Pet Attachment and the Interpersonal Theory of Suicide.

Background: Pet ownership is often assumed to have mental health benefits, but the effect of pets on suicide risk has a scant literature. Aims: Using the interpersonal theory of suicide, we examined the relationships between perceived burdensomeness (PB), thwarted belongingness (TB), overall attachment to one's pet, pet attachment avoidance or anxiety, and suicide risk. The following three hypotheses were investigated: (1) Higher attachment would be indirectly associated with lower suicide risk via lower TB and lower PB; (2) attachment would be associated with higher suicide risk, as conditioned on attachment avoidance/anxiety; and (3) attachment avoidance/anxiety would be associated with higher suicide risk via higher TB/PB. Method: Undergraduates (N = 187) completed surveys, and indirect effect and conditional effect analyses were utilized. Results: Overall attachment was associated with lower PB, which was associated with lower suicide risk. The relationship between overall attachment and suicide risk was not conditional upon attachment anxiety/avoidance. Attachment avoidance was associated with increased levels of TB, which was associated with increased suicide risk. Attachment anxiety was associated with increased suicide risk via TB and PB. Limitations: We used a university sample that had limited access to pets. Conclusions: Findings suggest that pet ownership may provide mixed associations with suicide risk.

Recruiting to surgical trials in the emergency setting: using a mixed methods study to understand clinician and patient perspectives.

BACKGROUND: Undertaking randomized clinical trials (RCTs) in emergency surgical settings is associated with methodological and practical challenges. This study explored patients' and clinicians' perspectives associated with the conduct of an RCT comparing laparoscopic and open colorectal surgery in the acute setting. METHODS: All eligible patients screened and enrolled for the 'Laparoscopic versus open colorectal surgery in the acute setting (LaCeS)' multicentre, randomized clinical feasibility trial in five UK NHS Trusts were invited to respond to a survey. Patients and healthcare professionals were also invited to take part in semi-structured interviews. Survey and interviews explored the acceptability of the feasibility trial. Interviews were audio recorded, transcribed verbatim, and analysed using thematic analysis. Survey data were analysed descriptively to assess patient views of the trial and intervention. RESULTS: Out of 72 patients enrolled for the LaCeS RCT, survey data were collected from 28 patients (38.9 per cent), and interviews were conducted with 16 patients and 14 healthcare professionals. Thirteen out of 28 patients (46 per cent) had treatment preferences but these were not strong enough to deter participation. Twelve of the patients interviewed believed that their surgeon preferred laparoscopic surgery, but this did not deter them from participating in the trial. Half of the surgeons interviewed expressed the view that laparoscopic surgery was of benefit in this setting, but recognized that the need for research evidence outweighed their personal treatment preferences. Eight of the 14 recruiters reported that the emergency setting affected recruitment, especially in centres with fewer recruiting surgeons. Interviewees reported that recruitment was helped significantly by using surgical trainees to consent patients. CONCLUSION: This study identified specific challenges for the LaCeS trial design to address and adds significant insights to our understanding of recruiting to emergency surgical trials more broadly.

Borderline personality disorder symptoms as mediational mechanisms linking childhood trauma and nonsuicidal self-injury among women with bulimia nervosa.

OBJECTIVE: Nonsuicidal self-injury (NSSI) frequently co-occurs with eating disorders, especially bulimia nervosa (BN). Theoretical models and empirical evidence show many overlapping risk factors for the onset and maintenance of NSSI and BN. However, among those with BN, it remains unclear what distinguishes those who do versus do not engage in NSSI. The primary objective of the present study was to identify factors predicting NSSI among women with BN. Specifically, we tested four domains of borderline personality disorder as mediators between childhood trauma and NSSI. METHOD: Using structural equation modeling we tested a parallel mediation model to predict NSSI among women with BN (N = 130). Childhood trauma (measured by the Childhood Trauma Questionnaire at baseline) was the independent variable. The four parallel mediators (measured at baseline via the Diagnostic Interview for Borderlines, Revised) were lifetime negative affect, impulsive actions, atypical cognitions (e.g., odd thinking, unusual perceptual experiences, quasi-psychotic thinking), and interpersonal problems. The dependent variable was instances of NSSI during a subsequent two-week ecological momentary assessment protocol. RESULTS: Childhood trauma was significantly associated with all four mediators (all p values < .01), but only atypical cognitions predicted NSSI (p = .03). The indirect path from childhood trauma to NSSI, through atypical cognitions was significant (path coefficient = .001, SE < .001, p = .01). DISCUSSION: Among women with BN, childhood trauma was associated with atypical cognitions, which in turn predicted NSSI. Atypical cognitions may be a mechanism for NSSI in this population.

