Latent Growth Mixture Modeling Research Articles

Depressive symptoms predict trajectories of electronic delivery nicotine systems, cigarette, and cannabis use across 4.5 years among college students

BackgroundThis study examined the role of depressive symptoms on trajectories of electronic nicotine delivery systems (ENDS), cigarette, and cannabis use across 4.5 years in a sample of college students aged 18–19 at the initial study wave. MethodsParticipants were 2,264 students enrolled in one of 24 Texas colleges that participated in a multi-wave study between 2014 and 2019. Latent growth mixture models were fit to identify longitudinal trajectories for past 30-day ENDS, cigarette, and cannabis use over a 4.5-year period. Class membership was regressed on baseline depressive symptoms in multinomial regression models. ResultsFour trajectory classes were identified for each product: abstainer/minimal, decreasing, increasing, and high. Depressive symptoms were associated with a greater likelihood of belonging to the decreasing, increasing, and high trajectory classes relative to the abstainer/minimal class for all products, with the exception of the increasing ENDS class and the decreasing cannabis class. DiscussionThe findings demonstrate that there is considerable similarity across trajectories of ENDS, cigarette, and cannabis use during traditional collegiate years. Furthermore, depressive symptoms increased the likelihood of belonging to substance using trajectory classes for all products.

Trajectories of Traumatic Stress Symptoms Among Siblings of Children With Cancer: The First Two Years Post-Diagnosis.

Identify and describe trajectories of cancer-related posttraumatic stress symptoms (PTSS) among siblings of children with cancer within two years of diagnosis. Siblings (aged 8-18; M = 11.2 years) across the United States, and for each, one caregiver, were recruited for a cohort sequential longitudinal study with three data collection points six months apart beginning at 6- or 12-months after cancer diagnosis. Siblings (N = 229; 42% of eligible/approached; 53% identifying as female; 68% identifying as non-Hispanic White) completed the Child Posttraumatic Stress Disorder Symptom Scale. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ). Latent class growth analysis (LCGA) and growth mixture modeling (GMM) identified PTSS patterns across time. Fit statistics supported models with three to five PTSS trajectories. The three-class LCGA model included a large mild PTSS group (61%), a moderate PTSS group (35%), and a small (4%) stable severe PTSS group. The four-class LCGA and three- and four-class GMM included groups improving from moderate to mild PTSS (7-21%) and worsening to moderate PTSS across time (12-17%). Across models, siblings with mild PTSS had fewer caregiver-reported emotional and behavioral difficulties on the SDQ. A large group of siblings of children with cancer demonstrate resiliency, however, substantial subsets experience patterns of PTSS that include levels in the moderate-to-severe range during the first two years post-diagnosis. Future research should examine these patterns in more diverse/representative samples and identify factors associated with increasing and sustained severe PTSS to inform intervention targets and reduce cancer-related burden on families.

Characteristics and Correlates of Ten-Year Trajectories of Posttraumatic Stress Symptoms in Older U.S. Military Veterans

ObjectivesTo examine the nature and correlates of 10-year trajectories of posttraumatic stress disorder (PTSD) symptoms in older U.S. military Veterans. Design and SettingA nationally representative web-based survey of older U.S. Veterans who participated in the National Health and Resilience in Veterans Study over 5 waves between 2011 and 2021. ParticipantsA total of 1,843 U.S. Veterans aged 50 and older (mean age = 67). MeasurementsPTSD symptoms were assessed using the PTSD Checklist. Self-report measures at baseline assessed sociodemographic characteristics; trauma exposures; psychiatric and substance use disorders; mental, cognitive, and physical functioning; and psychosocial factors including expectations of aging. Latent growth mixture modeling identified the nature and correlates of 10-year PTSD symptom trajectories. ResultsMost of the sample had no/low PTSD symptoms (88.7%), while 6.0% had consistently subthreshold symptoms, 2.7% consistently high symptoms, and 2.6% increasing symptoms. Relative to the no/low symptom group, the subthreshold and high symptom groups reported more medical conditions and cognitive difficulties, with younger age and more lifetime traumatic events additionally linked to the high symptom trajectory. Relative to the no/low symptom group, Veterans with increasing symptoms were more likely to report functional disability and lifetime nicotine use disorder, cognitive difficulties, negative expectations regarding physical and emotional aging, and traumatic events over the study period. ConclusionsDespite high rates of trauma exposure, most older Veterans do not evidence symptomatic PTSD trajectories; however, about 11% do. Results underscore the importance of assessing PTSD symptoms in this population and considering longitudinal trajectories as well as associated risk and protective factors.

