Large Community Sample Research Articles

Convergent Validity of Experimental Cognitive Tests in a Large Community Sample

Experimental cognitive tests are designed to measure particular cognitive domains, although evidence supporting test validity is often limited. The Consortium for Neuropsychiatric Phenomics test battery administered 23 experimental and traditional neuropsychological tests to a large sample of community volunteers ( n = 1,059) and patients with psychiatric diagnoses ( n = 137), providing a unique opportunity to examine convergent validity with factor analysis. Traditional tests included subtests from the Wechsler and Delis–Kaplan batteries, while experimental tests included the Attention Networks Test, Balloon Analogue Risk Task, Delay Discounting Task, Remember–Know, Reversal Learning Task, Scene Recognition, Spatial and Verbal Capacity and Manipulation Tasks, Stop-Signal Task, and Task Switching. Several experimental cognitive measures were insufficiently related to other tests and were excluded from factor analyses. In the remaining 18 tests, exploratory factor analysis and subsequent multigroup confirmatory factor analysis supported a three-factor structure broadly corresponding to domains of verbal/working memory, inhibitory control, and memory. In sum, several experimental measures of inhibitory control had weak relationships with all other tests, while the convergent validity of most tests of working memory and memory was supported.

Predictors of duty sex frequency in women.

Duty Sex-the act of engaging in sex out of a sense of duty or obligation to a partner-is a commonly reported reason why women have sex, with studies indicating associations between Duty Sex and sexual dysfunction, as well as nonconsensual sexual experiences (NSEs). This study sought to examine the associations between Duty Sex frequency, sexual function, and NSEs using comprehensive, validated measures of sexual function and NSE histories in a large community sample of women. Six hundred and fifty-eight women with (n = 293) and without (n = 365) NSE histories completed measures of sexual function and sexual motivations. Women with NSE histories reported more sexual pain, lower sexual satisfaction, and more frequent Duty Sex. The relation between NSE history and Duty Sex remained after controlling for the variance in sexual function. The type of NSE behavior, but not the timing of the first NSE nor the perceived impact of the experience, predicted Duty Sex frequency. Clinicians should consider sexual motivations, particularly Duty Sex, when treating women with NSE histories or who experience sexual dysfunction. To our knowledge, this was the first study to examine how NSEs relate to all domains of sexual function and sexual motives, revealing a link between NSEs, sexual function, and Duty Sex. However, we were unable to account for what percentage of sexual encounters are considered Duty Sex. Therefore, our measurement of Duty Sex lacks specificity, which may explain the relatively low variance accounted for by the models in our analyses. There are consequences of NSEs, including difficulties with communicating sexual boundaries and impairment of sexual function, that may contribute to the increased likelihood of engaging in Duty Sex.

Longitudinal trajectory classes and correlates of the Multidimensional Personality Questionnaire-triarchic psychopathy scales from adolescence to young adulthood.

The present study examined longitudinal trajectory classes and correlates of triarchic psychopathy domains (boldness, meanness, and disinhibition) from age 16 to 22, leveraging Multidimensional Personality Questionnaire (MPQ)-based triarchic scales data gathered on a large community sample (ns ranging between 483 and 775 across waves) oversampled for parental substance use disorder (SUD). Growth mixture models were conducted to examine longitudinal trajectory classes for each domain, and their associations with environmental covariates (e.g., neighborhood disadvantage and parental SUD) and outcomes at age 22 (e.g., violent behavior, antisocial personality disorder, and an overall problem index capturing internalizing symptoms and social problems). For boldness, all participants fell in the same class showing relative stability over time. Comparable solutions were recovered for meanness and disinhibition (high-stable/increasing, mid-range decreasing, and low-decreasing). Links with external correlates supported well-known differences between boldness and both meanness and disinhibition and additionally revealed interesting differences between meanness and disinhibition, suggesting that environmental covariates better discriminated meanness trajectory classes. These results demonstrate considerable developmental heterogeneity in these traits across adolescence into young adulthood, which relates to outcomes associated with antisociality and general life struggles. Further, these findings support the adequacy of the MPQ as an operationalization tool for longitudinal investigations on psychopathy.

Factor Structure, Construct Validity, and Measurement Invariance of the Neuroception of Psychological Safety Scale (NPSS).

