Publications by authors named "Diana Paksarian"

25 Publications

  • Page 1 of 1

Associations of Social Capital with Mental Disorder Prevalence, Severity, and Comorbidity among U.S. Adolescents.

J Clin Child Adolesc Psychol 2021 Mar 3:1-12. Epub 2021 Mar 3.

Intramural Research Program, National Institute of Mental Health.

: To examine cross-sectional associations between social capital constructs and 1) adolescent lifetime mental disorders, 2) severity of functional impairment, and 3) psychiatric comorbidity.: Data were from the National Comorbidity Survey Adolescent Supplement, a nationally representative mental health survey of 6,483 U.S. adolescents aged 13-18 years. Information from fully-structured diagnostic interviews, including adolescent and caregiver reports, was used to measure seven social capital constructs and lifetime DSM-IV mental disorders (mood, anxiety, behavior, substance use and eating disorder classes). Disorder severity was divided into severe vs. mild/moderate. Comorbidity was measured as the number of different classes of lifetime mental disorders.: Adjusted for socio-demographics and caregivers' mental health, the most consistent associations with adolescent mental disorder were for supportive friendships (any disorder OR = 0.95, 95%CI = 0.91-0.99), family cohesion (OR = 0.81, 95%CI = 0.75-0.86), school bonding (OR = 0.76, 95%CI = 0.71-0.81), and extracurricular participation (OR = 0.90, 95%CI = 0.86-0.95), although results differed by disorder class. Caregiver-reported neighborhood trust and reciprocity and caregiver community involvement were less consistently associated with mental disorder. Medium levels of adolescent-reported affiliation with neighbors was associated with lower odds of mood (OR = 0.81, 95%CI = 0.66-0.98) and anxiety (OR = 0.78, 95%CI = 0.64-0.96) disorder, while high levels were associated with higher odds of behavior disorder (OR = 1.47, 95%CI = 1.16-1.87). Several associations were stronger for severe vs. mild/moderate disorder and with increasing comorbidity.: Although we cannot infer causality, our findings support the notion that improving actual and/or perceived social capital, especially regarding friendships, family, and school, (e.g., through multimodal interventions) could aid in the prevention and treatment of both individual adolescent mental disorders and psychiatric comorbidity.
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http://dx.doi.org/10.1080/15374416.2021.1875326DOI Listing
March 2021

The Coronavirus Health and Impact Survey (CRISIS) reveals reproducible correlates of pandemic-related mood states across the Atlantic.

medRxiv 2020 Aug 27. Epub 2020 Aug 27.

The COVID-19 pandemic and its social and economic consequences have had adverse impacts on physical and mental health worldwide and exposed all segments of the population to protracted uncertainty and daily disruptions. The CoRonavIruS health and Impact Survey (CRISIS) was developed for use as an easy to implement and robust questionnaire covering key domains relevant to mental distress and resilience during the pandemic. In the current work, we demonstrate the feasibility, psychometric structure and construct validity of this survey. We then show that pre-existing mood states, perceived COVID risk, and lifestyle changes are strongly associated with negative mood states during the pandemic in population samples of adults and in parents reporting on their children in the US and UK. Ongoing studies using CRISIS include international studies of COVID-related ill health conducted during different phases of the pandemic and follow-up studies of cohorts characterized before the COVID pandemic.
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http://dx.doi.org/10.1101/2020.08.24.20181123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457620PMC
August 2020

Association of Outdoor Artificial Light at Night With Mental Disorders and Sleep Patterns Among US Adolescents.

JAMA Psychiatry 2020 Jul 8. Epub 2020 Jul 8.

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland.

Importance: Indoor nighttime light exposure influences sleep and circadian rhythms and is known to affect mood-associated brain circuits in animals. However, little is known about the association between levels of nighttime outdoor light and sleep and mental health in the population, especially among adolescents.

Objective: To estimate associations of outdoor artificial light at night (ALAN) with sleep patterns and past-year mental disorder among US adolescents.

Design, Setting, And Participants: This population-based, cross-sectional study of US adolescents used the National Comorbidity Survey-Adolescent Supplement, a nationally representative cross-sectional survey conducted from February 2001 through January 2004. A probability sample of adolescents aged 13 to 18 years was included. Analyses were conducted between February 2019 and April 2020.

Exposures: Levels of outdoor ALAN, measured by satellite, with means calculated within census block groups. ALAN values were transformed into units of radiance (nW/cm2/sr).

Main Outcomes And Measures: Self-reported habitual sleep patterns (weeknight bedtime, weeknight sleep duration, weekend bedtime delay, and weekend oversleep) and past-year mood, anxiety, behavior, and substance use disorders, measured via an in-person structured diagnostic interview. Parent-reported information was included in behavior disorder diagnoses.

Results: Among 10 123 adolescents (4953 boys [51.3%]; mean [SE] age, 15.2 [0.06] years [weighted]; 6483 for behavior disorder outcomes), ALAN was positively associated with indicators of social disadvantage, such as racial/ethnic minority status (median [IQR] ALAN: white adolescents, 12.96 [30.51] nW/cm2/sr; Hispanic adolescents: 38.54 [47.84] nW/cm2/sr; non-Hispanic black adolescents: 37.39 [51.88] nW/cm2/sr; adolescents of other races/ethnicities: 30.94 [49.93] nW/cm2/sr; P < .001) and lower family income (median [IQR] ALAN by family income-to-poverty ratio ≤1.5: 26.76 [52.48] nW/cm2/sr; >6: 21.46 [34.38] nW/cm2/sr; P = .005). After adjustment for several sociodemographic characteristics, as well as area-level population density and socioeconomic status, this study found that higher ALAN levels were associated with later weeknight bedtime, and those in the lowest quartile of ALAN reported the longest weeknight sleep duration. Those in the highest quartile of ALAN went to bed 29 (95% CI, 15-43) minutes later and reported 11 (95% CI, 19-2) fewer minutes of sleep than those in the lowest quartile. ALAN was also positively associated with prevalence of past-year mood and anxiety disorder: each median absolute deviation increase in ALAN was associated with 1.07 (95% CI, 1.00-1.14) times the odds of mood disorder and 1.10 (95% CI, 1.05-1.16) times the odds of anxiety disorder. Further analyses revealed associations with bipolar disorder (odds ratio [OR], 1.19 [95% CI, 1.05-1.35]), specific phobias (OR, 1.18 [95% CI, 1.11-1.26]), and major depressive disorder or dysthymia (OR, 1.07 [95% CI, 1.00-1.15]). Among adolescent girls, differences in weeknight bedtime by ALAN (third and fourth quartiles vs first quartile) were greater with increasing years since menarche (F3, 8.15; P < .001).

Conclusions And Relevance: In this study, area-level outdoor ALAN was associated with less favorable sleep patterns and mood and anxiety disorder in adolescents. Future studies should elucidate whether interventions to reduce exposure to ALAN may positively affect mental and sleep health.
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http://dx.doi.org/10.1001/jamapsychiatry.2020.1935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344797PMC
July 2020

Problematic internet use in children and adolescents: associations with psychiatric disorders and impairment.

BMC Psychiatry 2020 05 27;20(1):252. Epub 2020 May 27.

Healthy Brain Network, Child Mind Institute, New York, NY, USA.

Background: Problematic internet use (PIU) is an increasingly worrisome issue, as youth population studies are establishing links with internalizing and externalizing problems. There is a need for a better understanding of psychiatric diagnostic profiles associated with this issue, as well as its unique contributions to impairment. Here, we leveraged the ongoing, large-scale Child Mind Institute Healthy Brain Network, a transdiagnostic self-referred, community sample of children and adolescents (ages 5-21), to examine the associations between PIU and psychopathology, general impairment, physical health and sleep disturbances.

Methods: A total sample of 564 (190 female) participants between the ages of 7-15 (mean = 10.80, SD = 2.16), along with their parents/guardians, completed diagnostic interviews with clinicians, answered a wide range of self-report (SR) and parent-report (PR) questionnaires, including the Internet Addiction Test (IAT) and underwent physical testing as part of the Healthy Brain Network protocol.

Results: PIU was positively associated with depressive disorders (SR: aOR = 2.43, CI: 1.22-4.74, p = .01; PR: aOR = 2.56, CI: 1.31-5.05, p = .01), the combined presentation of ADHD (SR: aOR = 1.91, CI: 1.14-3.22, p = .01; PR: n.s.), Autism Spectrum Disorder (SR: n.s.; PR: aOR = 2.24, CI: 1.34-3.73, p < .001), greater levels of impairment (SR: Standardized Beta = 4.63, CI: 3.06-6.20, p < .001; PR: Standardized Beta = 5.05, CI: 3.67-6.42, p < .001) and increased sleep disturbances (SR: Standardized Beta = 3.15, CI: 0.71-5.59, p = .01; PR: Standardized Beta = 3.55, CI: 1.34-5.75, p < .001), even when accounting for demographic covariates and psychiatric comorbidity.

Conclusions: The association between PIU and psychopathology, as well as its impact on impairment and sleep disturbances, highlight the urgent need to gain an understanding of mechanisms in order to inform public health recommendations on internet use in U.S. youth.
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http://dx.doi.org/10.1186/s12888-020-02640-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251845PMC
May 2020

Adolescent residential mobility, genetic liability and risk of schizophrenia, bipolar disorder and major depression.

Br J Psychiatry 2020 07;217(1):390-396

National Center for Register-Based Research, Business and Social Sciences, Aarhus University; and The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark.

Background: Residential mobility during upbringing, and especially adolescence, is associated with multiple negative mental health outcomes. However, whether associations are confounded by unmeasured familial factors, including genetic liability, is unclear.

Aims: We used a population-based case-cohort study to assess whether polygenic risk scores (PRSs) for schizophrenia, bipolar disorder and major depression were associated with mobility from ages 10-14 years, and whether PRS and parental history of mental disorder together explained associations between mobility and each disorder.

Method: Information on cases (n = 4207 schizophrenia, n = 1402 bipolar disorder, n = 18 215 major depression) and a random population sample (n = 17 582), born 1981-1997, was linked between Danish civil and psychiatric registries. Genome-wide data were obtained from the Danish Neonatal Screening Biobank and PRSs were calculated based on results of separate, large meta-analyses.

