Validating New Summary Indices for the Childhood Trauma Interview: Associations with First Onsets of Major Depressive Disorder and Anxiety Disorders

Childhood and adolescent adversity is of great interest in relation to risk for psychopathology, and interview measures of adversity are thought to be more reliable and valid than their questionnaire counterparts. One interview measure, the Childhood Trauma Interview (CTI; Fink et al., 1995), has been positively evaluated relative to similar measures, but there are some psychometric limitations to an existing scoring approach that limit the full potential of this measure. We propose several new summary indices for the CTI that permit examination of different types of adversity and different developmental periods. Our approach creates several summary indices: one sums the severity scores of adversities endorsed; another utilizes the number of minor and major (moderate to severe) adversities. The new indices were examined in association with first onsets of major depressive disorder (MDD) and anxiety disorders across a 5-year period using annual clinical diagnostic interviews (Structured Clinical Interview for DSM–IV–TR). Summary scores derived with the previously used approach were also examined for comparison. Data on 332 participants came from the Youth Emotion Project, a longitudinal study of risk for emotional disorders. Results support the predictive validity of the proposed summary scoring methods and indicate that several forms of major (but typically not minor) adversity are significantly associated with first onsets of MDD and anxiety disorders. Finally, multivariate regression models show that, in many instances, the new indices contributed significant unique variance predicting disorder onsets over and above the previously used summary indices

Do Depression and Inhibitory Control Increase Vulnerability for Family Dysfunction During Adolescence?

Adolescence is a period of increased risk for depression. Adolescents experience delayed development of brain regions supporting executive functions (e.g., emotional and behavioral control) and concurrent changes in family dynamics due to increased autonomy and time with peers. Collectively, these changes may increase parent-adolescent conflict and impair family communication, which in turn may exacerbate and maintain depressive illness. Despite evidence that adolescent depression is associated with deficits in family problem solving and communication, literature in this area is methodologically limited. Moreover, it is unclear whether executive function deficits (e.g., inhibitory control) translate to functional impairments in family interactions, such as difficulties communicating and resolving conflicts. To date, no studies have empirically tested interrelationships between mood, executive functioning, and family functioning. We seek to answer the following research question in a sample of 36 adolescents with a broad range of mood severity: Do depression and inhibitory control increase vulnerability for family dysfunction during adolescence? We capitalize on multi-informant (adolescent, parent, observer) and multi-method (objective, subjective, and observational) assessments and a longitudinal design to examine associations between adolescent depression, inhibitory control, and family problem solving and communication in a demographically diverse sample. Results indicate that adolescent depression was associated with deficits in family problem solving and communication and impairments in inhibitory control were associated with deficits in family communication among a racially and ethnically diverse sample of youth and their parents. Further, findings highlight the value of multi-informant and multi-method assessments in gaining a more comprehensive understanding of family dynamics. Finally, we found evidence for racial differences in perceptions and observations of family communication. Our results emphasize the importance of early detection and intervention efforts to address adolescent affective and cognitive processes that may contribute to the maintenance of depression. Results also underscore the importance of incorporating family members into evidence-based treatments for adolescent depression to enhance family problem solving and communication

Parent, Child, and Family Predictors of Dropout in Psychosocial Treatment for Pediatric Bipolar Disorder

Premature termination and dropouts are ongoing problems among children and adolescents receiving psychosocial treatment for mental health needs. A growing body of literature has identified parent, child, and family characteristics that contribute to poor treatment engagement among children seeking or utilizing mental health services across diagnoses. However, little is known about the role of these factors specifically among children with pediatric bipolar disorder (PBD). Thus, the present study explored baseline characteristics, including indicators of parent functioning (stress, coping, self-efficacy, and psychopathology), child symptom severity (mania and depression), and family functioning (coping, adaptability and cohesion), as predictors of dropout among a sample of 71 youth with PBD participating in family-based psychosocial treatment. In this study we chose to focus on characteristics that are likely to be impaired in families affected by PBD—aspects of parent, child, and family functioning—that we believe are modifiable through targeted treatment approaches. Results indicate that aspects of parent and family functioning demonstrated the greatest potential as predictors of dropout, while child symptomatology was not associated with dropout. In addition, our findings suggest that the influence of some aspects of parent and family coping behaviors on dropout may vary as a function of the type of treatment delivered. An intensive family-based treatment specifically developed to meet the needs of families affected by PBD may be particularly beneficial for engaging parents and families with poor coping behaviors. Results from this study have important implications for how we design and tailor interventions to meet the needs of families affected by PBD. Future work is needed to optimize treatment outcomes for these families

Predictors of Dropout in Family-Based Psychosocial Treatment for Pediatric Bipolar Disorder: An Exploratory Study

Family-based psychosocial treatments have been developed to address the significant impairments in psychosocial functioning among youth with pediatric bipolar disorder (PBD), yet factors impacting engagement in these treatments have yet to be extensively studied. Early termination from treatment may lead to negative outcomes among youth with PBD. Thus, the primary aim of this exploratory study was to identify predictors and moderators of treatment dropout in PBD. Drawing from the child attrition literature, this study examined characteristics likely to be associated with dropout in families affected by PBD, including potential targets of treatment. Using Cox proportional hazards regressions, we explored the impact of modifiable parent, child, and family characteristics (i.e., parent stress, family coping, child symptoms) and stable demographic characteristics (i.e., family income, ethnic minority status) on dropout among 59 youth aged 7 to 13 who participated in a randomized clinical trial comparing a manualized psychotherapy for PBD (child- and family-focused cognitive behavioral therapy; CFF-CBT) versus treatment as usual (TAU). Specifically, we explored whether dropout was related to baseline levels and changes in these characteristics over the course of treatment in CFF-CBT versus TAU. Findings provide preliminary support for high parental stress as a predictor of dropout across treatments and low baseline parent coping as a predictor of retention in CFF-CBT specifically. Worsening of child depression symptoms over treatment predicted greater likelihood of dropout in CFF-CBT. Finally, improvement in children’s global functioning was associated with reduced dropout across treatments. Results have important implications for tailoring interventions for PBD

Validating new summary indices for the Childhood Trauma Interview: associations with first onsets of major depressive disorder and anxiety disorders.

Childhood and adolescent adversity is of great interest in relation to risk for psychopathology, and interview measures of adversity are thought to be more reliable and valid than their questionnaire counterparts. One interview measure, the Childhood Trauma Interview (CTI; Fink et al., 1995), has been positively evaluated relative to similar measures, but there are some psychometric limitations to an existing scoring approach that limit the full potential of this measure. We propose several new summary indices for the CTI that permit examination of different types of adversity and different developmental periods. Our approach creates several summary indices: one sums the severity scores of adversities endorsed; another utilizes the number of minor and major (moderate to severe) adversities. The new indices were examined in association with first onsets of major depressive disorder (MDD) and anxiety disorders across a 5-year period using annual clinical diagnostic interviews (Structured Clinical Interview for DSM-IV-TR). Summary scores derived with the previously used approach were also examined for comparison. Data on 332 participants came from the Youth Emotion Project, a longitudinal study of risk for emotional disorders. Results support the predictive validity of the proposed summary scoring methods and indicate that several forms of major (but typically not minor) adversity are significantly associated with first onsets of MDD and anxiety disorders. Finally, multivariate regression models show that, in many instances, the new indices contributed significant unique variance predicting disorder onsets over and above the previously used summary indices

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine