Latent Growth Mixture Modeling Research Articles

Trajectories of posttraumatic stress symptoms following the September 11, 2001, terrorist attacks: A comparison of two modeling approaches.

Several studies have analyzed longitudinal data on posttraumatic stress symptoms (PTSS) from individuals who were proximal to the September 11, 2001, terrorist attacks (9/11) in an attempt to identify different trajectories of mental health in the years following mass trauma. The results of these studies have been heterogeneous, with researchers who used latent growth mixture modeling (LGMM) tending to identify four trajectories and those who used group-based trajectory modeling (GBTM) identifying five to seven trajectories. Given that no study has applied both GBTM and LGMM to their data, it remains unknown which modeling approach and what number of trajectories best fit post-9/11 PTSS data. The present study aimed to address that question by applying both LGMM and GBTM to data from the largest sample of survivors to date, comprising 37,545 New York City community members. When analyzing four waves of PTSS, reflecting participants' mental health up to 15 years post-9/11, LGMM fit the data better than GBTM. Our optimal solution consisted of four trajectories: low-stable (72.2% of the sample), decreasing (12.8%), increasing (9.5%), and high-stable (5.5%) symptoms. Covariate analyses indicated that economic factors (i.e., having a household income less than $25,000 and experiencing job loss due to 9/11) increased the odds of belonging to the high-stable symptom trajectory group to the greatest degree, ORs=4.93-6.08. The results suggest that providing financial support, including affordable mental health care, could be an important intervention in the wake of future mass traumatic events.

Trajectories of disability in low back pain.

Low back pain (LBP) is the leading course of years lived with disability. Unfortunately, not much knowledge exists about distinct trajectories of recovery from disability after LBP and their potential psychological predictors. Hence, the aim of the present study was to identify trajectories of functional disability in LBP and their potential baseline psychological predictors. A 1-year consecutive cohort (N = 1048) of patients with LBP referred to the Spine Centre if they have not improved satisfactorily from a course of treatment in primary care after 1 to 2 months were assessed by self-report questionnaires at their first visit and at 6- and 12-month follow-up. Data from patients who responded to the Roland Morris Disability Questionnaire at least twice (N = 747) were used to assess trajectories of functional disability by Latent Growth Mixture Modeling. The following measures were used as baseline predictors of the trajectories: Pain Intensity Numerical Rating Scales, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Hospital Anxiety and Depression Scale. Four distinct trajectories were identified: high-stable (22.0%), high-decreasing (20.4%), medium-stable (29.7%), and low-decreasing (27.9%). Using the low-decreasing trajectory as reference, baseline pain intensity, depressive symptoms, and pain-catastrophizing predicted membership of all 3 symptomatic trajectories. However, using the high-decreasing trajectory as reference, age, baseline pain intensity, and depression were predictors of the high-stable trajectory. In particular, the finding of a high-stable trajectory characterized by high levels of baseline psychological distress is of potential clinical importance because psychological distress may be targeted by cognitive behavioral therapeutic approaches.

Long-term psychological profile of general population following COVID-19 outbreak: symptom trajectories and evolution of psychopathological network.

COVID-19 has long-term impacts on public mental health, while few research studies incorporate multidimensional methods to thoroughly characterise the psychological profile of general population and little detailed guidance exists for mental health management during the pandemic. This research aims to capture long-term psychological profile of general population following COVID-19 by integrating trajectory modelling approaches, latent trajectory pattern identification and network analyses. Longitudinal data were collected from a nationwide sample of 18 804 adults in 12 months after COVID-19 outbreak in China. Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 and Insomnia Severity Index were used to measure depression, anxiety and insomnia, respectively. The unconditional and conditional latent growth curve models were fitted to investigate trajectories and long-term predictors for psychological symptoms. We employed latent growth mixture model to identify the major psychological symptom trajectory patterns, and ran sparse Gaussian graphical models with graphical lasso to explore the evolution of psychopathological network. At 12 months after COVID-19 outbreak, psychological symptoms generally alleviated, and five psychological symptom trajectories with different demographics were identified: normal stable (63.4%), mild stable (15.3%), mild-increase to decrease (11.7%), mild-decrease to increase (4.0%) and moderate/severe stable (5.5%). The finding indicated that there were still about 5% individuals showing consistently severe distress and approximately 16% following fluctuating psychological trajectories, who should be continuously monitored. For individuals with persistently severe trajectories and those with fluctuating trajectories, central or bridge symptoms in the network were mainly 'motor abnormality' and 'sad mood', respectively. Compared with initial peak and late COVID-19 phase, aftermath of initial peak might be a psychologically vulnerable period with highest network connectivity. The central and bridge symptoms for aftermath of initial peak ('appetite change' and 'trouble of relaxing') were totally different from those at other pandemic phases ('sad mood'). This research identified the overall growing trend, long-term predictors, trajectory classes and evolutionary pattern of psychopathological network of psychological symptoms in 12 months after COVID-19 outbreak. It provides a multidimensional long-term psychological profile of the general population after COVID-19 outbreak, and accentuates the essentiality of continuous psychological monitoring, as well as population- and time-specific psychological management after COVID-19. We believe our findings can offer reference for long-term psychological management after pandemics.