Results: PRSs for schizophrenia and major depression were weakly associated with moving once (odds ratio 1.07, 95% CI 1.00-1.16; and odds ratio 1.10, 95% CI 1.04-1.17, respectively), but not twice or three or more times. Mobility was positively associated with each disorder, with more moves associated with greater risk. Adjustment for PRS produced slight reductions in the magnitude of associations. Adjustment for PRS and parental history of mental disorder together reduced estimates by 5-11%. In fully adjusted models mobility was associated with all three disorders; hazard ratios ranged from 1.33 (95% CI 1.08-1.62; one move and bipolar disorder) to 3.05 (95% CI 1.92-4.86; three or more moves and bipolar disorder).

Conclusions: Associations of mobility with schizophrenia, bipolar disorder and depression do not appear to be attributable to genetic liability as measured here. Potential familial confounding of mobility associations may be predominantly environmental in nature.
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http://dx.doi.org/10.1192/bjp.2020.8DOI Listing
July 2020

Trends in the Prevalence and Incidence of Attention-Deficit/Hyperactivity Disorder Among Adults and Children of Different Racial and Ethnic Groups.

JAMA Netw Open 2019 11 1;2(11):e1914344. Epub 2019 Nov 1.

Center for the Developing Brain, Child Mind Institute, New York, New York.

Importance: An increasing prevalence of adult attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment has been reported in clinical settings and administrative data in the United States. However, there are limited data on recent trends of adult ADHD diagnosis among racial/ethnic subgroups.

Objective: To examine trends, including associated demographic characteristics, psychiatric diagnoses, and negative outcomes, in the prevalence and incidence of adult ADHD diagnosis among 7 racial/ethnic groups during a 10-year period.

Design, Setting, And Participants: This cohort study investigated trends in the diagnosis of ADHD in adults who identified as African American or black, Native American, Pacific Islander, Latino or Hispanic, non-Hispanic white, Asian American, or other using the Kaiser Permanente Northern California health plan medical records. A total of 5 282 877 adult patients and 867 453 children aged 5 to 11 years who received care at Kaiser Permanente Northern California from January 1, 2007, to December 31, 2016, were included. Data analysis was performed from January 2017 through September 2019.

Exposures: Period of ADHD diagnosis.

Main Outcomes And Measures: Prevalence and incidence of licensed mental health clinician-diagnosed ADHD in adults and prevalence of licensed mental health clinician-diagnosed ADHD in children aged 5 to 11 years.

Results: Of 5 282 877 adult patients (1 155 790 [21.9%] aged 25-34 years; 2 667 562 [50.5%] women; 2 204 493 [41.7%] white individuals), 59 371 (1.12%) received diagnoses of ADHD. Prevalence increased from 0.43% in 2007 to 0.96% in 2016. Among 867 453 children aged 5 to 11 years (424 449 [48.9%] girls; 260 236 [30.0%] white individuals), prevalence increased from 2.96% in 2007 to 3.74% in 2016. During the study period, annual adult ADHD prevalence increased for every race/ethnicity, but white individuals consistently had the highest prevalence rates (white individuals: 0.67%-1.42%; black individuals: 0.22%-0.69%; Native American individuals: 0.56%-1.14%; Pacific Islander individuals: 0.11%-0.39%; Hispanic or Latino individuals: 0.25%-0.65%; Asian American individuals: 0.11%-0.35%; individuals from other races/ethnicities: 0.29%-0.71%). Incidence of ADHD diagnosis per 10 000 person-years increased from 9.43 in 2007 to 13.49 in 2016. Younger age (eg, >65 years vs 18-24 years: odds ratio [OR], 0.094; 95% CI, 0.088-0.101; P < .001), male sex (women: OR, 0.943; 95% CI, 0.928-0.959; P < .001), white race (eg, Asian patients vs white patients: OR, 0.248; 95% CI, 0.240-0.257; P < .001), being divorced (OR, 1.131; 95% CI, 1.093-1.171; P < .001), being employed (eg, retired vs employed persons: OR, 0.278; 95% CI, 0.267-0.290; P < .001), and having a higher median education level (OR, 2.156; 95% CI, 2.062-2.256; P < .001) were positively associated with odds of ADHD diagnosis. Having an eating disorder (OR, 5.192; 95% CI, 4.926-5.473; P < .001), depressive disorder (OR, 4.118; 95% CI, 4.030-4.207; P < .001), bipolar disorder (OR, 4.722; 95% CI, 4.556-4.894; P < .001), or anxiety disorder (OR, 2.438; 95% CI, 2.385-2.491; P < .001) was associated with higher odds of receiving an ADHD diagnosis. Adults with ADHD had significantly higher odds of frequent health care utilization (OR, 1.303; 95% CI, 1.272-1.334; P < .001) and sexually transmitted infections (OR, 1.289; 95% CI 1.251-1.329; P < .001) compared with adults with no ADHD diagnosis.

Conclusions And Relevance: This study confirmed the reported increases in rates of ADHD diagnosis among adults, showing substantially lower rates of detection among minority racial/ethnic subgroups in the United States. Higher odds of negative outcomes reflect the economic and personal consequences that substantiate the need to improve assessment and treatment of ADHD in adults.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.14344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826640PMC
November 2019

Environmental noise and sleep and mental health outcomes in a nationally representative sample of urban US adolescents.

Environ Epidemiol 2019 Aug 13;3(4):e056. Epub 2019 Aug 13.

Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, California.

