LSAC)’. Group-based trajectory modelling was applied to identify asthma symptoms trajectories, and multivariable logistic regression models used to assess associations between these and environmental factors. Findings: Of 5,107 children in the LSAC cohort, 3,846 were included in our final analysis. We identified three distinct symptom trajectories: ‘Low/no (69%)’, ‘Transient high (17%)’, and ‘Persistent high (14%)’ from age 0-1 to 14-15 years. Compared with the 'Low/no' group, children exposed to persistently bad external dwelling conditions (RR:1·31, 95% CI:1·10; RR:1·19, 95% CI:1·00,1·43); high & increasing cluttered homes (RR:1·13, 95% CI:1·01,1·29; RR:1·35, 95% CI:1·18,1·55); and high prevalence of maternal smoking (RR:1·40, 95% CI:1·23,1.60; RR:1·26, 95% CI:1·10,1·44), were at increased risk being classified as transient high and persistent high trajectories of asthma-symptoms. Exposure to tobacco smoke inside the home increased the risk of being in the persistent high trajectory group (RR:1·30, 95% CI:1·12,1·50). Interpretation: Poor home environment increased the risk of asthma-symptoms over childhood. Improving the home environment and reducing tobacco smoke exposure may facilitate a favourable asthma-symptoms trajectory in childhood. Funding: None to declare. Declaration of Interest: The authors have no interests to declare. Ethical Approval: This study was approved by the Human Research Ethics Committee of The Australian Institute of Family Studies (AIFS).

Posttraumatic Stress Disorder Symptom Trajectories in ICU Family Caregivers.

Prospective cohort study. The medical ICU at a tertiary-care center in the United States. Adult patients experiencing acute cardiorespiratory failure (defined as requiring at least one of the following: 1) vasopressors, 2) noninvasive positive pressure ventilation, 3) high-flow nasal cannula, or 4) mechanical ventilation) were enrolled in a pair with their primary family caregivers. Participants were enrolled within the first 48 hours of ICU admission. Family caregiver posttraumatic stress disorder symptoms were measured using the Impact of Events Scale-Revised at four time points: at enrollment, shortly after ICU discharge, and at 3 and 6 months after ICU discharge. The data were examined using latent class growth analysis to identify posttraumatic stress disorder symptom trajectories. Two distinct symptom trajectories were identified: a persistently high trajectory, characterized by high posttraumatic stress disorder symptoms at initial assessment, which remained elevated over time, and a persistently low trajectory, characterized by low posttraumatic stress disorder symptoms at initial assessment, which remained low over time. Approximately two-thirds of caregivers belonged to the persistently high trajectory, and one-third of caregivers belonged to the persistently low trajectory. Using latent class growth analysis to measure 6-month ICU family caregiver posttraumatic stress disorder symptom trajectories, we identified two distinct trajectories (persistently low and persistently high). A larger cohort study is warranted to further delineate posttraumatic stress disorder trajectories in this population, with the ultimate goal of targeting high-risk caregivers for interventions to reduce psychologic distress and improve long-term caregiver outcomes.

Trajectories of depression and anxiety symptoms during the COVID-19 pandemic in a representative Australian adult cohort.

ObjectivesTo estimate initial levels of symptoms of depression and anxiety, and their changes during the early months of the COVID‐19 pandemic in Australia; to identify trajectories of symptoms of depression and anxiety; to identify factors associated with these trajectories.Design, setting, participantsLongitudinal cohort study; seven fortnightly online surveys of a representative sample of 1296 Australian adults from the beginning of COVID‐19‐related restrictions in late March 2020 to mid‐June 2020.Main outcome measuresSymptoms of depression and anxiety, measured with the Patient Health Questionnaire (PHQ‐9) depression and Generalised Anxiety Disorder (GAD‐7) scales; trajectories of symptom change.ResultsYounger age, being female, greater COVID‐19‐related work and social impairment, COVID‐19‐related financial distress, having a neurological or mental illness diagnosis, and recent adversity were each significantly associated with higher baseline depression and anxiety scores. Growth mixture models identified three latent trajectories for depression symptoms (low throughout the study, 81% of participants; moderate throughout the study, 10%; initially severe then declining, 9%) and four for anxiety symptoms (low throughout the study, 77%; initially moderate then increasing, 10%; initially moderate then declining, 5%; initially mild then increasing before again declining, 8%). Factors statistically associated with not having a low symptom trajectory included mental disorder diagnoses, COVID‐19‐related financial distress and social and work impairment, and bushfire exposure.ConclusionOur longitudinal data enabled identification of distinct symptom trajectories during the first three months of the COVID‐19 pandemic in Australia. Early intervention to ensure that vulnerable people are clinically and socially supported during a pandemic should be a priority.