Facial femininity and perceptions of eating disorders: A reverse-correlation study.

Eating disorders are prevalent in college students but college students are not accurate in identifying the presence of eating disorders (ED) especially when race is involved. Much has been researched about diagnostic ability in vignette form, but little outside of this. For example, it is not known how facial features, such as perceived femininity, may affect observers' beliefs about the likelihood of disordered eating depending on race. In the present study, we examined how biases regarding facial appearance and disordered eating may differ depending on the race of face images. Using a technique called reverse correlation, we estimated the image templates associated with perceived likelihood of disordered eating using both White and Black Faces. Specifically, we recruited 28 college students who categorized White and Black faces according to perceived likelihood of an eating disorder diagnosis in the presence of image noise. Subsequently, we asked Amazon Mechanical Turk participants to categorize the resulting race-specific face templates according to perceived ED likelihood and femininity. The templates corresponding to a high likelihood of an ED diagnosis were distinguished from low-likelihood images by this second independent participant sample at above-chance levels. For Black faces, the templates corresponding to a high likelihood of an ED diagnosis were also selected as more feminine than low-likelihood templates at an above-chance level, whereas there was no such effect found for White faces. These results suggest that stereotyped beliefs about both femininity and the likelihood of disordered eating may interact with perceptual processes.

The roles of weight stigma, emotion dysregulation, and eating pathology in suicide risk.

Using an interpersonal theory of suicide and affect regulation framework, we investigated the relationships between perceived burdensomeness, thwarted belongingness, weight stigmatization, emotion dysregulation, eating pathology, and suicide risk. Three main hypotheses were investigated. First, we predicted a positive linear relationship between weight stigmatization and risk. Second, an indirect effect of weight stigmatization on risk via perceived burdensomeness and thwarted belongingness was posited. Third, we hypothesized that weight stigmatization would indirectly affect suicide risk via emotion dysregulation and eating pathology. Undergraduates (N = 156) completed online surveys. Linear regressions and indirect effect analyses were performed. Weight stigmatization was directly, positively associated with increased suicide risk. Weight stigmatization indirectly affected suicide risk via perceived burdensomeness but not thwarted belongingness. Higher stigmatization was associated with higher levels of perceived burdensomeness, which was associated with higher risk. An indirect effect of weight stigmatization on suicide risk through emotional dysregulation emerged. Higher weight stigmatization was associated with higher emotional dysregulation, which was associated with higher suicide risk. When all models were combined, only an indirect effect via perceived burdensomeness remained. Our findings may have clinical and public health implications for suicide prevention among people with weight stigma-related risk factors.

A multicenter retrospective study of patients with pulmonary hypertension transitioned from inhaled to oral treprostinil.

Oral treprostinil has recently been shown to delay disease progression in patients with pulmonary arterial hypertension in a long-term outcomes study. The potential advantages of an oral formulation have resulted in patients transitioning from inhaled to oral treprostinil. The current study reports a retrospective analysis of patients who transitioned from treatment with inhaled to oral treprostinil. A multicenter retrospective chart review was conducted for 29 patients with pulmonary hypertension that transitioned from inhaled to oral treprostinil. Data were collected from inhaled treprostinil initiation and patients were followed until discontinuation of oral treprostinil or the end of the observation period. Persistence was calculated using Kaplan-Meier estimates. Prior to transition to oral treprostinil, patients had received inhaled treprostinil for a median of 643 (IQR: 322-991) days and 52% of patients were New York Heart Association/World Health Organization Functional Class III. For patients that cross-titrated between formulations, the median time to complete the cross titration was 24 (IQR: 1-57) days. At 16- and 24-weeks post-transition, oral treprostinil persistence was 86 and 76%, respectively. Persistence was 59% at 52 weeks post-transition. Clinical stability for the majority of patients at first follow-up post-transition was suggested based on available New York Heart Association/World Health Organization Functional Classification. Transitions from inhaled to oral treprostinil appeared safe and tolerable in the short-term. Additional prospective studies are needed to fully evaluate the safety and efficacy of transitions from inhaled to oral treprostinil.

