Favorable Trajectories Research Articles

P61 Trajectories of foot pain severity over seven years and relationship to potential prognostic factors: the clinical assessment study of the foot

Abstract Background Foot pain is common and disabling in older adults however little is known about its course. The objective of this study was to identify foot pain trajectories over seven years and examine the associations between progressive symptom trajectories and potential prognostic factors. Methods All adults aged ≥50 years registered with four general practices in North Staffordshire, UK were mailed a health survey at baseline. Those reporting foot pain in the previous 12 months were invited to attend a research clinic that included a standardised interview, physical examination, and plain radiographs of the feet. Follow-up was by repeated postal surveys at 18 months, three years, 54 months, and seven years. Trajectories of repeated measures of foot pain severity in the previous month (10-point numerical rating scale) were identified using Latent Class Growth Analysis (LCGA). Logistic regression was undertaken to explore the relationship between these trajectories and both person-level and foot-level prognostic factors adjusted for covariates (age, gender, and body mass index). Results Of 560 adults with foot pain attending baseline research clinics, 425 (76%) provided data at baseline and ≥two follow-up time-points and were included in the analysis. The optimum LGCA model for foot pain severity was a 4-class model with the following trajectories: mild improving pain (n = 109, 26%); moderate improving pain (n = 179, 42%); moderate persistent pain (n = 122, 29%); severe persistent pain (n = 15, 4%). Compared with individuals with mild/moderate improving pain trajectories, those with moderate/severe persistent pain trajectories over 7 years did not differ significantly by age, sex, foot posture or radiographic foot OA phenotype at baseline, but were more likely to be overweight/obese. After adjustment for covariates, these less favourable long-term trajectories were associated with lower socioeconomic position, poorer physical and mental health, catastrophising, greater foot-specific functional limitation (Manchester Foot Pain and Disability Index), and self-reported hallux valgus at baseline (Table 1). Conclusion Over a 7-year period, one-third of individuals had persistent moderate to severe pain. Targeting interventions to modifiable prognostic factors such as obesity and hallux valgus may have the potential to improve long-term outcomes in people with foot pain. Disclosures M. Marshall None. M. Blagojevic-Bucknall None. T. Rathod-Mistry None. M.J. Thomas None. J.J. Edwards Other; JJE is part of The Keele Academic General Practice which has received funding from Bristol-Myers Squibb to develop and evaluate a quality improvement tool in anticoagulation. G. Peat None. H.B. Menz None. E. Roddy None.

Gastrointestinal symptoms are predictive of trajectories of cognitive functioning in de novo Parkinson's disease

IntroductionNon-motor symptoms such as cognitive and gastrointestinal (GI) symptoms are common in Parkinson's disease (PD). In PD, GI-symptoms often present prior to motor symptoms. It is hypothesized that GI-symptoms reflect disruptions of the microbiome-gut-brain axis, which leads to altered immune functioning, chronic neuroinflammation, and subsequent neurodegeneration. Initial evidence links gut-dysbiosis to PD pathology and motor symptom severity. The present study examines the longitudinal relationship between severity of GI-symptoms and cognitive impairment in newly diagnosed PD patients. MethodsA secondary data analysis of the Parkinson's Progression Markers Initiative (PPMI) included 423 newly diagnosed PD patients who were followed for up to 5 years. Participants underwent neuropsychological tests of processing speed, attention, visuospatial functioning, verbal learning and verbal delayed recall. Participant were classified as cognitive intact, mild cognitive impairment or Parkinson's disease dementia. Frequency of GI-symptoms were assessed with the Scales for Outcomes in Parkinson's Disease Autonomic (SCOPA-AUT). Multi-level models (MLM) examined the longitudinal relationship between GI symptoms and cognitive impairment. ResultsAll cognitive outcomes were predicted by the main effect of GI symptoms, or the GI-symptom X Occasion interaction term. Specifically, more severe GI-symptoms were predictive of a less favorable trajectory of performance on tests of letter fluency, visuospatial, learning and memory. Cognitive performance was uniquely associated with GI-symptoms and unrelated to non-GI autonomic symptoms. ConclusionsThe presence of GI symptoms may serve as an early marker of cognitive impairment in PD. Future studies should examine specific mechanisms underlying the relationship between gut-dysbiosis and cognitive impairment.