Distinctiveness of prolonged-grief-disorder- and depressive-symptom trajectories in the first 2 years of bereavement for family caregivers of terminally ill cancer patients.

Grief reactions in bereaved caregivers of cancer patients have been identified individually as distinct prolonged grief disorder (PGD)-and major depressive disorder (MDD)-symptom trajectories, but no research has examined whether the patterns of change (trajectories) for PGD and MDD symptoms synchronize during bereavement. We conducted a secondary analysis study to investigate the construct distinctiveness of PGD and MDD by simultaneously identifying and examining similarities and differences between bereaved caregivers' PGD- and depressive-symptom trajectories from immediately post-loss through 2 years later. PGD and depressive symptoms were measured for 849 cancer patients' caregivers over their first 2 years of bereavement using 11 grief-symptom items of the prolonged grief-13 scale (PG-11) and the center for epidemiologic studies-depression (CES-D) scale, respectively. PGD- and depressive-symptom trajectories were identified using latent class growth analysis with continuous latent-class indicators (total PG-11 and CES-D scores). Concordance of caregiver participants' membership in PGD- and depressive-symptom trajectories was examined by a percentage and a kappa value. Five distinct symptom trajectories were identified for both PGD and MDD, with four shared trajectories (endurance, transient-reaction, resilience, and prolonged-symptomatic) having different prevalence rankings. Nonetheless, unique trajectories were identified for PGD (potential recurrence) and depressive symptoms (chronically distressed), respectively. Concordance between membership in PGD- and depressive-symptom trajectories was moderate (61.3%, kappa [95% CI]: 0.49 [0.44, 0.53]). PGD and MDD are related but distinct constructs indicated by the unique trajectories identified for each, different prevalence rankings for PGD- and depressive-symptom trajectories, and moderate concordance between membership in PGD- and depressive-symptom trajectories, respectively.

Using Latent Profile Analysis to Classify Longitudinal Symptom Burden in Children with Advanced Cancer (GP767)

• Explain how groups of children with advanced cancer experience different levels of symptom burden over time.• Describe factors associated with symptom classes. Children with advanced cancer experience physical and psychological symptom burden. Emphasis on cross-sectional evaluation of symptoms in children with advanced cancer has led to gaps in understanding the dynamic nature of symptoms over time and factors associated with different trajectories of symptom burden. The presence of distinct symptom trajectories in children with advanced cancer is largely unknown. To describe symptom burden trajectories and factors associated with those trajectories using latent profile analysis of longitudinal symptom data from children with advanced cancer. Symptom data were collected every two weeks for a median of 21 weeks from 46 children with advanced cancer. Data were analyzed using latent profile analysis to classify trajectories in symptom prevalence (burden) over time. Age, gender, and clinical characteristics were compared between the observed classes. The best fitting model described two distinct classes of symptom burden based on the prevalence of pain, fatigue, nausea, sleeping difficulties, dyspnea, anxiety, and sadness over time. Participants in Class 2 experienced a trajectory of higher symptom burden over time compared to Class 1. Most children were represented in either Class 1 (n=23) or Class 2 (n=20). Classes did not differ by diagnosis or age, but differed by sex and disease status. Class 1 had a higher proportion of males, while Class 2 had a higher proportion of females, children with active disease, and recent disease progression (<30 days). A subgroup of children with advanced cancer experienced a trajectory of high symptom burden. Female sex, active disease, and recent disease progression were associated with higher symptom burden over time.

4545 Identifying Symptom Pattern Trajectories among Heart Failure Patients in a Palliative Care Trial: A Work In Progress