Identifying patient subgroups with different trends of patient-reported outcomes (PROMs) after elective knee arthroplasty

BackgroundPatient-reported outcome measures (PROMs) are increasingly being used to assess the effectiveness of elective total knee arthroplasty (TKA). However, little is known about how PROMs scores change over time in these patients. The aim of this study was to identify the trajectories of quality of life and joint functioning, and their associated demographic and clinical features in patients undergoing elective TKA.MethodsA prospective, cohort study was conducted, in which PROMs questionnaires (Euro Quality 5 Dimensions 3L, EQ-5D-3L, and Knee injury and Osteoarthritis Outcome Score Patient Satisfaction, KOOS-PS) were administered to patients at a single center undergoing elective TKA before surgery, and at 6 and 12 months after surgery. Latent class growth mixture models were used to analyze the patterns of change in PROMs scores over time. Multinomial logistic regression was used to investigate the association between patient characteristics and PROMs trajectories.ResultsA total of 564 patients were included in the study. The analysis highlighted differential patterns of improvement after TKA. Three distinct PROMs trajectories were identified for each PROMs questionnaire, with one trajectory indicating the most favorable outcome. Female gender appears to be associated with a presentation to surgery with worse perceived quality of life and joint function than males, but also more rapid improvement after surgery. Having an ASA score greater than 3 is instead associated with a worse functional recovery after TKA.ConclusionThe results suggest three main PROMs trajectories in patients undergoing elective TKA. Most patients reported improved quality of life and joint functioning at 6 months, which then stabilized. However, other subgroups showed more varied trajectories. Further research is needed to confirm these findings and to explore the potential clinical implications of these results.

Longitudinal trajectories of dietary quality and cognitive functions in Chinese older adults: The Taiwan Initiative for Geriatric Epidemiological Research (TIGER) cohort study

AbstractBackgroundDietary factors influence cognitive functions, but most previous studies were conducted in Western settings and assessed diet only once. Trajectory analysis of diet measured at multiple timepoints can track changes in diet and identify subpopulations requiring more intervention efforts. We thus assessed associations between dietary trajectories and cognitive functions in an understudied Asian elderly population.MethodThe TIGER study involves non‐demented community‐dwelling participants aged ≥65 years recruited between 2011‐2013. Dietary intakes were assessed using a food frequency questionnaire during baseline and 4th‐ and 6th‐year follow‐ups. Modified Alternative Healthy Eating Index (mAHEI) scores (energy‐adjusted using the residual method) were generated at each timepoint to reflect diet quality. Longitudinal trajectories of dietary quality were derived using latent growth mixture modelling. The Montreal Cognitive Assessment—Taiwanese version was used to assess global cognition for outcomes. Cognitive functions (baseline‐normalized z‐scores) of four cognitive domains, i.e., memory, attention, executive function, and verbal fluency, were also assessed. Associations between trajectories of dietary quality and cognitive functions were assessed using linear regressions, adjusting for important covariates including sex, apolipoprotein (APOE) e4 status, baseline age, body mass index (BMI), and depressive symptoms.ResultIncluded participants (n = 356) were 54.2% female, had a mean age of 71.6 years, and a mean BMI of 23.8 kg/m2 at baseline. The overall mean mAHEI scores were close to 37 (out of 70 possible) at all three time points. Three trajectories of dietary quality, namely 1) ‘increasing’, 2) ‘decreasing’, and 3) ‘stable‐high’ were identified and deemed optimal considering fit indices and interpretability. Compared with ‘stable‐high’ dietary quality trajectory, the ‘increasing’ trajectory was associated with worse memory performance (adjusted‐β = ‐0.424; 95% CI: ‐0.679, ‐0.169; P = 0.001) whereas the ‘decreasing’ trajectory was associated with worse performance for the verbal fluency domain (adjusted‐β = ‐0.342; 95% CI: ‐0.653, ‐0.030; P = 0.031). No other significant associations were observed.ConclusionMaintaining a stable‐high dietary quality trajectory over time is associated with better cognitive functions among Taiwanese older adults. Since there is much room for dietary improvement in this Taiwanese population, interventions to promote and sustain better dietary quality over time can have substantial impacts on their cognitive functions.

