Group-based Trajectory Modeling Research Articles

Cigarette Smoking Trajectories of US Young Adults by Sex.

While cigarette smoking is the leading cause of preventable morbidity and mortality in the United States (US), nearly one-fifth of young adults continue to smoke cigarettes, however, the prevalence remains higher in males than females. The restricted panel data from the Monitoring the Future (MTF) study from 1976-2020 (n=24,293) was used. A group-based trajectory model (GBTM) was fit to the data for each sex (male/female), where groups were determined by cigarette smoking (yes/no) from the base year through the six biennial follow-up questionnaires. The analysis was then repeated overall and by decade. Four trajectory groups of cigarette smoking emerged for both sexes (male/female). Group 1 (60.8/62.0%) included participants with non-use of cigarettes. Group 2 (13.1/14.2%) captured individuals with moderate probability of use of cigarettes at baseline that decreased over time. Group 3 (7.1/5.5%) was the opposite of Group 2, where participants had low/moderate probability of cigarette smoking at baseline that increased over time. Group 4 (19.0/18.3%) captured individuals with high/moderate to high use of cigarettes throughout the study period. Overall and by decade analyses produced similar results. Almost one quarter of the sample had increasing or high cigarette smoking, which suggests prioritizing interventions on recent high school graduates, regardless of sex, who begin with low cigarette smoking and increase over time and those with consistently high cigarette smoking. Future research will examine how different cigarette smoking trajectories relate to substance use and mental health outcomes. This study provides a novel viewpoint on cigarette trajectory analysis among the adolescent and young adult population, stratified by sex. This stratification showed that regardless of sex, the same four distinct trajectory groups were present. This result was somewhat unanticipated as there are known discrepancies in both cigarette smoking initiation and cessation between the sexes.

Trajectories in waist circumference and waist-to-height ratio with left ventricular hypertrophy in childhood

Background and objectivePrevious studies have shown positive associations of waist circumference (WC) and waist-to-height ratio (WHtR) with left ventricular hypertrophy (LVH) among children and adolescents. However, most of these studies were cross-sectional or limited to only two time points. We aim to estimate the association of trajectories in WC and WHtR with LVH during childhood.MethodsData were from the prospective “Huantai Childhood Cardiovascular Health Cohort Study” conducted from 2017 to 2023 in Huantai County, Zibo City, Shandong Province. Group-based trajectory modeling was used to categorize WC into three groups: low-increasing, moderate-increasing, and high-increasing trajectories. Similarly, WHtR was categorized into three groups: stabilizing, decreasing, and increasing trajectories. Linear and log-binomial regression analyses were used to examine the associations of WC and WHtR trajectories with increased left ventricular mass index (LVMI) and LVH.ResultsA total of 946 children were included, with 51.9% being boys and an average age of 8 years at baseline. After adjustment for potential covariates, children in the high-increasing WC group and the increasing WHtR trajectory group had increased LVMI (β = 5.16 g/m2.7, 95% confidence interval (CI): 4.37, 5.95 and β = 4.91 g/m2.7, 95% CI: 4.15, 5.68) and a higher risk of LVH [risk ratio (RR) = 5.84, 95% CI: 3.39, 10.05 and RR = 7.38, 95% CI: 4.14, 13.14] compared to the low-increasing WC group and stabilizing WHtR group, respectively. Interestingly, the moderate-increasing WC and decreasing WHtR trajectory groups still have an increased LVMI (β = 2.83 g/m2.7, 95% CI: 2.05, 3.61 and β = 2.25 g/m2.7, 95% CI: 1.50, 3.01) and a higher risk of LVH (RR = 2.04, 95% CI: 1.00, 4.15 and RR = 2.23, 95% CI: 1.06, 4.71) compared to the low-increasing WC group and stabilizing WHtR group, respectively. Similar results were found when stratified by sex.ConclusionWe found the risk of LVH was not fully eliminated among children with a decreasing WHtR trajectory. These findings underscore the need for early prevention and continuous monitoring of WC and WHtR to help prevent future sub-clinical cardiovascular damage in childhood.

