Interactions Between Serotonin Transporter Gene and Adverse Childhood Experience in a Generalized Additive Model: A Pilot Study.

BACKGROUND: While most people experience potentially traumatic events (PTEs), including Adverse Childhood Experiences (ACEs), the stress reactions to PTEs on mental health outcomes are highly heterogeneous. Resilience is influenced by a complex biopsychosocial ecological system, including gene serotonin transporter-linked promoter region or 5-HTTLPR /rs25531 by ACEs interactions. AIMS: This pilot study investigated the gene-by-environment interactions on mental health outcomes in adults enrolled in a health care profession program using a generalized additive model (GAM). METHODS: Seventy health care college students (mean age = 27.4 years, 67.1% women) participated in this cross-sectional study. Saliva samples were collected from students to analyze 5-HTTLPR/rs25531. Participants completed the ACE Questionnaire and the Mental Health Inventory. GAMs with different interaction terms were built adjusting for age, gender, and race. The value of the effective degree of freedom (EDF) quantifies the curvature of the relationship. RESULTS: Among participants with the long allele of 5-HTTLPR/rs25531, a linear pattern was found between the total ACE score and mental health outcomes (EDF = 1). Conversely, among participants with the short allele, EDF was approximately 2, indicating a curved association suggesting that mental health worsens in individuals exposed to up to four types of ACEs. CONCLUSIONS: The impact of up to four ACEs on mental health was stronger among individuals with the short allele of 5-HTTLPR/rs25531 than those with the long allele. Although this study does not claim to provide a definite approach to analyzing gene-by-environment interactions, we offer a different perspective to explore the relationship.

Comparing factors related to perceived control and preventive behaviors from COVID-19 between Japanese and American nursing students: A cross-sectional study.

AIM: Higher levels of perceived control are important to maintain health. The difference in factors related to perceived control and preventive behaviors during the COVID-19 pandemic between Japanese and American nursing students remains unknown. This study aimed to compare factors related to perceived control and infection preventive behaviors between the two countries. METHODS: This cross-sectional study included nursing students attending four universities in Japan and one in the United States. Using Google Forms, the participants answered a survey comprising sociodemographic data, the Perceived Control and Self-Efficacy Scale, the Perceived Health Competence Scale, and a preventive behavior questionnaire. The data were collected from November 2020 to May 2021. Linear and logistic regressions were used to analyze the factors related to perceived control and preventive behaviors, respectively. RESULTS: Data from 878 students were analyzed. University/campus emerged as a strong predictor for perceived control and preventive behaviors in both countries, with a positive correlation between perceived control and preventive behaviors. Older age, less frequent alcohol consumption, higher perceived health competence, less frequent work in Japan; and chronic conditions in the United States were associated with frequent preventive behaviors. Younger age was correlated with higher perceived control in Japan, while religion and increased workload were potential factors for American students. CONCLUSION: Individual factors were pivotal in Japan, whereas interpersonal factors were more likely related to perceived control in the United States. Additionally, in both countries, policy or organizational factors significantly influenced students' preventive behaviors.

Identification of Relationships Among Resilience Factors Using Network Analysis: A Pilot Study.

BACKGROUND: Although college life can be fulfilling, it can be stressful, particularly for health professional students. In addition, they may have had Adverse Childhood Experience (ACE) that increases their sensitivity to academic stress. Yet, students need to overcome challenges to become successful professionals. The literature suggests the following factors may be associated with resilience: ACE and academic stress as the antecedents; ego-resilience, emotion regulation, resources, social support, inflammatory markers, and genes as the defining attributes; and mental health and sense of coherence (SOC) as the consequences. AIMS: The purpose is to identify the relationships among factors associated with resilience using network analysis. METHODS: A total of 70 college students participated in this cross-sectional pilot study. They completed measures of psychosocial variables and provided saliva samples, which were analyzed for Serotonin Transporter-Linked Promoter Region (5-HTTLPR)/rs25531 and inflammatory markers. Mixed graphical models including all variables were estimated using the R-package mgm. RESULTS: Network analysis revealed positive associations between (1) mental health and SOC; (2) mental health and resources; (3) mental health and social support; (4) SOC and reappraisal of emotion regulation; (5) resources and reappraisal of emotion regulation; and (6) resources and social support. In addition, SOC and academic stress were negatively associated. Furthermore, the short variant of 5-HTTLPR/rs25531 was associated with stronger suppression of emotion regulation and fewer resources compared with the long variant. CONCLUSION: Resilience may be influenced by biopsychosocial factors, notably SOC and 5-HTTLPR/rs25531. However, longitudinal research is needed with a larger sample size to better understand how these and other factors may affect resilience.