Exacerbated PTSD symptoms among older U.S. military veterans during the COVID-19 pandemic: Results from the national health and resilience in veterans study

Research has demonstrated that the impact of the coronavirus 2019 (COVID-19) pandemic on the mental health of United States (U.S.) veterans was less negative than originally anticipated. However, U.S. veterans are susceptible to exacerbation of post-traumatic stress disorder (PTSD) symptomology in late life. The aims of this study were to examine the extent to which older U.S. veterans experienced an exacerbation of PTSD symptoms during the COVID-19 pandemic, and to identify pre- and peri-pandemic factors that conferred risk for symptom exacerbation. Participants were U.S. military veterans aged 60 and older who completed three waves of the 2019–2022 National Health and Resilience in Veterans Study (NHRVS) (n=1858). PTSD symptoms were measured at all waves using the PTSD Checklist for DSM-5, and a latent growth mixture model was conducted to compute latent slopes of change of PTSD symptoms over the 3-year period. 159 (8.3%) participants experienced a worsening of PTSD symptomology over the pandemic period. Factors related to PTSD exacerbation were incident trauma exposure between Waves 1 and 2, more medical conditions with onset prior to the pandemic, and peri-pandemic social restriction stress. Number of incident traumas moderated the relationship between both number of pre-pandemic medical conditions and pre-pandemic social connectedness, and exacerbated PTSD symptoms. These results suggest that the pandemic did not confer additional risk for PTSD exacerbation than would be expected over a 3-year period for older veterans. Those who experience incident trauma exposure should be monitored for symptom exacerbation.

Distinct patterns of adult transport-related physical activity (TRPA) behaviour exist independent of the TRPA behaviours of childhood: the childhood determinants of adult health study

BackgroundTransport-related physical activity (TRPA) is recognised as a potential means of increasing total physical activity participation that may yield substantial health benefits. Public health campaigns focusing on promoting TRPA from a young age aim to develop life-long healthy habits. However, few studies have examined how TRPA changes across the lifecourse and whether childhood TRPA levels influence those observed later in life.MethodsUsing the Australian Childhood Determinants of Adult Health study (baseline, 1985), latent class growth mixture modelling with adjustment for time-varying covariates was performed using four timepoints (ranging from 7 to 49 years) to assess behavioural patterns and retention of TRPA across the lifecourse. As child and adult adjusted TRPA measures could not be harmonised, trajectories of adult TRPA (n = 702) were instead identified, and log-binomial regression analysis was performed to determine whether childhood levels of TRPA (high/medium/low) influenced these trajectories.ResultsTwo stable groups of adult TRPA trajectories were identified: persistently low (n = 520; 74.2%), and increasingly high TRPA (n = 181; 25.8%). There was no significant relationship between childhood TRPA levels and patterns in adulthood (relative risk of high childhood TRPA yielding high adult TRPA trajectory membership = 1.06; 95% confidence interval = 0.95–1.09).ConclusionThis study found childhood TRPA levels were not associated with TRPA patterns in adulthood. These findings suggest that while TRPA in childhood may have health, social, and environmental benefits, it does not appear to impact adult TRPA directly. Therefore, further intervention is required beyond childhood to promote the implementation of healthy TRPA behaviours into adulthood.

Prevalence and factors associated with trajectories of antenatal depression: a prospective multi-center cohort study in Chengdu, China

