Emotional Battery Research Articles

A Confirmatory Factor Analysis of the NIH Emotions Toolbox Among People Living with HIV and Who May Use Methamphetamine.

The National Institutes of Health Toolbox Emotion Battery (NIHTB-EB) was developed to provide researchers and clinicians with a concise tool for measuring emotional health. The NIHTB-EB has been validated and normed in English and Spanish-speaking populations in the United States. However, its application in certain groups, such as people living with HIV (PWH) and who may use methamphetamine has not been tested. This paper evaluates the factor structure in a sample of people without HIV and PWH who may or may not use methamphetamine. The sample included 773 adults ages 18 to 87. The factorial structure of the NIHTB-EB was examined using confirmatory factor analysis (CFA) in the full sample and among four subgroups based on HIV status and methamphetamine use. The CFA confirmed a three-factor structure that mirrors the previously validated structure with latent factors measuring negative affect, social relationships, and psychological well-being for three subgroups. While each latent factor was confirmed in all groups, we could not confirm, with confidence, the full battery in the smallest subgroup (HIV-seronegative participants who use methamphetamine). The three-factor NIHTB-EB is appropriate for use among PWH who may use methamphetamine, but further examination with larger samples is warranted.

Longitudinal Investigation of Alexithymia as a Predictor of Empathy, Emotional Functioning, Resilience, and Life Satisfaction 2 Years After Brain Injury

ObjectiveTo examine the unique contribution of alexithymia at 1 year after traumatic brain injury (TBI) to the prospective prediction of emotional and social health outcomes at 2 years after injury. DesignMulticenter, longitudinal cohort study. SettingData were collected during year 1 and year 2 postinjury follow-up interviews across 4 TBI Model System centers. ParticipantsPersons with TBI (N=175; 134 men and 41 women) who had English fluency and were capable of providing self-reported data. InterventionsNot applicable. Main Outcome MeasuresPrimary independent variable was the Toronto Alexithymia Scale-20. Outcome measures included the Interpersonal Reactivity Index, National Institute of Health Toolbox Emotion Battery Anger, Difficulty with Emotion Regulation Scale, Connor-Davidson Resilience Scale, Posttraumatic Stress Disorder Checklist – Civilian, Satisfaction with Life Scale, General Anxiety Disorder-7, Patient Health Questionnaire 9, suicidal ideation, and problematic substance use. ResultsSimple adjusted models demonstrated that after controlling for the specific outcome at year 1, Toronto Alexithymia Scale-20 scores significantly predicted year 2 scores for perspective-taking, physical aggression, emotional dysregulation, resilience, anxiety, depression, and suicidal ideation. All of these predictive findings except for physical aggression were maintained in the fully adjusted models that also controlled for age, sex, education level, number of prior TBIs, and motor and cognitive functioning. ConclusionsCompared with those with lower alexithymia scores, persons with TBI who had higher alexithymia scores at 1 year after injury reported poorer emotional health at 2 years after TBI, even after controlling for year 1 outcome scores, sociodemographic characteristics, and injury-related factors. These results support the need to assess for elevated alexithymia and to provide interventions targeting alexithymia early in the TBI recovery process.

Stress and Psychosocial Distress Scale with Blunted Oscillatory Dynamics Serving Abstract Reasoning

Background. Chronic stress is associated with a multitude of psychopathological disorders that share similar alterations in neural dynamics and symptomatology. Applying the National Institute of Mental Health’s Research Domain Criteria (RDoC) framework, we probed the stress-diathesis model by identifying how a transdiagnostic psychosocial distress index representing high-dimensional patterns of stress-related aberrations was coupled to the neural oscillatory dynamics serving abstract reasoning. Methods. The sample consisted of 69 adults (mean age=44.77 years, SD=13.66) who completed the NIH Toolbox Emotion Battery (NIHTB-EB) and a matrix reasoning task during magnetoencephalography (MEG). A transdiagnostic psychosocial distress index was computed using exploratory factor analysis with assessments from the NIHTB-EB. Whole-brain correlations were conducted using the resulting psychosocial distress index for each oscillatory response, and the resulting peak voxels were extracted for mediation analyses to assess the degree to which neural oscillatory activity mediates the interplay between perceived stress and psychosocial distress. Results. We found that elevated psychosocial distress was associated with blunted oscillatory alpha/beta and gamma responses in key cortical association regions. Further, we found that only alpha/beta activity in the right superior temporal sulcus partially mediated the relationship between perceived stress and psychosocial distress. Conclusions. The present study is among the first to couple perceived stress and psychosocial distress with alterations in oscillatory activity during a matrix reasoning task. These findings illuminate the relationship between perceived stress and neural alterations associated with psychopathology.