Profiles of competence development in mathematics and reading in early secondary education

This article examines the development of reading and mathematical competence in early secondary education and aims at identifying distinct profiles of competence development. Since reading and mathematical competences are highly correlated both cross-sectionally and longitudinally, we expected to find a generalized profile of competence development with students developing parallel in reading and mathematical competences. Moreover, previous research confirmed individuals’ specific focus on one of the two domains, for example, in their interest, self-concept, or motivation. Also, differences in competence levels between both domains were found in cross-sectional studies. Therefore, we hypothesized that additional to the generalized profile, there are specialized profiles of competence development with students developing distinctively faster in one of the two domains. To identify both types of profiles, latent growth mixture modeling was used on a sample of 5,301 students entering secondary education from the German National Educational Panel Study. To demonstrate the robustness of the results, these analyses were repeated using different model specifications and subgroups with higher homogeneity (with students belonging to the highest track, i.e., “Gymnasium”). The results indicate only small to non-existent specialized profiles of competence development in all conditions. This finding of roughly parallel development of reading and mathematical competences throughout early secondary education indicates that potential specializations are less important at this point in students’ educational careers.

Identification of Youthful Neurocognitive Trajectories in Adults Aging with HIV: A Latent Growth Mixture Model

Despite the neurocognitive risks of aging with HIV, initial cross-sectional data suggest a subpopulation of older people with HIV (PWH) possess youthful neurocognition (NC) characteristic of SuperAgers (SA). Here we characterize longitudinal NC trajectories of older PWH and their convergent validity with baseline SA status, per established SuperAging criteria in PWH, and baseline biopsychosocial factors. Growth mixture modeling (GMM) identified longitudinal NC classes in 184 older (age ≥ 50-years) PWH with 1–5 years of follow-up. Classes were defined using ‘peak-age’ global T-scores, which compare performance to a normative sample of 25-year-olds. 3-classes were identified: Class 1Stable Elite (n = 31 [16.8%], high baseline peak-age T-scores with flat trajectory); Class 2Quadratic Average (n = 100 [54.3%], intermediate baseline peak-age T-scores with u-shaped trajectory); Class 3Quadratic Low (n = 53 [28.8%], low baseline peak-age T-scores with u-shaped trajectory). Baseline predictors of Class 1Stable Elite included SA status, younger age, higher cognitive and physiologic reserve, and fewer subjective cognitive difficulties. This GMM analysis supports the construct validity of SuperAging in older PWH through identification of a subgroup with longitudinally-stable, youthful neurocognition and robust biopsychosocial health.

Influence of the trajectory of the urine output for 24\xa0h on the occurrence of AKI in patients with sepsis in intensive care unit

BackgroundSepsis-associated acute kidney injury (S-AKI) is a common and life-threatening complication in hospitalized and critically ill patients. This condition is an independent cause of death. This study was performed to investigate the correlation between the trajectory of urine output within 24 h and S-AKI.MethodsPatients with sepsis were studied retrospectively based on the Medical Information Mart for Intensive Care IV. Latent growth mixture modeling was used to classify the trajectory of urine output changes within 24 h of sepsis diagnosis. The outcome of this study is AKI that occurs 24 h after sepsis. Cox proportional hazard model, Fine–Gray subdistribution proportional hazard model, and doubly robust estimation method were used to explore the risk of AKI in patients with different trajectory classes.ResultsA total of 9869 sepsis patients were included in this study, and their 24-h urine output trajectories were divided into five classes. The Cox proportional hazard model showed that compared with class 1, the HR (95% CI) values for classes 3, 4, and 5 were 1.460 (1.137–1.875), 1.532 (1.197–1.961), and 2.232 (1.795–2.774), respectively. Competing risk model and doubly robust estimation methods reached similar results.ConclusionsThe trajectory of urine output within 24 h of sepsis patients has a certain impact on the occurrence of AKI. Therefore, in the early treatment of sepsis, close attention should be paid to changes in the patient's urine output to prevent the occurrence of S-AKI.