BackgroundAntenatal depression (AD) is a major depressive disorder during pregnancy, which may lead to devastating sequelae for the expectant mothers and infants. This study aimed to investigate the prevalence, to analyze trajectory model based on EPDS score, and to explore the influence factors of AD among pregnant women in Chengdu, China.MethodsParticipants from four maternity hospitals in Chengdu, China were recruited when they had their first pregnancy medical check-up during March 2019 to May 2020. All participants were required to fill in Edinburgh Postnatal Depression Scale Chinese version (EPDS) once during three trimesters and provided information about their health status, social-demographic etc. The trajectory model, chi-square test and multivariate binary logistic regression were used to analyze all collected data.ResultsA total of 4560 pregnant women were recruited, while 1051 women completed the study. The prevalence of depression symptoms during the first, second and third trimesters were 32.92% (346/1051), 19.79% (208/1051) and 20.46% (215/1051) respectively. According to the results of the latent growth mixture modeling, the trajectory model of three categories based on EPDS score were identified in this study: low-risk group (38.2%, 401/1051), medium-risk group (54.8%, 576/1051) and high-risk group (7%, 74/1051). Good marital relationship (P = 0.007, OR = 0.33, 95% CI 0.147 ~ 0.74), good relationship with parents-in-law (P = 0.011, OR = 0.561, 95% CI 0.36 ~ 0.874), planned pregnancy (P = 0.018, OR = 0.681, 95% CI 0.496 ~ 0.936) were the protective factors while lower education level (P = 0.036, OR = 1.355, 95% CI 1.02 ~ 1.799), fear about dystocia (P = 0.0, OR = 1.729, 95% CI 1.31 ~ 2.283), recent major negative life events (P = 0.033, OR = 2.147, 95% CI 1.065 ~ 4.329) were the risk factors of medium-risk group. Good marital relationship (P = 0.005, OR = 0.2, 95% CI 0.065 ~ 0.615), good relationship with parents-in-law (P = 0.003, OR = 0.319, 95% CI 0.15 ~ 0.679) were also protective factors of high-risk group, but the risk factors for high-risk group were medical history (P = 0.046, OR = 1.836, 95% CI 1.011 ~ 3.334), pregnancy complications (P = 0.022, OR = 2.015, 95% CI 1.109 ~ 3.662), worry about dystocia (P = 0.003, OR = 2.365, 95% CI 1.347 ~ 4.153), recent major negative life events (P = 0.011, OR = 3.661, 95% CI 1.341 ~ 9.993). No protective or risk factors were identified for low-risk group.ConclusionEven the incidence and levels of depression in the first trimester of pregnancy were the highest, the probability of pregnancy women get depression during gestation period were higher than other population. Therefore, it’s important to monitor the psychological status of pregnant women during the whole pregnancy, especially in the first trimester. The study suggested a good partner relationship and good relations with parents-in-law both protected pregnant women from depression and promoted the well-being of mothers and children.

Baseline level and change trajectory of the triglyceride-glucose index in relation to the development of NAFLD: a large population-based cohort study.

Insulin resistance (IR) and nonalcoholic fatty liver disease (NAFLD) are closely related. The triglyceride-glucose index (TyG index) has been proposed as a new indicator of IR. It remains unclear whether the triglyceride-glucose (TyG) index is prospectively associated with incident nonalcoholic fatty liver disease (NAFLD). This large-scale study comprised 1 prospective cohort totaling 22,758 subjects without NAFLD at baseline who underwent repeated health examinations and 1 subcohort totaling 7,722 subjects with more than three visits. The TyG index was ascertained mathematically by ln (fasting triglycerides [mg/dL] × fasting glucose [mg/dL]/2). NAFLD was diagnosed by ultrasound without other concomitant liver diseases. A combinatorial Cox proportional hazard model and latent class growth mixture modeling method were used to identify the association of the TyG index and its transition trajectories with NAFLD risk. During 53,481 person-years of follow-up, there were 5319 incident cases with NAFLD. Compared with those in the lowest quartile of the baseline TyG index, participants in the highest quartile had 2.52-fold (95% confidence interval, 2.21-2.86) higher odds of incident NAFLD. Similarly, restricted cubic spline analysis showed a dose-response relationship (p nonlinearity<0.001). Subgroup analyses showed a more significant association in the female and normal body size populations (p for interaction<0.001). Three distinct trajectories of changes in the TyG index were identified. Compared with the continued low group, the moderately increasing and highly increasing groups conferred 1.91-fold (1.65-2.21) and 2.19-fold (1.73-2.77) higher NAFLD risk, respectively. Participants with a higher baseline TyG index or a higher excessive TyG exposure were associated with an increased NAFLD risk. The findings imply that lifestyle interventions and modulation of IR might be considered to both reduce TyG index levels and prevent NAFLD development.

Predictors and Functional Outcomes Associated With Longitudinal Trajectories of Anxiety and Depression from 2 to ≥36 Months After Moderate to Severe Traumatic Brain Injury.

This study investigated longitudinal trajectories of anxiety and depressive symptoms following moderate-severe traumatic brain injury (TBI), predictors of the trajectories, and associations with 1-year return to productivity. One hundred forty-eight patients with moderate-severe TBI were assessed at 2, 5, 12, and ≥36 months post-injury on the Beck Anxiety Inventory and the Beck Depression Inventory. Clinical interviews obtained information about demographics, injury characteristics, and 1-year return to productivity. Latent growth mixture modeling identified trajectories of anxiety and depression across time. The three-step method identified predictors of trajectories, and χ2 analyses determined associations between trajectories and 1-year return to productivity. Analyses revealed that four-class models of anxiety and depression best fit the data. Most individuals had stable minimal (67%) or low (18%) levels of anxiety over time. Two other subsets of individuals were classified by anxiety that worsened rapidly (7%) or improved in the 1st year but worsened by 3 years post-injury (9%). Similarly for the depression trajectories, most individuals had stable minimal (70%) or low (10%) levels of depression over time. Others had depression that worsened rapidly (12%) or was delayed, with onset 1-year post-injury (8%). Predictors of worsening anxiety and depression included younger age, less education, and male gender. Those with worsening anxiety or depression were less likely to return to productivity by 1-year post-injury. There is a significant burden of anxiety (15%) and depression (20%) in the 3 years after moderate-severe TBI. Future research targeting at-risk patients may help to improve quality of life and functional recovery.