Background: Environmental noise has been linked to negative health outcomes, like poor sleep, poor mental health, and cardiovascular disease, and likely accounts for more than 1 million disability-adjusted life years annually in Western Europe. Adolescence may be a particularly sensitive period for noise exposure due to an increased need for sleep, failure to meet sleep guidelines, and increased risk for first onset of some mental health disorders. However, the potential health effects of living in high-noise environments have not been studied in US adolescents, rarely in European adolescents, and mental health outcomes studied have not corresponded to diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Methods: Using a US-based nationally representative survey of urban adolescents (N = 4,508), we estimated associations of day-night average sound levels exceeding the US Environmental Protection Agency's 55 decibel limit with sleep outcomes and lifetime mental health DSM diagnoses. We implemented doubly robust targeted minimum loss-based estimation coupled with propensity score matching to account for numerous potential adolescent, household, and environmental confounders.

Results: Living in a high- versus low-noise Census block group was associated with later bedtimes on weeknights (0.48 hours, 95% confidence interval [CI] = -0.15, 1.12) and weekend nights (0.65 hours, 95% CI = 0.37, 0.93), but not with total hours slept. Associations between living in a high- versus low-noise Census block group and mental disorders were mixed, with wide CIs, and not robust to sensitivity analyses.

Conclusions: We find evidence for an association between residence in a high-noise area and later bedtimes among urban adolescents but no consistent evidence of such an association with mental health disorders.
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http://dx.doi.org/10.1097/EE9.0000000000000056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693982PMC
August 2019

Lithium in drinking water associated with adverse mental health effects.

Schizophr Res 2019 08 5;210:313-315. Epub 2019 Jul 5.

Centre for Integrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark.

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http://dx.doi.org/10.1016/j.schres.2019.06.016DOI Listing
August 2019

Lithium in drinking water associated with adverse mental health effects.

Schizophr Res 2019 08 5;210:313-315. Epub 2019 Jul 5.

Centre for Integrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark; National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark; Big Data Centre for Environment and Health, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark.

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http://dx.doi.org/10.1016/j.schres.2019.06.016DOI Listing
August 2019

Causal Mediation Analysis With Observational Data: Considerations and Illustration Examining Mechanisms Linking Neighborhood Poverty to Adolescent Substance Use.

Am J Epidemiol 2019 03;188(3):598-608

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Understanding the mediation mechanisms by which an exposure or intervention affects an outcome can provide a look into what has been called a "black box" of many epidemiologic associations, thereby providing further evidence of a relationship and possible points of intervention. Rapid methodologic developments in mediation analyses mean that there are a growing number of approaches for researchers to consider, each with its own set of assumptions, advantages, and disadvantages. This has understandably resulted in some confusion among applied researchers. Here, we provide a brief overview of the mediation methods available and discuss points for consideration when choosing a method. We provide an in-depth explication of 2 of the many potential estimators for illustrative purposes: the Baron and Kenny mediation approach, because it is the most commonly used, and a recently developed approach for estimating stochastic direct and indirect effects, because it relies on far fewer assumptions. We illustrate the decision process and analytical procedure by estimating potential school- and peer-based mechanisms linking neighborhood poverty to adolescent substance use in the National Comorbidity Survey Adolescent Supplement.
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http://dx.doi.org/10.1093/aje/kwy248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6395164PMC
March 2019

Physical Activity and Mental Disorder Among Adolescents in the United States.

J Adolesc Health 2018 11 29;63(5):628-635. Epub 2018 Aug 29.

Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland. Electronic address:

Objective: To estimate associations between physical activity (PA) and a broad range of lifetime mental disorders among adolescents, and to evaluate whether the context of sports participation impacts these associations.

Methods: The sample included 6,483 13-18 year-olds from the National Comorbidity Survey Adolescent Supplement. Adolescents completed face-to-face psychiatric interviews and a parent provided diagnostic and other family-level information on the participating adolescent by completing a self-administered questionnaire. PA was measured by adolescent self-report and dichotomized to indicate vigorous exercise several times a week. Nineteen psychiatric disorders were assessed using the Diagnostic and Statistical Manual of Mental Disorders criteria. Multiple logistic regression analyses were used to estimate associations of PA with mental disorders, suicidality, and psychological distress.

Results: Two thirds of adolescents reported being physically active. Active adolescents had significantly lower odds of mood disorder (Odds ratio[OR] = .74, 95% confidence interval [CI]=.58-.94), bipolar II disorder (OR = .54, 95% CI=.30-.99), and general psychological distress (OR = .71, 95% CI=.52-.96) than less/inactive adolescents. In contrast, adolescents who engaged in PA were more likely to have lifetime alcohol use disorder (OR = 1.78, 95% CI = 1.11-2.85), bulimia (OR = 5.84, 95% CI = 2.48-13.79), generalized anxiety disorder (OR = 2.04, 95% CI = 1.16-3.58), and posttraumatic stress disorder (OR = 1.65, 95% CI = 1.07-2.55). The direct associations between PA and alcohol use disorder and bulimia appeared to be specific to adolescents who participated in organized sports.

Discussion: Associations between PA and lifetime mental disorder among adolescents may differ according to both disorder type and the context in which PA occurs. Longitudinal studies that assess the context of PA may be able to explain apparent discrepant associations between PA and mental disorder.
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http://dx.doi.org/10.1016/j.jadohealth.2018.05.030DOI Listing
November 2018

Prevalence of Mental Disorder and Service Use by Immigrant Generation and Race/Ethnicity Among U.S. Adolescents.