Prenatal Hemoglobin Concentration and Long-Term Child Neurocognitive Development.

Anemia in pregnancy, defined by a hemoglobin level (Hb) of less than 110 g/L, contributes to infant mortality and morbidity in sub-Saharan Africa. Maternal Hb changes physiologically and pathologically during pregnancy. However, the impact of these changes on long-term child neurocognitive function is unknown. This study therefore investigates the association between Hb at specific antenatal care visits and prenatal Hb trajectories during pregnancy and long-term child neurocognitive function. We analyzed data from a prospective cohort study that included 6-year-old singleton children born to women enrolled before 29 weeks of gestation into an antimalarial drug clinical trial. Hemoglobin level was analyzed from venous blood collected at least twice during pregnancy and at delivery. We used group-based trajectory modeling to identify distinct prenatal Hb trajectories. In total, 478 children (75.1% of eligible children) had assessment of cognitive and motor functions at 6 years of age. Three distinct Hb trajectories were identified: persistently anemic (Hb <110 g/L throughout the second and third trimesters), anemic to nonanemic (Hb <110 g/L at second trimester with increasing Hb toward the third trimester to Hb ≥110 g/L), and persistently nonanemic (Hb ≥110 g/L throughout the second and third trimesters). Children of women in the persistently anemic and anemic-to-nonanemic groups had significantly lower neurocognitive scores than children of women in the persistently nonanemic group (β = -6.8, 95% CI: -11.7 to -1.8; and β = -6.3, 95% CI: -10.4 to -2.2, respectively). The study shows that maintaining an elevation of Hb at or above 110 g/L from the second to third trimester of pregnancy may be associated with optimal long-term child neurocognitive function.

Trajectories of language development, cognitive flexibility and phoneme awareness knowledge in early childhood.

Early childhood is a critical period of language development. Yet less is known about how language growth relates to the development of phoneme awareness and cognitive flexibility during this period. To examine the longitudinal associations between growth in phonological awareness and cognitive flexibility from 4 to 5 years in relation to three patterns of child language development: early, intermediate and late. A sample of 439 four-year-old children were recruited and underwent repeated language, phonological awareness and cognitive flexibility testing to age 5. Children were classified into three language development groups based on their listening comprehension: early, intermediate and late. Group-based trajectory modelling was then used to examine the relations between cognitive flexibility and phonological awareness over time in relation to language outcome. Early language developers were characterized by higher levels and greater improvement in language and phonological awareness skills between 4 and 5 years. Late language developers exhibited slower growth in expressive language development (in addition to lower receptive language at age 4). Intermediate and late language developers showed steeper growth in cognitive flexibility over the study. Findings affirm the interconnected nature of phoneme awareness, cognitive and language skill development in early childhood. Results suggest the importance of targeting skills across literacy and executive functioning/regulatory domains for children with language difficulties. What is already known on the subject It is already known that language skills are related to self-regulation and phoneme awareness skills. However, it is also important to examine how different patterns of language growth are related to the timing and level of growth in self-regulation and phoneme awareness. Further, it is important to examine the relationship between language development and cognitive flexibility (one component of self-regulation) to understand this relationship more fully. What this paper adds to the existing knowledge This study is novel in its examination of the trajectory of language development and other key foundational literacy variables along with modelling the timing of development across the constructs included in the study. The findings have implications for optimizing the content and timing of approaches designed to enhance literacy development in children with language difficulties. What are the potential or actual clinical implications of this work? The findings suggest that interprofessional approaches across speech-language therapy, education and psychology are important for enhancing literacy outcomes of children with language difficulties. Results also provide support for language intervention approaches to be developed and trialled that target language, cognitive flexibility and phonological awareness in an integrated manner.

