Midlife diseases of despair and cardiometabolic risk: testing shared origins in adolescent psychopathology.

BACKGROUND: Rising midlife mortality in the United States is largely attributable to 'deaths of despair' (deaths from suicide, drug poisonings, and alcohol-related diseases) and deaths from cardiometabolic conditions. Although despair- and cardiometabolic-related mortality are increasing concurrently, it is unclear whether they share common developmental origins. We tested adolescent psychopathology as a potential common origin of midlife diseases of despair and cardiometabolic risk. METHODS: Participants (N = 4578) were from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative cohort followed from adolescence to early midlife. Adolescent psychopathology included depression, anxiety, eating disorders, PTSD, conduct disorder, and ADHD at ages 11-18. Diseases of despair (suicidality, substance misuse, pain, and sleep problems) and cardiometabolic risk (hypertension, hyperlipidemia, high-risk waist circumference, diabetes, and cardiovascular conditions) were multi-modally measured at ages 33-43. RESULTS: At midlife, adolescents who experienced psychopathology exhibited more indicators of despair-related diseases and cardiometabolic risk (IRRs = 1.67 [1.46-1.87] and 1.13 [1.04-1.21], respectively), even after accounting for demographics, adolescent SES, and adolescent cognitive ability. Associations were evident for internalizing and externalizing conditions, and in a dose-response fashion. In mediation analyses, low education explained little of these associations, but early-adult substance use explained 21.5% of psychopathology's association with despair-related diseases. Midlife despair-related diseases and cardiometabolic risk co-occurred within individuals (IRR = 1.12 [1.08-1.16]). Adolescent psychopathology accounted for 8.3% of this co-occurrence, and 16.7% together with adolescent SES and cognitive ability. CONCLUSIONS: Adolescent psychopathology precedes both diseases of despair and cardiometabolic risk. Prevention and treatment of psychopathology may mitigate multiple causes of poor midlife health, reducing premature mortality.

Tracing the origins of midlife despair: association of psychopathology during adolescence with a syndrome of despair-related maladies at midlife.

BACKGROUND: Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence. METHODS: Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains - suicidality, substance misuse, sleep problems, and pain - were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data. RESULTS: We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [ß = 0.23, 95% CI (0.16-0.30), p < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [ß = 0.26, 95% CI (0.19-0.33), p < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders. CONCLUSIONS: Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair.

Which Types of Stress Are Associated With Accelerated Biological Aging? Comparing Perceived Stress, Stressful Life Events, Childhood Adversity, and Posttraumatic Stress Disorder.

OBJECTIVE: Stress and stressful events are associated with poorer health; however, there are multiple ways to conceptualize and measure stress and stress responses. One physiological mechanism through which stress could result in poorer health is accelerated biological aging. This study tested which types of stress were associated with accelerated biological aging in adulthood. METHODS: Studying 955 participants from the Dunedin Longitudinal Study, we tested whether four types of stress assessed from ages 32 to 45 years-perceived stress, number of stressful life events, adverse childhood experiences, and posttraumatic stress disorder-were associated with accelerated biological aging. RESULTS: Higher levels of all four measures of stress were significantly associated with accelerated aging in separate models. In a combined model, more perceived stress and more stressful life events remained associated with faster aging, and the stress measures explained 6.9% of the variance in aging. The magnitudes of the associations between the four measures of stress and biological aging were comparable to associations for smoking and low education, two established risk factors for accelerated aging. People with high levels of perceived stress, numerous adverse childhood experiences (4+), high stressful life event counts, or posttraumatic stress disorder were aging an additional estimated 2.4 months, 1.1 additional months, 1.4 months, and 1.4 months per year, respectively. CONCLUSIONS: Assessing stress, particularly perceived stress, could help identify people at risk of accelerated aging. Intervening to treat stress or the health-relevant sequelae of stress could potentially slow the rate at which people are aging, improving their health as they age.