J Am Acad Child Adolesc Psychiatry 2018 04 15;57(4):280-287.e2. Epub 2018 Feb 15.

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health. Electronic address:

Objective: To examine differences in lifetime prevalence of mental disorder and service use among U.S. adolescents by both immigrant generation and race/ethnicity.

Method: A total of 6,250 adolescents aged 13 to 18 years in the National Comorbidity Survey Replication Adolescent Supplement were assessed for lifetime prevalence of mood and/or anxiety disorders, behavior disorders, and mental health service use. Twelve groups defined by self-identified race/ethnicity (non-Hispanic white, Hispanic, non-Hispanic black, Asian) and immigrant generation (first, second, third, or more) were compared.

Results: Differences in prevalence of lifetime mental disorder were most apparent when immigrant generation and race/ethnicity were considered jointly. Compared to third+generation non-Hispanic white adolescents, the odds of mood/anxiety disorder were increased among second-generation Asian (adjusted odds ratio [AOR] = 2.51; 95% CI = 1.22-5.17) and third+generation Hispanic (AOR = 1.28; 95% CI = 1.00-1.63) but reduced among first-generation Asian (AOR = 0.27; 95% CI = 0.10-0.71) and second-generation non-Hispanic white adolescents (AOR = 0.50; 95% CI = 0.30-0.81). The odds of behavior disorder were lower among first-generation Asian (AOR = 0.26; 95% CI = 0.09-0.71) and all generations of non-Hispanic black adolescents (AOR range 0.43-0.55). Adjusting for lifetime disorder, first-generation Hispanic and non-Hispanic white adolescents and all generations of non-Hispanic black adolescents were less likely to receive mental health services (AOR range 0.24-0.55).

Conclusions: Variation in risk of disorder by immigrant generation and race/ethnicity underscores the importance of considering social, economic, and cultural influences in etiologic and treatment studies of adolescent psychopathology. Lower rates of service use, particularly among first-generation immigrant adolescents, highlight the need to identify and address barriers to recognition and treatment of mental disorders among adolescents from immigrant and racial/ethnic minority backgrounds.
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http://dx.doi.org/10.1016/j.jaac.2018.01.020DOI Listing
April 2018

Olfactory processing in bipolar disorder, major depression, and anxiety.

Bipolar Disord 2018 09 13;20(6):547-555. Epub 2018 Feb 13.

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.

Objectives: Although olfactory abnormalities are well established in schizophrenia, considerably less work has examined olfactory performance in other neuropsychiatric conditions. In the current study, we examined odor identification, odor discrimination, detection threshold, and odor hedonic processing performance in individuals with bipolar I disorder (n = 43; n = 13 with psychotic features), bipolar II disorder (n = 48), major depressive disorder (MDD) (n = 134), anxiety (n = 48), and no mental disorder (n = 72) who participated in a community-based family study.

Methods: Best estimate DSM-IV diagnoses were based on in-depth personal interviews as well as interviews with family members. Olfactory tests were administered during an in-person clinical visit and were compared using robust linear regression adjusting for age, sex, and psychiatric medication use, as well as nicotine use when necessary.

Results: Compared to controls, odor identification performance was lower among individuals with MDD (b = -1.37, 95% confidence interval [CI]: -2.50, -0.24) and bipolar I disorder (b = -1.79, 95% CI: -3.51, -0.67). Among the latter group, performance was only reduced among those with psychotic features (b = -3.49, 95% CI: -6.33, -0.65), particularly for pleasant odors (b = -1.46, 95% CI: -2.51, -0.42). Those with MDD showed lower identification accuracy for neutral odors (b = -0.63, 95% CI: -1.20, -0.06). Performances on measures of odor discrimination and detection threshold did not differ by diagnostic group.

Conclusions: Collectively, these findings indicate that odor identification difficulties may exist in mood disorders, especially when psychotic features are present. In contrast, the global olfactory dysfunction observed in schizophrenia may not be a feature of other neuropsychiatric conditions.
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http://dx.doi.org/10.1111/bdi.12625DOI Listing
September 2018

Parenting style and mental disorders in a nationally representative sample of US adolescents.

Soc Psychiatry Psychiatr Epidemiol 2018 01 6;53(1):11-20. Epub 2017 Nov 6.

Genetic Epidemiology Branch, Intramural Research Program, National Institute of Mental Health, Building 35, Room 2E480, 35 Convent Drive, MSC #3720, Bethesda, MD, 20892, USA.

Purpose: We examined associations between parenting style and past-year mental disorders in a nationally representative cross-sectional survey of US adolescents and whether the associations differed by adolescent demographic characteristics.

Methods: The sample included 6483 adolescents aged 13-18 years who were interviewed for a full range of DSM-IV mental disorders. Parenting style was assessed by adolescent-reported maternal and paternal care and control using items from the Parental Bonding Instrument. We controlled for socio-demographics, parental history of mental disorders, stressful life events, sexual violence, inter-parental conflict, and household composition. We also tested for two-way interactions between parental care and control and adolescent age, sex, and race/ethnicity.