Plantation development and colonization of woody species in response to post-mining spoil preparation methods

Rising mineral and fossil fuel demand have accelerated the global prevalence of surface mining, resulting in adverse impacts to many forest ecosystems. Post-mining reclamation techniques, specifically spoil preparation methods, can influence reforestation success and the trajectory of future stand dynamics. Compaction is a common post-mining spoil stabilization technique but consequently creates high-density rooting media unconducive to forest succession. In the eastern USA, mine operators have traditionally attempted mine reforestation in compacted soils, achieving little success. In 1996–1997, a series of reforestation plots were created on a reclaimed surface mine in eastern Kentucky, USA, to evaluate the impacts of post-mining spoil preparation on plantation development of six native tree species. We conducted follow-up inventories 19 years after planting to elucidate the effect of three spoil preparation methods on tree growth, stand structure, and natural regeneration during the initial period of the stem exclusion stage of stand development. Low compaction reclamation techniques prior to tree planting generally resulted in higher survival and larger trees of all species nearly two decades after establishment when compared with compacted spoil. Natural recruitment and relative percentage of native colonizing species were also inversely correlated with level of grading treatment. Height and biomass growth of plantations in low-compaction treatments approximated those of naturally regenerating stands in unmined forests during similar periods. Study findings indicate that choice of spoil preparation technique during initial stages of reclamation guides forest dynamics up to two decades after planting and that loose-dump and strike-off treatments each promote favorable long-term growth trajectories.

Conservative vs. preservative management of chronic kidney disease

Dialysis has been the prevailing treatment paradigm in advanced chronic kidney disease (CKD) for patients ineligible for or unlikely to receive kidney transplantation. As dialysis may neither offer survival benefit nor improved quality of life in certain groups, there has been increasing interest in conservative management as an alternative approach. Experts and workgroups suggest the main goals of conservative management are to optimize quality of life, treat symptoms of end-stage renal disease without dialysis or transplant, and improve survival and cardiovascular health. Given the implications of preserved kidney function on clinical outcomes, preservative management has been proposed as an integral component of conservative management. Growing evidence suggests the survival benefit of dialysis vs. conservative management without dialysis is marginal or even reversed in certain subpopulations (elderly, multimorbid, cardiovascular disease). Limited data suggest that conservative and preservative management is associated with equivalent to more favorable trajectories of health-related quality of life and symptom burden over time as opposed to dialysis. Whereas existing data suggest conservative management is a viable patient-centered treatment strategy, further research is needed to determine the comparative effectiveness of preservative kidney management vs. dialysis or palliative management, as well as which patient subgroups will most benefit from these treatment strategies.

Interpersonal Psychotherapy for Gender Dysphoria in a Transgender Woman.

We present a case of a 32-year-old natal male seeking medical follow-up care, due to gender dysphoria (GD) along with other complaints (depressive symptoms, anxiety, and suicidal ideation). The attending team chose interpersonal psychotherapy (IPT), with a focus on role transition in order to help her. The patient presented a favorable trajectory throughout treatment and demonstrated personal growth one year after treatment. To our knowledge, little was found in the literature on the use of IPT in the treatment of those with GD; we also did not find any other publication or case report using IPT exclusively to treat the problems accompanying role transition. Psychotherapy was not intended to change the gender identity of this individual. However, further studies will be required to explore possible benefits of IPT for GD treatment.

Trajectories of effort-reward imbalance in Swedish workers: Differences in demographic and work-related factors and associations with health

ABSTRACT The aim of the study was to identify trajectories of effort-reward imbalance (ERI), to examine these with respect to demographic (age, gender, socio-economic position) and work-related (employment contract, work hours, shift work, sector) factors, and to investigate associations with different health indicators (self-rated health, depressive symptoms, migraine, sickness absence). The study used four waves of data (N = 6702), collected biennially within the Swedish Longitudinal Occupational Survey of Health (SLOSH). Using latent class growth modelling, we identified four trajectories: a stable low imbalance trajectory, which comprised 90% of all participants, and three change trajectories including a decreasing trajectory (4% of the participants), an inverted U-shaped trajectory and an increasing imbalance trajectory, both in 3% of the participants. Results indicate that a sizeable proportion of Swedish employees’ experience imbalance between efforts and rewards at work. The most favourable trajectory comprised relatively more men and was characterised by better work-related characteristics than the less favourable ERI trajectories. All change trajectories were dominated by women and employees in the public sector. Health developments followed ERI trajectories, such that less favourable trajectories associated with impaired health and more favourable trajectories associated with better health. Sickness absence increased among all ERI trajectories, most so for the decreasing and increasing ERI trajectory.

How Conscientiousness and Neuroticism Affect Academic Procrastination

Abstract. We examined students’ procrastinatory behavior in a specific higher-education learning situation in relation to conscientiousness and neuroticism as well as motivational regulation. We hypothesized that conscientiousness would be associated with low levels and favorable trajectories of academic procrastinatory behavior, and neuroticism would be associated with high levels and unfavorable trajectories of procrastinatory behavior. Furthermore, we examined whether motivational regulation mediates these effects. To answer our research questions, we used data from a diary study that spanned a period of 28 days with a total of 3,121 single measurements of 128 university students (mean age = 21.7 years; SD = 2.2; 53 % female). The results of conditional growth curve models indicated that levels of procrastinatory behavior were negatively linked to conscientiousness and positively linked to neuroticism. Motivational regulation mediated the relation between conscientiousness and procrastinatory behavior. No effects on the trajectories of procrastinatory behavior were found. Our findings provide insights into procrastinatory behavior in a specific learning situation and emphasize the functional effects of motivational regulation on academic procrastination.

Prospective Cohort Study of Haptic Virtual Reality Laparoscopic Appendicectomy Learning Curve Trajectory.

Background: Simulation training is strongly advocated by 24/7 risk-rich professions because swift learning curve inflection point attainment delivers earlier competence; the left-shift effect. The aim of this study was to determine the value of haptic laparoscopic virtual reality simulation, by iterative benchmark exercise (n = 8), before simulated laparoscopic appendicectomy (SLA); the hypothesis was that favorable benchmark learning curve trajectories would be associated with improved SLA competence when compared with consultant expert performance. Methods: A 28-trainee cohort completed 1349 Laparoscopic Haptic Virtual Reality Skills (LHVRS) tasks, during which 19 ergonomic variables were assessed by virtual interface, including force feedback (Surgicalscience.com), before 153 SLAs. Primary outcome measure was SLA composite competence score related to six consultant trainer experts. Results: Of the eight LHVRS tasks, the three with the steepest learning curve trajectories correlated with better median overall SLA competence scores, namely tissue grasping/lifting (rho = 0.362, P = .049), fine dissection (rho = 0.388, P = .028), and camera navigation (rho = 0.518, P = .007); fine dissection was the only haptic laparoscopic virtual reality simulation task that predicted a SLA score within a Youden index defined, 70% of the consultant expert level (area under curve [AUC] = 0.803, P = .028). A significant SLA learning curve emerged, with a learning curve trajectory inflection point at the fourth SLA attempt (first SLA 30.5% versus fourth SLA score 76.0%, gradient 76°, P = .010). Conclusion: Learning curve trajectory can be measured, influenced, and accelerated significantly; a pronounced left-shift effect, with translational potential for enhanced shorter training time and improved patient safety.

Impact of kidney transplantation on aortic stiffness and aortic stiffness index β0

In chronic kidney disease, the enhanced aortic stiffness increases risk of cardiovascular events. Kidney transplantation (KTx) may improve aortic stiffness; however, it is unclear whether the improvement of aortic stiffness is merely the outcome of the reduction of blood pressure (BP) post-KTx. Furthermore, the long-term trajectory of aortic stiffness remains uncertain, as activation of the immune system may have a negative long-term impact on arterial wall property. Using aortic stiffness β0 as a BP-independent stiffness parameter, and a statistical adjustment for BP, we aimed to examine the early vs. late changes in aortic stiffness, and to define the characteristics of patients with favourable and unfavourable long-term trajectories of aortic stiffness. In this longitudinal study, aortic stiffness was assessed before, 3, 6 and 24 months after KTx in 79 individuals. Aortic stiffness was determined by carotid-femoral pulse wave velocity (cf-PWV), and aortic stiffness index β0 was obtained by applying the stiffness parameter β0 theory to cf-PWV based on Bramwell-Hill's equation using a reference pressure. There was an early reduction of β0 3 months after KTx (29.0 ± 2.0 to 25.8 ± 1.2, P = 0.033) followed by a gradual increase at 6 (28.0 ± 1.4, P = 0.005 vs. 3 months) and 24 months (28.3 ± 1.3, P = 0.003 vs. 3 months). A late increase in β0 was associated with higher levels of the interleukin-6 (P = 0.029) even after adjustment for potential cofounders. Using statistical adjustments for BP showed similar results. Reduction of aortic stiffness index β0 3 months after KTx suggests that KTx leads to an early de-stiffening of the intrinsic mechanical properties of aorta. However, this improvement is followed by a later stiffening, which is associated with increased interleukin-6, suggesting that activation of the immune system may be involved in arterial wall remodelling in kidney recipients.