OBJECTIVES/GOALS: This work-in-progress aims to: 1) identify and differentiate symptom pattern trajectories in a sample of older adult heart failure (HF) patients over 24 weeks, and 2) examine associations between sociodemographic/clinical/physiological characteristics, dyadic health, and symptom trajectories. METHODS/STUDY POPULATION: ENABLE CHF-PC, a palliative care RCT (NCT02505425), was conducted at a Southeastern US medical center. Between 2016-2018, 415 older adult HF patients and 159 family caregivers were randomized to receive a psychoeducational intervention or usual care. Baseline sociodemographic information (age, gender, rurality, etc.) were collected. Outcome variables of interest include symptoms (Kansas City Cardiomyopathy Questionnaire (KCCQ), Functional Assessment of Chronic Illness Therapy-Palliative 14, Hospital Anxiety and Depression Scale (HADS)) and dyadic health (PROMIS-SF Global Health). We have calculated baseline descriptive statistics. Future work includes latent growth mixture modeling to identify distinct symptom trajectories and univariate associations with patient level factors. RESULTS/ANTICIPATED RESULTS: Of 415 patient participants, mean age was 64, 53% were male; 55% were African American; 26% were rural dwellers; 46% had +15.8) and low anxiety (6.7+3.6) and depressive symptoms (5.7+4.3) on the HADS. Of 159 family caregivers participants, the mean age was 57.9, 85.4% were female, 51.9% were African-American, and 65.2% were the patient’s spouse/partner. DISCUSSION/SIGNIFICANCE OF IMPACT: Limited data describes HF symptom pattern trajectories.How co-occurring symptoms affect quality of life or are affected by personal or situational factors are not well-understood. This study will help to identify factors and symptom phenotypes that may serve as targets for future interventions.

Religion/Spirituality and Gender-Differentiated Trajectories of Depressive Symptoms Age 13-34.

Studies examining religion/spirituality (R/S) and depressive symptoms report divergent findings, often depending on the types of variables considered. This study assessed whether subjective and experiential R/S variables were associated with increased depressive symptom burden from adolescence to young adulthood. Variations by gender were also assessed. Using group-based trajectory modeling with a cohort-sequential design, four distinct symptom trajectories were identified for women and five for men. 27.4% of women and 10.2% of men were classified on peak trajectory groups. Religious attendance was protective for men and women. Prayer was protective for women but linked to risk for men. Born-again and life-changing spiritual experiences, along with belief in supernatural leading and angelic protection, were broadly associated with increased classification on elevated symptom trajectories. In one exception, belief in supernatural leading was associated among some men with decreased risk of depressive symptoms during adolescence. Researchers must take a variety of R/S variables into account when assessing depressive symptoms, not simply religious attendance, prayer frequency, or affiliation as is commonly practiced. Religion and spirituality are multidimensional and in some cases may operate differently for men than women vis-à-vis mental well-being.

Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms.

Postpartum depression is a heterogeneous disorder in phenotype and etiology. Characterizing the longitudinal course of depressive symptoms over the first year after birth and identifying variables that predict distinct symptom trajectories will expedite efficient mental health treatment planning. The purpose was to determine 12-month trajectories of postpartum depressive symptoms, identify characteristics that predict the trajectories, and provide a computational algorithm that predicts trajectory membership. A prospective cohort of women delivering at an academic medical center (2006-2011) was recruited from an urban women's hospital in Pittsburgh, PA. Women with a postpartum depressive disorder (n = 507) participated and completed symptom severity assessments at 4-8 weeks (intake), 3 months, 6 months, and 12 months. Women were predominantly Caucasian (71.8%), married (53.3%), and college educated (38.7%). Clinician interviews of depressive symptom severity, medical and psychiatric history, assessment of function, obstetric experience, and infant status were conducted. Analyses resulted in identification of three distinct trajectories of depressive symptoms: (1) gradual remission (50.4%), (2) partial improvement (41.8%), and (3) chronic severe (7.8%). Key predictive characteristics of the chronic severe versus gradual remission and partial improvement trajectories included parity, education, and baseline global functioning and depression severity. We were able to predict trajectory membership with 72.8% accuracy from these characteristics. Four maternal characteristics predicted membership in the chronic severe versus gradual remission and partial improvement trajectories with 72.8% accuracy. The trajectory groups comprise clinically relevant subgroups with the potential for tailored treatments to reduce the disease burden of postpartum depression.

Trajectories of Posttraumatic Stress and Depression in Police and Community Members Following the Violence during Civil Unrest in Ferguson, Missouri.

Longitudinal research following discreet traumatic events reveals distinct symptom trajectories in untreated survivors of trauma. Trajectories within communities exposed to shared, prolonged violence involving subgroups differing in perspectives, and roles during the event have not been studied. This study examined trajectories of posttraumatic stress (PTS) and depressive symptoms secondary to exposure to violence during civil unrest in citizens (n=311) and law enforcement (n=255) over 1.5years following exposure. Latent class growth modeling was used to examine trajectories of PTS and depressive symptoms. Four-class quadratic solutions for both PTS and depressive symptoms demonstrated best fit. Similar patterns emerged for such that most participants were classified as resistant (57% and 67%, respectively), followed by resilience (23.8% and 17.2%), chronic (12.6% and 12.0%), and worsening (6.1% and 4.4%). When all predictors were entered in a single model, race, and membership in citizen or law enforcement groups did not distinguish trajectories of recovery. Higher income and social support emerged as consistent protective factors against PTS and depressive symptoms, while trauma history emerged as a risk factor for PTS. Women were more at risk for depressive symptoms only. Implications for improving police/civilian relations in Ferguson, Missouri, and other communities are discussed.

Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs

BackgroundAs mortality from coronary heart disease (CHD) falls, years lived with disability increase. Depression and anxiety are known indicators of poor outcomes in CHD, but most research has measured distress symptoms at one time point, often following acute events. Here we consider the long-term trajectories of these symptoms in established CHD, and examine their association to distinct measures of disability and impact on costs. Methods and results803 patients with diagnosis of CHD were recruited from primary care, and completed detailed assessments every 6months for 3years. Latent class growth analysis (LCGA) was used to identify 5 distinct symptom trajectories based on the Hospital Anxiety and Depression Questionnaire (HADS): ‘stable low’, ‘chronic high’, ‘improving’, ‘worsening’, and ‘fluctuating’. The ‘chronic high’ group had highest association with reporting of chest pain (RRR 5.8, CI 2.9 to 11.7), smoking (2.9, 1.1 to 6.3), and poorer physical (0.88, 0.83–0.93) and mental (0.78, 0.73–0.84) quality of life. The ‘chronic high’ and ‘worsening’ trajectories had significantly higher health-care costs over the ‘stable low’ trajectory (107.2% and 95.5% increase, respectively). In addition, our trajectories were the only significant variable associated with increased health-care costs across the 3years. ConclusionsSymptoms of depression and anxiety are highly prevalent in stable CHD patients, and their long-term trajectories are the single biggest driver of health care costs. Managing morbidity in these patients, in which depression and anxiety play a key role in, should become the primary focus of policy makers and future clinical trials.

Latent classes of nonresponders, rapid responders, and gradual responders in depressed outpatients receiving antidepressant medication and psychotherapy.

We used growth mixture modeling (GMM) to identify subsets of patients with qualitatively distinct symptom trajectories resulting from treatment. Existing studies have focused on 12-week antidepressant trials. We used data from a concurrent antidepressant and psychotherapy trial over a 6-month period. Eight hundred twenty-one patients were randomized to receive either fluoxetine or tianepine and received cognitive-behavioral therapy, supportive therapy, or psychodynamic therapy. Patients completed the Montgomery-Åsberg depression rating scale (MADRS) at the 0, 1, 3, and 6-month periods. Patients also completed measures of dysfunctional attitudes, functioning, and personality. GMM was conducted using MADRS scores and the number of growth classes to be retained was based on the Bayesian information criterion. Criteria supported the presence of four distinct latent growth classes representing gradual responders of high severity (42% of sample), gradual responders of moderate severity (31%), nonresponders (15%), and rapid responders (11%). Initial severity, greater use of emotional coping strategies, less use of avoidance coping strategies, introversion, and less emotional stability predicted nonresponder status. Growth classes were not associated with different treatments or with proportion of dropouts. The longer time period used in this study highlights potential overestimates of nonresponders in previous research and the need for continued assessments. Our findings demonstrate distinct growth trajectories that are independent of treatment modality and generalizable to most psychotherapy patients. The correlates of class membership provide directions for future studies, which can refine methods to predict likely nonresponders as a means to facilitate personalized treatments.

ABSTRACT 169

Background and aims: Advances in modern medicine have increasingly improved survival rates of critically ill and injured children. Evidence suggests that there is a significant risk for posttraumatic stress symptoms (PTSS) for children following admission to the Paediatric Intensive Care (PICU), however few studies have explored individual recovery patterns, especially in children. Aims: This paper identifies patterns of PTSS in children aged from 1 year following PICU admission using group-based trajectory modelling. Methods: Following IRB approval, maternal reports of child distress from the acute stage and up to 2 years post-PICU admission (n = 272) were examined to: (1) assess the prevalence of distress in the child, (2) identify symptom trajectories, and (3) identify risk factors associated with poor child mental health outcomes following PICU admission. Results: Analysis identified three distinct symptom trajectories in the children. The majority were resilient (82%). A small group had very high symptoms in the acute phase but were below the clinical cut-off after 6 months (recovery 3%). A significant group of children had clinical level symptoms that did not appear to improve over time (chronic 15%). There was no evidence of delayed onset PTSS. Child age and gender do not predict trajectory patterns. Conclusions: There is growing evidence that significant distress in the peri-trauma period is linked to continuing clinical level distress symptoms which have the potential to impact on child physical recovery and long term functioning. Research into early interventions for distressed children following critical illness is a matter of urgency.

