The Effects of Childhood Maltreatment and Genomic Variation in the Hypothalamic-Pituitary-Adrenal (HPA) Axis on Neuropsychological Functioning in Offspring of Depressed Parents

Childhood maltreatment has been associated with an increased risk for psychiatric disorders and suicide. The primary role of the hypothalamic-adrenal-pituitary (HPA) axis is to maintain homeostasis when challenged with stress. Genomic variation in genes of the HPA axis may play a role in the effects of maltreatment on neuropsychological functioning. The aims of the dissertation study were: (1) to examine the effect of childhood maltreatment on neuropsychological functioning; (2) to examine the effects polymorphisms in genes of the HPA axis (CRH, CRHBP, CRHR1, CRHR2, and NR3C1) with neuropsychological functioning; and (3) to explore gene environment interactions between genes of the HPA axis and exposure to childhood maltreatment on neuropsychological function. This was a secondary data analysis of neuropsychological testing, psychiatric assessments, and genomic data from the Familial Pathways to Early Onset Suicide Attempt Study. A total of 369 subjects were included in Aim 1 and 145 subjects in Aims 2 and 3. Multiple linear regression was used to analyze the effects of maltreatment, genotype, and their interactions on neuropsychological functioning. Physical abuse was associated with poorer performance in the memory domain (p=.006). While no longer significant after controlling for multiple comparisons, results trended trend toward significance (q=.088). Emotional abuse was associated with better scores on measures of verbal fluency (p=.03), but the results were no longer significant after false discovery rate (FDR) correction. Before FDR testing, significant protective effects were detected for two SNPs in the CRHBP gene and one single nucleotide polymorphisms (SNPs) in the CRHR2 gene; and significant risk effects were detected for two SNPs in the CRHR1 gene and one SNP in the NR3C2 gene. However, after FDR corrections, only one result remained significant, a protective effect for CRHBP rs7704995 on the Impulse Control Domain. No significant gene environment interactions were detected. These findings are consistent with the literature showing that exposure to physical abuse is associated with deficits in memory. Further studies are needed with larger sample sizes and all the relevant genes of the HPA axis to determine whether genomic variation in genes of the HPA axis have a direct effect on neuropsychological functioning

Automated Monitoring of Suicidal Adolescents’ Digital Media Use: Qualitative Study Exploring Acceptability Within Clinical Care

BackgroundMonitoring linguistic cues from adolescents’ digital media use (DMU; ie, digital content transmitted on the web, such as through text messages or social media) that could denote suicidal risk offers a unique opportunity to protect adolescents vulnerable to suicide, the second leading cause of death among youth. Adolescents communicate through digital media in high volumes and frequently express emotionality. In fact, web-based disclosures of suicidality are more common than in-person disclosures. The use of automated methods of digital media monitoring triggered by a natural language processing algorithm offers the potential to detect suicidal risk from subtle linguistic units (eg, negatively valanced words, phrases, or emoticons known to be associated with suicidality) present within adolescents’ digital media content and to use this information to respond to alerts of suicidal risk. Critical to the implementation of such an approach is the consideration of its acceptability in the clinical care of adolescents at high risk of suicide. ObjectiveThrough data collection among recently suicidal adolescents, parents, and clinicians, this study examines the current context of digital media monitoring for suicidal adolescents seeking clinical care to inform the need for automated monitoring and the factors that influence the acceptance of automated monitoring of suicidal adolescents’ DMU within clinical care. MethodsA total of 15 recently suicidal adolescents (aged 13-17 years), 12 parents, and 10 clinicians participated in focus groups, qualitative interviews, and a group discussion, respectively. Data were recorded, transcribed, and analyzed using thematic analysis. ResultsParticipants described important challenges to the current strategies for monitoring the DMU of suicidal youth. They felt that automated monitoring would have advantages over current monitoring approaches, namely, by protecting web-based environments and aiding adolescent disclosure and support seeking about web-based suicidal risk communication, which may otherwise go unnoticed. However, they identified barriers that could impede implementation within clinical care, namely, adolescents’ and parents’ concerns about unintended consequences of automated monitoring, that is, the potential for loss of privacy or false alerts, and clinicians’ concerns about liability to respond to alerts of suicidal risk. On the basis of the needs and preferences of adolescents, parents, and clinicians, a model for automated digital media monitoring is presented that aims to optimize acceptability within clinical care for suicidal youth. ConclusionsAutomated digital media monitoring offers a promising means to augment detection and response to suicidal risk within the clinical care of suicidal youth when strategies that address the preferences of adolescents, parents, and clinicians are in place