Psychometric properties of the NIH Toolbox Cognition and Emotion Batteries among children and adolescents with congenital heart defects

ABSTRACT The NIH Toolbox offers brief, computerized measures of cognitive and psychosocial functioning. However, its psychometric properties were established among typically developing children and adolescents. The current study provides the first comprehensive assessment of its psychometric properties among young patients with congenital heart defects (CHD). We prospectively recruited 58 patients with CHD and 80 healthy controls between the ages of 6 and 17. Participants completed the NIH Toolbox Cognition and Emotion Batteries, a battery of clinician-administered neuropsychological tests, and ratings of their quality of life. Their parents also completed ratings of their functioning. On the Cognition Battery, we found expectable group differences and developmentally expected gains across ages. For the most part, composites and subtests were significantly correlated with neuropsychological measures of similar constructs. Higher scores were generally associated with ratings of better day-to-day functioning among children with CHD. On the Emotion Battery, we found no significant group differences, echoing prior research. For the most part, scales showed acceptable internal consistency among both groups. There was adequate construct coherence for most of questionnaires among healthy control but not participants with CHD. Correlations with a comparison tool were largely within expectable directions. The NIH Toolbox may provide a valid and useful assessment of cognitive functioning among youths with CHD. While it may offer reliable and valid scales of psychosocial functioning, further research is needed to understand the meaningfulness of the scales for participants with CHD.

Loneliness in older primary care patients and its relationship to physical and mental health-related quality of life.

Loneliness is a significant public health challenge in the United States, especially among older adults. The epidemiology of loneliness among older adults in primary care is lacking, and specific research is needed on how loneliness impacts older primary patients' physical, mental, and cognitive health. A large sample of older primary care patients were recruited for a trial during the COVID-19 pandemic to measure the relationship between loneliness and physical and mental quality of life (QOL). Baseline data come from the Caregiver Outcomes of Alzheimer's Disease Screening (COADS) study, an ongoing randomized controlled trial evaluating benefits and risks of Alzheimer's disease and related dementias screening among primary care patients ages 65 and older, collected April 2020 to September 2021. Loneliness was measured with the 5-item, Loneliness Fixed Form Ages 18+ from The NIH Toolbox Emotion Battery, physical and mental health-related QOL was measured with the SF-36v2, and depression and anxiety severity were measured with the PHQ-9 and GAD-7, respectively. Spearman correlation analyses revealed that loneliness was moderately correlated with mental health QOL (r[601] = -0.43, p < 0.001), anxiety severity (r[601] = 0.44, p < 0.001), and depression severity (r[601] = 0.42, p < 0.001), while weakly correlated with physical health QOL (r[601] = -0.15, p < 0.001). After conducting unadjusted and adjusted linear regression models, we found that loneliness was significantly associated with both lower mental (p < 0.001) and physical (p < 0.001) QOL. Furthermore, loneliness remained significantly associated with worse mental QOL after adjusting for age, gender, race, ethnicity, educational level, perceived income status, neighborhood disadvantage, severity of comorbidities, and comorbid depression and anxiety. Primary care providers should discuss loneliness with their older adult patients and provide resources to help patients develop and maintain meaningful social relationships.

Theta oscillatory dynamics serving cognitive control index psychosocial distress in youth

BackgroundPsychosocial distress among youth is a major public health issue characterized by disruptions in cognitive control processing. Using the National Institute of Mental Health's Research Domain Criteria (RDoC) framework, we quantified multidimensional neural oscillatory markers of psychosocial distress serving cognitive control in youth. MethodsThe sample consisted of 39 peri-adolescent participants who completed the NIH Toolbox Emotion Battery (NIHTB-EB) and the Eriksen flanker task during magnetoencephalography (MEG). A psychosocial distress index was computed with exploratory factor analysis using assessments from the NIHTB-EB. MEG data were analyzed in the time-frequency domain and peak voxels from oscillatory maps depicting the neural cognitive interference effect were extracted for voxel time series analyses to identify spontaneous and oscillatory aberrations in dynamics serving cognitive control as a function of psychosocial distress. Further, we quantified the relationship between psychosocial distress and dynamic functional connectivity between regions supporting cognitive control. ResultsThe continuous psychosocial distress index was strongly associated with validated measures of pediatric psychopathology. Theta-band neural cognitive interference was identified in the left dorsolateral prefrontal cortex (dlPFC) and middle cingulate cortex (MCC). Time series analyses of these regions indicated that greater psychosocial distress was associated with elevated spontaneous activity in both the dlPFC and MCC and blunted theta oscillations in the MCC. Finally, we found that stronger phase coherence between the dlPFC and MCC was associated with greater psychosocial distress. ConclusionsGreater psychosocial distress was marked by alterations in spontaneous and oscillatory theta activity serving cognitive control, along with hyperconnectivity between the dlPFC and MCC.