Adverse childhood experiences and 10-year depressive-symptoms trajectories among middle-aged and older adults in China: a population-based cohort study

BackgroundAdverse childhood experiences (ACEs) influence depressive symptoms. Depressive symptoms were heterogeneous from the perspective of life course.ObjectiveTo explore the effects of ACEs on the trajectory of depressive symptoms in China.ParticipantsThe data is from the 5 waves of the China Health and Retirement Longitudinal Study (CHARLS) and the 2014 Life Course Survey of it. A total of 17,106 individuals were included, without the people younger than 45 years.MethodsWe dealt with the missing values using multiple interpolation. The CESD-10 and a 12-item questionnaire was used to assess the depressive symptom and ACEs, respectively. We used group-based trajectory modelling (GBTM) to identify the 10-year depressive-symptoms. Logistic regression models were used to explore associations between the trajectory and the ACEs.ResultsFive depressive-symptom trajectories were identified based on the GBTM analysis (BIC = 540533.61; AIC = 540347.68; n = 17,106). Compared to the participants without depressive symptoms, the older adults who have more adverse childhood experiences have more odds of being in the other four groups, and the more ACEs the older adults experienced, the more likely it is.ConclusionThe 10-year depressive-symptoms trajectories among middle-aged and older adults in China were different from previous features. The significance of a life-course intervention plan to prevent childhood adversity and the related mental health damage in later life is demonstrated by the long-term influence of ACEs on depressive symptoms.

The Impact of Prior Incarceration on Cognitive Trajectories Among Older Adults: Evidence from the Health and Retirement Study.

This study examines the association between prior incarceration and cognition trajectories among older adults in the United States. Data are from Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States. The analysis included respondents aged 55 and older who participated in the 2012-2020 HRS surveys and had valid responses on Langa-Weir cognition scores, incarceration history, and covariates (n = 5,663). Cognition trajectories were estimated using group-based trajectory modeling (GBTM), and multinomial logistic regression was used to assess the relationship between prior incarceration and cognition trajectory group membership. The study identified four distinct cognition trajectories. Formerly incarcerated individuals were significantly more likely to be in cognition trajectory groups defined by lower cognition scores and steeper declines in cognitive functioning over time. However, these associations were attenuated after accounting for sociodemographic and health-related characteristics, and all associations were rendered statistically non-significant after accounting for educational attainment. These findings highlight poorer cognition among older formerly incarcerated individuals compared to their never incarcerated counterparts, as well as underscore the role of educational attainment in this relationship. Future research and data collection efforts are needed to understand further the nexus between incarceration and cognitive functioning and the mechanisms underpinning this association.

Sickness absence trajectories among young and early midlife employees with psychological distress: the contributions of social and health-related factors in a longitudinal register linkage study.

Psychological distress has been associated with sickness absence (SA), but less is known about whether there are distinct patterns in the development of SA among people with psychological distress. We examined trajectories of short- and long-term SA among employees with psychological distress and how social and health-related factors are associated with them. We used the employer's register data on all-cause short- (≤ 10 working days) and long-term (> 10 working days) SA with a two-year follow-up. We prospectively linked the Helsinki Health Study survey data on 19-39-year-old employees of the City of Helsinki, Finland, in 2017, to the SA data. We included 1060 participants (81% women) who reported experiencing psychological distress, measured by the emotional wellbeing scale of RAND-36. Survey responses of age; gender; education; marital status; social support, procedural and interactional organisational justice, and bullying at work; physical activity; diet; tobacco and alcohol use; prior SA; and the level of psychological distress were included as exposures. Group-based trajectory modelling and multinomial logistic regression were used for the analyses. We identified four short-term SA trajectories: 'low' (n = 379, 36% of participants), 'descending' (n = 212, 20%), 'intermediate' (n = 312, 29%), and 'high' (n = 157, 15%); and two long-term SA trajectories: 'low' (n = 973, 92%) and 'high' (n = 87, 8%). A higher education, fewer prior SA, and lower levels of psychological distress were associated with the 'low' short- and long-term SA trajectories. SA trajectories differ among employees with psychological distress. Early intervention and support are needed among employees with mental health symptoms to prevent future SA.

Complex Multimorbidity and Trajectories of Functional Disabilities in the Last Three Years of Life: A Prospective Cohort Study of Older Adults in Japan.