Radical Cystectomy Against Intravesical BCG for High-Risk High-Grade Nonmuscle Invasive Bladder Cancer: Results From the Randomized Controlled BRAVO-Feasibility Study.

PURPOSE: High-grade nonmuscle invasive bladder cancer (HRNMIBC) is a heterogeneous disease. Treatments include intravesical maintenance Bacillus Calmette-Guerin (mBCG) and radical cystectomy (RC). We wanted to understand whether a randomized trial comparing these options was possible. MATERIALS AND METHODS: We conducted a two-arm, prospective multicenter randomized study to determine the feasibility in Bacillus Calmette-Guerin-naive patients. Participants had new high-risk HRNMIBC suitable for both treatments. Random assignment was stratified by age, sex, center, stage, presence of carcinoma in situ, and prior low-risk bladder cancer. Qualitative work investigated how to maintain equipoise. The primary outcome was the number of patients screened, eligible, recruited, and randomly assigned. RESULTS: We screened 407 patients, approached 185, and obtained consent from 51 (27.6%) patients. Of these, one did not proceed and therefore 50 were randomly assigned (1:1). In the mBCG arm, 23/25 (92.0%) patients received mBCG, four had nonmuscle invasive bladder cancer (NMIBC) after induction, three had NMIBC at 4 months, and four received RC. At closure, two patients had metastatic BC. In the RC arm, 20 (80.0%) participants received cystectomy, including five (25.0%) with no tumor, 13 (65.0%) with HRNMIBC, and two (10.0%) with muscle invasion in their specimen. At follow-up, all patients in the RC arm were free of disease. Adverse events were mostly mild and equally distributed (15/23 [65.2%] patients with mBCG and 13/20 [65.0%] patients with RC). The quality of life (QOL) of both arms was broadly similar at 12 months. CONCLUSION: A randomized controlled trial comparing mBCG and RC will be challenging to recruit into. Around 10% of patients with high-risk HRNMIBC have a lethal disease and may be better treated by primary radical treatment. Conversely, many are suitable for bladder preservation and may maintain their prediagnosis QOL.

Electronic Patient Reporting of Adverse Events and Quality of Life: A Prospective Feasibility Study in General Oncology.

PURPOSE: Adverse event (AE) reporting is essential in clinical trials. Clinician interpretation can result in under-reporting; therefore, the value of patient self-reporting has been recognized. The National Cancer Institute has developed a Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) for direct patient AE reporting. A nonrandomized prospective cohort feasibility study aimed to explore the compliance and acceptability of an electronic (Internet or telephone) system for collecting patient self-reported AEs and quality of life (QOL). METHODS: Oncology patients undergoing treatment (chemotherapy, targeted agents, hormone therapy, radiotherapy, and/or surgery) at 2 hospitals were sent automated weekly reminders to complete PRO-CTCAE once a week and QOL (for a maximum of 12 weeks). Patients had to speak/understand English and have access to the Internet or a touch-tone telephone. Primary outcome was compliance (proportion of expected questionnaires), and recruitment rate, attrition, and patient/staff feedback were also explored. RESULTS: Of 520 patients, 249 consented (47.9%)-mean age was 62 years, 51% were male, and 70% were married-and 230 remained on the study at week 12. PRO-CTCAE was completed at 2,301 (74.9%) of 3,074 timepoints and QOL at 749 (79.1%) of 947 timepoints. Individual weekly/once every 4 weeks compliance reduced over time but was more than 60% throughout. Of 230 patients, 106 (46.1%) completed 13 or more PRO-CTCAE, and 136 (59.1%) of 230 patients completed 4 QOL questionnaires. Most were completed on the Internet (82.3%; mean age, 60.8 years), which was quicker, but older patients preferred the telephone option (mean age, 70.0 years). Positive feedback was received from patients and staff. CONCLUSION: Self-reporting of AEs and QOL using an electronic home-based system is feasible and acceptable. Implementation of this approach in cancer clinical trials may improve the precision and accuracy of AE reporting.

Correction to: Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study.

Changes within text are indicated in bold.

Medication Adherence and Healthcare Costs Among Patients with Pulmonary Arterial Hypertension Treated with Oral Prostacyclins: A Retrospective Cohort Study.