Patient-reported mental health and well-being trajectories in oncology patients during radiation therapy: an exploratory retrospective cohort analysis using the Ontario Cancer Registry.

Mental health and well-being trajectories are not expected to be homogeneous in diverse clinical populations. This exploratory study aims to identify subgroups of patients with cancer receiving radiation therapy who have different mental health and well-being trajectories, and examine which socio-demographic, physical symptoms, and clinical variables are associated with such trajectories. Retrospective analysis of radiation therapy patients diagnosed with cancer in 2017 was conducted using data from the Ontario Cancer Registry (Canada) and linked with administrative health data. Mental health and well-being were measured using items from the Edmonton Symptom Assessment System-revised questionnaire. Patients completed up to 6 repeated measurements. We used latent class growth mixture models to identify heterogeneous mental health trajectories of anxiety, depression, and well-being. Bivariate multinomial logistic regressions were conducted to explore variables associated with the latent classes (subgroups). The cohort (N = 3416) with a mean age of 64.5years consisted of 51.7% females. Respiratory cancer was the most common diagnosis (30.4%) with moderate to severe comorbidity burden. Four latent classes with distinct anxiety, depression, and well-being trajectories were identified. Decreasing mental health and well-being trajectories are associated with being female; living in neighborhoods with lower income, greater population density, and higher proportion of foreign-born individuals; and having higher comorbidity burden. The findings highlight the importance of considering social determinants of mental health and well-being, in addition to symptoms and clinical variables, when providing care for patients undergoing radiation therapy.

Placenta DNA methylation levels of the promoter region of the leptin receptor gene are associated with infant cortisol

The intrauterine environment and early life stress regulation are widely recognized as an early foundation for lifelong physical and mental health. Methylation of CpG sites in the placenta represents an epigenetic modification that can potentially affect placental function, influence fetal development, and ultimately impact the health of offspring by programming the hypothalamic-pituitary-adrenal (HPA) axis stress response during prenatal development. Leptin, an adipokine produced by the placenta, is essential for energy homeostasis. It is also epigenetically regulated by promoter DNA methylation. Mounting evidence suggests that leptin also affects the stress response system. Though heterogeneity in the early stress response system may influence life-long mental and physical health, few studies explicitly examine the heterogeneity in the newborn stress response system. Less is known about leptin's association with the human hypothalamic-pituitary-adrenocortical (HPA) axis early in life. This study sought to serve as a proof of concept study investigating the relationship between newborn cortisol output trajectories and placental leptin DNA methylation in 117 healthy newborns from socioeconomically and racially- and ethnically-diverse families. We characterized heterogeneity in newborn cortisol output during the NICU Network Neurobehavioral Scales exam in the first week of life with latent growth mixture models. We then evaluated whether leptin promoter (LEP) methylation in placental samples was associated with newborn cortisol trajectories. Our findings suggest that increased placental LEP methylation, which corresponds to decreased leptin production, is associated with infant cortisol trajectories marked by increased cortisol output in the NNNS exam. These results provide important insights into the role of placental leptin DNA methylation in human newborn HPA axis development and subsequent developmental origins of health and disease processes.

중학생 비행 유형에 대한 초등학교 6학년 시점 예측요인 탐색

Objectives The purpose of this study is to classify middle school students accoring to the change of their delinquency measures and to find predictors of delinquency among variables in their 6th grade.&#x0D; Methods Using Gyeonggi Education Panel Study(GEPS) data for the elementary students panel from 3th year(6th grade in elementary school) to 6th year(3rd grade in middle school), latent growth mixture modeling was applied to classfy middle school students' pattern of delinquency changes, and multinomial logistic regression was conducted to find predictor variables.&#x0D; Results With latent growth mixture analyses, three latent classes were identified: ‘decreasing from high level’, ‘increasing from low level’, and ‘low-level’. The probability of class membership was significantly predicted by gender, physical self-concept, academic achievement, parental attachment, parental monitoring, and peer relationship.&#x0D; Conclusions It was suggested to develop a policy-based support system to affect variables in elementary school that predicts students' delinquency in middle school and that teachers in elementary schools can detect easily. Specifically, an early intervention for students with low academic achievement was suggested as an effective approach to prevent delinquency.