We sought to understand the impact of multimorbidity (MM) on the trajectories of functional decline in the last three years of life among older people in Japan. We used nationwide longitudinal cohort data with 6-year follow-up and analyzed 3731 functionally independent residents aged 65years and older. The primary outcome was the five trajectory groups of functional disability in the last three years of life, defined by group-based trajectory modeling (GBTM). The explanatory variable was two alternative definitions of MM: basic MM (BMM; two or more comorbid diseases) versus complex MM (CMM; three or more body system disorders due to disease). A multinomial logistic regression analysis showed both MMs were associated with earlier trajectories of functional decline (maximum odds ratio: BMM 1.12 [0.99-1.27]; CMM 1.29 [1.16-1.44]). Preventing MMs, especially CMM, by providing appropriate care and support could contribute to healthy longevity by delaying the onset of functional disability.

Trajectory, interactions, and predictors of higher symptom burden during induction therapy for multiple myeloma

BackgroundPatients with multiple myeloma (MM) experience disabling symptoms that are difficult to manage and may persist after induction therapy. Monitoring disease-related and induction therapy–induced symptoms and identifying patients at greater risk for high symptom burden are unmet clinical needs. The objective of this study was to examine the trajectories of symptom severity over time and identify predictors of high symptom burden during MM induction therapy.MethodologyEligible patients with MM rated their symptoms by completing the MD Anderson Symptom Inventory MM module repeatedly during 16 weeks of induction therapy. Group-based trajectory modeling identified patient groups with persistently high-severity (versus low-severity) symptom trajectories over time. Quality of life (QOL) and affective and physical functioning status were assessed. Predictors of high symptom burden were examined by regression analysis.ResultsSixty-four MM patients participated. Most patients (89%) received bortezomib-based therapy. The five most-severe symptom trajectory groups were pain (59%), muscle weakness (46%), numbness (42%), disturbed sleep (41%), and fatigue (31%). Patients in the high-severity trajectory group for the five most-severe symptoms (31% of the sample) were more likely to have high-severity cognitive and affective symptoms. Patients in the high-severity trajectory groups for fatigue, muscle weakness, disturbed sleep, and bone aches were more likely to have high pain scores (all p < 0.05). Significant increases over time were observed in scores for pain (estimate: 0.026), numbness (0.051), muscle weakness (0.020), physical items (0.028), and affective items (0.014) (all p < 0.05). A higher baseline composite score of the five most-severe symptoms predicted worse QOL (− 6.24), and poor affective (0.80) and physical (1.10) statuses (all p < 0.01). Female sex predicted higher risk for being in the high-severity trajectory group for muscle weakness.ConclusionAlmost one-third of MM patients suffer from up to 5 moderate to severe symptoms persistently, including pain, muscle weakness, numbness, disturbed sleep, and fatigue. Importantly, these results identify a group of symptoms that should be monitored and managed as part of routine patient care during MM induction therapy and suggest that pre-therapy pain management is necessary for better symptom control.

Trajectories of plant-based diet indices and the associated risk of hypertension among Chinese adults: a cohort study based on the China Health and Nutrition Survey 2004–2015

BackgroundPlant-based diets have been found to be associated with hypertension. Dietary intake is a dynamic and changing process that can be better characterized by trajectories of dietary indices. However, the associations between plant-based diet trajectories and hypertension over time remained unknown.MethodsWe used data from the China Health and Nutrition Survey 2004–2015 to analyze a cohort of Chinese adults ≥ 18 years of age who had no hypertension at baseline. Plant-based diets were measured by an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) based on three 24-hour recalls. Trajectories of PDI, hPDI, and uPDI (2004 to 2011) were identified using group-based trajectory modeling. The associations between trajectories of PDIs and the risk of new-onset hypertension were estimated using Cox proportional hazard models.ResultsWe identified three trajectories for PDI, two for hPDI, and four for uPDI among the 2853 participants with a mean follow-up of 9.6 years. Compared with the PDI “low and stable” class, the PDI “high and decreasing” class had a 23% decreased risk (HR: 0.77; 95% CI: 0.62–0.95) of hypertension. There was no significant association with PDI “low and increasing” class. Compared with the hPDI “low and stable” class, the hPDI “high and stable” class had a 24% decreased risk (HR: 0.76; 95%CI: 0.64–0.91). For uPDI trajectories, compared with the “low and decreasing” class, the “high and increasing,” “high and stable,” and “low and increasing” classes had increased risks of 43% (HR: 1.43; 95% CI: 1.06–1.94), 77% (HR: 1.77; 95% CI: 1.26–2.49), and 72% (HR: 1.72; 95% CI: 1.26–2.33), respectively.ConclusionsThis study underscores the importance of maintaining high intakes of healthful plant-based diets and low intakes of unhealthful plant-based diets overtime for hypertension prevention.