BACKGROUND: Given the improved convenience of oral prostacyclins, there is a shift toward their use in treating pulmonary arterial hypertension (PAH). OBJECTIVES: Our objective was to compare patient characteristics, medication adherence, healthcare resource use (HCRU), and costs among patients receiving oral treprostinil or selexipag. METHODS: We used Truven Health MarketScan Commercial and Medicare databases to identify patients with PAH with a diagnosis code for pulmonary hypertension (PH) plus a prescription for oral treprostinil or selexipag from July 2013 to September 2017. Medication adherence, persistence, and all-cause and PAH-related HCRU and costs were compared between cohorts during the 6-month follow-up. Adjusted healthcare costs were obtained using recycled predictions and bootstrapped samples. RESULTS: A total of 256 (130 oral treprostinil, 126 selexipag) patients fulfilled the study criteria. The oral treprostinil cohort was more likely to be male, to have previously used parenteral prostacyclins, and to have higher outpatient costs at baseline than the selexipag cohort. During follow-up, both cohorts had similar proportions of patients who were adherent to and persistent with their respective therapies. All-cause and PAH-related medical utilization was generally similar between cohorts. The oral treprostinil cohort had 66.9% lower total PAH-related healthcare costs (mean difference - $75,183; 95% confidence interval [CI] - 102,584 to - 49,771) and 70.6% lower PAH-related pharmacy costs (mean difference - $76,439; 95% CI - 104,512 to - 51,458) than the selexipag cohort, with similar differences in all-cause healthcare and pharmacy costs. CONCLUSIONS: Lower all-cause and PAH-related total healthcare and pharmacy costs were observed in patients receiving oral treprostinil compared with those receiving selexipag. It will be important to study longer-term costs and clinical outcomes.

Suicidal thoughts and behaviors in adolescents who underwent bariatric surgery.

BACKGROUND: Extant literature warns of elevated suicide risks in adults postbariatric surgery, making understanding risks for adolescent patients imperative. OBJECTIVES: To examine prevalence and predictors/correlates of suicidal thoughts and behaviors (STBs) in adolescents with severe obesity who did/did not undergo bariatric surgery from presurgery/baseline to 4 years postsurgery. SETTING: Five academic medical centers. METHODS: Using a prospective observational design, surgical adolescents (n = 153; 79% female, 65% white, mean [M]age = 17 yr, Mbody mass index[BMI] = 52 kg/m2) and nonsurgical comparators (n = 70; 80% female, 54% white, Mage = 16 yr, MBMI = 47 kg/m2) completed psychometrically sound assessments at presurgery/baseline and postsurgery years 2 and 4 (year 4: n = 117 surgical [MBMI = 38 kg/m2], n = 56 nonsurgical [MBMI = 48 kg/m2]). RESULTS: For the surgical group, rates of STBs were low (year 2 [1.3%-4.6%]; year 4 [2.6%-7.9%], similar to national base rates. Groups did not differ on a year 4 postsurgical STBs (post-STBs) composite (post-STBs: ideation/plan/attempt; n = 18 surgical [16%], n = 10 nonsurgical [18%]; odds ratio = .95, P = .90). For the surgical group, predictors/correlates identified within the broader suicide literature (e.g., psychopathology [P < .01], victimization [P < .05], dysregulation [P < .001], drug use [P < .05], and knowing an attemptor/completer [P < .001]) were significantly associated with post-STBs. Surgery-specific factors (e.g., percent weight loss, weight satisfaction) were nonsignificant. Of those reporting a lifetime attempt history at year 4, only a minority (4/13 surgical, 3/9 nonsurgical) reported a first attempt during the study period. Of 3 decedents (2 surgical, 1 nonsurgical), none were confirmed suicides. CONCLUSIONS: The present study indicates that undergoing bariatric surgery in adolescence does not heighten (or lower) risk of STB engagement across the initial 4 years after surgery. Suicide risks present before surgery persisted, and also newly emerged in a subgroup with poorer psychosocial health.

Impact of inhaled treprostinil on risk stratification with noninvasive parameters: a post hoc analysis of the TRIUMPH and BEAT studies.