Associations among ADHD symptoms, ODD symptoms, and borderline personality features: A network analysis.

Attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are common childhood syndromes that exhibit a high degree of comorbidity. Both ADHD and ODD symptoms in childhood predict higher levels of borderline personality features (BPF) later in development. Yet ADHD, ODD, and BPF each consist of a heterogeneous group of symptoms, and symptom-level associations between these groups remain unclear. The present study examined symptom-level associations, as well as sex differences in symptom-level associations, among ADHD, ODD, and BPF using network analysis. Caregivers of 962 children between the ages of 5 and 12 completed rating scales of ADHD, ODD, and BPF. Assessment of Bridge Expected Influence indicated a number of bridge symptoms linking ADHD to ODD; these bridge symptoms were primarily from the hyperactive-impulsive (rather than the inattentive) dimension of ADHD (e.g., blurts out answers, leaves seat, runs excessively). A smaller number of bridge symptoms were identified linking ADHD and ODD to BPF, and these bridge symptoms were different for girls versus boys. Overall, several ADHD hyperactive-impulsive symptoms were related to the BPF item gets in trouble for doing things without thinking, and the ODD item touchy/easily annoyed was related to the BPF item goes back and forth between different feelings. Moreover, whereas we observed stronger links between ODD antagonistic symptoms (e.g., blames others) and BPF among girls, we observed stronger links between ODD oppositional symptoms (e.g., defies/refuses to comply) and BPF among boys. Taken together, results provide a more nuanced, symptom-level understanding of the overlap among ADHD, ODD, and BPF.

Caregiver Strain Questionnaire-Short Form 11 (CGSQ-SF11): A Validation Study.

Caregiver strain is associated with caregiver and child well-being and clinical outcomes. The present study examined the psychometric properties of a revised 11-item measure of caregiver strain, the Caregiver Strain Questionnaire-Short Form 11 (CGSQ-SF11). In a sample of 962 caregivers, we found support for a three-factor model of the CGSQ-SF11, consisting of objective (e.g., financial impact), subjective internalized (e.g., sadness about the child's problems), and subjective externalized (e.g., anger directed toward the child) strain factors. Measurement invariance was supported across multiple demographic and clinical groups, and all three subscales displayed high internal consistency. Convergent validity was also supported through positive correlations with measures of child psychopathology symptoms and psychosocial impairment. Moreover, caregiver strain was associated with number of child disorders as well as breadth of child symptoms across both internalizing and externalizing domains. Findings provide initial validation of the CGSQ-SF11 as a comprehensive yet brief measure of caregiver strain.

Cognitive mechanisms influencing facial emotion processing in psychopathy and externalizing.

Psychopathy and externalizing are distinct forms of disinhibitory psychopathology whose destructive social behaviors are thought to be underpinned by different aberrations in social cognition. Facial emotion processing is a foundational component of social cognition, yet previous studies on facial emotion processing in psychopathy and externalizing have focused on traditional behavioral measures (e.g., response accuracy), which have limited reliability and precision. Diffusion modeling is a valuable tool for elucidating more reliable and precise sources of performance differences because it estimates parameters that reflect latent cognitive processes, including bias, drift rate (efficiency of evidence accumulation), threshold separation (extent of evidence accumulation), and nondecision time (time spent on non-decision-related processes such as stimulus encoding and motor response execution). In a sample of 92 incarcerated males, we applied diffusion modeling to an emotion identification task in which ambiguous blends of anger, happiness, and fear were identified while contextual threat (i.e., apparent movement of faces) was manipulated. Results indicated that psychopathy was associated with longer nondecision time (i.e., slower processing) across all the emotion blends in the task and particularly for mostly angry faces under greater ambiguity. In direct contrast, externalizing was associated with shorter nondecision time (i.e., faster processing) as well as greater threshold separation (i.e., more extensive evidence accumulation) for mostly angry faces under greater ambiguity, but this pattern of preferential processing of anger was only evident in the absence of contextual threat. These findings link psychopathy and externalizing to different profiles of cognitive processes influencing facial emotion processing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Aggressive Realism: More Efficient Processing of Anger in Physically Aggressive Individuals.