Nonlinear Relationship Between C-Reactive Protein and Depression Among Obese Middle-Aged Adults.

BACKGROUND: Despite the agreement on the significance of the relationship between the C-reactive protein (CRP) and depression, research results have been discrepant by gender. OBJECTIVE: We attempted to address this uncertainty via a generalized additive model and more carefully analyzed the shape of the CRP-depression relationship in terms of sex. METHODS: This is a secondary data analysis using the National Health and Nutrition Examination Survey (2017-2020) data targeting 1,581 obese middle-aged adults (40-70 years, 51.4% women) with CRP ≤ 10 mg/L. The study outcome was depression severity, assessed by the nine-item Patient Health Questionnaire. Several models were built, adjusting for relevant sociodemographic, lifestyle, and clinical covariates. The value of the effective degree of freedom (EDF) quantifies curvature of the relationship. The threshold effect was investigated using a two-piecewise linear regression model, when needed. RESULTS: Among men, an increasing linear pattern was found (EDF ≈ 1). Contrastingly among women, the EDF value was > 2 in all unadjusted and adjusted models, indicating the smooth (curved) association. The threshold level affected the association pattern particularly for women, among whom the depression severity related to CRP significantly increased as the CRP level increased to an inflection point of 3.6 mg/L but decreased thereafter. DISCUSSION: Assuming linearity for the CRP association with depression may not be appropriate for middle-aged obese women. Although we do not claim to provide a definite method of assessing the CRP-depression relationship, we hope to offer a different perspective when exploring this relationship. Thus, the results should be interpreted cautiously, and future studies on this topic should replicate this approach with generalized additive models.

A Case Report of Collaborative Online International Learning in Nursing and Health Studies Between the United States and Japan.

ABSTRACT: Collaborative online international learning (COIL) is an innovative and cost-effective pedagogy to develop cross-cultural awareness through digital technology across shared multicultural learning environments. We implemented our first COIL virtual exchange for undergraduate students at universities in the United States and Japan. We used Padlet for asynchronous discussions to build rapport among students at each institution and Zoom for synchronous discussions to deliver oral presentations. Feedback from students indicate an overall increase in intercultural competence and cultural sensitivity. COIL can provide meaningful, affordable, and feasible health education that enhances cultural understanding through virtual exchange.

C-Reactive Protein and Specific Depression Symptoms Among Older Adults: An Exploratory Investigation of Multi-Plane Networks Using Cross-Sectional Data From NHANES (2017-2020).

INTRODUCTION: Studies investigating the association between C-reactive protein (CRP) and depression among older adults have yielded inconsistent results. We suspect that this may be due to varying associations between CRP and particular depression symptom criteria, and we addressed this challenge using network analysis. METHODS: We used cross-sectional data from prepandemic National Health and Nutrition Examination Survey questionnaires (2017-2020) and included a sample of 1698 adults aged 65 years or older. Depression symptoms were assessed using the Patient Health Questionnaire-9. Unregularized Mixed Graphical Models were estimated using the R package mgm before and after adjusting for relevant sociodemographic, clinical, and lifestyle covariates. RESULTS: In the model with no covariates, the only symptom criterion associated with CRP was "appetite problems." This association remained robust after controlling for all covariates. Although not associated with CRP, other criteria such as "fatigue" and "concentration difficulty" showed associations with important covariates for older adults such as white blood cell count or hemoglobin, respectively. DISCUSSION: The CRP-related variability in the depression symptom network that we have demonstrated may help explain the reported inconsistencies. The present study stands as exploratory, and future research should focus on applying longitudinal designs and including several other inflammatory proteins and covariates that were not measured in the current network model.