Genetic and Environmental Risk Factors Associated With Trajectories of Depression Symptoms From Adolescence to Young Adulthood

Less favorable trajectories of depressive mood from adolescence to early adulthood are associated with current and later psychopathology, impaired educational attainment, and social dysfunction, yet the genetic and environmental risk factors associated with these trajectories are not fully established. Examining what risk factors are associated with different trajectories of depressive mood could help identify the nature of depression symptoms and improve preventive interventions for those at most risk. To examine the differential associations of genetic and environmental risk factors with trajectories of depression symptoms among individuals observed from ages 10 to 24 years. In a longitudinal cohort study established in 1990 and currently ongoing (the Avon Longitudinal Study of Parents and Children [ALSPAC]), growth mixture modeling was used to identify trajectories of depression symptoms in 9394 individuals in the United Kingdom. Associations of different risk factors with these trajectories were then examined. Analysis was conducted between August 2018 and January 2019. Trajectories were composed from depression symptoms measured using the Short Mood and Feelings Questionnaire at 9 occasions from ages 10 to 24 years. Risk factors included sex, a polygenic risk score taken from a recent genome-wide association study of depression symptoms, maternal postnatal depression, partner cruelty to the offspring's mother when the child was aged 2 to 4 years, childhood anxiety at age 8 years, and being bullied at age 10 years. Data on all risk factors, confounders, and the outcome were available for 3525 individuals, including 1771 (50.2%) who were female. Trajectories were assessed between the mean (SD) age of 10.7 (0.3) years and mean (SD) age of 23.8 (0.5) years. Overall, 5 distinct trajectories of depression symptoms were identified: (1) stable low (2506 individuals [71.1%]), (2) adolescent limited (325 individuals [9.2%]), (3) childhood limited (203 individuals [5.8%]), (4) early-adult onset (393 individuals [11.1%]), and (5) childhood persistent (98 individuals [2.8%]). Of all the associations of risk factors with trajectories, sex (odds ratio [OR], 6.45; 95% CI, 2.89-14.38), the polygenic risk score for depression symptoms (OR, 1.47; 95% CI, 1.10-1.96), and childhood anxiety (OR, 1.30; 95% CI, 1.16-1.45) showed the strongest association with the childhood-persistent trajectory of depression symptoms compared with the stable-low trajectory. Maternal postnatal depression (OR, 2.39; 95% CI, 1.41-4.07) had the strongest association with the early-adult-onset trajectory, while partner cruelty to mother (OR, 2.30; 95% CI, 1.36-3.90) had the strongest association with the adolescent-limited trajectory. Bullying (OR, 8.08; 95% CI, 4.92-13.26) showed the strongest association with the childhood-limited trajectory. The least favorable trajectories of depression symptoms (childhood persistent and early-adult onset) were associated with both genetic and environmental risk factors, but the 2 trajectories of limited duration that had resolved by early adulthood (childhood limited and adolescent limited) were not associated with the polygenic risk score or maternal postnatal depression. Bullying was strongly associated with both the childhood-persistent and childhood-limited trajectories, suggesting that this risk factor may have a time-specific effect. These findings suggest that examining genetic and multiple time-specific environmental antecedents could help identify trajectories of varying onset and chronicity.

Trajectories of hemoglobin A1c and body mass index z-score over four decades among 2 to 18 year olds with type 1 diabetes.