Multivariate base rates of potentially problematic scores on the NIH Toolbox Emotion Battery.

To examine the normal frequency of obtaining one or more scores considered potentially problematic based on normative comparisons when completing the NIH Toolbox Emotion Battery (NIHTB-EB). Participants (N = 753; ages 18-85, 62.4% women, 66.4% non-Hispanic White) from the NIHTB norming study completed 17 scales of emotional functioning fitting into three subdomains (i.e., Negative Affect, Psychological Well-being, Social Satisfaction). Scores were considered potentially problematic if they were 1 SD above/below the mean, depending on the orientation of the scale, and cutoffs for 1.5 and 2 SD were also included for reference. Multivariate base rates quantified the rate at which participants obtained one or more potentially problematic scale or subdomain scores. The portion of participants obtaining one or more potentially problematic scores on the NIHTB-EB scales and subdomains was 61.2 and 23.2%, respectively. Participants who were younger (i.e., 18-49) or had less education had higher rates of potentially problematic scores within specific subdomains. There were no significant differences by sex or race/ethnicity. Elevated scores on the NIHTB-EB were common in the normative sample and related to education/age. The multivariate base rates provided indicate obtaining one or more potentially problematic scores on the NIHTB-EB is broadly normal among adults, which may guard against overinterpreting a single score as clinically significant. These base rates should be considered in the context of other assessment findings, such as interviews, medical history or informant reports, to ensure that true emotional problems are not dismissed, and normal variation in emotional functioning is not pathologized.

1 The Mobile Toolbox for Monitoring Cognitive Change

Objective:To present the Mobile Toolbox (MTB), comprised of an expandable library of cognitive and other tests, including adapted versions of NIH Toolbox® measures. The MTB provides a complete research platform for app creation, study management, data collection, and data management. We will describe the MTB project and MTB research platform and demonstrate examples of assessments.Participants and Methods:MTB is the product of an NIH-funded, multi-institutional effort involving Northwestern University, Sage Bionetworks, Penn State, University of California San Francisco, University of California San Diego, Emory University, and Washington University. The MTB assessment library is a dynamic repository built upon Sage Bionetworks mobile health platform. All MTB measures are created or adapted for a mobile interface using iOS and Android smartphones. Guided by the principles of open science, many components are open source to allow researchers and developers to integrate externally developed tests, including supplemental scales (e.g., passively collected contextual factors) assessing variables such as mood and fatigue that might influence cognitive test performance.Results:The current MTB library includes eight core cognitive tests based on well-established neuropsychological measures: two language tasks (Spelling and Word Meaning), two executive functioning tasks (Arrow Matching and Shape-Color Sorting), an associative memory task (Faces and Names), an episodic memory task (Arranging Pictures), a working memory task (Sequences) and a processing speed task (Numbers and Symbols). Additional cognitive assessments from other popular test libraries including the International Cognitive Ability Resource (ICAR), Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRACS) and Test My Brain are currently being implemented, as are non-cognitive measures from the NIH Toolbox Emotion Battery and the Patient-Reported Outcomes Measurement Information System (PROMIS). The MTB library includes measures suitable for use in research studies incorporating point-in-time and burst designs as well as ecological momentary assessment (EMA).Conclusions:The MTB was created to address many of the scientific, practical, and technical challenges to cognitive assessment by capitalizing on advances in technology measurement and cognitive research. Initial psychometric evaluation of measures has been performed, and additional clinical validation is underway in studies with persons at risk for cognitive impairment or Alzheimer’s disease (AD), diagnosed with mild cognitive impairment (MCI) or AD, Parkinson’s disease, and HIV-associated Neurocognitive Disorders. Calculation of norms and reliable change indicators is in progress. The MTB is currently available to beta testers with public release planned for Summer, 2023. Clinical researchers will be able to use the MTB system to design smartphone-based test batteries, deploy and manage mobile data collection in their research studies, and aggregate and analyze results in the context of large-scale norming data.

H - 42 Multivariate Base Rates for the NIH Toolbox Emotion Battery in the Spanish-Speaking Normative Sample.