Trajectory Classes of Relational and Physical Bullying Victimization: Links with Peer and Teacher-Student Relationships and Social-Emotional Outcomes

Bullying victimization is a prevalent problem in upper elementary school that predicts various detrimental outcomes. Increasing evidence suggests that interindividual differences in the severity of these outcomes result from differences in victimization experiences. However, longitudinal research largely overlooked victimization forms. Additionally, it is unclear how the quality of students' relationships with peers and teachers functions as a risk or protective factor for different patterns of victimization development. This one-year longitudinal study investigated joint trajectories of relational and physical victimization and examined differences between these trajectory classes regarding classroom social relationships as possible antecedents and social-emotional well-being as a possible outcome. A sample of 930 fourth to sixth graders (55 classes, 53.1% girls, Mage = 10.55, SD = 0.90) completed self-reports about relational and physical victimization and social-emotional outcomes (i.e., depressive symptoms, self-esteem). Peer nominations were used to measure the social antecedents (i.e., peer rejection and acceptance, teacher-student closeness and conflict). A 3-step approach including Latent Class Growth Analyses and Growth Mixture Modeling yielded two trajectory classes. Most students experienced low, decreasing relational and physical victimization. A smaller group experienced higher, generally stable victimization, more relational than physical. Younger students and girls were more likely to be members of the latter class. This class was more rejected, less accepted, reported more depressive symptoms and lower self-esteem. Teacher-student closeness and conflict were similar across classes. The current study showed that relational and physical victimization followed a largely parallel development. Low social status was found to be a risk factor for belonging to a victimization trajectory that is characterized by stable levels of both relational and physical victimization, with higher levels of the relational form.

Latent Change and Co-Occurrence of Overactive and Underactive Behavior Problems in American Early Education

This research examined growth and co-occurrence of latent developmental patterns of classroom behavior problems among young, economically disadvantaged children. A nationally representative sample (N = 3,827) of children was assessed for overactive and underactive behavior problems through two years of prekindergarten, kindergarten and first grade. Latent growth mixture modeling revealed three distinct subpopulations of change in overactivity and two in underactivity. A parallel-process growth mixture model showed that well-adjusted patterns of overactivity and underactivity co-occurred in the majority of the sample, whereas co-occurrence of marginal overactivity and underactivity existed in approximately 7% of the sample. Results are discussed in light of theory and implications for practice. Impact Statement Young children’s classroom behavior develops in different ways and at different rates, but some patterns of development are more common than others. In looking at children’s overactive and underactive behavior, we found that most children have fewer behavior problems from preschool through 1st grade, some have relatively moderate overactive problems that show little change over time, and a small proportion have increasingly difficult problems with overactivity and with underactivity. Even though overactivity and underactivity are distinct aspects of classroom behavior, children with increasing patterns of overactive behavior problems were more likely than expected to also show more underactivity in the classroom, and these children may require more support from parents and teachers during the early school years. Supplemental data for this article can be accessed online at https://doi.org/10.1080/2372966X.2021.2000842.

Trajectories of depression and anxiety during COVID-19 associations with religion, income, and economic difficulties

ObjectiveThe current study examined trajectories of anxiety and depression symptoms at three-time points during the COVID-19 pandemic and examined correlates of those trajectories. DesignData were collected at three time points during the COVID-19 pandemic. ParticipantsThe sample in the current study consisted of 804 respondents who had completed the online questionnaire at all three time points designed for the study. ResultsUsing Latent Growth Mixture Modeling (LGMM) we identified four trajectories: (a) A resilient group reported consistently low levels of symptoms (62% anxiety and 72% depression), (b) a chronic group reported consistently high levels of symptoms (12% anxiety and 14% depression), (c) an emerging group reported low initial symptoms that increased steadily across time (20% anxiety and 13% depression), and (d) an improving group reported high initial symptoms that decreased across time (6% anxiety and 3% depression). ConclusionsThe salient conclusion that emerged from these results is that even in a severe and prolonged crisis, such as the COVID-19 pandemic, the most common outcome in the population is that of resilience. Moreover, examining predictors of these trajectories, we found that the resilience trajectory was associated with fewer economic difficulties due to the COVID-19, greater income, and self-identification as religious.