Results: In adjusted models, high maternal care was associated with lower odds of depressive, eating, and behavioral disorders, and high maternal control was associated with greater odds of depressive, anxiety, eating, and behavioral disorders. High paternal care was associated with lower odds of social phobia and alcohol abuse/dependence. High paternal control was associated with greater odds of agoraphobia and alcohol abuse/dependence but with lower odds of attention-deficit/hyperactivity disorder. Associations of maternal and paternal control with anxiety disorders and substance abuse/dependence differed by sex. High paternal care was associated with lower odds of anxiety disorders only among Hispanics and non-Hispanic blacks.

Conclusions: Perceived parental care and control were associated with adolescent mental disorders after controlling for multiple potential confounders. Differential patterns of association were found according to adolescent sex and race/ethnicity. Findings have implications for prevention and intervention programs that incorporate familial contextual factors.
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http://dx.doi.org/10.1007/s00127-017-1435-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823599PMC
January 2018

Stability and change in reported age of onset of depression, back pain, and smoking over 29 years in a prospective cohort study.

J Psychiatr Res 2017 05 10;88:105-112. Epub 2017 Jan 10.

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.

Accurate age of onset (AOO) measurement is vital to etiologic and preventive research. While AOO reports are known to be subject to recall error, few population-based studies have been used to investigate agreement in AOO reports over more than a decade. We examined AOO reports for depression, back/neck pain, and daily smoking, in a population-based cohort spanning 29 years. A stratified sample of participants from Zurich, Switzerland (n = 591) completed a psychiatric and physical health interview 7 times between 1979, at ages 20 (males) and 21 (females), and 2008. We used one-way ANOVA to estimate intraclass correlations (ICCs) and weighted mixed models to estimate mean change over time and test for interactions with sex and clinical characteristics. Stratum-specific ICCs among those with 2 + reports were 0.19 and 0.29 for depression, 0.46 and 0.35 for back pain, and 0.66 and 0.75 for smoking. The average yearly increases in AOO report from the wave of first 12-month diagnosis or reported smoking, estimated in mixed models, were 0.57 years (95% confidence interval: 0.35, 0.79) for depression, 0.44 (95%CI: 0.28, 0.59) years for back pain, and 0.08 (95%CI: 0.03, 0.14) years for smoking. Initial impairment and frequency of treatment were associated with differences in average yearly change for depression. There is substantial variability in AOO reports over time and systematic increase with age. The degree of increase may differ by outcome, and for some outcomes, by participant clinical characteristics. Future studies should identify predictors of AOO report stability to ultimately benefit etiologic and preventive research.
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http://dx.doi.org/10.1016/j.jpsychires.2017.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382717PMC
May 2017

Stability and change in reported age of onset of depression, back pain, and smoking over 29 years in a prospective cohort study.

J Psychiatr Res 2017 05 10;88:105-112. Epub 2017 Jan 10.

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.

Accurate age of onset (AOO) measurement is vital to etiologic and preventive research. While AOO reports are known to be subject to recall error, few population-based studies have been used to investigate agreement in AOO reports over more than a decade. We examined AOO reports for depression, back/neck pain, and daily smoking, in a population-based cohort spanning 29 years. A stratified sample of participants from Zurich, Switzerland (n = 591) completed a psychiatric and physical health interview 7 times between 1979, at ages 20 (males) and 21 (females), and 2008. We used one-way ANOVA to estimate intraclass correlations (ICCs) and weighted mixed models to estimate mean change over time and test for interactions with sex and clinical characteristics. Stratum-specific ICCs among those with 2 + reports were 0.19 and 0.29 for depression, 0.46 and 0.35 for back pain, and 0.66 and 0.75 for smoking. The average yearly increases in AOO report from the wave of first 12-month diagnosis or reported smoking, estimated in mixed models, were 0.57 years (95% confidence interval: 0.35, 0.79) for depression, 0.44 (95%CI: 0.28, 0.59) years for back pain, and 0.08 (95%CI: 0.03, 0.14) years for smoking. Initial impairment and frequency of treatment were associated with differences in average yearly change for depression. There is substantial variability in AOO reports over time and systematic increase with age. The degree of increase may differ by outcome, and for some outcomes, by participant clinical characteristics. Future studies should identify predictors of AOO report stability to ultimately benefit etiologic and preventive research.
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http://dx.doi.org/10.1016/j.jpsychires.2017.01.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5382717PMC
May 2017

Latent Trajectories of Common Mental Health Disorder Risk Across 3 Decades of Adulthood in a Population-Based Cohort.

JAMA Psychiatry 2016 Oct;73(10):1023-1031

Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland.

Importance: Epidemiologic evidence indicates that most of the general population will experience a mental health disorder at some point in their lives. However, few prospective population-based studies have estimated trajectories of risk for mental disorders from young through middle adulthood to estimate the proportion of individuals who experience persistent mental disorder across this age period.

Objectives: To describe the proportion of the population who experience persistent mental disorder across adulthood and to estimate latent trajectories of disorder risk across this age period.

Design, Setting, And Participants: A population-based, prospective cohort study was conducted between 1979 and 2008 in the canton of Zurich, Switzerland. A stratified random sample of 591 Swiss citizens was enrolled in 1978 at ages 19 years (men) and 20 years (women); 7 interviews were performed during a 29-year period. Men were sampled from military enrollment records and women from electoral records. From those initially enrolled, participants with high levels of psychiatric symptoms were oversampled for follow-up. Data analysis was performed from July 28, 2015, to June 8, 2016.

