Lower Symptoms Research Articles

Latent class analysis of post-acute sequelae of SARS-CoV-2 infection.

Symptoms post-SARS-CoV-2 infection may persist for months and cause significant impairment and impact to quality of life. Acute symptoms of SARS-CoV-2 infection are well studied, yet data on clusters of symptoms over time, or post-acute sequelae of SARS-CoV-2 infection (PASC), are limited. We aim to characterize PASC phenotypes by identifying symptom clusters over a six-month period following infection in individuals vaccinated (boosted and not) and those unvaccinated. Subjects with ≥1 self-reported symptom and positive RT-PCR for SARS-CoV-2 at CVS Health US test sites were recruited between January and April 2022. Patient-reported outcomes symptoms, health-related quality of life (HRQoL), work productivity and activity impairment (WPAI) were captured at 1 month, 3 months, and 6 months post-acute infection. Phenotypes of PASC were determined based on subject matter knowledge and balanced consideration of statistical criteria (lower AIC, lower BIC, and adequate entropy) and interpretability. Generalized estimation equation approach was used to investigate relationship between QoL, WPAI and number of symptoms and identified phenotypes, and relationship between phenotypes and vaccination status as well. LCA identified three phenotypes that are primarily differentiated by number of symptoms. These three phenotypes remained consistent across time periods. Subjects with more symptoms were associated with lower HRQoL, and worse WPAI scores. Vaccinated individuals were more likely to be in the low symptom burden latent classes at all time points compared to unvaccinated individuals.

Abstract 4120274: Symptom cluster profiles predict all-cause mortality among U.S. community-dwelling older adults with heart failure

Background: Individual symptoms are predictors of mortality in adults with heart failure (HF). However, symptom clusters may be more predictive of future risks than isolated symptoms, yet research on these symptom clusters in older adults with HF is limited. Aims: To explore the extent to which symptom cluster profiles predict all-cause mortality among community-dwelling older adults with HF, while adjusting for known risk factors. Methods: We conducted a secondary analysis of data of the 2008 to 2016 surveys of the U.S. Health and Retirement Study using latent class analysis to identify baseline cluster profiles, and survival analysis for time to death with Cox proportional hazard (Cox PH) models, and Kaplan Meier survival analyses. Results: We included 684 participants [mean age=74.9, (SD=10) years, 56.6% female, 16.2% Black/African American]. Three baseline symptom cluster profiles were identified: high-burden (pain, shortness of breath, fatigue, swelling, depressive symptoms, dizziness), low-burden, and cardiopulmonary-depressive (shortness of breath, pain, and dizziness). The estimated median time-to-death was 71 (95% CI=64, 79) months. Of the 364 participants in the cardiopulmonary-depressive profile, 240 (65.9%) died (median time= 65 months, 95% CI= 55, 73) compared to those in the low-burden profile, of which 49% died. Approximately 61% in the high burden profile died (median time=67 months, 95% CI= 51, 90). A significant difference in survival times between the 3 cluster profiles was found (Log-rank= 9.13, p = 0.01). In the adjusted Cox PH model, participants in the high symptom burden and respiratory-depressive distress profiles had adjusted HR of 1.48 (95% CI=1.15, 1.94) and 1.44 (95% CI=1.14, 1.80) compared to those in the low burden symptom cluster profile, after controlling for age, gender, smoking, and comorbidities. Conclusions: The identified symptom cluster profiles predict 8-year all-cause mortality in older adults with HF, after controlling for known risk factors. An evaluation of symptom clusters, rather than individual symptoms, may provide additive prognostic information.

Low perceived social support in mothers during pregnancy and early childhood; associations with anxiety and ADHD symptoms in children at 3 and 8 years.

Low perceived social support is associated with adverse effects on maternal mental health, and often coexists with other risk factors for offspring anxiety and attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate whether low maternal social support during pregnancy and early childhood predicted anxiety and ADHD symptoms in children at ages 3.5 and 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father, and Child Cohort Study. Mothers were queried about perceived social support twice during pregnancy, and again at child ages 18 months and 3 years. They were interviewed about their children's symptoms of anxiety and ADHD at 3.5 years. At 8 years (n = 781), the Child Symptom Inventory-4 was used to identify children who fulfilled the criteria for anxiety disorders and ADHD. Logistic regression models estimated the risk of child anxiety and ADHD, depending on maternal social support. Low maternal social support predicted child anxiety symptoms at both ages 3.5 and 8 years as well as ADHD symptoms at 8 years. When including other maternal stressors and child risk factors, low maternal social support remained a significant predictor for child anxiety symptoms at 3.5 years, and there was a trend towards also predicting child anxiety and ADHD symptoms at 8 years. The associations between low maternal social support and child symptoms of anxiety and ADHD found in the present study, suggest that focusing on mothers with low social support may hold significance for child symptoms years later.