The Impact of Collaborative Online International Learning on Intercultural Sensitivity Among Nursing Students in the United States and Japan.

ABSTRACT: Collaborative online international learning (COIL) is a curricular approach that allows students to collaborate across cultures using various communication technologies. Little is known about the influence of COIL on intercultural sensitivity, a key competency for nursing students to better serve increasingly diverse patient populations. We implemented COIL in undergraduate nursing courses in the United States and Japan and examined its impact on intercultural sensitivity using the Intercultural Sensitivity Scale (ISS) as a pretest and posttest. The results of a paired t -test indicated ISS total scores significantly increased after COIL, supporting its use in nursing education courses.

Factors related to mental health effect among nursing students in Japan and the United States during the coronavirus pandemic: A cross-sectional study.

In the context of mental health, university students have been considered a vulnerable population. However, limited studies have underscored the association between preventive health behaviour levels and mental health effects among nursing students. The current cross-sectional study provides a comparative analysis of the impact of mental health factors on nursing students in Japan and the United States (US) in the context of the coronavirus disease 2019 (COVID-19) pandemic. The study consisted of 878 participants, comprising both undergraduate and graduate nursing students from four universities in Japan, and one from the US. Hierarchical logistic regression was used to analyse the participant data in this study. In contrast to the American students, the Japanese students demonstrated significantly lower levels of perceived control and significantly higher levels of preventive health behaviours. Furthermore, Japanese students exhibited significantly higher levels of stress and/or symptoms of depression induced by the social distancing orders compared to the American students (z = -4.218, P < 0.001). However, no difference was observed after adjusting for perceived control, individual factors, socio-economic factors, and preventive behaviours. During the pandemic, risk factors that can worsen mental health among the nursing students included younger age [odds ratio (95%CI) = 0.62 (0.48-0.81)], women [OR = 2.17 (1.02-4.61)], higher preventive health behaviour [OR = 1.05 (1.02-1.08)], lower perceived control [OR = 0.97 (0.94-0.99)], and lower perceived health competence [OR = 0.93 (0.90-0.96)]. Thus, this study recommends establishing training programmes that enhance perceived control and perceived health competence while encouraging preventive behaviour to support the mental health of nursing students, particularly young female students.

Healthcare graduate students' perceived control and preventive behavior for COVID-19 in Japan and the United States: A cross-sectional study.

Background: Both individual and policy level perceived control are known to be positively related to preventive behavior, and both may differ among healthcare graduate students with different cultural backgrounds. This study compared the preventive health behavior and perceived control among domestic and international healthcare graduate students in Japan and the United States during the COVID-19 pandemic, and analyzed factors associated with preventive health behavior and perceived control. Methods: The study used a self-administered online survey, conducted at two universities in Japan and one university in the United States. The survey included sociodemographic data and scales of preventive health behaviors, perceived control (policy level), and perceived health competence (individual level). Association among variables were analyzed using structural equation modeling. Results: A total of 610 students (485 domestic and 125 international) in Japan and 231 students (220 domestic and 11 international) in the United States completed the survey. Participants' average age was 31.3 years, and 67.0% were female. Model fit of structural equation modeling was good (χ2 = 9.419, P = 0.151, comparative fit index = 0.995, RMSEA = 0.026). Japanese students had better preventive health behavior than American (ß = -0.407, P < 0.001) and international students in both countries (ß = -0.112, P < 0.001). However, Japanese students had significantly lower perceived control than American students (ß = 0.346, P < 0.001) and international students in both countries (ß = 0.188, P < 0.001). Overall higher perceived control (ß = 0.175, P < 0.001) and being female (ß = 0.141, P < 0.001) were significantly associated with better preventive behavior. Although higher perceived control was related to higher perceived health competence (ß = 0.295, P < 0.001), perceived health competence was not associated with preventive behavior (ß = 0.025, P = 0.470). Religion was not associated with perceived control or preventive behavior. Conclusion: Nationality was identified as the main factor associated with both perceived control and preventive behavior. Policy level perceived control was more strongly associated with preventive health behavior than individual level perceived health competence. Further investigations in the contribution of specific cultural dimensions associated with perceived control and preventive behaviors are recommended.