Longitudinal trajectories of dietary quality and cognitive performance in older adults: Results from a 6-year cohort study

Diet affects cognitive performance, but most previous studies only assessed diet once. Trajectory analysis of diet measured at multiple timepoints can identify subpopulations requiring more interventional efforts. We thus assessed associations between dietary trajectories and cognitive performance in older adults. This was a 6-year prospective cohort study involving 356 ethnically Chinese, non-demented, community-dwelling older adults recruited between 2011 and 2013. At baseline and at 4th- and 6th-year follow-ups, dietary intakes of the participants were assessed using food frequency questionnaires. Dietary quality was graded using the modified Alternative Healthy Eating Index (mAHEI) with seven components; longitudinal trajectories of dietary quality were derived using latent growth mixture modelling. Outcomes were global- and domain-specific cognitive performance (attention, memory, executive functions, and verbal fluency). Multivariable regressions adjusting for important covariates (sex, age, energy intake, APOE risk alleles, depressive symptoms, and body mass index (BMI)) assessed associations between the dietary trajectories and cognitive outcomes. Included participants had a mean age of 71.6 years and a mean BMI of 23.8kg/m2. Three mutually exclusive dietary quality trajectories, namely "deteriorating", "improving", and "stable-high", were derived. Compared with the stable-high trajectory, the improving trajectory was associated with a lower z-score for the memory domain (β:-0.403; 95% CI:-0.656,-0.151; P=0.002), which was consistently observed for the four individual tests of the domain (β range:-0.324 to-0.448; all P<0.05). In unadjusted analysis, the deteriorating trajectory was associated with a 0.369 lower z-score for the verbal fluency domain (95% CI:-0.700,-0.039 P=0.028), though attenuated to borderline significance with adjustment for covariates. Sex and BMI modified some of these associations. No other associations were observed for global cognition or other cognitive domains. In Taiwanese older adults, consistently high dietary quality is associated with better cognitive performance. Interventions to promote and sustain better dietary quality over time can have substantial impacts on cognitive function.

Changes in UK parental mental health symptoms over 10months of the COVID-19 pandemic.

The threats to health, associated restrictions and economic consequences of the COVID-19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home-schooling their children and other caring responsibilities. Yet, it remains unclear how parental mental health has changed throughout the pandemic or what factors may have mitigated or compounded the impact of the pandemic on parents' mental health. We examined monthly survey data from two linked UK-based longitudinal studies: COVID-19: Supporting Parents, Adolescents and Children during Epidemics' (Co-SPACE) and COVID-19: Supporting Parents and Young Children during Epidemics' (Co-SPYCE). Data from 5576 parents/carers of 2-17-year-old children collected between April 2020 and January 2021 was analysed using mixed-effect modelling and latent class growth (mixture) modelling. Parental stress and depression, but not anxiety, were higher during the periods of restrictions. This pattern was most pronounced for parents with primary-school-aged children, those that worked at home or had other adults in the household. Being younger, reporting secondary or below education, working out of home, having secondary-school-aged children or children with special education needs (SEN)/neurodevelopmental disorders (ND) further moderated whether, how and when parental mental health symptoms changed. Although around three quarters of parents reported consistently low mental health symptoms, a substantial minority reported consistently high or increasing symptoms of anxiety, stress and depression. The latter were more likely to be parents who were younger than average, were a single adult in the household, had a pre-existing mental health diagnosis or had a child with special educational needs or a ND. These findings emphasise how different personal circumstances and pre-existing inequalities shaped how parents were affected by this unprecedented global pandemic and highlight the need for support and consideration to meet the needs of families in the future.