Unveiling Frequency-Specific Microstate Correlates of Anxiety and Depression Symptoms.

Electroencephalography (EEG) microstates are canonical voltage topographies that reflect the temporal dynamics of brain networks on a millisecond time scale. Abnormalities in broadband microstate parameters have been observed in subjects with psychiatric symptoms, indicating their potential as clinical biomarkers. Considering distinct information provided by specific frequency bands of EEG, we hypothesized that microstates in decomposed frequency bands could provide a more detailed depiction of the underlying neuropathological mechanism. In this study, with a large open access resting-state dataset (n = 203), we examined the properties of frequency-specific microstates and their relationship with anxiety and depression symptoms. We conducted clustering on EEG topographies in decomposed frequency bands (delta, theta, alpha and beta), and determined the number of clusters with a meta-criterion. Microstate parameters, including global explained variance (GEV), duration, coverage, occurrence and transition probability, were calculated for eyes-open and eyes-closed states, respectively. Their ability to predict the severity of depression and anxiety symptoms were systematically identified by correlation, regression and classification analyses. Distinct microstate patterns were observed across different frequency bands. Microstate parameters in the alpha band held the best predictive power for emotional symptoms. Microstates B (GEV, coverage) and parieto-central maximum microstate E (coverage, occurrence, transitions from B to E) in the alpha band exhibited significant correlations with depression and anxiety, respectively. Microstate parameters of the alpha band achieved predictive R-square of 0.100 for anxiety scores, which is much higher than those of broadband (R-square = -0.026, p < 0.01). Similar results were found in classification of participants with high and low anxiety symptom scores (68% accuracy in alpha vs. 52% in broadband). These results suggested the value of frequency-specific microstates in predicting emotional symptoms.

A Nature-Based Intervention and Mental Health of Schoolchildren: A Cluster Randomized Clinical Trial.

Nature-based therapeutic or preventive interventions for mental health are increasingly popular, but their effectiveness for improving mental health is not well documented. To investigate the effectiveness of the Open Sky School Program (École à Ciel Ouvert), a 12-week nature-based intervention for elementary schoolchildren in grades 5 and 6, for reducing mental health symptoms. This 2-arm, cluster randomized clinical trial was conducted from February 27 to June 16, 2023, in French-language elementary schools in Quebec, Canada, with green space within 1 km. Participants were teachers and students in grades 5 and 6. In the intervention group, for 2 hours per week for 12 weeks, classes were taught outdoors in a nearby park or wooded area. Teachers were encouraged to engage students in basic subjects and in 10 or more mental health activities (mindfulness, philosophy, and/or art therapy). Control group schools conducted classes as usual. The primary outcome was change in student mental health (internalizing and externalizing symptoms, social problems) based on teacher- and student-reported 30-item Social Behavior Questionnaire (SBQ) scores (3-point scale) from baseline to the immediate postintervention follow-up, assessed in per-protocol and intent-to-treat mixed-model analyses. Secondary outcomes were student self-reported changes in depressive symptoms, positive or negative affect, pro-environmental efforts and/or attitudes, and nature connectedness. A total of 33 schools participated (53 teachers, 1015 students), including 16 schools (25 teachers, 515 students) in the intervention group and 17 schools (28 teachers, 500 students) in the control group. Student mean (SD) age was 10.9 (0.75) years; 507 (50.7%) were girls. Per-protocol and intent-to-treat mixed-model analyses showed no differences in mental health symptom change between groups; for example, the adjusted mean difference in SBQ scores between the intervention and control groups for externalizing symptoms was -0.04 (95% CI, -0.13 to 0.04) in the intent-to-treat analysis and -0.06 (95% CI, -0.16 to 0.04) in the per-protocol analysis. Post hoc analyses revealed low mental health symptoms at baseline, with low variability. Slightly greater reductions in symptoms were observed in the intervention group, but only for children with higher mental health symptoms at baseline (P < .05 for interaction). For example, for children with internalizing symptoms 1 SD above the mean at baseline, internalizing symptoms decreased by 0.38 SD (mean change, -0.15; P < .001) in the intervention group vs the control group. In this large cluster randomized clinical trial in daily-life elementary school settings, 12 weeks of classes in green space for 2 hours per week did not reduce mental health symptoms in students aged 10 to 12 years in either the per-protocol or the intent-to-treat analysis. However, this low-cost, safe outdoor intervention may provide unmeasured or longer-term benefits for children with higher risk of mental health symptoms. ClinicalTrials.gov Identifier: NCT05662436.