Main Outcomes And Measures: Latent trajectories, estimated using growth mixture modeling, of past-year mood/anxiety disorder (ie, major depressive episode, phobias, panic, generalized anxiety disorder, and obsessive-compulsive disorder), substance use disorder (ie, drug abuse or dependence and alcohol abuse or dependence), and any mental disorder (ie, any of the above) assessed during in-person semistructured interviews at each wave. Diagnoses were based on DSM-III, DSM-III-R, and DSM-IV criteria.

Results: Of the 591 participants at baseline, 299 (50.6%) were female. Persistent mental health disorder across multiple study waves was rare. Among 252 individuals (42.6%) who participated in all 7 study waves, only 1.2% met criteria for disorder every time. Growth mixture modeling identified 3 classes of risk for any disorder across adulthood: low (estimated prevalence, 40.0%; 95% CI, -8.7% to 88.9%), increasing-decreasing (estimated prevalence, 15.3%; 95% CI, 1.0% to 29.6%), and increasing (estimated prevalence, 44.7%; 95% CI, -0.9% to 90.1%). Although no classes were characterized by persistently high disorder risk, for those in the increasing-decreasing class, risk was high from the late 20s to early 40s. Sex-specific models indicated 4 trajectory classes for women but only 3 for men.

Conclusions And Relevance: Persistently high mental health disorder risk across 3 decades of adulthood was rare in this population-based sample. Identifying early determinants of sex-specific risk trajectories would benefit prevention efforts.
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http://dx.doi.org/10.1001/jamapsychiatry.2016.1921DOI Listing
October 2016

Erratum to "Racial-ethnic disparities in empirically-derived subtypes of subclinical psychosis among a U.S. sample of youths" [Schizophr. Res. 170 (2016) 205-210].

Schizophr Res 2016 May 11;173(1-2):119. Epub 2016 Mar 11.

Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 10th Floor, Gates Bldg., Philadelphia, PA 19104, USA.

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http://dx.doi.org/10.1016/j.schres.2016.02.030DOI Listing
May 2016

Racial-ethnic disparities in empirically-derived subtypes of subclinical psychosis among a U.S. sample of youths.

Schizophr Res 2016 Jan 18;170(1):205-10. Epub 2015 Dec 18.

Neuropsychiatry Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St., 10(th) Floor, Gates Bldg., Philadelphia, PA 19104, USA.

Introduction: Racial-ethnic minority status is a consistent risk factor for schizophrenia, with associations extending to bipolar disorder and subthreshold psychotic experiences. However, few epidemiologic studies have been conducted in the U.S., and evidence is inconsistent. Furthermore, no U.S. studies of youths have directly investigated the phenomenological overlap between schizophrenia and bipolar disorder. We aimed to do so at the subthreshold level in the Philadelphia Neurodevelopmental Cohort.

Methods: Participants included 6533 individuals, age 11-21years, from a community healthcare network. Latent class analysis was used to form subtypes of sub-psychosis based on 12 attenuated positive items and 7 mania items without duration criteria. Associations between race-ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, "other") and sub-psychosis subtype were estimated using latent class regression.

Results: Four classes were identified: Sub-positive Only (13.4%), Mania Only (15.5%), Both (9.1%), and Neither (62.0%). Minority participants were generally more likely than non-Hispanic whites to belong to one of the three sub-psychosis classes compared to the Neither class. Associations for Hispanics and non-Hispanic blacks remained after adjustment for age, sex, and maternal education, and restriction to participants without significant physical health conditions. Racial-ethnic disparities were greater in magnitude for the two classes characterized by sub-positive symptoms, Sub-positive Only and Both, than for the Mania Only class. This pattern was statistically significant among non-Hispanic blacks.

Conclusions: We found evidence for racial-ethnic disparities in empirically-derived subtypes of subthreshold psychosis, broadly defined, among U.S. youths. Further research is needed to determine whether these disparities persist to the clinical disorder level in adulthood.
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http://dx.doi.org/10.1016/j.schres.2015.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4790463PMC
January 2016

School Start Time and Adolescent Sleep Patterns: Results From the U.S. National Comorbidity Survey--Adolescent Supplement.

Am J Public Health 2015 Jul 14;105(7):1351-7. Epub 2015 May 14.

Diana Paksarian, Jian-Ping He, and Kathleen R. Merikangas are with the Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD. Kara E. Rudolph is with the School of Public Health, University of California, Berkeley, and Center for Health and Community, University of California, San Francisco.

Objectives: We estimated associations between school start time and adolescent weeknight bedtime, weeknight sleep duration, and weekend compensatory sleep and assessed whether associations differ by age, sex, or urbanicity.

Methods: We used a subsample of a nationally representative, cross-sectional survey of 7308 students aged 13 to 18 years attending 245 schools to estimate associations of school start time, reported by school principals, with weeknight bedtime and sleep duration and weekend compensatory sleep, reported during adolescent face-to-face interviews.

Results: Start time was positively associated with weeknight bedtime. Associations between start time and weeknight sleep duration were nonlinear and were strongest for start times of 8:00 am and earlier. Associations differed by sex and urbanicity, with the strongest association among boys in major metropolitan counties. Start time was negatively associated with sleep duration among boys in nonurban counties. Start time was not associated with weekend compensatory sleep.

