Cognitive functioning throughout the treatment history of clinical late-life depression.

OBJECTIVE: Previous investigations into the relationship between late-life depressive symptoms and cognitive functioning have resulted in mixed findings concerning whether or not depressive symptoms and cognitive functioning are related. The mixed reports may be due in part to differences in clinical and nonclinical samples and to inadequate consideration of the dynamic nature (i.e., fluctuating course) of depressive symptoms and cognitive functioning in older adults. The current study examined the chronic, acute, and longitudinal relationships between depressive symptoms and cognitive functioning in older adults in an ongoing treatment study of major depressive disorder (MDD). METHODS: The neurocognitive outcomes of depression in the elderly study operates in a naturalistic treatment milieu using a pharmacological treatment algorithm and regular psychiatric assessment. Four hundred and fifty-three older adults [mean age 70 years, standard deviation (SD) = 7.2] meeting criteria for MDD at study enrollment received annual neuropsychological testing and depressive symptom monitoring for an average of 8.5 years (SD = 4.5). RESULTS: Hierarchical linear modeling revealed that higher age, lower education, and higher average/chronic levels of depressive symptoms were related to lower cognitive functioning. Additionally, results revealed that when an individual's depressive symptoms are higher than is typical for a specific individual, general cognitive function was worse than average. There was no evidence of lagged/longitudinal relationships between depressive symptoms and cognitive functioning in older adults in treatment for MDD. CONCLUSIONS: Cognitive functioning and depressive symptoms are concurrently associated in older adults with MDD, highlighting the potential importance for stabilizing mood symptoms as a means to manage cognitive deficits in late-life depression.

A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence.

HIV-related stigma has a damaging effect on health outcomes among people living with HIV (PLWH), as studies have associated it with poor HIV medication adherence and depressive symptoms. We investigated whether depressive symptoms mediate the relationship between stigma and medication adherence. In a cross-sectional study, 720 PLWH completed instruments measuring HIV-related stigma, depressive symptoms, and HIV medication adherence. We used structural equation modeling (SEM) to investigate associations among these constructs. In independent models, we found that poorer adherence was associated with higher levels of stigma and depressive symptoms. In the simultaneous model that included both stigma and depressive symptoms, depression had a direct effect on adherence, but the effect of stigma on adherence was not statistically significant. This pattern suggested that depressive symptoms at least partially mediated the association between HIV-related stigma and HIV medication adherence. These findings suggest that interconnections between several factors have important consequences for adherence.

Migrating from a legacy fixed-format measure to CAT administration: calibrating the PHQ-9 to the PROMIS depression measures.

PURPOSE: We provide detailed instructions for analyzing patient-reported outcome (PRO) data collected with an existing (legacy) instrument so that scores can be calibrated to the PRO Measurement Information System (PROMIS) metric. This calibration facilitates migration to computerized adaptive test (CAT) PROMIS data collection, while facilitating research using historical legacy data alongside new PROMIS data. METHODS: A cross-sectional convenience sample (n = 2,178) from the Universities of Washington and Alabama at Birmingham HIV clinics completed the PROMIS short form and Patient Health Questionnaire (PHQ-9) depression symptom measures between August 2008 and December 2009. We calibrated the tests using item response theory. We compared measurement precision of the PHQ-9, the PROMIS short form, and simulated PROMIS CAT. RESULTS: Dimensionality analyses confirmed the PHQ-9 could be calibrated to the PROMIS metric. We provide code used to score the PHQ-9 on the PROMIS metric. The mean standard errors of measurement were 0.49 for the PHQ-9, 0.35 for the PROMIS short form, and 0.37, 0.28, and 0.27 for 3-, 8-, and 9-item-simulated CATs. CONCLUSIONS: The strategy described here facilitated migration from a fixed-format legacy scale to PROMIS CAT administration and may be useful in other settings.

Impact of NRTIs on lipid levels among a large HIV-infected cohort initiating antiretroviral therapy in clinical care.