Interaction Effects Between Low Self-Control and Meaning in Life on Internet Gaming Disorder Symptoms and Functioning in Chinese Adolescents: Cross-Sectional Latent Moderated Structural Equation Modeling Study.

Internet gaming disorder (IGD) is an emerging behavioral addiction with mental health implications among adolescents. Low self-control is an established risk factor of IGD. Few studies have, however, examined the moderating role of meaning in life (MIL) on the relationships between low self-control and IGD symptoms and functioning. This study aimed to examine the effects of low self-control and MIL and their interaction effects on IGD symptoms and family and school functioning in a structural equation model. A sample of 2064 adolescents (967, 46.9% male; mean age 14.6 years) was recruited by multistage cluster random sampling from 5 middle schools in Sichuan, China, in 2022. The participants completed a self-report questionnaire with validated measures on low self-control, presence of MIL, search for MIL, IGD symptoms, school commitment, and family functioning. Construct validity, measurement invariance, and structural invariance of the measures were evaluated by confirmatory factor analysis across sex. Structural equation modeling was conducted to examine the indirect effects of low self-control and MIL on family and school functioning through IGD symptoms. Latent moderated structural equation modeling was performed to examine the interaction effects between low self-control and MIL on IGD symptoms, school commitment, and family functioning. All scales showed satisfactory model fit and scalar measurement invariance by sex. Males showed significantly greater IGD symptoms and lower levels of self-control (Cohen d=0.25-1.20, P<.001) than females. IGD symptoms were significantly and positively associated with impulsivity (β=.20, P=.01), temper (β=.25, P<.001), and search for meaning (β=.11, P=.048) and significantly and negatively associated with presence of meaning (β=-.21, P<.001). Presence of MIL and impulsivity showed a significant and negative interaction effect (β=-.11, SE .05; P=.03) on IGD symptoms. The positive effect of impulsivity on IGD symptoms was stronger among adolescents with low presence of MIL than those with high presence of MIL. Temper showed significant and positive interaction effects with presence of MIL (β=.08, SE .04; P=.03) and search for MIL (β=.08, SE .04; P=.04) on family functioning. The negative effects of temper on family functioning were stronger among adolescents with low levels of MIL than among those with high levels of MIL. This study provides the first findings on the interaction effects between low self-control and presence of MIL and search for MIL on IGD symptoms and functioning among a large sample of adolescents in rural China. The results have implications for targeted interventions to help male adolescents with lower self-control and presence of meaning.

Patterns and relationships of prolonged grief, post-traumatic stress, and depressive symptoms in Chinese shidu parents: Latent profile and network analyses

Parents who experience the trauma of losing an only child are called “shidu” parents in China. There are individual differences in post-loss outcomes.1,061 Chinese shidu parents were asked to complete questionnaires assessing prolonged grief, post-traumatic stress, and depressive symptoms. The mean age of the sample was 59.68 (SD = 7.52), with the average time since the loss was 9.46 years (SD = 7.05). Most participants were female (62.3%). The main cause of the loss was an unnatural case (52.7%). Latent profile analysis was used to identify similar symptom patterns. Network analysis was used to explore the relationships among symptoms within different subgroups. A two-profile model based on symptom severity identified a “low symptom severity” subgroup (n = 419) and a “high symptom severity” subgroup (n = 642). In the low symptom severity subgroup network, the most central symptoms were loss of interest, feeling numb, and meaninglessness. In the high symptom severity subgroup network, the most central symptoms were physiological cue reactivity, emotional pain, and feeling easily startled. Individual differences in the post-loss outcomes of Chinese shidu parents are reflected not only in symptom patterns but also in the relationships among symptoms.