This study involved the calculation of multivariate base rates for the NIH Toolbox Emotion Battery (NIHTB-EB) for the Spanish-speaking normative sample, stratifying by sociocultural variables. Participants were 224 Spanish-speaking adults from the NIHTB norming study (M = 42.2years-old, SD = 16.3; 40.2% Male; 100% Hispanic/Latinx). Frequencies of obtaining one or more "potentially problematic" emotion scores (i.e., either T60, depending on scale orientation) were calculated with stratifications by gender, education, country of birth and education, bilingualism, and household income. The NIHTB-EB includes 17 scales measuring negative affect, social satisfaction, and psychological well-being. When interpreting all 17 scales, 59.8% of participants had one or more potentially problematic score(s). Only education was related to problematic score frequencies (p < 0.014, phi = 0.19). Adults with less than high school education (68.4%) had the highest frequency scores compared to adults with a high school diploma (42.3%) or greater education (54.5%). Although non-significant, bilingual adults (66.7%) tended to have more potentially problematic scores than monolingual adults (56.8%; p = 0.16, phi = 0.09) and higher income (49.0%) was related to more potentially problematic scores than lower income (63.8%; p = 0.07, phi = 0.14). Most Spanish-speaking adults obtained one or more potentially problematic NIHTB-EB scores, with more emotional difficulties associated with less education and modestly associated with lower socioeconomic status and bilingualism. Future research may explore how these variables interact with emotional health among Spanish-speaking Hispanic/Latinx adults.

Emotional and Synesthetic Test of Hypnosis Induction with Video to relieve the patient from psycho-physical pain

Introduction: Emotions consist of patterns of physiological changes associated with behaviors. The urgency of putting them into action accompanied by emotional sensations that determine behavior and adaptive functions have guided the evolution of our brain. Emotions are also called "response frames" and their neuronal and hormonal control affects moral judgments and social behaviors. Historically, their expressions and recognitions have also been addressed to examine the nature of the sensations that accompany the different emotions [1]. With Multidisciplinary Team ABA, we have done two Tests on Emotions and Synesthesia in Google Tool and Video-EBT-CVS test to induce in a gradual state of hypnosis, patients properly evaluated and in the management of emotions during the Covid and post-pandemic Covid. With the aim of teaching him to recognize and manage emotions with a gradual induction to a pseudo-hypnopompic state to tell us spontaneous story of their memories that, with a meditative music, lets flow and induce first an initial induction of emotions and final recognition of their emotions and others. Clinical study: The dissemination of the Tool Emotional/Synesthesia Battery Test among adults and students at Italian schools is in an early stage, but the partial data received until now, with informed consensus, are only 19 in total and among these only 5 patients have, for health reasons that we specify in detail below, have agreed to perform the preliminary evaluation tests after the EBT/CVS Tool of 90 minutes maximum with the aim to complete the Video induction EBT-CVS with hypnosis and training to management/ treatment emotions for a total time of 1 hour 14 minutes and 40 seconds. Materials and Methods: The sample was taken after a presentation of the research made in collaboration between Private Medical Study and ASST Bergamo West/East with a total of patients who performed Tool Test on Emotions and Synesthesia. The study sample that performed Tool Test remotely with Quilgo, 19 patients performed the Tool in Google, among them 5 also performed the Test of emotions and hypnotic induction in video EBT-CVS program. Only the Video-Emotional induction/synesthetic test with evaluation of the 5 subjects, already known for years, evaluate their neuro-endocrinal and psychological pathology conditions, as described above, with 3 preliminary tests for stable their psycho-intellectual state of departure in sufficient well-being, the respective tests are: Mini Mental state examination (Italian) by MF Folstein, Raven’s standard Matrices, Test to evaluate the Hypnosis Induction Profile or Hypnotic Induction Profile of Spiegel (HIP), the Program with Tool Emotional/ Synesthesia Battery Test (EBT-CVS) and Video Test with Emotion Induction Test/Synesthesia Colombo-Vassallo-Shore or EBT-video CVS. Data analysis: The Google Test Tool EBT-CVS was sent to 44 patients in charge, of which 19 completed and sent within the 90 minutes required as the maximum time of performance. Of the 19 patients who performed it correctly. The data of the 19 tests performed have for age a range of 10-84 years, average 41,78 of years old and an average score of EQ (Emotional Quotient) of 56%, median of 54,02% and a range of 38,98%-91,10% at the EBT or Emotional Battery Test standard in Google Tool. 5 out of 19 patients tested by means of preliminary assessments, inherent our Video-Test of induction of emotions up to hypnosis, induced by the same associated video, and music in the final part of the test of recognition related also to facial expressions own and others. We analyzed the data with Anova-Mongomery 2001 to perform a variance analysis of the Tool Emotional Battery Test attended by 19 patients (Attachment 1-2, tables and graphics). Conclusions: Considering the data collected, I think it is appropriate to reflect on the tests available to us to evaluate the Emotional Quotient (Emotional/Synesthetic) of 19 persons to better understand the conscious and unconscious behavior of our patients. They can do this test in Google Tool and/or Video-Test of the Emotional Battery Test. The aim of EBT-CVS is to induce emotions with 5 senses

Emotional characteristics associate with fronto‐amygdala connectivity in older‐old adults: Results from I‐CONECT