Physically aggressive individuals' heightened tendency to decide that ambiguous faces are angry is thought to contribute to their destructive interpersonal behavior. Although this tendency is commonly attributed to bias, other cognitive processes could account for the emotion-identification patterns observed in physical aggression. Diffusion modeling is a valuable tool for parsing the contributions of several cognitive processes known to influence decision-making, including bias, drift rate (efficiency of information accumulation), and threshold separation (extent of information accumulation). In a sample of 90 incarcerated men, we applied diffusion modeling to an emotion-identification task. Physical aggression was positively associated with drift rate (i.e., more efficient information accumulation) for anger, and drift rate mediated the association between physical aggression and heightened anger identification. Physical aggression was not, however, associated with bias or threshold separation. These findings implicate processing efficiency for anger-related information as a potential mechanism driving aberrant emotion identification in physical aggression.

Physical aggression is associated with heightened social reflection impulsivity.

Physical aggression harms individuals, disrupts social functioning across multiple forms of psychopathology, and leads to destruction within communities. Physical aggression is associated with aberrations in the interpretation of ambiguous information. However, the specific cognitive mechanisms supporting this link remain elusive. One potentially relevant cognitive mechanism is reflection impulsivity, the amount of information gathered during decision-making. Reflection impulsivity characterizes how individuals resolve ambiguity in the process of forming judgments when multiple interpretations of a stimulus are possible. In a sample of 98 incarcerated men, we examined reflection impulsivity using a novel social information sampling task. The primary aim of the study was to investigate the relationship between physical aggression and social reflection impulsivity. Additionally, we assessed the frequency of different social judgments (hostile vs. benign), the extent to which reflection impulsivity varied in the context of these different social judgments, and subjective certainty about social judgments. Finally, we investigated whether social reflection impulsivity moderated the relationship between physical aggressiveness and violent crime. Results indicated that more physically aggressive individuals displayed heightened social reflection impulsivity, which was amplified in the context of hostile judgments. Moreover, more physically aggressive individuals were more certain about their hostile judgments and more certain when judgments were made with unconstrained access to behavioral information. Finally, impulsive hostile judgments in physically aggressive individuals related to a more extensive history of assault charges. These findings suggest that physically aggressive individuals exhibit deficits in information gathering, leading to ill-informed and inflexible social judgments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neural Correlates of Compulsive Alcohol Seeking in Heavy Drinkers.

BACKGROUND: Compulsive alcohol use, the tendency to continue alcohol seeking and taking despite negative consequences, is a hallmark of alcohol use disorder. Preclinical rodent studies have suggested a role for the medial prefrontal cortex, anterior insula, and nucleus accumbens in compulsive alcohol seeking. It is presently unknown whether these findings translate to humans. We used a novel functional magnetic resonance imaging paradigm and tested the hypothesis that heavy drinkers would compulsively seek alcohol despite the risk of an aversive consequence, and that this behavior would be associated with the activity of frontostriatal circuitry. METHODS: Non-treatment-seeking heavy and light drinkers (n = 21 per group) completed a functional magnetic resonance imaging paradigm in which they could earn alcohol or food points at various threat levels (i.e., various probabilities of incurring an aversive consequence). Brain function was evaluated when individuals had the opportunity to earn reward points at the risk of an aversive consequence, an electric shock on the wrist. RESULTS: Compared with light drinkers, heavy drinkers attempted to earn more aversion-paired alcohol points. Frontostriatal circuitry, including the medial prefrontal cortex, anterior insula, and striatum, was more active in this group when viewing threat-predictive alcohol cues. Heavy drinkers had increased connectivity between the anterior insula and the nucleus accumbens. Greater connectivity was associated with more attempts to earn aversion-paired alcohol points and self-reported compulsive alcohol use scores. CONCLUSIONS: Higher activation of frontostriatal circuitry in heavy drinkers may contribute to compulsive alcohol seeking. Treatments that disrupt this circuitry may result in a decrease in compulsive alcohol use.