Psychological safety has recently emerged as a central construct, strictly implicated in mental health and emotional well-being. The Neuroception of Psychological Safety Scale (NPSS) is the first scale designed to assess feelings of psychological safety from a multidimensional perspective. However, the robustness of its factorial structure requires further examination in large community samples, and evidence of construct validity along with measurement invariance across genders is scarce. The present study aimed to address these gaps through a comprehensive cross-validation approach. A community sample of 660 Italian adults, aged 18-65, completed self-report questionnaires including the NPSS, the Compassionate Engagement and Action Scale (CEAS), the Sussex-Oxford Compassion for Others (SOCS), and the Body Perception Questionnaire (BPQ). A three-factor model, i.e., Social Engagement, Compassion, and Bodily Sensations, demonstrated a good fit to the data in two random subsamples. Moreover, the measurement model was factorially invariant across genders. Model-based omega coefficients supported the internal consistency of the NPSS scores (ω ranged between 0.879 and 0.918). Zero-order correlations between NPSS subscales and CEAS, SOCS, and BPQ provided construct validity evidence. Additionally, inter-correlations between latent factors and Harman's single-factor test supported the discriminant validity of the NPSS dimensions. Overall, this study provided compelling evidence regarding the psychometric properties of the NPSS, demonstrating for the first time the invariance of its factorial structure across gender.

Factor Structure and Invariance of a German Adaptation of the Primary Levenson Self-Report Psychopathy Scale

Abstract: This study was conducted to test the psychometric properties of a German adaptation of the Primary Levenson Self-Report Psychopathy Scale (LSRP). A large community sample ( N = 1,040) was collected and divided into two parallel subsamples. One was used to explore the latent structure with a hierarchical cluster analysis, whereas the other subsample was used to test the structure with confirmatory factor analyses. A solution comprising two correlated factors offered the best model fit. The allocation of the three Machiavellianism items to the two factors differed from that found in previous studies and suggested an interpretation of the factors as egocentricity and deceitfulness. This revised measurement model with the refined item allocation possessed superior fit and reliability compared to one-factor and two-factor models that have previously been proposed for the Primary LSRP. Furthermore, the revised measurement model proved to be measurement invariant across male and female participants.

Is Progressive Ideology on the Test? Education and Intelligence in the Development of Nontraditional Attitudes.

Enhanced educational attainment and intelligence are consistent correlates of socially liberal, nontraditional attitudes. However, it is unclear how such associations unfold developmentally. Here, we propose an interaction effect between college exposure and intelligence on the development of nontraditional attitudes. Our rationale builds from the fact that a desired learning outcome of college education is to challenge traditional dogma and encourage diverse perspectives. Those with higher intellectual ability should be particularly adept at understanding the intended lesson and to show attendant increases in nontraditional attitudes. Data on social attitudes were obtained in a large community sample of youth at age 17 and remeasured at two points in early adulthood (N = 2,769). Intelligence was linked with growth in nontraditional attitudes among those with higher educational attainment; no such association was observed among individuals who never attended college. Environments that encourage critical inquiry may thus steer brighter individuals toward the adoption of progressive worldviews.

Identifying analogue samples of individuals with clinically significant social anxiety: Updating and combining cutoff scores on the Social Phobia Inventory and Sheehan Disability Scale.

The use of analogue samples, as opposed to clinical groups, is common in mental health research, including research on social anxiety disorder (SAD). Recent observational and statistical evidence has raised doubts about the validity of current methods for establishing analogue samples of individuals with clinically significant social anxiety. Here, we used data from large community samples of clinical and nonclinical participants to determine new cutoff scores on self-report measures of social anxiety symptoms and symptom-related impairment. We then examined whether using these newly determined cutoff scores alone or in combination improves the identification of individuals who have SAD from those who do not, revealing the most ideal cutoff combination to be 34 or above on the Social Phobia Inventory and 11 or above on the Sheehan Disability Scale. Finally, we compared the effects of our new cutoff scores with old cutoff scores by extracting analogue samples of participants with high social anxiety from historical data on seven large groups of undergraduate Psychology research participants from the authors' institution spanning the past 5 years (2018-2023). We observed that the new combined cutoff scores identified markedly fewer students as having high social anxiety, lending credibility to their utility. We also observed a striking increase in levels of social anxiety symptoms in the undergraduate population from before to after the COVID-19 pandemic. Of note, most participants were under 30 and identified as Caucasian or Asian women, indicating that future research is needed to examine whether our findings generalize to diverse populations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence and Factors Associated With Healthy Aging in a Large Representative Community Sample of Older Ethiopians.

Objectives: To examine the prevalence and predictors of healthy aging among community-dwelling older adults living in Bahir Dar, Ethiopia. Methods: A community-based cross-sectional study included older adults aged 60 and above (n = 845; Mage = 71 years; 56.4% females). Poisson regression estimated the Relative Risk (RR) of factors associated with healthy aging status. Results: 36.7% of respondents were classified as healthy agers. Factors associated with an increased likelihood of healthy aging included reporting not being lonely, adequate nutrition, no multimorbidity, good self-rated health, financial independence, and engaging in at least 1hour of moderate physical activity per week. Discussion: The proportion of healthy agers in this study was substantially lower compared to developed countries but comparable to the prevalence reported in similar developing nations. Enhancing physical activity, ensuring proper nutrition, interventions to foster social participation engagement, and networking, and managing chronic diseases were identified as promising strategies to promote healthy aging.

Distressing Problems with Sexual Function and Symptoms of Attention-Deficit/Hyperactivity Disorder.

Cognitive models of sexual dysfunction situate distraction as a core mechanism underlying difficulties with sexual function. It follows that individuals who have difficulties with inattention and distractibility (e.g., attention-deficit/hyperactivity disorder; ADHD) may be at increased risk of problems with their sexual function, though previous research is mixed, and no research has examined links with sexual distress despite distress being a necessary criterion for sexual dysfunction. The goals of the current study were to: (1) examine associations between ADHD symptoms, sexual function, and sexual distress; (2) examine group differences in sexual function and sexual distress as a function of presumptive ADHD diagnosis; and (3) establish whether individuals with presumptive ADHD are at greater risk of distressing problems with sexual function relative to controls. In a large mixed-gender community sample (N = 943: controls n = 837, presumptive ADHD n = 106), we found that ADHD symptoms were positively correlated with worse overall sexual function, as well as orgasm difficulties and greater sexual distress. Relative to controls, individuals with presumptive ADHD reported worse sexual function and greater sexual distress, controlling for age, biological sex, and sexual orientation. Individuals with presumptive ADHD were significantly more likely (OR = 2.16) to have distressing problems with sexual function than controls. Core difficulties related to ADHD, including inattention, distractibility, and emotion dysregulation, may make individuals more vulnerable to experiencing problems with sexual function and sexual distress, putting them at risk for developing sexual dysfunction. Taken together, these data support associations between ADHD and distressing sexual function problems, including possible mechanisms explaining these links such as difficulties with emotion regulation.

The Hemianopia Reading Questionnaire (HRQ): Development and Psychometric Qualities in a Large Community Sample.

The ability to read is important for daily life functioning. Individuals with homonymous visual field defects (iwHs) after brain injury experience frequent reading difficulties. The current study presents a novel self-report questionnaire aimed at measuring the wide variety of reading difficulties iwHs can experience: the Hemianopia Reading Questionnaire (HRQ). The 24-item HRQ was developed with help from clinical experts and experts by experience and was inspired by existing reading questionnaires for adults. The three tested subscales of the HRQ assess the relationship to reading, reading skills and daily life functional reading. The factor structure, reliability, convergent validity and divergent validity were examined in a large community sample (i.e., individuals without homonymous visual field defects) with a comparable distribution of age, gender and level of education to those who have suffered a stroke (N = 998). Two competing hypothesized models were tested and a good fit was found for a three-bifactor model of the HRQ. The reliability of the three subscales was found to be good (ω range 0.93-0.99), as well as the convergent and divergent validity (9 out of 12 Spearman's correlations, according to expectations). The results support further use of the HRQ in iwHs, especially in the context of reading rehabilitation. Suggestions for clinical and scientific use and future psychometric research on the HRQ are provided.

Testing the distinctiveness of prolonged grief disorder from posttraumatic stress disorder and depression in large bereaved community samples

BackgroundThis study sought to test the distinctiveness of symptoms of prolonged grief disorder (PGD) from posttraumatic stress disorder (PTSD) and depression. MethodsConfirmatory factor analysis (CFA) and target exploratory factor analysis (EFA), were used to test the distinctiveness of PGD from PTSD and depression symptoms in a large sample of adults bereaved for at least six months (N = 1917). Identified factors were explored in relation to demographic (i.e., age, gender) and loss-related (i.e., time since bereavement, nature of death, relationship to deceased, age of deceased, and frequency of contact with deceased) correlates. ResultsThe CFA model provided a good fit to the data, while the target EFA provided a slightly improved fit. All items loading strongly and significantly onto their respectively factors, and the IGQ items had few significant cross-factor loadings. All demographic and loss-related variables (except for death of a sibling and death from other causes) were associated with each of the factors, however, these associations were strongest for the PGD factor. LimitationsParticipants were recruited using a non-probability sampling method and were from a relatively affluent Western nation. ConclusionFindings from the current study demonstrate that PGD reflects an empirically distinguishable albeit related disorder to PTSD and depression in a sample of bereaved adults. The identification of correlates common to PGD, PTSD, and depression, as well as those unique to PGD, affords a comprehensive understanding of the risk factors associated with bereavement-related psychopathology.