Tree Nut Crop Response to Simulated Florpyrauxifen-benzyl and Triclopyr Herbicide Drift

California is the nation’s primary producer of almonds, pistachios, and walnuts, and an important producer of rice. Because of California’s diverse cropping systems, off-target herbicide drift can be a considerable problem, particularly from aerial applications that are commonly used in flooded rice production systems. Triclopyr is an auxin-mimic type herbicide that has been commonly used in rice for many years for control of broadleaf weeds and the industry is familiar with symptoms of off-target triclopyr drift. Florpyrauxifen-benzyl is a newly registered auxin-mimic herbicide in California rice with activity on key weeds and is being rapidly adopted. Although symptoms typically are similar among auxinic herbicides, it is important to understand subtle differences and risks among these herbicides as stewardship for newly registered products. This research was conducted in 2020 and 2021 to determine the relative sensitivity of almond, pistachio, and walnut trees to simulated drift rates of florpyrauxifen-benzyl and triclopyr as well as characterize and compare symptoms caused by these two herbicides. The fractional herbicide rates tested were 1/200X, 1/100X, 1/33X, and 1/10X of the florpyrauxifen-benzyl use rate of 29.4 g·ha−1 a.i. and 1/200X, 1/100X, and 1/33X of the triclopyr use rate of 420.3 g·ha−1 a.e. Florpyrauxifen-benzyl and triclopyr herbicides were applied directly to one side of the canopy of 1- to 2-year-old almond, pistachio, and walnut trees. The general symptoms of florpyrauxifen-benzyl and triclopyr were chlorosis, chlorotic spots, leaf curling, leaf narrowing, leaf distortion, leaf malformation, leaf crinkling, shoot curling, stem coloring, stunting, terminal bud death, and twisting. The florpyrauxifen-benzyl and triclopyr injury symptoms were compared at the same fractional rates and found to be similar to each other. The herbicide injury was observed on the entire pistachio canopy, particularly on developing leaves and terminal buds. In contrast, injury symptoms on almond and walnut were more apparent on the side of the canopy to which the herbicides were applied. Symptom severity peaked at 14 days after treatment with the 1/10X florpyrauxifen-benzyl rate, when the visible injury was 16%, 48%, and 78% on almond, walnut, and pistachio, respectively. Although almond and walnut symptoms from the 1/10X florpyrauxifen-benzyl rate remained visible longer than all other treatments, all trees gradually recovered throughout the growing season. In contrast, pistachio trees did not recover fully and had injury symptoms that persisted for the remainder of the treatment year and at leaf-out the following spring. When drift occurs, it is typically at rates below 1/100X up to 1/33X of herbicide use rates. This research suggested that proper herbicide drift management practices and application precautions are likely to minimize the risk of significant injury from florpyrauxifen-benzyl drift to almond and walnut because of low injury symptoms at the typical drift rates. However, extra precautions may be needed if there are nearby pistachio orchards.

High levels of glycated haemoglobin (HbA1c) are associated with lower knee joint cartilage quality and higher knee joint symptoms in healthy individuals.

In an asymptomatic population, we investigated the relationships between glycated haemoglobin (HbA1c) and cartilage T2 relaxation time at the knee joint level. Fourteen and 17 participants with high and normal levels of HbA1c were recruited, respectively. A blood sample was used to determine the HbA1c level. T2 relaxation time (T2) of the superficial and deep parts of the femoral cartilage in the anterior, central, and posterior topographical sites was calculated using magnetic resonance (1.5T) images. Each participant completed a knee injury and osteoarthritis outcome score questionnaire (KOOS) and a series of biomechanical analyses while running at their self-selected speed. The group with a high level of HbA1c had a lower score of KOOS symptoms than the other group (P < 0.05). HbA1c was found to be negatively related to the KOOS symptoms score. The group with a high level of HbA1c had low T2 values in all of the investigated topographical sites of the knee femoral cartilage (P < 0.05 in all cases). T2 was negatively correlated with HbA1c levels in all investigated knee femoral cartilage regions. Our data suggest that the subjects with high levels of HbA1c were those with low knee joint symptoms and lower values of T2. These results indicate that HbA1c could be correlated with cartilage deterioration due to its ability to dehydrate collagen fibre, possibly acting as a risk factor for the development of osteoarthritis.

Identifying transdiagnostic and multidimensional prognostic indicators among veterans with PTSD symptoms in brief integrated care settings.