AbstractBackgroundResearch into the emotional health of older adults, as it relates to brain network function, lags research into cognitive health, despite the importance of emotional health to quality of life. Here, we examine associations between three summary scores of emotional health from the NIH Toolbox Emotion Battery (NIHTB‐EB) – negative affect, social satisfaction, and psychological well‐being – and their associations with intrinsic brain network functional connectivity within three systems implicated in emotional function – the default mode network (DMN), salience network (SAL), and amygdala‐based connectivity.MethodFifty participants completed resting‐state functional magnetic resonance imaging (rs‐fMRI; 33 women, 80.7±4.4 years). We used two analytic approaches:Seed‐to‐voxel (amygdala): We extracted timeseries from bilateral amygdalae for a voxelwise, whole‐brain analysis. Separate analyses were conducted for each NIHTB‐EB summary score.ROI‐to‐ROI (DMN/SAL): Pairwise correlations were averaged to provide a single measure of within‐network connectivity for each network. ROI‐to‐ROI analyses were calculated in separate regression models using each NIHTB‐EB summary score to predict connectivity within each brain network.NIHTB‐EB outcomes were generated with subscale scores weighted by factor loading. Both sets of analyses included age, sex, site, in‐scanner motion, and cognitive status (unimpaired cognition or mild cognitive impairment).ResultPsychological well‐being associated negatively with amygdala connectivity with ventromedial prefrontal cortex (vmPFC; Fig1; peak T = ‐4.28; MNI xyz: [‐6,24,‐24]; k = 63 voxels). Conversely, negative affect associated positively with amygdala connectivity with vmPFC (Fig2; T = 4.24; [8,22,‐22]; k = 27).NIHTB‐EB summary scores did not associate with DMN or SAL connectivity.ConclusionThese results highlight the relevance of fronto‐amygdala connectivity in understanding emotional aging in older‐old adults. Previous research suggests that the inhibition of amygdala activity by frontal regions plays a key role in emotion regulation. In this light, diminished amygdala‐vmPFC connectivity may reflect better emotion regulation, which here associates with higher levels of psychological well‐being and lower levels of negative affect.While research on younger adults has established the relevance of DMN and SAL connectivity to emotional health, this work suggests that these networks may not be as relevant to emotional health in the older‐old population. These results should be interpreted with caution, as they use an uncorrected voxelwise threshold (p&lt;0.001).

The relationship between emotion and cognition in cognitively healthy cohort: Using NIH toolbox emotion battery

AbstractBackgroundThe NIH Toolbox was designed to provide brief, reliable, and valid measures of neurological and behavioral functions. Emotion assessment using the NIH Toolbox Emotion Battery has recently received significant attention given emerging evidence that emotional health is predictive of physical health and overall well‐being. The purpose of this study is to examine whether the modified emotion toolbox model is associated with cognition in sample of cognitively healthy adults.MethodParticipants were 529 enrollees in the Wisconsin ADRC who had normal cognition. The majority of participants were female (65.8%) and White (78.3%). Average age was 63.69 (SD = 8.37). NIH Toolbox Emotion Battery factors and a measure of executive function, Trail Making Test (TMT) Parts A &amp; B were examined using SEM. To evaluate the overall goodness‐of‐fit, we used the following criteria: χ2 nonsignificant, χ2/df between1‐3, comparative fit index (CFI)&gt;0.95, Tucker–Lewis index (TLI)&gt;0.95, standardized root mean square residual (SRMR)&lt;0.05, and the root mean square error of approximation (RMSEA)&lt;0.08.ResultThe initial SEM results indicated a non‐acceptable fit for the data: χ2(51,N = 529) = 275.99, p&lt;.01 (should be not significant), χ2/df = 5.41 (&lt;3), CFI = 0.92(&gt;.95), TLI = 0.90 (&gt;.95), SRMR = 0.05, and RMSEA = 0.09 (&lt;.08), 90% confidence interval (CI) = [0.08, 0.10] based on previously reported goodness‐of‐fit criteria. Based on modification indices, conceptually and statistically meaningful correlated error terms were added to the model (e,g., proximity between emotional support and friendship; emotional support and instrumental support; stress and sadness). After correlating some error terms based on theoretical background and modification indices, the modified SEM results indicated an acceptable fit for the data: χ2/df = 2.52 (&lt;3), CFI = 0.98, TLI = 0.97, SRMR = 0.03 and RMSEA = 0.05, 90% confidence interval (CI) = [0.04,0.06].ConclusionOur modified model using the NIH Toolbox Emotion Battery had an acceptable fit for the data in a cognitively healthy cohort. Although we did not include all emotion toolbox variables, our modified model still had a great fit to the data. We specifically found that positive emotions including social satisfaction measures were correlated with cognition. We did not find any correlation between negative affect and cognition, which could be due to limited sample size. Measuring and identifying positive and negative emotions are important in clinical and research practice.