The 2015 European Society of Cardiology/European Respiratory Society treatment guidelines recommend frequent risk assessment in pulmonary arterial hypertension utilizing risk variables. Our objectives were: (1) to investigate the impact of inhaled treprostinil on risk stratification using the French noninvasive approach and REVEAL 2.0, and (2) to analyze the prognostic utility of both risk stratification methods in the predominantly New York Heart Association/World Health Organization functional class III/IV cohorts of TRIUMPH and BEAT. A post hoc analysis was performed to assess risk at baseline and follow-up at Week 12 in the TRIUMPH cohort (n = 148) and at Week 16, 21, and 30 in the inhaled treprostinil naïve placebo BEAT cohort (n = 73). Overall survival, clinical worsening-free survival, and pulmonary arterial hypertension-related hospitalization-free survival were all assessed in the pooled TRIUMPH and inhaled treprostinil naïve placebo BEAT cohorts based on risk group/strata at Week 12/16 follow-up. Inhaled treprostinil improved REVEAL 2.0 risk stratum (OR: 2.38, 95% CI: 1.09-5.19, p = 0.0298) and REVEAL 2.0 score (p = 0.0008) compared to placebo in the TRIUMPH cohort at Week 12. REVEAL 2.0 risk stratum and the number of low-risk criteria by the French approach improved at Weeks 16, 21, and 30 in the inhaled treprostinil naïve placebo BEAT cohort. Combining cohorts, REVEAL 2.0 risk stratification at follow-up was prognostic for clinical worsening-free, pulmonary arterial hypertension hospitalization-free, and overall survival, whereas the number of low-risk criteria was not. These post-hoc pooled analyses suggest inhaled treprostinil improves risk status and indicates that the REVEAL 2.0 calculator may be more suitable than the French noninvasive method for evaluating short-term clinical change in the New York Heart Association/World Health Organization functional class III/IV population.

The interaction of sociocultural attitudes and gender on disordered eating.

OBJECTIVE: The Tripartite Influence Model posits that social agents emphasize a thin ideal for women and a muscularity ideal for men. There is a gap in the literature of how sociocultural body ideal internalization affects overall disordered eating symptoms in men and specifically drive for muscularity in women. METHOD: The sample consisted of 1,929 participants (44.2% men) who completed online surveys. It was predicted that internalization would be a stronger predictor for overall disordered eating in women and for muscularity in men. RESULTS: Women with high internalization had increased disordered eating symptoms in comparison to men, whereas for men, increased internalization was linked to more drive for muscularity, as compared with women. CONCLUSIONS: It is important to emphasize, however, that men still exhibited higher rates of disordered eating symptoms when they had increased internalization and women exhibited an increased drive for muscularity when they had higher internalization.

A longitudinal examination of suicide-related thoughts and behaviors among bariatric surgery patients.

BACKGROUND: Past research suggests self-harm/suicidality are more common among adults who have undergone bariatric surgery than the general population. OBJECTIVES: To compare prevalence of self-harm/suicidal ideation over time and identify presurgery risk factors for postsurgery self-harm/suicidal ideation. SETTING: The Longitudinal Assessment of Bariatric Surgery-2 is a cohort study with presurgery and annual postsurgery assessments conducted at 10 U.S. hospitals. METHODS: Adults with severe obesity undergoing bariatric surgery between March 2006 and April 2009 (n = 2458). Five-year follow-up is reported. Self-reported history of suicidality assessed retrospectively via the Suicide Behavior Questionnaire-Revised (SBQ-R) and self-reported self-harm/suicidal ideation assessed prospectively via the Beck Depression Inventory-Version 1 (BDI-1). RESULTS: The SBQ-R was completed by 1540 participants; 2217 completed the BDI-1 pre- and postsurgery. Over 75% of participants were female, with a median age of 46 years and body mass index of 45.9 kg/m2. Approximately one fourth of participants (395/1534) reported a presurgery history of suicidal thoughts or behavior (SBQ-R). The prevalence of self-harm/suicidal ideation (BDI-1) was 5.3% (95% confidence interval [CI], 3.7-6.8) presurgery and 3.8% (95% CI, 2.5-5.1) at year 1 postsurgery (P = .06). Prevalence increased over time postsurgery to 6.6% (95% CI, 4.6-8.6) at year 5 (P = .001) but was not significantly different than presurgery (P = .12). CONCLUSIONS: A large cohort of adults with severe obesity who underwent bariatric surgery had a prevalence of self-harm/suicidal ideation that may have decreased in the first postoperative year but increased over time to presurgery levels, suggesting screening for self-harm/suicidality is warranted throughout long-term postoperative care. Several risk factors were identified that may help with enhanced monitoring.

Identifying Patients with Pulmonary Arterial Hypertension Using Administrative Claims Algorithms.