To determine trajectories of glycemic control and body mass index (BMI) z-score in a large pediatric sample with type 1 diabetes (T1D) over a 38-year period, and to evaluate sex differences and temporal changes in the prevalence of these trajectories. We conducted a longitudinal, retrospective study of 7002 2 to 18 year olds with T1D followed between 1978 and 2016 at a single center. Group-based modeling was used to identify trajectories for hemoglobin A1c (HbA1c) and BMI z-score. Multinomial logistic regression identified predictors of membership to less favorable glycemic trajectories. Group-based modeling yielded 5 HbA1c trajectories. A total of 86% of the sample fell within 3 trajectories that were largely stable across childhood and adolescence, and 14% fell within 2 trajectories characterized by marked deterioration beginning in pre-adolescence. Girls were more likely to be in the HbA1c trajectory with the highest starting HbA1c and significant deterioration during adolescence, and in the highest two BMI z-score trajectories. Patients with non-white race had the highest odds of belonging to a less favorable HbA1c trajectory. Prevalence of the high stable HbA1c trajectory decreased and prevalence of the low stable HbA1c trajectory increased over the study period. A minority of youth with T1D experienced deterioration of glycemic control during adolescence. Girls were more likely to belong to the worst HbA1c trajectory and to BMI z-score trajectories in the overweight/obese range, which may increase cardiometabolic risk. Addressing racial/ethnic disparities in glycemic control should remain a priority. Advances in T1D management correlated with favorable shifts in HbA1c trajectory prevalence.

Twenty-Year Trajectories of Physical Activity Types from Midlife to Old Age.

Correlates of physical activity (PA) vary according to type. However, predictors of long-term patterns of PA types into old age are unknown. This study aimed to identify 20-yr trajectories of PA types into old age and their predictors. Seven thousand seven hundred thirty-five men (age, 40-59 yr) recruited from UK towns in 1978 to 1980 were followed up after 12, 16, and 20 yr. Men reported participation in sport/exercise, recreational activity and walking, health status, lifestyle behaviors and socio-demographic characteristics. Group-based trajectory modeling identified the trajectories of PA types and associations with time-stable and time-varying covariates. Men with ≥3 measures of sport/exercise (n = 5116), recreational activity (n = 5085) and walking (n = 5106) respectively were included in analyses. Three trajectory groups were identified for sport/exercise, four for recreational activity and three for walking. Poor health, obesity and smoking were associated with reduced odds of following a more favorable trajectory for all PA types. A range of socioeconomic, regional and lifestyle factors were also associated with PA trajectories but the magnitude and direction were specific to PA type. For example, men with manual occupations were less likely to follow a favorable sport/exercise trajectory but more likely to follow an increasing walking trajectory compared to men with nonmanual occupations. Retirement was associated with increased PA but this was largely due to increased sport/exercise participation. Physical activity trajectories from middle to old age vary by activity type. The predictors of these trajectories and effects of major life events, such as retirement, are also specific to the type of PA.

Relative effects of postnatal rapid growth and maternal factors on early childhood growth trajectories.

A range of postnatal and maternal factors influences childhood obesity, but their relative importance remains unclear. This study aimed to assess the relative impact of postnatal rapid growth and maternal factors on early childhood growth trajectories. Secondary longitudinal analysis of pooled data from the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program and the InFANT Extend Program (n=977) was performed. Children's height and weight were collected at birth, 3, 9, 18, and 36/42months. Body mass index-for-age and height-for-age z-scores (BAZ, HAZ) were computed using WHO growth standards. Mixed-effect polynomial regression models were fitted to examine BAZ and HAZ trajectories and their determinants. Rapid growth from birth to 3months, maternal country of birth, and pre-pregnancy BMI were each independently associated with BAZ from 3 to 42months. Children with rapid growth, those whose mothers were Australian-born, and those whose mothers were overweight/obese pre-pregnancy had higher BAZ from 3 to 42months. Children with rapid growth had an increase in HAZ growth, but their average HAZ from 3 to 42months was smaller than children without rapid growth. Children of tall mothers (above average height) had higher HAZ than those of short mothers (below average height). Average HAZ from 3 to 42months did not differ by maternal country of birth. Children who experienced rapid growth from birth to 3months, whose mothers were Australian-born or whose mothers were overweight/obese pre-pregnancy demonstrated less favourable growth trajectories across early childhood, potentially predispose them for development of future obesity.