Emotional health and its association with neurocognition in Hispanic and non-Hispanic White people with HIV.

Emotional functioning is linked to HIV-associated neurocognitive impairment, yet research on this association among diverse people with HIV (PWH) is scant. We examined emotional health and its association with neurocognition in Hispanic and White PWH. Participants included 107 Hispanic (41% primarily Spanish-speakers; 80% Mexican heritage/origin) and 216 White PWH (Overall age: M = 53.62, SD = 12.19; 86% male; 63% AIDS; 92% on antiretroviral therapy). Emotional health was assessed via the National Institute of Health Toolbox (NIHTB)-Emotion Battery, which yields T-scores for three factor-based summary scores (negative affect, social satisfaction, and psychological well-being) and 13 individual component scales. Neurocognition was measured via demographically adjusted fluid cognition T-scores from the NIHTB-cognition battery. 27%-39% of the sample had problematic socioemotional summary scores. Hispanic PWH showed less loneliness, better social satisfaction, higher meaning and purpose, and better psychological well-being than Whites (ps <.05). Within Hispanics, Spanish-speakers showed better meaning and purpose, higher psychological well-being summary score, less anger hostility, but greater fear affect than English speakers. Only in Whites, worse negative affect (fear affect, perceived stress, and sadness) was associated with worse neurocognition (p <.05); and in both groups, worse social satisfaction (emotional support, friendship, and perceived rejection) was linked with worse neurocognition (p <.05). Adverse emotional health is common among PWH, with subgroups of Hispanics showing relative strengths in some domains. Aspects of emotional health differentially relate to neurocogntition among PWH and cross-culturally. Understanding these varying associations is an important step towards the development of culturally relevant interventions that promote neurocognitive health among Hispanic PWH.

The presence, nature and network characteristics of behavioural phenotypes in temporal lobe epilepsy.

The relationship between temporal lobe epilepsy and psychopathology has had a long and contentious history with diverse views regarding the presence, nature and severity of emotional-behavioural problems in this patient population. To address these controversies, we take a new person-centred approach through the application of unsupervised machine learning techniques to identify underlying latent groups or behavioural phenotypes. Addressed are the distinct psychopathological profiles, their linked frequency, patterns and severity and the disruptions in morphological and network properties that underlie the identified latent groups. A total of 114 patients and 83 controls from the Epilepsy Connectome Project were administered the Achenbach System of Empirically Based Assessment inventory from which six Diagnostic and Statistical Manual of Mental Disorders-oriented scales were analysed by unsupervised machine learning analytics to identify latent patient groups. Identified clusters were contrasted to controls as well as to each other in order to characterize their association with sociodemographic, clinical epilepsy and morphological and functional imaging network features. The concurrent validity of the behavioural phenotypes was examined through other measures of behaviour and quality of life. Patients overall exhibited significantly higher (abnormal) scores compared with controls. However, cluster analysis identified three latent groups: (i) unaffected, with no scale elevations compared with controls (Cluster 1, 37%); (ii) mild symptomatology characterized by significant elevations across several Diagnostic and Statistical Manual of Mental Disorders-oriented scales compared with controls (Cluster 2, 42%); and (iii) severe symptomatology with significant elevations across all scales compared with controls and the other temporal lobe epilepsy behaviour phenotype groups (Cluster 3, 21%). Concurrent validity of the behavioural phenotype grouping was demonstrated through identical stepwise links to abnormalities on independent measures including the National Institutes of Health Toolbox Emotion Battery and quality of life metrics. There were significant associations between cluster membership and sociodemographic (handedness and education), cognition (processing speed), clinical epilepsy (presence and lifetime number of tonic-clonic seizures) and neuroimaging characteristics (cortical volume and thickness and global graph theory metrics of morphology and resting-state functional MRI). Increasingly dispersed volumetric abnormalities and widespread disruptions in underlying network properties were associated with the most abnormal behavioural phenotype. Psychopathology in these patients is characterized by a series of discrete latent groups that harbour accompanying sociodemographic, clinical and neuroimaging correlates. The underlying neurobiological patterns suggest that the degree of psychopathology is linked to increasingly dispersed abnormal brain networks. Similar to cognition, machine learning approaches support a novel developing taxonomy of the comorbidities of epilepsy.

NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations.

Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH. Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests ("problematic" emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH. PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen's d=0.71, p<0.001), Psychological Well-Being (Cohen's d=0.49, p<0.001) and Negative Affect (Cohen's d=0.19, p<0.01) summary T-scores, and most component scales. PWH also had higher rates of "problematic" emotional health, particularly in Social Satisfaction (45% vs 17%, p<0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence. The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.