Relation Between Serum Sodium Trajectory and Survival in Septic Patients with Cardiopulmonary Bypass Surgery: Based on Medical Information Mart for Intensive Care-IV Database

Objective The influence of serum sodium level changes on septic patient survival after cardiopulmonary bypass surgery is not clear. We attempted to figure out the impact of serum sodium trajectory changes on the 30-day mortality rate of such patients. Methods The Medical Information Mart for Intensive Care (MIMIC)-IV database was searched to gather patients who developed sepsis after cardiopulmonary bypass surgery. A group-based trajectory model (GBTM) was employed to determine the serum sodium trajectory within 72 h of ICU admission. Patients’ survival differences between different trajectory groups were compared using Kaplan–Meier (K–M) survival curves. Cox regression models were further employed to explore the correlation between survival status and serum sodium trajectory. Results 1,038 eligible patients were involved in this project. GBTM identified 3 serum sodium trajectories, all showing a trend of initial decrease followed by an increase. K–M curve analysis uncovered a notable difference in 30-day survival status between Class 1 and Class 2 (Log-rank p = 0.039), while no obvious differences were observed between other groups. Cox hazard analysis revealed that in the three models adjusting for different covariates, Class 2 was connected with the increased risk of survival (OR > 1, p < 0.05). Conclusion Higher serum sodium trajectory is linked with elevated 30-day death risk in septic patients following cardiopulmonary bypass surgery. Repressing high levels of serum sodium may be beneficial for patient survival.

Association between buprenorphine dose and outcomes among pregnant persons with opioid use disorder.

To determine the associations between trajectories of buprenorphine utilization and dose during pregnancy on maternal and neonatal health outcomes. Retrospective cohort study among 2,925 pregnant persons with opioid use disorder, followed from the estimated start date of pregnancy through 90 days after delivery. We used administrative healthcare data from Medicaid-enrolled individuals to assess buprenorphine dose and use and maternal (postpartum buprenorphine continuation and overdose) and neonatal (low birthweight, neonatal abstinence syndrome (NAS)) outcomes. Group-based trajectory modelling was used to identify trajectories of buprenorphine dose and use during pregnancy. Weighted multivariable logistic regression assessed the association between buprenorphine trajectories and outcomes. We identified 8 trajectories of buprenorphine utilization and dose during pregnancy. Regression analyses found that high doses of buprenorphine and a longer duration of buprenorphine use during pregnancy was associated with higher odds of postpartum buprenorphine continuation and reduced rates of overdose. Higher doses and longer duration of buprenorphine treatment were not associated with an increase in NAS or term low birth weight, relative to moderate or low doses or shorter treatment duration. A longer duration and higher dose of buprenorphine treatment during pregnancy were associated with improved odds of postpartum buprenorphine continuation and were not associated with adverse neonatal outcomes.

Caries trajectories from childhood to adolescence: Analysis of data from a nationwide school dental service.