Antipsychotic use in a large community sample of patients with delusional disorder

BackgroundTo examine clinical and sociodemographic differences between patients with delusional disorder; with and without diagnoses of an additional severe mental disorder (SMD) or cognitive impairment. MethodsPopulation-based study including all individuals diagnosed with DD between 2005 and 2021 from a large catchment area in Madrid, Spain. Sociodemographic and clinical characteristics and the antipsychotic prescription patterns of the study population was described. Patients were divided into (i) patients with DD and no additional diagnosis of SMD or cognitive impairment (DD group), (ii) patients with DD and a diagnosis of an additional SMD (DD-SMD group), and (iii) patients with DD and cognitive impairment (DD-CI group). ResultsOf 1109 patients with a DD diagnosis (62.5 % female), 131 (11.8 %) patients were diagnosed with an additional SMD, and 69 (6.2 %) were diagnosed with cognitive impairment. DD-SMD patients were on average 10 years younger and had longer time between first mental healthcare contact and DD disorder than DD patients. DD-CI patients were on average 10 years older and had a higher proportion of females. Paliperidone (21.9 %) and aripiprazole (20.6 %) were the modal antipsychotic drugs chosen overall. DD-SMD patients were more likely to receive paliperidone and to be prescribed long-acting injectable medication; DD-CI were more likely to receive risperidone or quetiapine; and DD patients were more likely to receive olanzapine. ConclusionsSociodemographic and clinical characteristics and choice of antipsychotic drug and delivery method for individuals with DD vary based on its comorbidity.

Dimensions of Early-Life Adversity Are Differentially Associated With Patterns of Delayed and Accelerated Brain Maturation

BackgroundDifferent types of early-life adversity (ELA) have been associated with children’s brain structure and function. However, understanding the disparate influence of distinct adversity exposures on the developing brain remains a major challenge. MethodsThis study investigates the neural correlates of 10 robust dimensions of ELA identified through exploratory factor analysis in a large community sample of youth from the Adolescent Brain Cognitive Development Study. Brain age models were trained, validated, and tested separately on T1-weighted (n = 9524), diffusion tensor (n = 8834), and resting-state functional (n = 8233) magnetic resonance imaging data from two time points (mean age = 10.7 years, SD = 1.2, age range = 8.9–13.8 years). ResultsBayesian multilevel modeling supported distinct associations between different types of ELA exposures and younger- and older-looking brains. Dimensions generally related to emotional neglect, such as lack of primary and secondary caregiver support and lack of caregiver supervision, were associated with lower brain age gaps, i.e., younger-looking brains. In contrast, dimensions generally related to caregiver psychopathology, trauma exposure, family aggression, substance use and separation from biological parent, and socioeconomic disadvantage and neighborhood safety were associated with higher brain age gaps, i.e., older-looking brains. ConclusionsThe findings suggest that dimensions of ELA are differentially associated with distinct neurodevelopmental patterns, indicative of dimension-specific delayed and accelerated brain maturation.

Body Size Perceptions Associated with Body Mass Index and Weight Loss Intentions Among Two Immigrant Populations.

The rates of obesity among immigrant populations within the USA rise with increasing duration of residency. The aims of this study were to examine weight self-perception and body image discrepancy within a large community sample of Hispanic and Somali predominantly immigrant adults. Utilizing a community-based participatory research (CBPR) approach to collect survey data from a sample of adults who self-identified as Hispanic, Latino, or Somali in Southeast Minnesota. Correlations among actual body mass index (BMI), perceived weight category, and perceived body size were assessed with Spearman rank correlation coefficients. Associations of weight loss intentions with actual BMI, perceived weight category, perceived body size, and body image discrepancy were assessed using Kruskal-Wallis nonparametric tests. A total of 1256 adults completed the survey and biometric measurements (610 Hispanic, 646 Somali); 81% (457) and 50% (328) had a BMI in the overweight or obese category in the Hispanic and Somali cohorts, respectively. Among participants with a BMI of > 25, more participants reported a perceived body size that was overweight or obese than a perceived weight category that was in the overweight or obese category (79% vs. 48%, p = < 0.0001). Body image discrepancy, but not actual BMI, was associated with weight loss intentions for both groups. Perceived body size and perceived weight category were associated with weight loss intentions for Hispanic participants only. Perceived body size is a more accurate self-report proxy of BMI-defined weight status compared with the perceived weight category among Hispanic and Somali immigrant groups. Body image discrepancy may be more predictive of weight loss intentions than actual BMI.

The General Psychopathology 'p' Factor in Adolescence: Multi-Informant Assessment and Computerized Adaptive Testing.

Accumulating evidence supports the presence of a general psychopathology dimension, the p factor ('p'). Despite growing interest in the p factor, questions remain about how p is assessed. Although multi-informant assessment of psychopathology is commonplace in clinical research and practice with children and adolescents, almost no research has taken a multi-informant approach to studying youth p or has examined the degree of concordance between parent and youth reports. Further, estimating p requires assessment of a large number of symptoms, resulting in high reporter burden that may not be feasible in many clinical and research settings. In the present study, we used bifactor multidimensional item response theory models to estimate parent- and adolescent-reported p in a large community sample of youth (11-17 years) and parents (N = 5,060 dyads). We examined agreement between parent and youth p scores and associations with assessor-rated youth global functioning. We also applied computerized adaptive testing (CAT) simulations to parent and youth reports to determine whether adaptive testing substantially alters agreement on p or associations with youth global functioning. Parent-youth agreement on p was moderate (r =.44) and both reports were negatively associated with youth global functioning. Notably, 7 out of 10 of the highest loading items were common across reporters. CAT reduced the average number of items administered by 57%. Agreement between CAT-derived p scores was similar to the full form (r =.40) and CAT scores were negatively correlated with youth functioning. These novel results highlight the promise and potential clinical utility of a multi-informant p factor approach.

Association between residential greenness and incident delirium: A prospective cohort study in the UK Biobank

BackgroundContemporary environmental health investigations have identified green space as an emerging factor with promising prospects for bolstering human well-being. The incidence of delirium increases significantly with age and is fatal. To date, there is no research elucidating the enduring implications of green spaces on the occurrence of delirium. Therefore, we explored the relationship between residential greenness and the incidence of delirium in a large community sample from the UK Biobank. MethodsEnrollment of participants spanned from 2006 to 2010. Assessment of residential greenness involved the land coverage percentage of green space within a buffer range of 300 m and 1000 m. The relationship between residential greenness and delirium was assessed using the Cox proportional hazards model. Further, we investigated the potential mediating effects of physical activity, particulate matter (PM) with diameters ≤2.5 (PM2.5), and nitrogen oxides (NOx). ResultsOf 232,678 participants, 3722 participants were diagnosed with delirium during a 13.4-year follow-up period. Compared with participants with green space coverage at a 300 m buffer in the lowest quartile (Q1), those in the highest quartile (Q4) had 15 % (Hazard ratio [HR] = 0.85, 95 % confidence interval [CI]: 0.77, 0.94) lower risk of incident delirium. As for the 1000 m buffer, those in Q4 had a 16 % (HR = 0.84, 95 % CI: 0.76, 0.93) lower risk of incident delirium. The relationship between green space in the 300 m buffer and delirium was mediated partially by physical activity (2.07 %) and PM2.5(49.90 %). Comparable findings were noted for the green space percentage within the 1000 m buffer. ConclusionsOur results revealed that long-term exposure to residential greenness was related to a lower risk of delirium. Air pollution and physical activity exerted a significant mediating influence in shaping this association.

A two-generation study of attachment in mothers and their young adult offspring: Latent classes of attachment and associations with anxiety and depression

BackgroundEvidence supports the conceptualization of adult attachment as existing along a continuum of attachment security and insecurity; however, ongoing debates persist regarding the use of categorical versus continuous approaches to studying attachment. Attachment data collected from a large community sample of mothers and their offspring in young adulthood were used to examine i) latent classes of adult attachment, ii) associations between mother and offspring attachment, iii) the relationship between adult attachment and mental health symptoms. MethodsMothers and offspring were each administered the Attachment Style Questionnaire when offspring were aged 21-years. Latent class analyses (LCA) were performed to examine response patterns across ASQ items. Associations between mothers' and offspring attachment, and correlations between attachment domains and depression/anxiety subscales were examined. ResultsLCA identified four latent classes across a continuum of secure and insecure attachment rather than four distinct adult attachment styles. Anxious attachment subscales correlated strongly with depression/anxiety symptoms in both cohorts. Mothers' attachment was significantly but weakly correlated with their young adult offspring attachment. LimitationsAttachment was measured at one time point and as such, a causal maternal-offspring attachment relationship could not be established. ConclusionsFindings support a dimensional view of attachment security and insecurity over a four-category model of adult attachment. Attachment correlated with anxiety and depressive symptoms and highlights the importance of considering adult attachment when addressing mental health. There was limited evidence of a relationship between middle aged mothers and their offspring in young adulthood, suggesting other factors influence attachment in adulthood.