Conclusions: Positive overall associations between school start time and adolescent sleep duration at the national level support recent policy recommendations for delaying school start times. However, the impact of start time delays may differ by sex and urbanicity.
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http://dx.doi.org/10.2105/AJPH.2015.302619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463387PMC
July 2015

Childhood residential mobility, schizophrenia, and bipolar disorder: a population-based study in Denmark.

Schizophr Bull 2015 Mar 5;41(2):346-54. Epub 2014 Jun 5.

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

Introduction: Childhood adversity is gaining increasing attention as a plausible etiological factor in the development of psychotic disorders. Childhood residential mobility is a potential risk factor that has received little attention in this context.

Methods: We used registry data to estimate associations of residential mobility with narrow and broad schizophrenia and bipolar disorder across the course of childhood among 1.1 million individuals born in Denmark 1971-1991 and followed from age 15 through 2010. We assessed effect modification by sex, family history of mental disorder, the presence of siblings close in age, and distance moved.

Results: In individual-year models adjusted for family history, urbanicity at birth, and parental age, mobility at all ages except the year of birth was associated with heightened risk of narrow and broad schizophrenia, and risk increased with age at moving and with the number of moves. Further adjustment for mobility at all ages 0-15 revealed associations mainly during the latter half of childhood, which were strongest during adolescence. Associations between mobility and bipolar disorder were fewer and weaker compared to schizophrenia. There was modest evidence of interaction with family history of psychiatric diagnosis, but little evidence for interaction by sex, the presence of closely-aged siblings, or distance moved. Schizophrenia associations did not appear attributable to increased mobility among adolescents with earlier onset.

Conclusions: Mobility may increase risk for psychotic disorders, particularly schizophrenia. Children may be especially vulnerable during adolescence. Future research should investigate the importance of school changes and the potential for interaction with genetic risk.
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http://dx.doi.org/10.1093/schbul/sbu074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4332936PMC
March 2015

Perceived trauma during hospitalization and treatment participation among individuals with psychotic disorders.

Psychiatr Serv 2014 Feb;65(2):266-9

Unlabelled: OBJECTIVE; This study assessed the association of perceptions of traumatic experiences during psychiatric hospitalizations and treatment participation.

Methods: Participants (N=395) in the Suffolk County Mental Health Project, who had been admitted for the first time for a psychotic disorder ten years earlier, were interviewed. The authors examined associations of perceived trauma and distressing or coercive experiences during hospitalizations in the past ten years with patient characteristics and treatment participation.

Results: Sixty-nine percent of participants reported perceived trauma. Perceived trauma was more common among females versus males and homemakers versus full-time workers. It was not associated with treatment seeking or time in treatment. However, reporting forced medication was associated with reduced time in treatment, especially for persons with schizophrenia spectrum disorders.

Conclusions: Although perceptions of trauma during psychiatric hospitalization were common, they may be unrelated to treatment participation. However, there was modest evidence of a link between coercive experiences and reduced treatment time.
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http://dx.doi.org/10.1176/appi.ps.201200556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039016PMC
February 2014

Perceived trauma during hospitalization and treatment participation among individuals with psychotic disorders.

Psychiatr Serv 2014 Feb;65(2):266-9

Unlabelled: OBJECTIVE; This study assessed the association of perceptions of traumatic experiences during psychiatric hospitalizations and treatment participation.

Methods: Participants (N=395) in the Suffolk County Mental Health Project, who had been admitted for the first time for a psychotic disorder ten years earlier, were interviewed. The authors examined associations of perceived trauma and distressing or coercive experiences during hospitalizations in the past ten years with patient characteristics and treatment participation.

Results: Sixty-nine percent of participants reported perceived trauma. Perceived trauma was more common among females versus males and homemakers versus full-time workers. It was not associated with treatment seeking or time in treatment. However, reporting forced medication was associated with reduced time in treatment, especially for persons with schizophrenia spectrum disorders.

Conclusions: Although perceptions of trauma during psychiatric hospitalization were common, they may be unrelated to treatment participation. However, there was modest evidence of a link between coercive experiences and reduced treatment time.
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http://dx.doi.org/10.1176/appi.ps.201200556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039016PMC
February 2014

Nonaffective acute psychoses: uncertainties on the way to DSM-V and ICD-11.

Curr Psychiatry Rep 2011 Jun;13(3):203-10

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.

Since the early 20th century, a group of nonaffective psychoses with acute onset and brief duration have been described in different countries under various names, including cycloid psychosis, bouffée délirante, and reactive psychosis. These psychoses share several characteristics, including benign course, greater prevalence in women than men and in developing countries than in industrialized countries, and high prevalence of premorbid psychological and physiologic stressors. However, the variations in names and minute details of symptomatology have overshadowed the basic similarities across these various descriptions. Confusion in classification persists in the two contemporary diagnostic systems, the DSM-IV and the ICD-10. We believe that most cases of these psychoses could be captured under a broad, unified category of nonaffective psychosis with acute onset and brief duration, and urge the authors of the upcoming revisions of the DSM and ICD to create such a category. A unified diagnostic category for these disorders would reduce unnecessary fragmentation in the diagnostic systems and assist in the progress of research on these rare conditions.
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http://dx.doi.org/10.1007/s11920-011-0190-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662493PMC
June 2011