Cognitive ageing trajectories and mortality of Chinese oldest-old

ObjectiveThis study aims to identify distinctive cognitive trajectories jointly with mortality probabilities and to explore factors related to the particular trajectories of cognitive ageing in China. Method6842 individuals aged 80 years and above from 7 waves of the Chinese Longitudinal Healthy Longevity Survey were assessed with the Mini-Mental State Examination for up to 16 years. A group-based trajectory model was used to jointly estimate cognitive ageing and mortality trajectories; and to explore the factors related to membership of the trajectory groups. ResultsA four-group model best fit the data. For all groups, the cognitive function declined with age according to different rates. Group 4, 3, 2, and 1 showed slow (prevalence 52.8%), moderate (31.1%), progressive (12.6%) and rapid (3.5%) cognitive decline, respectively. Mortality probability trajectories followed a hierarchy in consistence with cognitive trajectories approximately. Females, illiteracy, and those born in rural areas were less likely to belong to the most favorable trajectory group. ConclusionsThe heterogeneity of cognitive ageing was identified among Chinese oldest-old. Childhood socioeconomic status, especially education, was associated with the rate of cognitive decline.

Discrete Trajectories of Resolving and Persistent Pain in People With Rheumatoid Arthritis Despite Undergoing Treatment for Inflammation: Results From Three UK Cohorts

Rheumatoid arthritis (RA) is an example of human chronic inflammatory pain. Modern treatments suppress inflammation, yet pain remains a major problem for many people with RA. We hypothesized that discrete RA subgroups might display favorable or unfavorable pain trajectories when receiving treatment, and that baseline characteristics will predict trajectory allocation. Growth mixture modelling was used to identify discrete trajectories of Short Form-36 bodily pain scores during 3 years in 3 RA cohorts (Early RA Network (n = 683), British Society for Rheumatology Biologics Register Biologics (n = 7,090) and nonbiologics (n = 1,720) cohorts. Logistic regression compared baseline predictor variables between trajectories. The role of inflammation was examined in a subgroup analysis of people with normal levels of inflammatory markers after 3 years. The mean Short Form-36 bodily pain scores in each cohort improved but remained throughout 3 years of follow-up of >1 standard deviation worse than the UK general population average. Discrete persistent pain (59–79% of cohort participants) and resolving pain (19–27%) trajectories were identified in each cohort. In Early RA Network, a third trajectory displaying persistently low pain (23%) was also identified. In people with normal levels of inflammatory markers after 3 years, 65% were found to follow a persistent pain trajectory. When trajectories were compared, greater disability (adjusted odds ratio = 2.3–2.5 per unit baseline Health Assessment Questionnaire score) and smoking history (adjusted odds ratio = 1.6–1.8) were risk factors for persistent pain trajectories in each cohort. In conclusion, distinct trajectories indicate patient subgroups with very different pain prognosis during treatment for RA. Inflammation does not fully explain the pain trajectories, and noninflammatory factors as well as acute phase response predict which trajectory an individual will follow. Targeted treatments additional to those which suppress inflammation might reduce the long-term burden of arthritis pain. PerspectiveImmunosuppression decreases inflammation in RA, but pain outcomes are less favorable. Discrete persistent and resolving pain trajectories were identified after treatment, both in early and established RA. Smoking and greater disability at baseline predicted persistent pain. Identifying patient subgroups with a poor pain prognosis could enable adjunctive treatment to improve outcomes.

Developmental Contributions of Schizophrenia Risk Alleles and Childhood Peer Victimization to Early-Onset Mental Health Trajectories.

Twin studies suggest that genetic factors contribute to continuity in mental health problems and that environmental factors are the major contributor to developmental change. The authors investigated the influence of psychiatric risk alleles on early-onset mental health trajectories and whether the trajectories were subsequently modified by exposure to childhood victimization. The sample was a prospective U.K. population-based cohort, the Avon Longitudinal Study of Parents and Children. The developmental trajectories of emotional problems were estimated in childhood (approximately ages 4-8 years) and adolescence (approximately ages 12-17 years). Psychiatric risk alleles were indexed by polygenic risk scores (PRS) for schizophrenia using genome-wide association study results from the Psychiatric Genomics Consortium. Chronic peer victimization in late childhood (ages 8.5 and 10.5 years) was assessed as an index of environmental exposure. Individuals with sufficient data on emotional problems, the PRS, and victimization were included in the main analyses (N=3,988). Higher schizophrenia PRSs were associated with a trajectory of early-onset increasing emotional problems (odds ratio=1.18, 95% CI=1.02-1.36) compared with a trajectory of low-stable emotional problems. Subsequent exposure to victimization increased the likelihood of transitioning from a trajectory of low-stable emotional problems during childhood (before exposure) to an increasing trajectory in adolescence (after exposure) (odds ratio=2.59, 95% CI=1.48-4.53). While the early development of emotional problems was associated with genetic risk (schizophrenia risk alleles), the subsequent course of emotional problems for those who might otherwise have remained on a more favorable trajectory was altered by exposure to peer victimization, which is a potentially modifiable environmental exposure.