Neural processing of social exclusion in individuals with psychopathic traits: Links to anger and aggression.

Psychopathy is a cluster of personality traits associated with high rates of aggression. While research on psychopathic traits largely focuses on neurobiological factors implicated in aggression, other research suggests that contextual factors, such as social exclusion, also contribute to promoting aggression. Yet, the relationships among psychopathic traits, neural processing of exclusion, and aggression remain unknown. A sample of 76 adolescents and young adults completed Cyberball, a task involving conditions of social inclusion, ambiguous exclusion, and unambiguous exclusion. During Cyberball, a slow wave (SW) event-related potential (an index of elaborative processing) and self-reported anger were measured. Additionally, acts of real-world aggression were assessed. Results indicated that as psychopathic traits increased, SW during ambiguous exclusion also increased, but SW during inclusion decreased. However, the combination of smaller SW during ambiguous exclusion and higher psychopathic traits predicted heightened anger following Cyberball and more frequent real-world aggression. This response to social exclusion among individuals with elevated psychopathic traits may represent an unreflective, reactive style that exacerbates anger and aggression in certain contexts. These data suggest that neurobiological dysfunction in elaborative processing is related to psychopathic traits, and social context comprises another important influence on the aggression of individuals with elevated psychopathic traits.

Brain-behavior relationships in externalizing: P3 amplitude reduction reflects deficient inhibitory control.

The use of endophenotypes to classify individuals at risk for or suffering from psychopathology has been criticized for lacking specificity and predictive utility. This issue is apparent in research on externalizing, a heritable predisposition to disinhibitory psychopathology and personality traits. Numerous studies have shown that P3 amplitude reduction (P3AR) reliably reflects externalizing, implicating P3AR as a candidate endophenotype for externalizing psychopathology. However, this endophenotype has not been connected directly to a key deficit in executive function (e.g., inhibitory control) commonly related to externalizing. Using a modified oddball task in a sample (N=74) of at-risk adolescents and young adults, we examined the associations among externalizing, P3AR, and inhibitory control. We also examined the associations of P3AR and inhibitory control with frequency of real-world disinhibited behavior. Results indicated that externalizing related to P3AR, which in turn related to deficient inhibitory control. Additionally, there were both unique and interactive associations of P3 amplitude and inhibitory control with indicators of real-world behavior. These findings provide the first direct evidence that P3AR reflects deficits in inhibitory control, thus linking this externalizing-related endophenotype to a specific cognitive process. Moreover, the results highlight the value of considering psychobiological measures alongside behavioral measures for indexing risk for externalizing behavior and psychopathology.

Blunted Ambiguity Aversion During Cost-Benefit Decisions in Antisocial Individuals.

Antisocial behavior is often assumed to reflect aberrant risk processing. However, many of the most significant forms of antisocial behavior, including crime, reflect the outcomes of decisions made under conditions of ambiguity rather than risk. While risk and ambiguity are formally distinct and experimentally dissociable, little is known about ambiguity sensitivity in individuals who engage in chronic antisocial behavior. We used a financial decision-making task in a high-risk community-based sample to test for associations between sensitivity to ambiguity, antisocial behavior, and arrest history. Sensitivity to ambiguity was lower in individuals who met diagnostic criteria for Antisocial Personality Disorder. Lower ambiguity sensitivity was also associated with higher externalizing (but not psychopathy) scores, and with higher levels of aggression (but not rule-breaking). Finally, blunted sensitivity to ambiguity also predicted a greater frequency of arrests. Together, these data suggest that alterations in cost-benefit decision-making under conditions of ambiguity may promote antisocial behavior.