Trajectories of body mass index Z-score and risk of high blood pressure in late adolescence in Suzhou children

Objective: To identify age and gender standardized body mass index among children and adolescents and explore their associations with high blood pressure (HBP) in late adolescence. Methods: The current study was based on the Health Promotion Program for Children and Adolescents, school-based surveillance successively conducted from 2012 to 2019 in Suzhou, China. A total of 11 812 children and adolescents aged 16-18 years, who had ≥4 examination records during 2012-2018 and were also involved in a surveillance program in 2019, were included. Latent class growth mixture modeling was used to identify the BMI-Z trajectories in different genders, and multivariate logistic regression was used to analyze the associations between different BMI-Z trajectories and risk of HBP in late adolescence. Results: Six distinct BMI-Z trajectories were determined for both genders:thin, slightly thin,standard, declining, overweight, and obese. Compared with the regular group, the obesity group had 94.0% (OR=1.94, 95%CI: 1.43-2.63) and 107.0% (OR=2.07, 95%CI: 1.33-3.22) increased risk of developing HBP in late adolescence in boys and girls, respectively. However, a neutral association was found between the descending group and HBP in late adolescence. Conclusions: Persistent obesity in children may increase the risk of HBP in their late adolescence. If an obese child restores normal weight before late adolescence, the risk of HBP may reduce.

Early co-occurrence of peer victimization and aggression.

An accelerated longitudinal research design was used to examine heterogeneity in the developmental co-occurrence of peer relational victimization and aggression and of peer overt victimization and aggression from age 4.5 to 10.5 years. Data were gathered from four cohorts of children in kindergarten to Grade 3 (N = 503) on six occasions across 2 years. Psychopathology, peer, and social-cognitive factors were examined as predictors of the joint trajectories. Sequential process latent growth mixture models identified four distinct subgroups for the relational trajectories (co-occurring increasing aggression, co-occurring increasing victimization, high chronic victimization, typical low risk) and four distinct subgroups for the overt trajectories (co-occurring decelerating aggression, high chronic victimization, moderate chronic victimization, typical low risk). Membership in the co-occurring trajectories was associated with psychopathology and membership in the chronic victimization trajectories was related to internalizing and social-cognitive problems but also peer likeability.

It's About Time! Identifying and Explaining Unique Trajectories of Solidarity-Based Collective Action to Support People in Developing Countries.

Social change occurs over years and decades, yet we know little about how people sustain, increase or diminish their actions over time, and why they do so. This article examines diverging trajectories of solidarity-based collective action to support people in developing nations more than 5 years. We suggest that sustained, diminished, and/or increased action over time will be predicted by identification as a supporter, group efficacy beliefs, and discrete emotions about disadvantage. Latent Growth Mixture Models (N = 483) revealed two trajectories with unique signatures: an activist supporter trajectory with a higher intercept and weakly declining action; and a benevolent supporter trajectory with a lower intercept but weakly increasing action. The activist trajectory was predicted by social identification, outrage, and hope, whereas the benevolent supporter trajectory was predicted by sympathy. The results highlight the role of combinations of emotions and the need for person-centered longitudinal methods in collective action research.

Determinants of profiles of competence development in mathematics and reading in upper secondary education in Germany.