Premenstrual syndrome and dysmenorrhea: Symptom trajectories over 13 years in young adults

ObjectivesTo ascertain the prevalence of premenstrual syndrome (PMS) and dysmenorrhea in Australia women and to examine whether there is population subgroups with distinct symptom trajectories. Study designA prospective cohort study, including 9671 young women random sampled from national Medicare database and followed up for 13 years, examined the prevalence, the trend and the symptom trajectories of the conditions. Main outcome measuresPrevalence of PMS and dysmenorrhea over time, their symptom trajectories, and the probability of symptom reporting at follow-up. ResultsThe prevalence of PMS varied between 33 and 41% and that of dysmenorrhea between 21 and 26%. The probabilities of reporting PMS and dysmenorrhea were 0.75 (95% CI, 0.73, 0.76) and 0.70 (95% CI, 0.68, 0.72), respectively, among women who reported them in three previous consecutive surveys. Four unique trajectories were identified for both conditions. PMS was experienced by 80% of women some time during the study period, with normative (22.1%), late onset (21.9%), recovering (26.5%) and chronic (29.5%) groups revealed. Dysmenorrhea occurred in 60% of women with normative (38.3%), low (28.0%), recovering (17.2%) and chronic (16.5%) groups identified. ConclusionsPMS and dysmenorrhea are common among young women. Both have relatively stable prevalence over time, but exhibit considerable variation at the individual level. Four subgroups of women who followed similar symptom trajectories were identified. PMS was experienced by 80% of women during the study period and it tended to be a long-lasting problem in many. Although 60% of women experienced dysmenorrhea, only a small group continuously reported it. Smoking and illicit drugs use, and smoking and obesity were more common among women with persistent PMS and dysmenorrhea respectively.

Using group-based trajectory modeling to examine heterogeneity of symptom burden in patients with head and neck cancer undergoing aggressive non-surgical therapy

Treatment-related symptom burden varies significantly among patients undergoing radiotherapy or chemoradiotherapy, yet such variation is typically not reflected in the results from single-group studies. We applied group-based trajectory modeling (GBTM) to describe the heterogeneity of symptom burden among patients with head and neck cancer and to identify subgroups with distinct symptom-development trajectories. Patients (n=130) were recruited pretherapy and rated multiple symptoms weekly for 10weeks via the M. D. Anderson Symptom Inventory. With the mean of five most severe symptoms over time as an outcome measure, GBTM was used to identify patient subgroups with distinct symptom trajectories. Linear mixed-effects modeling (LMM) was applied to compare with GBTM's ability to describe the longitudinal symptom data. The five most severe symptoms were problems with taste, difficulty swallowing or chewing, problems with mucus, fatigue, and dry mouth. A two-group GBTM model identified 68% of patients as having high symptom burden, associated with older age, worse baseline performance status, and chemoradiotherapy treatment. A four-group GBTM model generated one stable group (4% of patients) and three groups varying in symptom severity with both linear and quadratic functions over time. LMM revealed symptom-change patterns similar to that produced by GBTM but was inferior in identifying risk factors for high symptom burden. For cancer patients undergoing aggressive therapy, GBTM is capable of identifying various symptom-burden trajectories and provides severity groupings that will aid research and may be of clinical utility. These results may be generalizable to other cancer types and treatments.

Parental Response to Child Injury: Examination of Parental Posttraumatic Stress Symptom Trajectories Following Child Accidental Injury

Trajectory analyses were used to empirically differentiate patterns of posttraumatic stress symptoms in parents following child accidental injury and explore the relationship between parent and child recovery patterns. Parent (n = 189) self-reported symptoms from acute to 2 years post accident were examined to (1) identify distinct parent symptom trajectories; (2) identify risk factors; and (3) explore the patterns of children and parents together. Analysis revealed three distinct symptom trajectory groups for parents: resilient (78%); clinical level acute symptoms that declined to below clinical level by 6 months (recovery 8%); and chronic subclinical (14%). Children of resilient parents were most likely to be resilient. Half of the children of parents with chronic subclinical trajectories were likely to have chronic trajectories. Clinicians cannot rely only on clinical level symptoms in parents to identify high risk families but include families where the parent has subclinical level symptoms.