The aim of the study was to assess patterns of longitudinal changes in caries status among school-going children in Singapore. Dental records for a single cohort of students who received dental examinations in six standard examination years between 2009 and 2017 were analysed (n = 24 699). Group-based trajectory modelling with a zero-inflated Poisson distribution was carried out to determine dental caries trajectories in the permanent dentition. Associations between sociodemographic factors and trajectory group membership were assessed using multinomial logistic regression. The predicted population distribution across the four caries trajectory groups identified was 65.0% ('none'), 16.8% ('low'), 14.8% ('medium') and 3.4% ('high'). The 'none' trajectory group had a decayed, missing and filled teeth (DMFT) score of 0 throughout the 8 years. Higher baseline DMFT counts and nonlinear increases in DMFT scores were noted for the 'low', 'medium' and 'high' trajectory groups. The correlation coefficient between DMFT counts in years 6 and 8 was 0.91, as compared to 0.77 between baseline and year 1. Factors associated with the 'high' caries trajectory include lower socio-economic status, female gender, Chinese race (compared to the Indian race), enrolment in primary schools in the Eastern and Western regions of Singapore, and enrolment in public secondary schools. Under a nationwide school dental service, four trajectory patterns of caries counts in the permanent dentition were identified over 8 years. Among students in the 'low', 'medium' and 'high' trajectory groups, greater caries increment was noted during the transition from primary to secondary school. The correlation between DMFT counts in successive examinations was stronger in older than younger ages.

A Dual Group-Based 11-Year Trajectory Analysis of Cognitive Impairment and Transport Restriction for Community-Dwelling Older Adults.

To examine the trajectories of cognitive impairment and transport restriction over time and the interrelation between these trajectories among older adults. Group-based trajectory modeling was used on the longitudinal National Health and Aging Trends Study (NHATS) over 11years from 2011 to 2021, among 5753 participants, stratified by age in 2011 to three groups of 65-74years, 75-84years, and 85years and above. For transport restrictions, these trajectory groups were: (1) a majority with no restrictions, (2) low and increasing or stable, and (3) moderate or high and decreasing. The overall pattern was largely consistent across the three age groups, with the older group showing a higher predicted likelihood of transport restrictions compared to the younger group. For each of the three age groups, there were two cognitive impairment trajectories including (1) low and (2) increasing cognitive impairment. The proportions of increasing cognitive impairment were 12.3% among the 65-74years old, 27.3% among the 75-84years old, and 40.4% among the 85years and above old. Compared with those with no transport restriction, the other two trajectories with either low or moderate transport restrictions were more likely to belong to increasing cognitive impairment. The odds ratio was 3.06 (95% CI 2.0-4.68) for low & increasing transport restrictions versus 1.57 (95% CI 0.96-2.56) for moderate & decreasing transport restrictions among 65-74years old. The odds ratio was 2.38 (95% CI 1.68-3.38) for low & increasing transport restrictions versus 1.88 (95% CI 1.39-2.55) for moderate & decreasing transport restrictions among 75-84years old. Cognitive impairment was more likely to co-occur with those with low and increasing transport restrictions than with those with moderate and decreasing transport restrictions. Addressing transport restriction among older adults holds the potential to ameliorate cognitive outcomes.

Longitudinal multi-trajectory phenotypes of severe eosinophilic asthma on type 2 biologics treatment

BackgroundLimited understanding exists regarding the progression trajectory of severe eosinophilic asthma (SEA) patients on type 2 biologics therapies. ObjectiveWe aim to explore distinct longitudinal phenotypes of these patients based on crucial asthma biomarkers. MethodsWe enrolled 101 adult patients with SEA. Of these, 51 were treated with anti-IL5/IL5Rα or anti-IL5/IL5RαR antibody, and 50 with anti-IL-4Rα antibody. Multi-trajectory analysis, an extension of univariate group-based trajectory modeling, was used to categorize patients based on their trajectories of forced expiratory volume in 1 s (FEV1), blood eosinophil counts (BEC), and fractional exhaled nitric oxide (FeNO) levels at baseline, and after 1, 6, and 12 months of treatment. Associations between trajectory-based clusters and clinical parameters were examined. ResultsAmong anti-IL5/IL5Rα antibody-treated patients, 2 clusters were identified. The cluster characterized by higher baseline BEC and lower FEV1 showed a better response, with improvements in FEV1 and reductions in BEC over time. Among anti-IL-4Rα antibody-treated, 3 clusters were identified. Clusters with moderate BEC and FeNO at baseline demonstrated better improvements in FEV1 and reductions in FeNO, despite increased BEC during follow-up. Conversely, individuals with extremely low FeNO and high BEC at baseline were more likely to experience poorer progression, demonstrating an increase in FeNO and a reduction in FEV1. ConclusionTo optimally monitor treatment response in SEA patients on type 2 biologics, integrating longitudinal biomarker features is essential.