Long-term trajectories of depressive symptoms and machine learning techniques for fall prediction in older adults: Evidence from the China Health and Retirement Longitudinal Study (CHARLS)

BackgroundFalls are the most common adverse outcome of depression in older adults, yet a accurate risk prediction model for falls stratified by distinct long-term trajectories of depressive symptoms is still lacking. MethodsWe collected the data of 1617 participants from the China Health and Retirement Longitudinal Study register, spanning between 2011 and 2018. The 36 input variables included in the baseline survey were regarded as candidate features. The trajectories of depressive symptoms were classified by the latent class growth model and growth mixture model. Three data balancing technologies and four machine learning algorithms were utilized to develop predictive models for fall classification of depressive prognosis. ResultsDepressive symptom trajectories were divided into four categories, i.e., non-symptoms, new-onset increasing symptoms, slowly decreasing symptoms, and persistent high symptoms. The random forest-TomekLinks model achieved the best performance among the case and incident models with an AUC-ROC of 0.844 and 0.731, respectively. In the chronic model, the gradient boosting decision tree-synthetic minority oversampling technique obtained an AUC-ROC of 0.783. In the three models, the depressive symptom score was the most crucial component. The lung function was a common and significant feature in both the case and the chronic models. ConclusionsThis study suggests that the ideal model has a good chance of identifying older persons with a high risk of falling stratified by long-term trajectories of depressive symptoms. Baseline depressive symptom score, lung function, income, and injury experience are influential factors associated with falls of depression evolution.

Association of body roundness index and its trajectories with all-cause and cardiovascular mortality among a Chinese middle-aged and older population: A retrospective cohort study.

The body roundness index (BRI) is a novel anthropometric index that is a better indicator for predicting fat distribution than the body mass index (BMI). The longitudinal study can repeatedly collect measured results for the variables to be studied and then consider the potential effects of intraindividual changes in measurement. However, few population-based, longitudinal studies of BRI have been conducted, especially among the Chinese population. The study aimed to investigate the association of BRI and its longitudinal trajectories with all-cause and cardiovascular mortality. A total of 71,166 participants with four times BRI measurements between January 2010 and December 2019 were included in this longitudinal study, with a median follow-up was 7.93 years, and 11,538 deaths were recorded, of which 5,892 deaths were due to cardiovascular disease (CVD). A latent class growth mixture modeling (LCGMM) was used to identify BRI trajectories. Cox proportional hazard models were used to estimate associations between BRI trajectories and the risk of all-cause and cardiovascular mortality. In the restricted cubic spline regression models, a U-shaped relationship between BRI and all-cause and cardiovascular mortality was observed. Three BRI longitudinal trajectories of low-stable (mean BRI = 2.59), moderate-stable (mean BRI = 3.30), and high-stable (mean BRI = 3.65) were identified by LCGMM. After being adjusted for potential confounders, the HRs for all-cause mortality were 1.18 (1.13-1.24) for the moderate-stable group and 1.74 (1.66-1.82) for the high-stable group compared to the low-stable group. The HRs for cardiovascular mortality were 1.12 (1.05-1.18) for the moderate-stable group and 1.64 (1.53-1.75) for the high-stable group compared to the low-stable group. A nonlinear association of BRI with all-cause and cardiovascular mortality was observed, and participants in the higher BRI longitudinal trajectory group were significantly associated with an increased risk of all-cause and cardiovascular mortality.

Classification and prediction of cognitive trajectories of cognitively unimpaired individuals.

Efforts to prevent Alzheimer's disease (AD) would benefit from identifying cognitively unimpaired (CU) individuals who are liable to progress to cognitive impairment. Therefore, we aimed to develop a model to predict cognitive decline among CU individuals in two independent cohorts. A total of 407 CU individuals from the Alzheimer's Disease Neuroimaging Initiative (ADNI) and 285 CU individuals from the Samsung Medical Center (SMC) were recruited in this study. We assessed cognitive outcomes by using neuropsychological composite scores in the ADNI and SMC cohorts. We performed latent growth mixture modeling and developed the predictive model. Growth mixture modeling identified 13.8 and 13.0% of CU individuals in the ADNI and SMC cohorts, respectively, as the "declining group." In the ADNI cohort, multivariable logistic regression modeling showed that increased amyloid-β (Aβ) uptake (β [SE]: 4.852 [0.862], p < 0.001), low baseline cognitive composite scores (β [SE]: -0.274 [0.070], p < 0.001), and reduced hippocampal volume (β [SE]: -0.952 [0.302], p = 0.002) were predictive of cognitive decline. In the SMC cohort, increased Aβ uptake (β [SE]: 2.007 [0.549], p < 0.001) and low baseline cognitive composite scores (β [SE]: -4.464 [0.758], p < 0.001) predicted cognitive decline. Finally, predictive models of cognitive decline showed good to excellent discrimination and calibration capabilities (C-statistic = 0.85 for the ADNI model and 0.94 for the SMC model). Our study provides novel insights into the cognitive trajectories of CU individuals. Furthermore, the predictive model can facilitate the classification of CU individuals in future primary prevention trials.