Examining the Supports and Advice That Women With Intimate Partner Violence Experience Received in Online Health Communities: Text Mining Approach

BackgroundIntimate partner violence (IPV) is an underreported public health crisis primarily affecting women associated with severe health conditions and can lead to a high rate of homicide. Owing to the COVID-19 pandemic, more women with IPV experiences visited online health communities (OHCs) to seek help because of anonymity. However, little is known regarding whether their help requests were answered and whether the information provided was delivered in an appropriate manner. To understand the help-seeking information sought and given in OHCs, extraction of postings and linguistic features could be helpful to develop automated models to improve future help-seeking experiences. ObjectiveThe objective of this study was to examine the types and patterns (ie, communication styles) of the advice offered by OHC members and whether the information received from women matched their expressed needs in their initial postings. MethodsWe examined data from Reddit using data from subreddit community r/domesticviolence posts from November 14, 2020, through November 14, 2021, during the COVID-19 pandemic. We included posts from women aged ≥18 years who self-identified or described experiencing IPV and requested advice or help in this subreddit community. Posts from nonabused women and women aged <18 years, non-English posts, good news announcements, gratitude posts without any advice seeking, and posts related to advertisements were excluded. We developed a codebook and annotated the postings in an iterative manner. Initial posts were also quantified using Linguistic Inquiry and Word Count to categorize linguistic and posting features. Postings were then classified into 2 categories (ie, matched needs and unmatched needs) according to the types of help sought and received in OHCs to capture the help-seeking result. Nonparametric statistical analysis (ie, 2-tailed t test or Mann-Whitney U test) was used to compare the linguistic and posting features between matched and unmatched needs. ResultsOverall, 250 postings were included, and 200 (80%) posting response comments matched with the type of help requested in initial postings, with legal advice and IPV knowledge achieving the highest matching rate. Overall, 17 linguistic or posting features were found to be significantly different between the 2 groups (ie, matched help and unmatched help). Positive title sentiment and linguistic features in postings containing health and wellness wordings were associated with unmatched needs postings, whereas the other 14 features were associated with postings with matched needs. ConclusionsOHCs can extract the linguistic and posting features to understand the help-seeking result among women with IPV experiences. Features identified in this corpus reflected the differences found between the 2 groups. This is the first study that leveraged Linguistic Inquiry and Word Count to shed light on generating predictive features from unstructured text in OHCs, which could guide future algorithm development to detect help-seeking results within OHCs effectively

Depressive symptoms and clinical status during the Treatment of Adolescent Suicide Attempters (TASA) Study

To examine the course of depression during the treatment of adolescents with depression who had recently attempted suicide. Adolescents (N = 124), ages 12 to 18 years, with a 90-day history of suicide attempt, a current diagnosis of depressive disorder (96.0% had major depressive disorder), and a Children's Depression Rating Scale-Revised (CDRS-R) score of 36 or higher, entered a 6-month treatment with antidepressant medication, cognitive-behavioral therapy focused on suicide prevention, or their combination (Comb), at five academic sites. Treatment assignment could be either random or chosen by study participants. Intent-to-treat, mixed effects regression models of depression and other relevant ratings were estimated. Improvement and remission rates were computed with the last observation carried forward. Most patients (n = 104 or 84%) chose treatment assignment, and overall, three fourths (n = 93) received Comb. In Comb, CDRS-R declined from a baseline adjusted mean of 49.6 (SD 12.3) to 38.3 (8.0) at week 12 and to 27.0 (10.1) at week 24 (p < .0001), with a Clinical Global Impression -defined improvement rate of 58.0% at week 12 and 72.2% at week 24 and a remission (CDRS-R ≤ 28) rate of 32.5% at week 12 and 50.0% at week 24. The CDRS-R and the Scale for Suicidal Ideation scores were correlated at baseline (r = 0.43, p < .0001) and declined in parallel. When vigorously treated with a combination of medication and psychotherapy, adolescents with depression who have recently attempted suicide show rates of improvement and remission of depression that seem comparable to those observed in nonsuicidal adolescents with depression