Screen time trajectories and psychosocial well-being among Chinese adolescents: a longitudinal study

BackgroundWhile the association between screen time (ST) and psychosocial well-being has been extensively examined, limited studies have investigated the dynamic patterns of ST, and their impact on subsequent psychosocial well-being among adolescents. Therefore, this longitudinal study aimed to examine the association between ST trajectories and the subsequent psychosocial well-being among Chinese adolescents.MethodsData were drawn from the Longitudinal Study of Adolescents’ Mental and Behavioral Well-being Research (Registration No. ChiCTR1900022032). The final analysis included 1480 participants who completed baseline and two follow-up surveys. Standardized measures were employed to assess ST and multiple psychosocial well-being, including depressive symptoms, anxiety, externalizing problems, and coping style. Group-based trajectory modeling and generalized linear mixed models were performed.ResultsOver the two-year follow-up period, two distinct ST trajectories emerged: continued high (298 [20.1%]) and continued low (1182 [79.9%]). Compared with those in the continued low ST group, adolescents in the continued high group exhibited a higher likelihood of presenting depressive symptoms (β = 0.97, 95% CI = 0.43 ~ 1.50), anxiety symptoms (β = 0.29, 95% CI = 0.05 ~ 0.53), and emotional problems (β = 0.35, 95% CI = 0.22 ~ 0.48), and were less likely to demonstrate prosocial behavior or employ positive coping style. The stratified analysis demonstrated that the aforementioned associations only existed among female adolescents.ConclusionsPersistent high exposure to ST was associated with an increased odds of emotional problems and a decreased probability of engaging in prosocial behavior and positive coping style, with particularly noteworthy effects observed among female adolescents. These findings underscore the importance of reducing ST exposure to improve the psychological well-being of adolescents.

Longitudinal trajectories of symptom change during antidepressant treatment among managed care patients with depression and anxiety

Despite the high correlation between anxiety and depression, little remains known about the course of each condition when presenting concurrently. This study aimed to identify longitudinal patterns during antidepressant treatment in patients with depression and anxiety, and evaluate related factors associated with these patterns. By analyzing longitudinal self-report Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scores that tracked courses of depression and anxiety over a three-month window among the 577 adult participants, six depression and six anxiety trajectory subgroups were computationally derived using group-based trajectory modeling. Three depression subgroups showed symptom improvement, while three showed nonresponses. Similar patterns were observed in the six anxiety subgroups. Multinomial regression was used to associate patient characteristics with trajectory subgroup membership. Compared to patients in the remission group, factors associated with depressive symptom nonresponse included older age and lower depression severity.

Sleep Disturbances During Childhood Can Predict Adult Alcohol Consumption: A Longitudinal Cohort Study

Background Sleep disturbances (SDs) in childhood can negatively impact behavioral and emotional control, which can lead to an increase in risky behaviors, such as substance use, including alcohol. Methods Data from 2,132 subjects who participated in the French TEMPO cohort from 1991 to 2018 were used. Sleep disturbances observed from ages 3 to 16 years defined our exposure. Alcohol use in adulthood was measured by alcohol consumption trajectories ascertained by using Group-Based Trajectory Modeling (GBTM) and constitutes our outcomes. The association between sleep disturbances in childhood and alcohol consumption trajectories was studied using multinomial logistic regression. Results Sleep disturbances at ≤ 16 years were observed in 26.7% of participants. Three alcohol use trajectories were defined: “light-drinkers”, “moderate-drinkers”, and “heavy-drinkers”. Accounting for many confounders, we found statistically significant associations between sleep disturbances and alcohol use trajectories. Using “light-drinkers” trajectory as reference, we found that compared to children with no sleep disturbances, those with sleep disturbances had a higher likelihood to be in the “moderate-drinkers” (ORa = 1.51; 95% CI = 1.09–2.10) and “heavy-drinkers” trajectory (ORa = 2.34; 95% CI = 1.27–4.34). Conclusion This study suggests that sleep disturbances in childhood are associated with an increased risk of higher alcohol consumption in adulthood and highlights the importance of healthy sleep, particularly in children and adolescents, to prevent the onset of certain risky behaviors.