Brief integrated care settings hold promise for accessible and effective trauma-informed interventions. However, clinicians often have difficulty efficiently forecasting who is most appropriate for interventions in such settings and how to target individualized care. Multidimensional and transdiagnostic evaluations may provide valuable information to improve stepped-care and treatment practices for veterans. A middle-out approach was used to concurrently evaluate self-reported posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and physical health problems using cross-sectional (latent profile analysis) and longitudinal (latent growth mixture modeling) analyses that identified unique symptom profiles, trajectories of traumatic stress reactions, and correlates of these health outcomes. Data from 234 veterans who participated in a randomized controlled trial of primary care PTSD intervention were analyzed at 0, 8, 16, and 24 weeks. Latent profile analysis identified two homogenous baseline profiles: global symptoms (33.8%); low dysphoria-lower negative cognitions, mood, and depressive symptoms (66.2%). Low dysphoria participants reported more social relationships (OR = 1.32) and fewer environmental (OR = 0.89) and financial (OR = 0.23-0.35) stressors. Latent growth mixture modeling identified three trajectories: (a) reducing symptoms ("responders"; 21.3%) and chronic symptoms of (b) moderate (59.6%) and (c) high (19.1%) severity. Low dysphoria participants were 4.35 times more likely to be responders over time compared to participants with moderate severity symptoms. Findings indicated that veterans with moderate PTSD symptoms and physical health problems but low dysphoria may respond best to trauma-informed intervention in brief integrated care settings, while others may require further individualized stepped care. Findings demonstrate unique traumatic stress reactions that support individualized stepped care and may offer greater treatment utilization, retention, and efficacy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prenatal exposure to phthalates and children’s mental health trajectories: Rhea Cohort, Greece

Abstract Background Accumulating evidence suggests that phthalate exposure affects neurodevelopment, including emotional and behavioral outcomes. Our aim was to investigate if prenatal phthalate exposure affects the developmental course of internalizing and externalizing symptoms from early childhood to adolescence. Methods Concentrations of seven phthalate metabolites were measured in first-trimester maternal spot urine samples, and DEHP, and high and low molecular weight phthalate concentrations were calculated (HMW and LMW, respectively). Mothers reported internalizing and externalizing symptoms via the Strengths and Difficulties Questionnaire at 4 years and the Child Behavior Checklist at 6, 11 and 15 years. Group-Based Trajectory Modeling was used to classify 546 participants of the Rhea Cohort (Crete, Greece) into 4 distinct groups (Stable low, Stable high, Low-Increasing, and High-Decreasing symptoms). We evaluated the association of prenatal phthalate exposure with the odds of an adverse (Stable high, Low-Increasing, and High-Decreasing) internalizing and externalizing symptom trajectory in 150 children using multivariable-adjusted logistic regression (reference group: stable low). Results Only for girls, exposure to DEHP and HMW phthalates was associated with higher odds of being grouped in an adverse internalizing symptoms trajectory (OR [95%CI]: 1.52 [1.03, 2.25] and 1.57 [1.03, 2.39], respectively). Regarding externalizing symptoms, interactions with gender emerged for DEHP (p = 0.024) and HMW (p = 0.028) phthalates, and increased odds of being grouped into an adverse trajectory were observed in girls, whereas boys showed the opposite trend, albeit none reached statistical significance. Conclusions The findings suggest programming effects of prenatal phthalate exposure on the developmental course of emotional symptoms in girls. Further research is needed to clarify the association between in utero phthalate exposure and behavioral symptoms. Key messages • Phthalate exposure is linked to adverse trajectories of emotional symptoms, emerging from preschool age and up to adolescence. • Phthalate effect on internalizing and externalizing symptoms varies by gender.

Persistent organic pollutants and developmental trajectories of ADHD symptoms: The Rhea cohort study

Abstract Background Prenatal exposure to persistent organic pollutants (POPs) has been linked to elevated symptoms related to attention deficit hyperactivity disorder (ADHD) in a few studies, but findings remain inconclusive. We aimed to explore how prenatal exposure to POPs affects the developmental course of ADHD symptoms from early childhood to adolescence in the Rhea cohort in Crete, Greece. Methods We determined concentrations of HCB, DDE, and PCBs in first-trimester maternal serum. Child ADHD symptoms were reported by mothers using the ADHD Test at 4 years and the Conners’ Parent Rating Scale at 6, 11 and 15 years. Group-Based Trajectory Modeling was used to classify 551 participants into 4 distinct groups: Stable low (60.1%), Stable high (9.6%), Low-increasing (14.6%), and High-decreasing (15.7%) symptoms. Adjusted multinomial regression models were applied to assess the risk of being grouped into an adverse developmental trajectory as compared to the reference group (stable low), in relation to prenatal POP exposure in 465 children. The analyses were performed in sex-specific manner. Results Prenatal HCB exposure was associated with elevated risk of being grouped in the stable high ADHD symptoms trajectory only in girls (RRR [95%CI]: 2.0 [1.04, 3.82]). Overall, exposure to DDE and sum of PCBs was linked to decreased risk of membership in an adverse ADHD symptoms trajectory. More specifically, in utero exposure to DDE and sum of PCBs was associated with lower risk of being grouped in the low-increasing trajectory for boys (RRR [95%CI]: 0.7 [0.54, 0.95] and 0.5 [0.32, 0.88], respectively) and in the high-decreasing symptoms group for girls (RRR [95%CI]: 0.6 [0.44, 0.84] and 0.5 [0.30, 0.93], respectively). Conclusions The findings suggest that prenatal exposure to HCB is linked to increased risk of stable high ADHD symptoms from preschool age and up to adolescence. The association was pronounced only in girls, a group for which less is understood in relation to ADHD. Key messages • Prenatal exposure to HCB increases the risk of persistently high ADHD symptoms from preschool age to adolescence. • The impact of prenatal HCB exposure on ADHD symptoms is evident in girls.

