Contextualizing the News: Newspaper Front Pages in the Age of Fact-Checking Journalism.

This thesis investigates influences on the selection of stories on the front pages of newspapers. It investigates whether a daily newspaper that has an in-house, fact-checking unit (The Milwaukee (WI) Journal Sentinel) selects front-page stories differently from a newspaper that does not have an in-house, fact-checking unit (The Star Tribune in Minneapolis, MN). While the study found no direct influence of fact-checking journalism, it did find that newspaper front pages in 2014 were increasingly prioritizing contextual stories over conventional stories. It also found a decline in political/governmental stories on front pages. It is suggested that these changes might signal a changing role for newspaper journalism within society, shifting away from the delivery of information and putting more emphasis on the analysis of information

Prevalence of Depression and Depressive Symptoms Among Resident Physicians: A Systematic Review and Meta-analysis.

IMPORTANCE: Physicians in training are at high risk for depression. However, the estimated prevalence of this disorder varies substantially between studies. OBJECTIVE: To provide a summary estimate of depression or depressive symptom prevalence among resident physicians. DATA SOURCES AND STUDY SELECTION: Systematic search of EMBASE, ERIC, MEDLINE, and PsycINFO for studies with information on the prevalence of depression or depressive symptoms among resident physicians published between January 1963 and September 2015. Studies were eligible for inclusion if they were published in the peer-reviewed literature and used a validated method to assess for depression or depressive symptoms. DATA EXTRACTION AND SYNTHESIS: Information on study characteristics and depression or depressive symptom prevalence was extracted independently by 2 trained investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using meta-regression. MAIN OUTCOMES AND MEASURES: Point or period prevalence of depression or depressive symptoms as assessed by structured interview or validated questionnaire. RESULTS: Data were extracted from 31 cross-sectional studies (9447 individuals) and 23 longitudinal studies (8113 individuals). Three studies used clinical interviews and 51 used self-report instruments. The overall pooled prevalence of depression or depressive symptoms was 28.8% (4969/17,560 individuals, 95% CI, 25.3%-32.5%), with high between-study heterogeneity (Q = 1247, τ2 = 0.39, I2 = 95.8%, P < .001). Prevalence estimates ranged from 20.9% for the 9-item Patient Health Questionnaire with a cutoff of 10 or more (741/3577 individuals, 95% CI, 17.5%-24.7%, Q = 14.4, τ2 = 0.04, I2 = 79.2%) to 43.2% for the 2-item PRIME-MD (1349/2891 individuals, 95% CI, 37.6%-49.0%, Q = 45.6, τ2 = 0.09, I2 = 84.6%). There was an increased prevalence with increasing calendar year (slope = 0.5% increase per year, adjusted for assessment modality; 95% CI, 0.03%-0.9%, P = .04). In a secondary analysis of 7 longitudinal studies, the median absolute increase in depressive symptoms with the onset of residency training was 15.8% (range, 0.3%-26.3%; relative risk, 4.5). No statistically significant differences were observed between cross-sectional vs longitudinal studies, studies of only interns vs only upper-level residents, or studies of nonsurgical vs both nonsurgical and surgical residents. CONCLUSIONS AND RELEVANCE: In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among resident physicians was 28.8%, ranging from 20.9% to 43.2% depending on the instrument used, and increased with calendar year. Further research is needed to identify effective strategies for preventing and treating depression among physicians in training

Use of mobile technology to identify behavioral mechanisms linked to mental health outcomes in Kenya: protocol for development and validation of a predictive model

Objective:This study proposes to identify and validate weighted sensor stream signatures that predict near-term risk of a major depressive episode and future mood among healthcare workers in Kenya. Approach: The study will deploy a mobile application (app) platform and use novel data science analytic approaches (Artificial Intelligence and Machine Learning) to identifying predictors of mental health disorders among 500 randomly sampled healthcare workers from five healthcare facilities in Nairobi, Kenya. Expectation: This study will lay the basis for creating agile and scalable systems for rapid diagnostics that could inform precise interventions for mitigating depression and ensure a healthy, resilient healthcare workforce to develop sustainable economic growth in Kenya, East Africa, and ultimately neighboring countries in sub-Saharan Africa. This protocol paper provides an opportunity to share the planned study implementation methods and approaches. Conclusion: A mobile technology platform that is scalable and can be used to understand and improve mental health outcomes is of critical importanc

Systematic review and meta-analysis of depression, anxiety, and suicidal ideation among Ph.D. students