The registered report was targeted at identifying latent profiles of competence development in reading and mathematics among N = 15,012 German students in upper secondary education sampled in a multi-stage stratified cluster design across German schools. These students were initially assessed in grade 9 and provided competence assessments on three measurement occasions across six years using tests especially developed for the German National Educational Panel Study (NEPS). Using Latent Growth Mixture Models, Using Latent Growth Mixture Models, we aimed at identifying multiple profiles of competence development. Specifically, we expected to find at least one generalized (i.e., reading and mathematical competence develop similarly) and two specialized profiles (i.e., one of the domains develops faster) of competence development and that these profiles are explained by the specialization of interest and of vocational education of students. Contrary to our expectations, we did not find multiple latent profiles of competence development. The model describing our data best was a single-group latent growth model confirming a competence development profile, which can be described as specializing in mathematical competences, indicating a higher increase in mathematical competences as compared to reading competences in upper secondary school. Since only one latent profile was identified, potential predictors (specialization of vocational education and interest) for different profiles of competence development were not examined.

Adaptation to Limb Loss: Heterogeneous Trajectories of Resilience and Depression Predict Posttraumatic Stress

<h3>Research Objectives</h3> To identify longitudinal trajectories of depression in the first six months following amputation and to explore baseline predictors of these trajectories. A secondary aim was to utilize trajectories as predictors of PTSD as a 6-month distal outcome. <h3>Design</h3> Archival data from two inception cohort studies of persons with new onset limb loss. Participants completed assessments at initial, -3 and 6-month follow-ups. <h3>Setting</h3> hospitalized care, acute rehabilitation, ambulatory care, and community. <h3>Participants</h3> Individuals with new limb loss were recruited from consecutive cases within a large metropolitan hospital system over a four-year period (2002-2007). Final sample (n = 203) was predominantly male (78.8%) and white (83.3%) with an average age of 49.4 years (SD = 14.58) at the time of amputation. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Patient Health Questionnaire-9 (PHQ-9); PTSD checklist – Civilian Version (PCL-C). <h3>Results</h3> Using Latent Growth Mixture Modeling, four trajectories of depression were identified: resilience (73.2%), recovery (6.7%), emerging depression (8.9%), and chronic depression (11.2%). Pain intensity was a significant baseline predictor of trajectory membership, whereas demographic covariates were non-significant. In distal outcome analyses, trajectory membership significantly predicted PTSD at 6-months. Pairwise comparisons revealed significantly elevated PTSD in the chronic-depression trajectory versus all other classes; the resilient class had significantly fewer PTSD symptoms than the emerging depression class but did not differentiate from the recovery trajectory. <h3>Conclusions</h3> Findings support the conclusion that the course of depression post-amputation is heterogeneous, with varying profiles of symptom development and remission. Although the majority of individuals were classified as resilient, average depression was mildly elevated in the resilient class immediately post-amputation, underscoring the challenging nature of acute recovery. Further, a substantial minority of individuals (8.9%) developed clinically significant depression between 3 and 6-months, suggesting that early screening during acute care may be insufficient for the detection of emerging depression. The derivation of latent classes of depression in longitudinal data may prove useful as a clinical tool for the early identification of those at risk for PTSD, a diagnosis with unique time-course requirements. <h3>Author(s) Disclosuress</h3> None

Early weight gain trajectories in first episode anorexia: predictors of outcome for emerging adults in outpatient treatment

BackgroundEarly response to treatment has been shown to be a predictor of later clinical outcomes in eating disorders (EDs). Specifically, early weight gain trajectories in anorexia nervosa (AN) have been shown to predict higher rates of later remission in inpatient treatment. However, no study has, as of yet, examined this phenomenon within outpatient treatment of first episode cases of AN or in emerging adults.MethodsOne hundred seven patients with AN, all between the ages of 16 and 25 and with an illness duration of < 3 years, received treatment via the first episode rapid early intervention in eating disorders (FREED) service pathway. Weight was recorded routinely across early treatment sessions and recovery outcomes (BMI > 18.5 kg/m2 and eating psychopathology) were assessed up to 1 year later. Early weight gain across the first 12 treatment sessions was investigated using latent growth mixture modelling to determine distinct classes of change. Follow-up clinical outcomes and remission rates were compared between classes, and individual and clinical characteristics at baseline (treatment start) were tested as potential predictors.ResultsFour classes of early treatment trajectory were identified. Three of these classes (n = 95), though differing in their early change trajectories, showed substantial improvement in clinical outcomes at final follow-up. One smaller class (n = 12), characterised by a ‘higher’ start BMI (> 17) and no early weight gain, showed negligible improvement 1 year later. Of the three treatment responding groups, levels of purging, depression, and patient reported carer expressed emotion (in the form of high expectations and low tolerance of the patient) determined class membership, although these findings were not significant after correcting for multiple testing. A higher BMI at treatment start was not sufficient to predict optimal clinical outcomes.ConclusionFirst episode cases of AN treated via FREED fit into four distinct early response trajectory classes. These may represent subtypes of first episode AN patients. Three of these four trajectories included patients with substantial improvements 1 year later. For those in the non-response trajectory class, treatment adjustments or augmentations could be considered earlier, i.e., at treatment session 12.