Optimism mitigated impacts of pre-operative depression and anxiety on post-operative distress in cardiac patients

ABSTRACT Both anxiety and depression are comorbid mortality risks in middle-aged and older patients with heart diseases. Open-heart surgery (OHS), a life-altering procedure, can induce psychological distress that impedes postoperative recovery. Extensive research has shown the health benefit of optimism, an indicator of hope—a Character Strength in positive psychology. It predicts low mortality in cardiovascular disease—the number one killer of all Americans. Few studies, however, have explored whether that optimism mitigates the negative impact of preoperative depression and anxiety on postoperative general psychological distress. This interdisciplinary clinical study evaluated a hypothetical model of these relationships prior to and 1 month following OHS in 311 U.S. patients using a three-wave survey. Structural equation modeling (SEM) was performed to predict post-OHS general psychological distress. Optimism was indicated by two subscales in the Life Orientation Test (LOT). Based on the definition, general psychological distress was indicated by low symptom levels of somatization, depression, and anxiety as measured by the SCL-90 subscales. The final solution demonstrated a good fit. Optimism alleviates the negative effects of preoperative depression and anxiety, as indicators of poor mental health, on postoperative distress. Both older age and female gender were positively and directly associated with higher levels of post-OHS symptoms. The finding supports the beneficial role of optimism in mitigating the damage of poor mental health in the postoperative outcome of cardiac patients. The desirable function of character strength hope suggests that health providers should be attentive to and enhance inner strength for reducing the distress of cardiac patients in the postoperative recovery month.

Trajectories of depressive symptoms in early to mid-adolescence: associations with school pedagogical and social climate.

Adolescence is a critical period for mental health development, yet research exploring how contextual factors influence the development of depressive symptoms remains limited. This study explored trajectories of depressive symptoms during early to mid-adolescence and their association with various aspects of school climate. The study sample comprised 3671, 7th-grade students (aged 12-13 years) from 101 schools across Sweden, followed longitudinally across three time points spanning grades 7, 8 and 9. Depressive symptom trajectories were identified using latent class growth modelling. The Pedagogical and Social Climate questionnaire assessed school climate, and multinomial logistic regression was employed to predict trajectory membership based on sociodemographic and school climate factors. Four distinct developmental patterns of depressive symptoms emerged: 'Sustained low symptoms' (76.7%), 'Low-increasing' (10.9%), 'Sustained high symptoms' (7.9%), and 'High-decreasing' (4.5%). Gender, parental education and six specific school climate factors, out of the total 19 examined, significantly distinguished these trajectory classes. Positive teacher expectations and strong principal involvement were associated with more favourable trajectories, whereas teaching activities, teacher support and communication between school and home were associated with less favourable trajectories, suggesting a nuanced understanding of their relationship with depressive symptom trajectories. Few school factors were found to be relevant to depressive symptoms, highlighting the importance of considering external factors beyond the school environment in supporting adolescents during this developmental stage. Although the findings are multifaceted, it is primarily positive interpersonal relationships, especially through teacher expectations, that stand out as significant factors in promoting youth mental health.

Identifying Clusters of Curatively-Treated Esophageal Cancer Patients Using Patient-Reported Outcome Measures at Three Months from Discharge: A Secondary Analysis from a Longitudinal Single Center Study.