Psychosocial Functioning in Transgender Youth after 2 Years of Hormones

BackgroundLimited prospective outcome data exist regarding transgender and nonbinary youth receiving gender-affirming hormones (GAH; testosterone or estradiol).MethodsWe characterized the longitudinal course of psychosocial functioning during the 2 years after GAH initiation in a prospective cohort of transgender and nonbinary youth in the United States. Participants were enrolled in a four-site prospective, observational study of physical and psychosocial outcomes. Participants completed the Transgender Congruence Scale, the Beck Depression Inventory–II, the Revised Children’s Manifest Anxiety Scale (Second Edition), and the Positive Affect and Life Satisfaction measures from the NIH (National Institutes of Health) Toolbox Emotion Battery at baseline and at 6, 12, 18, and 24 months after GAH initiation. We used latent growth curve modeling to examine individual trajectories of appearance congruence, depression, anxiety, positive affect, and life satisfaction over a period of 2 years. We also examined how initial levels of and rates of change in appearance congruence correlated with those of each psychosocial outcome.ResultsA total of 315 transgender and nonbinary participants 12 to 20 years of age (mean [±SD], 16±1.9) were enrolled in the study. A total of 190 participants (60.3%) were transmasculine (i.e., persons designated female at birth who identify along the masculine spectrum), 185 (58.7%) were non-Latinx or non-Latine White, and 25 (7.9%) had received previous pubertal suppression treatment. During the study period, appearance congruence, positive affect, and life satisfaction increased, and depression and anxiety symptoms decreased. Increases in appearance congruence were associated with concurrent increases in positive affect and life satisfaction and decreases in depression and anxiety symptoms. The most common adverse event was suicidal ideation (in 11 participants [3.5%]); death by suicide occurred in 2 participants.ConclusionsIn this 2-year study involving transgender and nonbinary youth, GAH improved appearance congruence and psychosocial functioning. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.)

PSYCHOLOGICAL WELL-BEING IN OLDER ADULTS WITH TREATMENT-RESISTANT DEPRESSION

Abstract Geriatric psychiatry research has documented the importance of psychological well-being to older adults diagnosed with depression (Lenze et al., 2016). This presentation utilizes pre-treatment data from the Optimum Study of treatment-resistant depression in older adults recruited from five USA and Canadian metropolitan areas (N = 529). Social participation was measured with the PROMIS scale: Ability to Participate in Social Roles and Activities (Hahn et al., 2014). Positive affect and life satisfaction were assessed using scales from the Psychological Well-Being subdomain (Salsman et al., 2013) of the NIH Toolbox for Assessment of Neurological and Behavioral Function - Emotion Battery (NIHTB-EB). Along with associations between social participation and positive affect (r = .38, p &amp;lt; .01) and between social participation and life satisfaction (r = .26, p &amp;lt; .01), path analyses explored social participation as a mediator of the relationship between cognitive functioning (NIHTB-CB; Weintraub et al., 2013) and psychological well-being.

Examining I‐CONECT Intervention Effect on Psychosocial Wellbeing

AbstractBackgroundThe Internet‐based Conversational Engagement Clinical Trial (I‐CONECT, ClinicalTrials.gov:NCT02871921) intervention provided interpersonal interactions with video calls to socially isolated older adults. It is hypothesized that such intervention could improve individuals' psychosocial wellbeing by increasing social contacts. This abstract examines I‐CONECT intervention effects on psychological wellbeing outcomes.MethodThe intervention group received 30‐minute video chats 4 times/week for 6 months followed by 2 times/week for additional 6 months. The control group received weekly check‐in calls for 12 months. We used data from the baseline, six‐month and twelve‐month follow‐ups. Psychosocial outcomes were measured with NIH Toolbox Emotional Battery (NIHTB‐EB). Three domain scores, negative affect, social satisfaction, and psychological wellbeing, were calculated with 17 subscale scores weighted by factor loading. Mixed Models for Repeated Measures (MMRM) were run for the three psychosocial outcomes, controlling for age, sex, education, and experience of COVID‐19 pandemic. Participants were considered affected by COVID‐19 if any of the data points were collected after March 2020. Subsample analyses were conducted by participants' cognitive status (with normal cognition vs. MCI).ResultThe analysis included 134 participants, 70 with normal cognition and 64 with MCI. The sample’s mean age was 82.3, 44.9% were in the intervention group, 67.0% were female, the average year of education was 15.1, and 51.6% were affected by the pandemic. For the subsamples of individuals of normal cognition and MCI, we did not find any significant change in psychosocial outcomes due to the intervention. However, both intervention and control groups increased social satisfaction scores at both 6‐month and 12‐month (Table 1, Figure 1), suggesting that weekly phone check‐ins and frequent video‐chats interactions can provide the same magnitude of improvement in psychosocial wellbeing. We observed the COVID‐19 pandemic affected social satisfaction of both intervention and control groups negatively for those with MCI but did not affect the individuals with normal cognition.ConclusionBoth intervention and control groups improved in a measure of social satisfaction. Once per week 10‐minutes phone check‐ins provided for the control group seemed to be sufficient for improving social wellbeing. Implementing weekly phone check‐ins in the community might help improve psychological wellbeing among socially isolated older adults.

Relationships between psychosocial stress, cerebrospinal fluid markers of Alzheimer’s disease, and cognitive function in middle‐aged and older adults

AbstractBackgroundExposure to psychosocial stress empirically associates with risk of cognitive impairment and dementia. Plausible mechanisms include (I) direct influence on AD pathology, and (II) indirect influence through cognitive reserve processes. Current evidence for modifiable determinants of amyloid and tau deposition is mixed, and stress has rarely been studied in this context. In richly characterized cognitive aging samples, we explored preliminary associations between (i) stress measures and amyloid (A), tau (T) and neurodegeneration (N) biomarkers in cerebrospinal fluid (CSF), and (ii) synergistic effects of stress and ATN in cognition.MethodParticipants were enrolled in the Wisconsin Registry for Alzheimer’s Prevention (WRAP) or Wisconsin Alzheimer’s Disease Research Center (ADRC), were cognitively intact, had stress and cognition data from at least one timepoint, and had available CSF data assayed using the NeuroToolKit panel of robust prototype assays (Roche Diagnostics International Ltd). Predictors included Perceived Stress T‐scores from the NIH Toolbox Emotion Battery, and self‐reported recent (past‐year) stressors. ATN outcomes included CSF measures of amyloid positivity, tau positivity, and neurofilament light protein (NfL). Cognitive outcomes included performance in domains of (a) processing speed and mental flexibility and (b) episodic memory. Multivariable regression models assessed cross‐sectional predictor‐outcome relationships.ResultCharacteristics of the predominantly white, middle‐aged and older samples are in Table 1. Stress scores associated with poorer performance on tests of speed and mental flexibility but not memory. There were no significant associations between measures of stress and any AD biomarker (Table 2). Estimate precision was limited by sample sizes, but there were observable interactions between stress measures and tau positivity and NfL, specifically in domains of speed and flexibility (Table 3; eg Figure 1); higher stress predicted poorer performance in the presence of accumulated pathology.ConclusionThere was no evidence for direct relationships between stress exposure and ATN pathology. However, the presence of elevated AD biomarkers exacerbated cognitive detriment associated with psychosocial stress, particularly in a key domain of executive function. Our findings must be replicated in a larger and more diverse sample. However, this study provides preliminary evidence suggesting high stress may act on dementia risk indirectly, through reduced resilience to pathological changes in the brain.

Unpacking the NIH Toolbox Emotion Battery in Persons With Parkinson's disease.

Examine the relationship between the National Institutes of Health Toolbox Emotion Battery (Emotion Toolbox) and traditional measures in Parkinson's disease (PD). Persons with PD (n = 30) and cognitively healthy older adults (OA; n = 40) completed the Emotion Toolbox consisting of Well-Being, Negative Affect, and Social Satisfaction scores along with traditional measures of depression (Beck Depression Inventory-II [BDI-II]), anxiety (State-Trait Anxiety Inventory [STAI]), and apathy (Apathy Scale [AS]); total raw scores). Separate bootstrapped analyses of covariance indicated that the PD group scored higher on BDI-II and STAI-State compared to OA (ps < .01); groups did not differ on Emotion Toolbox. In the PD group, bootstrapped partial correlations indicated that Negative Affect was positively related to BDI-II and STAI (ps ≤ .001). Social Satisfaction was negatively related to BDI-II and STAI-Trait (.05 < ps < .004). Psychological Well-Being was negatively related to BDI-II, AS, and STAI (p < .004). No relationships emerged in OA. In the PD group, separate binary logistic regressions showed that traditional measures (BDI-II, AS, and STAI-Trait) correctly classified 79.6% those with formal psychiatric diagnoses (presence vs. absence; p < .011), whereas Emotion Toolbox measures correctly classified 73.3% (p < .019). The Emotion Toolbox showed moderate-strong correlations with traditional measures in persons with PD. Even so, it did not capture the group differences between PD and OA and had a somewhat lower classification accuracy rate for persons with PD who had a formal psychiatric diagnosis than traditional measures. Together, findings question the utility of the Emotion Toolbox as a stand-alone emotion screener in PD.