Retrospective administrative claims database studies provide real-world evidence about treatment patterns, healthcare resource use, and costs for patients and are increasingly used to inform policy-making, drug formulary, and regulatory decisions. However, there is no standard methodology to identify patients with pulmonary arterial hypertension (PAH) from administrative claims data. Given the number of approved drugs now available for patients with PAH, the cost of PAH treatments, and the significant healthcare resource use associated with the care of patients with PAH, there is a considerable need to develop an evidence-based and systematic approach to accurately identify these patients in claims databases. A panel of pulmonary hypertension clinical experts and researchers experienced in retrospective claims database studies convened to review relevant literature and recommend best practices for developing algorithms to identify patients with PAH in administrative claims databases specific to a particular research hypothesis.

Emotions before and after loss of control eating.

Our study examined momentary mood and emotional instability pre- and post-loss of control (LOC) eating on non-LOC and LOC eating days, using randomly timed assessments. Community and university participants (n = 45) who endorsed LOC eating at least once per week completed 2 weeks of ecological momentary assessment. All negative moods and emotional instability were elevated on LOC eating days, but trajectories between days did not differ. Guilt exhibited an increasing trajectory prior to a LOC eating episode, but remained elevated after LOC eating episodes. Additional analyses revealed that size of the LOC eating episode did not change these results dramatically.

An examination of the relationships between acculturative stress, perceived discrimination, and eating disorder symptoms among ethnic minority college students.

Empirical evidence suggests the importance of considering acculturative stress and perceived discrimination in understanding the mental health of ethnic minority groups, including their eating behaviors and associated psychopathology. The current study examined the effect of acculturative stress and perceived discrimination on eating disorder symptoms among ethnic minority undergraduate students. A total of 187 ethnic minority undergraduate students (41.2% men) completed this cross-sectional study by completing self-report questionnaires on a secure online system. Regression analyses revealed a main effect of acculturative stress on eating concern, shape concern, weight concern, drive for thinness, and bulimia but not restraint or body dissatisfaction. Gender moderated the effect of acculturative stress on drive for muscularity, suggesting that this effect was only significant in women, but not men. The main effect of perceived discrimination was significant for restraint, eating concern, shape concern, weight concern, and drive for muscularity but not drive for thinness, bulimia, or body dissatisfaction. Acculturative stress and perceived discrimination are important factors to consider in understanding the development and maintenance of eating disorder symptoms among ethnic minority populations. Targeting these two factors may improve the effectiveness of intervention programs for eating disorder symptoms among ethnic minority undergraduate students.

Empirically derived classes of eating pathology in male and female college students.

BACKGROUND: The empirical structure of eating disorder (ED) pathology has often been studied in female, clinical samples, leaving questions about the structure of ED pathology in males and nonclinical samples. METHOD: A latent class analysis was performed on data combined from two different studies (N = 1,751) using the behavioral items in the Eating Disorder Examination Questionnaire (EDE-Q; binge eating, self-induced vomiting, laxative use, and excessive exercise), with the addition of an item representing restraint. Validation analyses examined weight, shape, and eating concern among the classes. RESULTS: Three similar classes emerged for both the men and women's models: very low ED behaviors, binge eating, and high ED behaviors. DISCUSSION: These results suggest that binge eating occurs within the context of lower symptom and higher symptom presentations, and that the empirical structure of ED symptoms does not differ in men and women in the nonclinical population. Further research is needed to clarify whether ED phenotypes differ in men and women.

"I don't want to grow up, I'm a [Gen X, Y, Me] kid": Increasing maturity fears across the decades.

The current studies examined the hypothesis that maturity fears are increasing among undergraduate men and women from the United States over time. Study 1 used a time-lag method to assess generational effects of maturity fears among a large sample (n = 3,291) of undergraduate men and women assessed in 1982, 1992, 2002, and 2012. Results revealed that both men and women reported significantly higher rates of maturity fears across time. Study 2 replicated these findings, and used a more restricted time frame to more closely examine the rate of change. Undergraduate women (n = 554) were assessed in 2001, 2003, 2009, and 2012. Maturity fears were again found to increase from 2001 to 2012. Recent cohorts of emerging adults seem more reluctant to mature than previous cohorts. Many contributing factors may be at play, including challenging economic times, social pressures to remain youthful, and/or internal fears of assuming increased responsibility.