This study aims to identify meaningful clusters based on Patient-Reported Outcome Measures (PROMs) in curatively-treated esophageal cancer patients at three months post-discharge. This secondary analysis of a longitudinal single-center study included 46 esophageal cancer patients who underwent curative surgery. Patients were selected based on their completion of PROMs surveys at three months post-discharge, were aged 18 years or older, and had undergone surgical resection (esophagectomy) with or without neoadjuvant chemotherapy and/or radiotherapy. The analysis utilized t-distributed Stochastic Neighbor Embedding (t-SNE) for dimensionality reduction and hierarchical clustering to analyze PROMs data collected three months post-discharge. Clustering was performed on physical, emotional, cognitive, and social functioning variables, symptom burden, and health literacy. Three distinct clusters were identified: Cluster 1 (n = 24) with higher functioning and moderate symptoms, Cluster 2 (n = 14) with moderate functioning, higher symptoms, and lower health literacy, and Cluster 3 (n = 8) with the highest functioning, lowest symptoms, and highest health literacy. Significant differences between squamous cell carcinoma and adenocarcinoma subtypes were observed across several PROMs domains, including critical health literacy, general health status/quality of life, nausea and vomiting, and insomnia. These clusters provide an exploratory framework for tailoring post-operative interventions to enhance patient recovery, which necessitates further confirmatory investigations, including outcomes such as complications and mortality, in the analysis. This study fills a research gap by demonstrating the utility of PROMs in identifying distinct recovery patterns in esophageal cancer patients post-surgery. The findings support the use of PROMs to guide personalized post-operative care, potentially improving patient outcomes and quality of life. Further research is needed to validate these findings in larger, diverse populations.

"It Isn't What I Had to Do, It's What I Get to Do": The Experiences of Black Family Caregivers Managing Dementia.

Black family caregivers of persons with dementia experience high levels of stress that can negatively affect caregiver health outcomes and reduce caregiving capacity. However, Black caregivers tend to report low levels depressive symptoms or other negative health effects. This qualitative descriptive study aimed to identify factors that contribute to resilience among Black family caregivers. Using the rigorous and accelerated data reduction (RADaR) technique to complete thematic analysis, a team of five coders examined transcript data from three focus groups of Black current and former family caregivers (n = 17) of persons with dementia. We identified three primary factors that contributed to caregiver resilience including access to supportive environments, adaptability, and planning skills. Caregiver resistance to reporting depressive symptoms may be attributed to the strong Black woman schema. Findings from this study may be used to develop future culturally responsive interventions that support caregivers and promote family health.

Obsessive-compulsive symptom trajectories from pregnancy through the postpartum: examining longitudinal course and risk factors during the COVID-19 pandemic.

The peripartum is a time of increased risk for the development or worsening of obsessive-compulsive (OC) symptoms. Existing evidence suggests that OC symptoms commonly surge immediately postpartum followed by a gradual recovery. Yet how societal conditions, such as a widespread public health crisis, may affect this pattern remains unknown. Increased OC symptom prevalence in the general population during the COVID-19 pandemic coupled with the pre-existing vulnerability of peripartum women suggests they may have been at particularly high risk for sustained symptoms. Thus, the aim of the current study was to examine trajectories in OC symptoms, particularly contamination concerns, in women who gave birth during the COVID-19 pandemic, and to look at risk and resiliency factors that may influence symptom course METHODS: A sample of 164 US pregnant women were recruited during the COVID-19 pandemic. They reported OC symptoms at 3 timepoints: April/May, 2020, July, 2020, and February, 2022. We used a growth mixture modeling approach to examine OC symptom trajectories from pregnancy through the postpartum across these timepoints, comparing the goodness of fit of models with 1-5 trajectory classes for overall OC symptoms and for contamination-related OC symptoms. For total OC symptoms, two classes of trajectories were identified: recovering (29.27%) versus stable low (70.73%) symptoms; for contamination symptoms alone, a subset of total symptoms, three trajectories were identified: recovering (8.54%), stable low symptoms (68.29%), and stable high symptoms (23.17%). Peripartum stress, but not sociodemographic or obstetric factors, predicted class membership. These findings suggest that peripartum OC symptoms, particularly related to contamination, may persist beyond the postpartum period in some women, particularly for women exposed to elevated stress in pregnancy and the postpartum.

A Latent Class Analysis of Nutrition Impact Symptoms in Cancer Survivors

Those with a cancer diagnosis report experiencing a wide range of nutrition impact symptoms, the prevalence of which varies by study, group, and cancer type. We aimed to identify groups of cancer survivors with specific patterns of nutrition impact symptoms. Two hundred and twenty-nine individuals attending oncology day ward and outpatient clinics completed a series of questionnaires and physical measurements. A latent class analysis was performed to identify subgroups based on 13 nutrition impact symptoms taken from the Patient Generated Subjective Global Assessment short form. The identified classes were subsequently compared using analysis of variance and chi-square tests, by sociodemographic, clinical and nutritional variables, and by the Global Health Status (GHS) and five functioning scales determined using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Three latent subtypes were identified: (1) Fatigue (n = 58, 28%); (2) Low Symptom Burden (n = 146, 64%), and (3) High Symptom Burden (n = 25, 11%). Those in the High Symptom Burden group were more likely to be female, were currently receiving some form of treatment, were diagnosed ≥two years, and had consumed less food than usual in the last month compared to those in the Low Symptom Burden group. Those in the Fatigue group were less likely to have reported their food intake to be unchanged and more likely to be diagnosed ≥two years than those in the Low Symptom Burden group. The EORTC-QLQ-C30 functioning and GHS scores were all significantly different between the three nutrition impact symptoms classes (p &lt; 0.001). This is the first study to examine heterogeneity of nutrition impact symptoms in Irish cancer survivors. The findings of this work will inform and allow for more individualised nutrition care. By tailoring interventions to these specific groups, we can enhance the precision of care, improve prognostic accuracy, and significantly elevate the quality of life of survivors. This work underscores the critical importance of symptom management in the continuum of cancer care, ensuring that every survivor receives comprehensive support tailored to their unique journey.