OBJECTIVE: to assess the associations between nucleoside reverse transcriptase inhibitors (NRTIs) and change in lipid levels among a large cohort of HIV-infected patients in routine clinical care initiating their first potent antiretroviral regimen. DESIGN: longitudinal observational cohort study from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. METHODS: we used generalized estimating equations to examine the association between NRTIs and lipids accounting for within-patient correlations between repeated measures and key clinical and demographic characteristics including other antiretroviral medications. RESULTS: among 2267 individuals who started their first antiretroviral regimen, tenofovir with emtricitabine or lamivudine was associated with lower levels for total cholesterol, low-density lipoprotein (LDL), triglycerides, non-high-density lipoprotein (HDL), and HDL, compared with other NRTI pairs in adjusted analyses. LDL levels were highest among patients receiving didanosine/lamivudine. Triglyceride levels were highest in stavudine/lamivudine users. HDL levels were highest among patients receiving didanosine/stavudine. Hepatitis C infection and younger age were also associated with lower lipid levels. CONCLUSION: we found clinically important heterogeneity within the NRTI class of antiretroviral medications regarding their effect on lipid levels over time. Although the lipid profile of tenofovir with emtricitabine or lamivudine appeared to be less pro-atherogenic in this large longitudinal study of HIV-infected patients in routine clinical care, there was no association with beneficial HDL levels. In general, the change in lipid levels associated with most antiretroviral agents, particularly those NRTI combinations currently in common use, are relatively modest. Additional studies are needed to understand the long-term implications of these findings on cardiovascular disease risk.

Sex differences in developmental trends of suicide ideation, plans, and attempts among European American adolescents.

Although suicide ideation, plans, and attempts increase during adolescence, it remains unclear whether boys' and girls' risk for these outcomes peaks at different ages. We used longitudinal categorical data (never, once, 2+ times) from the Family Transitions Project (N = 1,248 rural European Americans, ages 11-19) to investigate whether yearly prevalence rates of adolescent suicidal episodes follow different patterns by sex. Multiple-group growth models revealed that peak levels of past-year ideation and plans occurred during mid adolescence for girls, but slowly increased through late adolescence for boys. We found that prevalence patterns for attempts were very similar for boys and girls, with both increasing through mid adolescence and then declining, although girls' risk declined slightly more rapidly. This information may help alert gatekeepers to developmental periods during which boys and girls are particularly vulnerable to suicide-related experiences, and also may help inform the timing of preventive efforts.

New approaches to studying problem behaviors: a comparison of methods for modeling longitudinal, categorical adolescent drinking data.

Analyzing problem-behavior trajectories can be difficult. The data are generally categorical and often quite skewed, violating distributional assumptions of standard normal-theory statistical models. In this article, the authors present several currently available modeling options, all of which make appropriate distributional assumptions for the observed categorical data. Three are based on the generalized linear model: a hierarchical generalized linear model, a growth mixture model, and a latent class growth analysis. They also describe a longitudinal latent class analysis, which requires fewer assumptions than the first 3. Finally, they illustrate all of the models using actual longitudinal adolescent alcohol-use data. They guide the reader through the model-selection process, comparing the results in terms of convergence properties, fit and residuals, parsimony, and interpretability. Advances in computing and statistical software have made the tools for these types of analyses readily accessible to most researchers. Using appropriate models for categorical data will lead to more accurate and reliable results, and their application in real data settings could contribute to substantive advancements in the field of development and the science of prevention.

Family and individual difference predictors of trait aspects of negative interpersonal behaviors during emerging adulthood.

A latent trait-state-occasion (TSO) model (D. A. Cole, N. C. Martin, & J. H. Steiger, 2005) was used to isolate the trait and state components of negative interpersonal behaviors toward a friend or romantic partner during emerging adulthood. Results indicate that variance in negative interpersonal behaviors was due to nearly equal portions of Trait and Occasion factors. Variability in the trait aspects of negative interpersonal behaviors was then predicted by theoretically relevant constructs. In particular, mothers' negative behaviors during adolescence, adolescent core self-evaluations, negative emotionality, and feelings of security in close relationships had independent effects in predicting the enduring aspects of negative interpersonal behaviors. All told, these results indicate that TSO models can be helpful tools for understanding the developmental antecedents of the trait-like aspects of interpersonal processes.