Trajectories of Vocational Recovery Among Persons with Severe Mental Illness Participating in a Randomized Three-Group Superiority Trial of Individual Placement and Support (IPS) in Denmark.

To investigate longitudinal trajectories of vocational recovery (VR) among individuals with severe mental illness (SMI) who participated in the Danish Individual Placement and Support (IPS) trial, and whether the IPS intervention, socio-demographic and disease-specific characteristics predicted trajectory membership. In an observational study design, we used previously collected data from the Danish IPS trial (N = 720). VR was defined as 'weeks in competitive employment or education in the past 6months and was measured after 0.5, 1, 1.5, 2 and 2.5years, using data from the Danish Register for Evaluation of Marginalization (DREAM) database. Latent growth mixture modelling in Mplus statistical software (version 7) was applied to identify trajectories of VR. Multinomial logistic regression analyses were used to estimate predictors for trajectory membership. Four trajectories were identified: 'Low VR' (61.3%), 'Low Increasing VR (8.2%), 'Increasing Decreasing VR' (7.2%) and 'High VR' (23.4%). Receiving the IPS intervention increased odds of membership in 'High VR' compared to 'Low VR' (OR = 2.18; 95% CI 1.37-3.48) and so did higher education (OR = 2.25; 95% CI 1.39-3.64), higher cognitive function (OR = 1.17; 95% CI 1.02-1.35), higher motivation to change (OR = 1.04; 95% CI 1.02-1.05) and previous work history (OR = 1.64; 95% CI 1.09-2.46). Higher age decreased odds of membership in the 'High VR' (OR = 0.95; 95% CI 0.93-0.98) compared to 'Low VR'. There was high heterogeneity in the identified VR trajectories, despite that all participants expressed a desire for work and education at baseline. Improvements of the IPS intervention are needed to support specific groups in achieving and retaining employment.

The Natural Course of Recovery After Hip Arthroscopy for Femoroacetabular Impingement According to the International Hip Outcome Tool–12 and Hip Outcome Score Sports Subscale

Background: A paucity of literature exists regarding trajectories of functional and sports-specific recovery after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To determine if subgroups of patients exist based on the recovery trajectory of patient-reported outcomes (PROs) after hip arthroscopy for FAIS in the short-term period and to determine clinical predictors for these subgroups of patients. Study Design: Case-control study; Level of evidence, 3. Methods: A prospectively maintained repository was queried for patients who had undergone primary hip arthroscopy for the treatment of FAIS between January 2012 and May 2018. Patients who completed the preoperative, 1-year, and 2-year International Hip Outcome Tool–12 (iHOT-12) or the Hip Outcome Score Sports Subscale (HOS-SS) were included. The latent class growth analysis (LCGA) and growth mixture models (GMMs) were used to identify subgroups of patients based on trajectories of recovery for the iHOT-12 and the HOS-SS utilizing preoperative, 1-year, and 2-year follow-ups. LCGA and GMM models using 1 to 6 classes for each PRO were performed, and the best-fit model for each PRO was selected. After final model selection, a multivariable multinomial logistic regression was performed, with the largest class being the reference group to determine clinical predictors of subgroup membership. Results: A total of 443 and 556 patients were included in the iHOT-12 and HOS-SS analyses, respectively. For the iHOT-12, we identified the following 3 subgroups: early progressors (70%), late regressors (22.3%), and late progressors (7.7%). Predictors of late regression were workers’ compensation status, psychiatric history, preoperative chronic pain, and lower preoperative iHOT-12 scores; and late progressors were less likely to participate in sports. For the HOS-SS, we identified the following 4 subgroups: early progressors (47.7%), late regressors (17.4%), late progressors (6.8%), and steady progressors (28.1%). Predictors of less favorable recovery trajectories (late regressors and late progessors) were older age, male sex, back pain, psychiatric history, preoperative chronic pain, greater alpha angle, and lower preoperative HOS-SS scores. Conclusion: Using the growth mixture modeling, 3 natural courses of health-related quality of life (early progression, late regression, and late progression) and 4 natural courses of recovery of athletic function (steady progression, late regression, late progression, and early progression) were identified. Preoperative psychiatric conditions, chronic pain, workers’ compensation status, and lower iHOT-12 scores were predictive of less than favorable trajectories of recovery according to the iHOT-12, and male sex, older age, back pain, preoperative narcotic use, and lower preoperative HOS-SS were predictors of less favorable recovery trajectories according to the HOS-SS.

Trajectories of posttraumatic growth in young and middle-aged stroke patients and their predictive effects on mental health.

The increasingly younger age of stroke onset has posed a serious threat to the physical and mental health of young and middle-aged adults. Young and middle-aged stroke patients often suffer from varying degrees of motor, cognitive, and language disabilities, which can trigger considerable psychological trauma. However, these patients may have certain posttraumatic growth (PTG). As a positive psychological experience, PTG provides a new entry point for clinical psychological interventions. Here, we explored the trajectories of PTG in young and middle-aged stroke patients and their predictive effects on mental health. A total of in 165 patients who were treated at our center from January to December 2019 were enrolled with randomized sampling. The survey was conducted at 5 times follow up through use of the Posttraumatic Growth Inventory (PTGI), Social Support Rating Scale (SSRS), and Symptom Checklist-90 (SCL-90). Data were analyzed by using the latent growth mixture modeling (LGMM). The PTG levels in young and middle-aged stroke patients showed a gradual increase (F=9.927; P<0.01). According to the relevant parameters of the trajectories, the subjects were divided into the high PTG group (n=43, 26.06%), low PTG group (n=25, 15.15%), rapidly increasing PTG group (n=47, 28.48%), and constantly decreasing PTG group (n=50 cases, 30.30%). Both the initial level and developmental rate of PTG had significantly negative predictive effects on SCL-90 score (B=-0.46, P<0.01; B=-0.31, P<0.01); in other words, they had positive predictive effects on mental health. There are different trajectories of PTG in young and middle-aged stroke patients, and the initial level and developmental speed of PTG have positive predictive effects on mental health in these patients.

Association between maternal vitamin D status with pregnancy outcomes and offspring growth in a population of Wuxi, China.

The role of maternal vitamin D in infantile growth remains unclear. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were examined for pregnancies who visited the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University from January 2016 to December 2017. Anthropometric measurements of corresponding offspring were performed from birth to 2 to 3 years old. Infantile body mass index (BMI) was transformed into age-, sex- and height- normalized z scores, and Latent Class Growth Mixture (LCGM) model was used to identify trajectories of BMI-Z. Among the 329 included pregnancy women, 109 (33.13 %), 190 (57.75%) and 30 (9.12%) were defined as vitamin D deficiency [25(OH)D <30 nmol/L], insufficiency [30 nmol/L≤25(OH)D<50 nmol/L] and sufficiency [25(OH)D ≥50 nmol/L], respectively. When compared with vitamin D sufficiency, maternal vitamin D deficiency was not associated with preterm birth [odds ratio (OR)=2.69, 95% confidence interval (95% CI)=0.57-12.80], small for gestation age (OR=0.99, 95% CI=0.29-3.46), and low birth weight (OR=1.69, 95% CI=0.34-8.51). Similarly, no significant relationships were found between maternal vitamin D concentrations and anthropometric indices (such as weight, length, BMI) during 0 to 3 years old. Furthermore, LCGM model identified two patterns of offspring growth: stable moderate BMI-Z and early transient BMI-Z groups. Maternal vitamin D levels were higher in the former group than the latter (p=0.037); however, maternal vitamin D status appeared to be unrelated with offspring BMI-Z trajectories in multivariable logistic regression models. Maternal vitamin D deficiency may not be related to adverse pregnancy outcomes as well as offspring growth.

Sick leave and return to work for patients with anxiety and depression: a longitudinal study of trajectories before, during and after work-focused treatment

ObjectivesSick leave due to anxiety and depression is a heterogeneous process constituting a pressing public health issue. This longitudinal study aimed to identify sick leave trajectories among patients before, during...