Associations of polygenic risk scores with posttraumatic stress symptom trajectories following combat deployment.

Identification of genetic risk factors may inform the prevention and treatment of posttraumatic stress disorder (PTSD). This study evaluates the associations of polygenic risk scores (PRS) with patterns of posttraumatic stress symptoms following combat deployment. US Army soldiers of European ancestry (n = 4900) provided genomic data and ratings of posttraumatic stress symptoms before and after deployment to Afghanistan in 2012. Latent growth mixture modeling was used to model posttraumatic stress symptom trajectories among participants who provided post-deployment data (n = 4353). Multinomial logistic regression models tested independent associations between trajectory membership and PRS for PTSD, major depressive disorder (MDD), schizophrenia, neuroticism, alcohol use disorder, and suicide attempt, controlling for age, sex, ancestry, and exposure to potentially traumatic events, and weighted to account for uncertainty in trajectory classification and missing data. Participants were classified into low-severity (77.2%), increasing-severity (10.5%), decreasing-severity (8.0%), and high-severity (4.3%) posttraumatic stress symptom trajectories. Standardized PTSD-PRS and MDD-PRS were associated with greater odds of membership in the high-severity v. low-severity trajectory [adjusted odds ratios and 95% confidence intervals, 1.23 (1.06-1.43) and 1.18 (1.02-1.37), respectively] and the increasing-severity v. low-severity trajectory [1.12 (1.01-1.25) and 1.16 (1.04-1.28), respectively]. Additionally, MDD-PRS was associated with greater odds of membership in the decreasing-severity v. low-severity trajectory [1.16 (1.03-1.31)]. No other associations were statistically significant. Higher polygenic risk for PTSD or MDD is associated with more severe posttraumatic stress symptom trajectories following combat deployment. PRS may help stratify at-risk individuals, enabling more precise targeting of treatment and prevention programs.

Patient-Reported Symptom Severity, Health-Related Quality of Life, and Emotional Distress Trajectories During and After Radiation Therapy for Human Papillomavirus–Associated Oropharyngeal Cancer: A TROG 12.01 Secondary Analysis

This secondary analysis of clinical trial TROG 12.01, involving patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma, aimed to identify patient-reported outcome (PRO) trajectories before, during, and after chemoradiotherapy. Head and neck cancer symptom severity (HNSS) and interference (HNSI), generic health-related quality of life (HRQL), and emotional distress were assessed with the MD Anderson Symptom Inventory-Head and Neck, Functional Assessment of Cancer Therapy-General, and Hospital Anxiety and Depression Scale questionnaires, respectively. Latent class growth mixture modeling (LCGMM) was used to identify distinct underlying trajectories. Baseline and treatment variables were compared between trajectory groups. The LCGMM identified latent trajectories for all PROs: HNSS, HNSI, HRQL, anxiety, and depression. Four HNSS trajectories (HNSS1-4) were identified, distinguished by differences in HNSS at baseline, during the peak of treatment symptoms, and during early and intermediate recovery. All trajectories were stable beyond 12 months. The reference trajectory (HNSS4, n=74) score was 0.1 (95% confidence interval [CI], 0.1-0.2) at baseline, peaking at 4.6 (95% CI, 4.2-5.0), with rapid early recovery (1.1; 95% CI, 0.8-2.2) and gradual improvement to 12 months (0.6; 95% CI, 0.5-0.8). Patients in HNSS2 (high baseline, n=30) reported higher baseline scores (1.4; 95% CI, 0.8-2.0) but were otherwise similar to HNSS4. Patients in HNSS3 (low acute, n=53) reported reduced acute symptoms (2.5; 95% CI, 2.2-2.9) with stable scores beyond 9 weeks after chemoradiotherapy (1.1; 95% CI, 0.9-1.4). Patients in HNSS1 (slow recovery, n=25) had slower recovery from an acute peak of 4.9 (95% CI, 4.3-5.6) to 0.9 (95% CI, 0.6-1.3) at 12 months. Age, performance status, education, receipt of cetuximab, and baseline anxiety varied between trajectories. The other PRO models demonstrated clinically relevant trajectories, with distinct associations with baseline factors. LCGMM identified distinct PRO trajectories during and after chemoradiotherapy. These and their associations with variations in the characteristics and treatment factors of patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma provide clinically relevant insights into identifying patients who may require increased support before, during, or after chemoradiotherapy.