Factor Structure of the Difficulties in Emotion Regulation Scale among Early Adolescents: Results from the Adolescent Brain Cognitive Development Study

IntroductionEmotion regulation (ER) deficits in early adolescence are associated with subsequent negative health consequences, including anxiety and depression. Yet, limited work has evaluated the factor structure of measures of ER deficits in early adolescents, leaving a methodological gap for at-risk youths.MethodThis study examined the Difficulties in Emotion Regulation Scale (DERS) factor structure in early adolescents (N = 2300) recruited from the Adolescent Brain Cognitive Development Study. We randomly split the sample into two sub-samples (n = 1150 each) and implemented an a-priori three-pronged approach: (1) A confirmatory factor analysis (CFA) assessed the fit of the six-factor DERS in Sample 1; (2) An exploratory factor analysis (EFA) identified an alternative factor structure in Sample 1; and (3) A second CFA assessed the new model in Sample 2. A bi-factor model was also used to assess the global structure of the DERS total and subscales.ResultsThe original six-factor model yielded poor-to-adequate fit. EFA results supported an alternative five-factor model with different item mappings and ten omitted items. CFA results supported the five-factor solution with good fit. The bi-factor model, estimating a general factor with the five subscales, also demonstrated good fit.DiscussionA five-factor structure of the DERS appears supported in a large community sample of early adolescents. Items from the former Awareness and Clarity subscales were combined into a single factor. Nearly all items from the former Strategies subscale were omitted, suggesting there may be developmental considerations rendering those items less relevant.

Associations of iron metabolism and inflammation with all-cause and cardiovascular mortality in a large NHANES community sample: Moderating and mediating effects

Background and aimsThis study aimed to assess the associations between serum iron concentration, C-reactive protein (CRP) concentration and the risk of all-cause mortality and cardiovascular mortality in the general population and to explore potential mediating and moderating effects. Methods and resultsThis study analyzed data from the National Health and Nutrition Examination Survey spanning the years 1999–2010, encompassing 23,634 participants. Cox proportional hazards regression models were employed to investigate the independent associations of serum iron and CRP with all-cause and cardiovascular mortality. Moderation and mediation analyses explored the moderating effect of CRP on the association between the serum iron concentration and all-cause and cardiovascular mortality, and the mediating role of the serum iron concentration in the association between the CRP concentration and all-cause and cardiovascular mortality. After multivariate adjustments in the Cox model, serum iron and CRP levels were independently correlated with both all-cause and cardiovascular mortality risk. Moderation analyses revealed a more pronounced correlation between the serum iron concentration and both all-cause and cardiovascular mortality in participants with higher CRP levels. Mediation analysis indicated that the serum iron concentration partly mediated the impact of CRP on the risk of all-cause mortality (13.79%) and cardiovascular mortality (24.12%). ConclusionSerum iron and CRP are independently associated with all-cause and cardiovascular mortality. Moreover, the associations between serum iron concentrations and both all-cause and cardiovascular mortality are more pronounced in individuals with elevated CRP. Serum iron partially mediates the effect of CRP on all-cause and cardiovascular mortality.

Cognition and Memory after Covid-19 in a Large Community Sample

BackgroundCognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear.MethodsWe invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating (“brain fog”).ResultsOf the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no–Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (−0.23 SD [95% confidence interval {CI}, −0.33 to −0.13] and −0.24 SD [95% CI, −0.36 to −0.12], respectively); larger deficits as compared with the no–Covid-19 group were seen in participants with unresolved persistent symptoms (−0.42 SD; 95% CI, −0.53 to −0.31). Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., −0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, −0.20 to −0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, −0.35 SD; 95% CI, −0.49 to −0.20). Results of the analyses were similar to those of propensity-score–matching analyses. In a comparison of the group that had unresolved persistent symptoms with the no–Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (−0.33 to −0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported.ConclusionsParticipants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain. (Funded by the National Institute for Health and Care Research and others.)