Comorbid disorders as moderators of response to family interventions among adolescents with bipolar disorder.

While family interventions have shown efficacy in improving mood symptoms and family functioning in pediatric bipolar disorder, few studies have examined the effects of comorbid psychiatric conditions on patients' symptomatic or functional responses to treatment. 145 adolescents with bipolar I or II disorder were randomly assigned to family-focused therapy (FFT-A) or a brief psychoeducational therapy (enhanced care; EC) and followed over 2 years. Participants received pharmacotherapy for the study's duration. We examined whether comorbid anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBDs; i.e., oppositional defiant and conduct disorder) predicted the proportion of weeks that participants experienced mood symptoms during follow-up, and whether comorbid disorders moderated the effects of treatment assignment on mood symptoms and family conflict. Comorbid anxiety was associated with a greater proportion of weeks with depressive symptoms, more severe (hypo)manic symptoms during follow-up, and greater family conflict over the 2-year study. Comorbid ADHD was associated with a greater proportion of weeks with (hypo)manic symptoms, more severe (hypo)manic symptoms, and greater family conflict. Additionally, youth with comorbid ADHD who received FFT-A had more favorable trajectories of (hypo)manic symptoms and family functioning than youth with comorbid ADHD who received EC. Comorbid DBDs were consistently associated with more severe depressive symptoms and greater family conflict throughout the study. Randomization to treatments was not stratified on comorbid disorders. The longitudinal trajectories of anxiety, attentional, and disruptive behavior symptoms were not examined. The course of bipolar disorder in adolescents is strongly affected by comorbid disorders. Future research should examine whether adolescents with more complex presentations of bipolar disorder should be treated with different or more intensive psychosocial protocols than adolescents without these presentations.

TERMINAL CHANGE IN FACETS OF AFFECTIVE EXPERIENCE AND DOMAIN SATISFACTION: BITTERSWEET EMOTIONS AT THE END OF LIFE

AbstractGeneral well-being is known to deteriorate sharply at the end of life. However, it is an open question how terminal change differs across affective and evaluative well-being facets and if socio-demographic, physical health, and psychosocial correlates operate in facet-specific ways. To examine these questions, we applied growth models to 9-year annual longitudinal data of 864 participants (age M = 75 years, 41% women) from the national Socio-Economic Panel. Findings revealed that six of the seven well-being facets examined became increasingly fragile late in life, but at vastly different rates. Correlates like perceived control were generally associated with more favorable late-life trajectories, whereas other correlates operate in more facet-specific ways: Those living with a partner were happier, but also reported more worries and steeper increases in sadness, a picture of bittersweet emotions very late in life. We discuss implications of our findings for theories of emotion and self-regulation.

Sick of family responsibilities?

This study estimates the effect of parenthood on the within-couple gender gap in paid sick leave. We find that as a result of parenthood, mothers more than double their sick leave compared with fathers. However, there is no corresponding effect on health measured by hospital stays. We also find that mothers’ income trajectory is strongly related to the magnitude of the effect: A less favorable income trajectory is associated with a larger effect of parenthood on the sick leave gap. Since mothers’ labor supply is measured 1 year prior to sick leave, this result suggests that the lower labor supply induces an increase in sick leave rather than the other way round.

Gender matters: Productive social engagement and the subsequent cognitive changes among older adults

This study examines the relationships between productive social engagement and cognitive functioning trajectories of older adults in South Korea and how the nature of the relationships differs for men and women. We exploit data from a nationally representative longitudinal survey of South Korea from 2006 to 2014 and apply the Growth Mixture Modeling approach to disentangle health causation from health selection processes. We find that socially productive activities are associated with more favorable cognitive functioning trajectories, independent of an individual's baseline health and cognitive status. The odds of maintaining higher cognitive functioning are greater for men who had participated in socially productive activities on a monthly basis. Social engagement protects against rapid cognitive decline for women, particularly for those with lower education. Among men, social activities in friendship/alumni organizations are likely to help maintain good cognitive functioning in older age while for women with lower cognition, religious activities may protect against cognitive decline.