Association between remnant cholesterol and the trajectory of arterial stiffness progression

Objective: To explore the impact of baseline remnant cholesterol levels at a single time point and cumulative remnant cholesterol exposure on the progression trajectories of arterial stiffness. Methods: This prospective cohort study included 2 401 eligible participants from the Beijing Health Management Cohort who consecutively attended health examinations in 2010-2011, 2012-2013, and 2014-2015. The remnant cholesterol value measured in 2014-2015 served as the baseline remnant cholesterol level at a single time point. The cumulative exposure indices were calculated based on remnant cholesterol values from three health examinations from 2010 to 2015, including cumulative exposure, cumulative exposure burden, and duration of high remnant cholesterol exposure. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV). The follow-up continued until December 31, 2019, with annual check-ups. During the follow-up period, a group-based trajectory model was employed to construct the progression trajectories of baPWV. The associations between the baseline remnant cholesterol level, cumulative exposure indices of remnant cholesterol and baPWV trajectories were examined using ordinal logistic regression models, adjusting for traditional cardiovascular risk factors and low-density lipoprotein cholesterol (LDL-C) levels. Results: The age of the 2 401 participants was 61 (54, 69) years, with 1 801 (75.01%) being male. The group-based trajectory model indicated that the best-fit model categorized the participants into three subgroups: low-rising group (1 036 individuals, 43.15%), moderate-rising group (1 137 individuals, 47.36%), and high-rising group (228 individuals, 9.50%). After adjusting for traditional cardiovascular risk factors, baseline remnant cholesterol levels at a single point (OR=1.170, 95%CI: 1.074-1.274), cumulative remnant cholesterol exposure (OR=1.194, 95%CI: 1.096-1.303), cumulative remnant cholesterol exposure burden (OR=1.270, 95%CI: 1.071-1.507), and high-remnant cholesterol exposure duration (6 years: OR=1.351, 95%CI: 1.077-1.695) were significantly associated with the risk of developing a poor baPWV progression trajectory. These results remained significant after adjusting for cumulative average LDL-C levels. The association between baseline remnant cholesterol levels and baPWV progression became insignificant after adjusting for cumulative remnant cholesterol levels (OR=1.053, 95%CI: 0.923-1.197), while the association between cumulative remnant cholesterol exposure and baPWV progression remained significant after adjusting for baseline remnant cholesterol levels (OR=1.145, 95%CI: 1.008-1.305). Conclusions: Higher levels of baseline remnant cholesterol and cumulative remnant cholesterol are independent risk factors for the progression of arterial stiffness. These associations remain significant even after adjusting for traditional cardiovascular risk factors and LDL-C levels. Furthermore, the effect of cumulative remnant cholesterol levels on the progression of arterial stiffness was stronger than the effect of baseline remnant cholesterol levels.

Examining the Online Posting Behaviors and Trajectories of Incel Forum Members

Involuntary celibates, or incels, have been of heightened interest to scholars and practitioners due to their ongoing engagement in misogynistic and violent discourse. The incel subculture is complex, requiring unique strategies to develop effective interventions. The present study investigates patterns in incels’ online posting behaviors and whether acceptance of subcultural beliefs is reflected in variations of user engagement and posting behaviors over time. A sample of postings are drawn from a well-known incel-moderated forum and analyzed using group-based trajectory modeling. The results demonstrate that three distinct posting trajectory groups are present. The findings demonstrate heterogeneity among users’ posting behaviors in the forum over time and suggest that variation may be a reflection of users’ subcultural beliefs.