Knowledge of Acute Coronary Syndrome Symptoms and the Intention to Call Emergency Medical Services in Culturally and Linguistically Diverse Australians

Prompt recognition of symptoms and response to acute coronary syndrome (ACS) are crucial for reducing pre-hospital delay. This study compares culturally and linguistically diverse (CALD) and non-CALD Australian populations in terms of their (i) ACS symptom knowledge and (ii) intention to call emergency medical services (EMS) for ACS. This cross-sectional study used data from HeartWatch, an online survey collected by the National Heart Foundation of Australia between 2018 and 2020 for Australian adults aged ≥18 years. CALD respondents were defined as non-Indigenous individuals who reported speaking a language other than English at home. Characteristics associated with ACS symptom knowledge and EMS calling intentions were analysed using multivariable logistic regression. Of 31,919 respondents, 16.3% were from CALD backgrounds (n=5,212). Compared with non-CALD, CALD respondents were less likely to name any ACS symptom (63.0% vs 76.0%; adjusted odds ratio [AOR] 0.66; 95% confidence interval [CI] 0.61-0.70) and were less likely to state that they would call an ambulance for ACS (50.2% vs 72.1%; AOR 0.53; 95% CI 0.50-0.57). Almost one-quarter (23.0%) of CALD respondents reported not knowing what they would do. In both groups, males, individuals aged ≤60 years, and those with diabetes were less likely to name an ACS symptom and had lower intention to call an ambulance. Those unable to list a single ACS symptom also had a lower intention to call an ambulance. Knowledge of ACS symptoms and intention to call an ambulance were lower among CALD respondents. The demographics of those with low ACS symptom knowledge and EMS calling intention were similar in the two groups. Future education efforts in Australia should focus on promoting ACS symptom knowledge and EMS use and should target these groups.

Heterogeneity in the association between social support and mental distress in old-age retirees – a computational approach using longitudinal cohort data

BackgroundMental distress among retirees and older people is a severe public health challenge, and information on new risk groups is needed. This study aims to identify subgroups of old-age retirees with varying associations between low social support and mental distress by applying model-based recursive partitioning (MOB).MethodsWe used the Helsinki Health Study follow-up survey data of old-age retired former municipal sector employees of the City of Helsinki, Finland. Phase 1 data were collected in 2000–2002, when all participants were employed, Phase 2 in 2007, Phase 3 in 2012, Phase 4 in 2017, and Phase 5 in 2022 (n = 4,466, 81% women). Social support and covariates were measured at each Phase 1–5 and the outcome, mental distress (Depression Anxiety Stress Scales [DASS-21]) was measured at a single occasion, during Phase 5. The three subscales and the common factor of general distress were analysed separately. An approach rooted in computational statistics was used to investigate risk factor heterogeneity in the association of low social support and mental distress. MOB combines decision trees with regression analysis to identify subgroups with the most significant heterogeneity among risk factors.ResultsMedian (IQR) general distress score from DASS-21 was 5.7 (3.0, 9.0), while Social Support Questionnaire number-score (SSQN) was 1.5 (1.15, 2.05). The primary effect modifier for the association between social support and general distress was education (p < 0.001). Those with high education had a different association of low social support and general distress than those with low or medium education. Additionally, the subgroup with low and medium education had a significant effect modification for age (p = 0.01). For the association between low social support and depressive symptoms, the moderating effect of education was dependent on gender, as men with medium–high education had the weakest association, while for women with medium–high education the association was strongest.ConclusionsOur results suggest that stratification by sociodemographic variables is justifiable when investigating risk factors of mental distress in old-age retirees. The incongruent association of low social support and depressive symptoms in men with medium–high education compared to women with medium–high education is a promising target for confirmatory research.