Genetic associations with resilience to potentially traumatic events and vantage sensitivity to social support.

INTRODUCTION: Stress responses and mental health outcomes greatly vary when individuals are exposed to potentially traumatic events (PTEs). The Differential Susceptibility Model (DSM) (Pluess, 2015) suggests individual differences in stress responses are influenced by gene-environment interactions, with genes conferring reactivity. While individuals can be resilient (or vulnerable) to PTEs, they can also have vantage sensitivity (or resistance) to social support. This study examined whether selected genotypes moderated the effect of PTEs and social support on mental health. METHODS: This cross-sectional candidate gene study included 450 college students (M age = 20.4, 79.3 % women) who provided buccal cells for genotyping and completed measures of psychosocial variables. DNA was genotyped for 12 genetic variants. RESULTS: Hierarchical regression revealed that the Mental Health Inventory (MHI) was associated with the Trauma History Questionnaire (THQ), rs1800795 in IL-6, and THQ × rs1800795 [R2 = 0.10, F(3, 418) = 15.68, p < .01]. The MHI was associated with the Social Support Survey (SSS), rs4680 in COMT, and SSS × rs4680 [R2 = 0.24, F(3, 429) = 44.19, p < .01]. Only THQ and SSS survived multiple testing corrections. DISCUSSION: Findings partially support the DSM that the G/G genotype of rs1800795 in IL-6 is associated with resilience to PTEs, and the Met/Met genotype of rs4680 in COMT is associated with vantage sensitivity to social support. Limitations include cross-sectional design, limited PTE measurement, small convenience sample, and noncorrection for multiple significance test. Clinicians need to view resilience holistically and understand resilience is associated with psychosocial and genetic factors.

Perceived Control, Preventative Health Behaviors, and the Mental Health of Nursing Students During the COVID-19 Pandemic: A Cross-Sectional Study.

Introduction: Perceived control is an individual's subjective beliefs about the amount of control he or she has over the environment or outcome. Objective: To examine the relationship between perceived control, preventive health behaviors, and mental health effects of undergraduate nursing students during the COVID-19 pandemic. Methods: This cross-sectional correlational study used online self-administered questionnaires. Participants were nursing students attending 3 universities in Tokyo, Japan. Relationships among variables were quantitatively analyzed using linear regressions and a structural equation modeling after adjusting for demographic factors. Results: A total of 557 students participated in the survey. The analysis indicated that higher levels of perceived control were significantly related to higher levels of preventive health behaviors. Although higher preventive health behaviors were related to negative mental health effects, higher levels of perceived health competence translated to improved mental health effects. Perceived control was not directly related to mental health effects but positively related to perceived health competence. Long work hours per week and short hours of sleep per day were associated with lower preventive health behaviors. There were significant differences in the levels of perceived control and preventive health behaviors among students at the 3 universities. Discussion: To improve health behaviors and health competence and subsequently alleviate the mental health effects caused by strictly adhering to recommended health behaviors, students may be supported by the strategies that increase their perceived control. In addition to institutional support, students also require adequate sleep and financial stability to help prevent infections while protecting their mental health.

A Systematic Review of Genetic Influence on Psychological Resilience.