Abstract University administrators and mental health clinicians have raised concerns about depression and anxiety among Ph.D. students, yet no study has systematically synthesized the available evidence in this area. After searching the literature for studies reporting on depression, anxiety, and/or suicidal ideation among Ph.D. students, we included 32 articles. Among 16 studies reporting the prevalence of clinically significant symptoms of depression across 23,469 Ph.D. students, the pooled estimate of the proportion of students with depression was 0.24 (95% confidence interval [CI], 0.18–0.31; I2 = 98.75%). In a meta-analysis of the nine studies reporting the prevalence of clinically significant symptoms of anxiety across 15,626 students, the estimated proportion of students with anxiety was 0.17 (95% CI, 0.12–0.23; I2 = 98.05%). We conclude that depression and anxiety are highly prevalent among Ph.D. students. Data limitations precluded our ability to obtain a pooled estimate of suicidal ideation prevalence. Programs that systematically monitor and promote the mental health of Ph.D. students are urgently needed

Cognitive Control as a 5-HT1A-Based Domain That Is Disrupted in Major Depressive Disorder

Heterogeneity within Major Depressive Disorder (MDD) has hampered identification of biological markers (e.g., intermediate phenotypes, IPs) that might increase risk for the disorder or reflect closer links to the genes underlying the disease process. The newer characterizations of dimensions of MDD within Research Domain Criteria (RDoC) domains may align well with the goal of defining IPs. We compare a sample of 25 individuals with MDD compared to 29 age and education matched controls in multimodal assessment. The multimodal RDoC assessment included the primary IP biomarker, positron emission tomography (PET) with a selective radiotracer for 5-HT1A [(11C)WAY-100635], as well as event-related functional MRI with a Go/No-go task targeting the Cognitive Control network, neuropsychological assessment of affective perception, negative memory bias and Cognitive Control domains. There was also an exploratory genetic analysis with the serotonin transporter (5-HTTLPR) and monamine oxidase A (MAO-A) genes. In regression analyses, lower 5-HT1A binding potential (BP) in the MDD group was related to diminished engagement of the Cognitive Control network, slowed resolution of interfering cognitive stimuli, one element of Cognitive Control. In contrast, higher/normative levels of 5-HT1A BP in MDD (only) was related to a substantial memory bias toward negative information, but intact resolution of interfering cognitive stimuli and greater engagement of Cognitive Control circuitry. The serotonin transporter risk allele was associated with lower 1a BP and the corresponding imaging and cognitive IPs in MDD. Lowered 5HT 1a BP was present in half of the MDD group relative to the control group. Lowered 5HT 1a BP may represent a subtype including decreased engagement of Cognitive Control network and impaired resolution of interfering cognitive stimuli. Future investigations might link lowered 1a BP to neurobiological pathways and markers, as well as probing subtype-specific treatment targets

Returning Individual Research Results from Digital Phenotyping in Psychiatry

Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants’ locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant’s real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas

Identifying genetic variants associated with the personality trait Neuroticism, a marker for depression.

Evidence from epidemiological studies indicates that genetic factors play a substantial role in determining our risk for depression. Unfortunately, no specific genes have been definitively identified to date. One promising approach is to determine whether genetic variants are associated not with disease per se, but with trait markers that are themselves associated with risk for the disease. The personality trait Neuroticism, characterized by anxiety, low mood vulnerability, is one such trait marker for depression. In this dissertation, we explore potential associations between polymorphisms in neurotransmitter genes and Neuroticism in a large community sample. Numerous lines of evidence implicate Brain Derived Neurotrophic Factor (BDNF) in the pathophysiology of depression via hippocampal mechanisms. In our sample, we find an association between the valine allele at a BDNF coding polymorphism (Val66Met) and increased Neuroticism (p = 0.005). In a subsequent analysis, we find an association between the same BDNF valine allele and decreased hippocampal volume (p = 0.009). The GABA (A) receptor alpha6 subunit gene has been associated with benzodiazepine and alcohol sensitivity, but has not been investigated in Neuroticism or depression risk. In our sample we find an association between a GABA (A) alpha6 coding variant (Pro385Ser) and Neuroticism (p = 0.003). The serotonin transporter promoter polymorphism (5-HTTLPR) is known to affect the strength of the promoter of the serotonin transporter gene. Lesch and colleagues initially reported that 5-HTTLPR is associated Neuroticism. Multiple replication attempts have produced conflicting results. In our sample we confirmed the association between 5-HTTLPR and Neuroticism (p = 0.008). Moreover, we performed a meta-analysis on 23 studies investigating this association to explain the contradictions in the literature. We found strong evidence for an association between 5-HTTLPR and Neuroticism as measured by the NEO personality inventory (p = 0.000016). Studies that did not replicate this association either had too small sample size, or used alternate personality inventories. Polymorphisms in two other candidate genes, monoamine oxidase A and the serotonin receptor 2A, showed no association with Neuroticism. In total, the three associated variants account for approximately 25% of the Neuroticism genetic variance in our sample. In a separate analysis, we find an association between a dopamine receptor 4 polymorphism (DRD4-IL3) and both systolic (p = 0.031) and diastolic (p = 0.034) blood pressure. Furthermore, we find evidence that the effects of DRD4-IL3 on blood pressure increase with age (p = 0.009).Ph.D.Biological SciencesClinical psychologyNeurosciencesPersonality psychologyPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/124930/2/3163926.pd