When exposed to adversity, some individuals are at an increased risk of posttraumatic stress disorder, experiencing persistent biopsychosocial disturbances, whereas others adapt well, described as resilience. Resilience is a complex biopsychosocial phenomenon conceptualized as adaptation to adversity influenced by an individual's genetic variants, epistasis, epigenetics, and gene-by-environment interactions. Studies on psychological resilience have focused on behavioral and psychosocial variables with far less examination of the genetic contributions. The purpose of this review is to identify specific genetic variants contributing to the biological capacity for psychological resilience. PubMed and PsycINFO were searched using the following key words: psychological resilience AND genotype(s). Additional articles were identified from the Human Genome Epidemiology Navigator using the term resilience, psychological. Ten studies met the criteria. Six genes were empirically associated with psychological resilience: serotonin-transporter-linked polymorphic region ( 5-HTTLPR), dopamine receptor D4, brain-derived neurotrophic factor ( BDNF), corticotropin-releasing hormone receptor 1, oxytocin receptor and regulator of G-protein signaling 2 . The findings of this systematic review suggest that the L/L or L'/L' genotype of 5-HTTLPR and rs25531 in children/adolescents and the S/S or S'/S' genotype in adults are most frequently related to resilience. Additionally, the Val/Val genotype of rs6265 in BDNF in Caucasians was also associated with resilience. There are numerous factors contributing to the complexity of determining the genetic influence on resilience including analysis of rs25531, assumptions of the mode of inheritance, operationalization of resilience, demographic and population characteristics, sample size, and other types of genetic influence including epistasis and epigenetics. While current evidence is supportive, further investigation of the genetic influence on resilience is required.

Virtual Mentorship Network to Address the Rural Shortage of Mental Health Providers.

INTRODUCTION: The process of identifying effective responses to the challenges of placing and retaining a rural behavioral health workforce remains elusive. The Virtual Mentorship Network was developed to test the feasibility of using distance technology to connect rural students interested in mental health careers with mentors. METHODS: In Year 1, college and high school students were virtually mentored using a near-peer approach both live and asynchronously as a cohort over 7 months. In Year 2, college students only were virtually intensely mentored live over 1 month. High school students were asynchronously provided with informational videos produced by mentors. Program benefits were measured using the Mentoring Functions Questionnaire, and an activity satisfaction survey captured student response to the content and delivery methods. Retrospective analysis of Years 1 and 2 mentoring and satisfaction variables mean differences was performed and overall feasibility assessed. RESULTS: Mentoring Functions Questionnaire scores, overall interaction, and reported satisfaction significantly improved in Year 2 over Year 1. CONCLUSIONS: These data suggest that distance mentoring is a feasible option, but that the near-peer benefits of virtually mentoring high school and college students together are overshadowed by different mentoring needs expressed for each group. High school students expressed needs for basic information about career possibilities, whereas college student needs are specific to achieving career goals. Shorter mentoring sessions may be more sustainable long-term and focus limited mentoring resources. This project may serve as a professional pipeline model for others who face a critical shortage of mental health providers. SUPPLEMENT INFORMATION: This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

A Concept Analysis of Resilience Integrating Genetics.

Although clinicians and researchers are interested in the phenomenon of resilience, there is no agreed-upon definition of resilience. Scientific evidence suggests that resilience is influenced by intrapersonal (e.g. personality traits) and environmental (e.g. social support) variables. A concept analysis was conducted to better understand the meaning of resilience. In this analysis, the antecedent of resilience was a potentially traumatic event; the defining attributes were ego-resiliency, emotion regulation, social support, and heredity; and the consequences were none to mild psychopathological symptoms and positive adaptation. This analysis can help nurses better understand resilience and its relationships to both intrapersonal and environmental variables.

A Pilot Study of the Psychological Impact of the Great East Japan Earthquake and Tsunami.

BACKGROUND: There is evidence that a large-scale disaster may have indirect psychological impact on the individuals who were not involved with the disaster first hand. The 2011 earthquake and tsunami disasters in Japan provide an opportunity to investigate the potential global effect of indirect exposure associated with intense media coverage. OBJECTIVES: To compare the disaster's psychological impact between Japanese and non-Japanese students; to determine what factors are associated with higher psychological impact. DESIGN: A cross-sectional, anonymous online survey of university students in the Midwest. RESULTS: Japanese students scored significantly higher on the Impact of Event Scale-Revised (IES-R) hyperarousal subscale compared with non-Japanese students. Those who were in Japan when the disaster occurred exhibited significantly higher psychological impact levels. There were significant correlations between media exposure and two IES-R subscales: avoidance and hyperarousal. CONCLUSIONS: The results support the finding from 9/11 studies that indirect exposure is associated with stress-related psychological responses.