Hardy-Weinberg analysis of a large set of published association studies reveals genotyping error and a deficit of heterozygotes across multiple loci

<p>Abstract</p> <p>In genetic association studies, deviation from Hardy-Weinberg equilibrium (HWD) can be due to recent admixture or selection at a locus, but is most commonly due to genotyping errors. In addition to its utility for identifying potential genotyping errors in individual studies, here we report that HWD can be useful in detecting the presence, magnitude and direction of genotyping error across multiple studies. If there is a consistent genotyping error at a given locus, larger studies, in general, will show more evidence for HWD than small studies. As a result, for loci prone to genotyping errors, there will be a correlation between HWD and the study sample size. By contrast, in the absence of consistent genotyping errors, there will be a chance distribution of <it>p</it>-values among studies without correlation with sample size. We calculated the evidence for HWD at 17 separate polymorphic loci investigated in 325 published genetic association studies. In the full set of studies, there was a significant correlation between HWD and locus-standardised sample size (<it>p </it>= 0.001). For 14/17 of the individual loci, there was a positive correlation between extent of HWD and sample size, with the evidence for two loci (<it>5-HTTLPR </it>and <it>CTSD</it>) rising to the level of statistical significance. Among single nucleotide polymorphisms (SNPs), 15/23 studies that deviated significantly from Hardy-Weinberg equilibrium (HWE) did so because of a deficit of hetero-zygotes. The inbreeding coefficient (F(is)) is a measure of the degree and direction of deviation from HWE. Among studies investigating SNPs, there was a significant correlation between F(is) and HWD (R = 0.191; <it>p </it>= 0.002), indicating that the greater the deviation from HWE, the greater the deficit of heterozygotes. By contrast, for repeat variants, only one in five studies that deviated significantly from HWE showed a deficit of heterozygotes and there was no significant correlation between F(is) and HWD. These results indicate the presence of HWD across multiple loci, with the magnitude of the deviation varying substantially from locus to locus. For SNPs, HWD tends to be due to a deficit of heterozygotes, indicating that allelic dropout may be the most prevalent genotyping error.</p

Antidepressant response and the serotonin transporter gene-linked polymorphic region

Background: The serotonin transporter gene-linked polymorphic region (5-HTTLPR) has been proposed as a predictor of antidepressant response. Insertion or deletion of a 44bp long region gives rise to short 'S' and long 'L' forms of the promoter region, the 'S' form being associated with reduced serotonin transporter expression. Methods: A systematic review and meta-analysis was performed to clarify the effect of 5-HTTLPR on antidepressant response and remission rates. Data were obtained from 28 studies with 5408 participants. Three genotype comparisons were tested - SS versus (SL or LL), (SS or SL) versus LL, and SS versus LL. Results: There was no statistically significant effect on antidepressant response. Compared to L carriers, there was an apparent effect of the SS genotype on remission rate (RR 0.88; 95% CI 0.79 to 0.98; p=0.02). However, after trim and fill correction for missing data, the effect disappeared (RR 0.92; 95% CI 0.81 to 1.05; p=0.23) indicating that the initial significant effect was likely the result of publication bias. No significant effect on remission rate was seen for SS versus LL and SS/SL versus LL. Substantial unexplained heterogeneity of effect sizes was observed between studies, pointing to additional interacting factors contributing to an association in some cases. Conclusions: The 5-HTTLPR biallelic short/long polymorphism by itself does not appear to usefully predict antidepressant response

Antidepressant response and the serotonin transporter gene-linked polymorphic region

Background: The serotonin transporter gene-linked polymorphic region (5-HTTLPR) has been proposed as a predictor of antidepressant response. Insertion or deletion of a 44bp long region gives rise to short 'S' and long 'L' forms of the promoter region, the 'S' form being associated with reduced serotonin transporter expression. Methods: A systematic review and meta-analysis was performed to clarify the effect of 5-HTTLPR on antidepressant response and remission rates. Data were obtained from 28 studies with 5408 participants. Three genotype comparisons were tested - SS versus (SL or LL), (SS or SL) versus LL, and SS versus LL. Results: There was no statistically significant effect on antidepressant response. Compared to L carriers, there was an apparent effect of the SS genotype on remission rate (RR 0.88; 95% CI 0.79 to 0.98; p=0.02). However, after trim and fill correction for missing data, the effect disappeared (RR 0.92; 95% CI 0.81 to 1.05; p=0.23) indicating that the initial significant effect was likely the result of publication bias. No significant effect on remission rate was seen for SS versus LL and SS/SL versus LL. Substantial unexplained heterogeneity of effect sizes was observed between studies, pointing to additional interacting factors contributing to an association in some cases. Conclusions: The 5-HTTLPR biallelic short/long polymorphism by itself does not appear to usefully predict antidepressant response