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Widge AS, Jordan A, Kraguljac NV, Sullivan CRP, Wilson S, Benton TD, Alpert JE, Carpenter LL, Krystal JH, Nemeroff CB, Dzirasa K. Structural Racism in Psychiatric Research Careers: Eradicating Barriers to a More Diverse Workforce. Am J Psychiatry 2023; 180:645-659. [PMID: 37073513 DOI: 10.1176/appi.ajp.20220685] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
Investigators from minoritized backgrounds are underrepresented in psychiatric research. That underrepresentation contributes to disparities in outcomes of access to mental health care. Drawing on lived experience, scholarly qualitative reports, and empirical data, the authors review how the underrepresentation of minoritized researchers arises from interlocking, self-reinforcing effects of structural biases in our research training and funding institutions. Minoritized researchers experience diminished early access to advanced training and opportunities, stereotype threats and microaggressions, isolation due to lack of peers and senior mentors, decreased access to early funding, and unique community and personal financial pressures. These represent structural racism-a system of institutional assumptions and practices that perpetuates race-based disparities, in spite of those institutions' efforts to increase diversity and in contradiction to the values that academic leaders outwardly espouse. The authors further review potential approaches to reversing these structural biases, including undergraduate-focused research experiences, financial support for faculty who lead training/mentoring programs, targeted mentoring through scholarly societies, better use of federal diversity supplement funding, support for scientific reentry, cohort building, diversity efforts targeting senior leadership, and rigorous examination of hiring, compensation, and promotion practices. Several of these approaches have empirically proven best practices and models for dissemination. If implemented alongside outcome measurement, they have the potential to reverse decades of structural bias in psychiatry and psychiatric research.
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Affiliation(s)
- Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Ayana Jordan
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Nina V Kraguljac
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Christi R P Sullivan
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Saydra Wilson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Tami D Benton
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Jonathan E Alpert
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Linda L Carpenter
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - John H Krystal
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
| | - Kafui Dzirasa
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis (Widge, Sullivan, Wilson); Department of Psychiatry, New York University Grossman School of Medicine, New York (Jordan); Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham (Kraguljac); Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (Benton); Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center and Albert Einstein College of Medicine, New York (Alpert); Butler Hospital and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I. (Carpenter); Department of Psychiatry, Yale University School of Medicine, New Haven, Conn. (Krystal); Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas at Austin, Austin (Nemeroff); Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C., and Howard Hughes Medical Institute, Chevy Chase, Md. (Dzirasa)
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Lathan EC, Guelfo A, La Barrie DL, Teer A, Powers A, Siegle G, Fani N. Differing associations of depersonalization with physiological response during rest and breath-focused mindfulness in a trauma-exposed female population. J Psychiatr Res 2023; 162:193-199. [PMID: 37172509 PMCID: PMC10305839 DOI: 10.1016/j.jpsychires.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/10/2023] [Accepted: 05/01/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Dissociative and posttraumatic stress disorder (PTSD) symptoms are commonly co-occurring responses to psychological trauma. Yet, these two groups of symptoms appear to be related to diverging patterns of physiological response. To date, few studies have examined how specific dissociative symptoms, namely, depersonalization and derealization, relate to skin conductance response (SCR), a marker of autonomic function, within the context of PTSD symptoms. We examined associations among depersonalization, derealization, and SCR during two conditions - resting control and breath-focused mindfulness - in the context of current PTSD symptoms. METHODS Sixty-eight trauma-exposed women (82.4% Black; Mage = 42.5, SDage = 12.1) were recruited from the community for a breath-focused mindfulness study. SCR data were collected during alternating resting control and breath-focused mindfulness conditions. Moderation analyses were conducted to examine relations among dissociative symptoms, SCR, and PTSD for these different conditions. RESULTS Moderation analyses revealed that depersonalization was linked to lower SCR during resting control, B = 0.0005, SE = 0.0002, p = .006, in participants low-to-moderate PTSD symptoms; however, depersonalization was associated with higher SCR during breath-focused mindfulness, B = -0.0006, SE = 0.0003, p = .029, in individuals with similar levels of PTSD symptoms. No significant interaction between derealization and PTSD symptoms on SCR was observed. CONCLUSIONS Depersonalization symptoms may associate with physiological withdrawal during rest, but greater physiological arousal during effortful emotion regulation in individuals with low-to moderate levels of PTSD, which has significant implications for barriers to treatment engagement as well as treatment selection in this population.
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Affiliation(s)
- Emma C Lathan
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Alfonsina Guelfo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | | | - Andrew Teer
- Home Base, a Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, MA, USA; Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Greg Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
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Fleischman DA, Arfanakis K, Leurgans SE, Zhang S, Lamar M, Han SD, Poole VN, Kim N, Bennett DA, Barnes LL. Late-life depressive symptoms and white matter structural integrity within older Black adults. Front Aging Neurosci 2023; 15:1138568. [PMID: 37205056 PMCID: PMC10186351 DOI: 10.3389/fnagi.2023.1138568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction Older Black adults experience a high burden of depressive symptoms and cerebrovascular disease but the specific neurobiological substrates underlying the association between late-life depressive symptoms and brain integrity are understudied, particularly in within-group designs. Methods Using the Center for Epidemiologic Studies Depression Scale and diffusion-tensor imaging, within-Black variation in the association between late-life depressive symptoms and white matter structural integrity was examined in 297 older Black participants without dementia that were enrolled across three epidemiological studies of aging and dementia. Linear regression models were used to test associations with DTI metrics (fractional anisotropy, trace of the diffusion tensor) as the outcomes and depressive symptoms as the predictor, while adjusting for age, sex, education, scanner, serotonin-reuptake inhibitor use, total volume of white-matter hyperintensities normalized by intracranial volume, and presence of white-matter hyperintensities at the voxel level. Results Higher level of self-reported late-life depressive symptoms was associated with greater diffusion-tensor trace (reduced white matter integrity) in connections between commissural pathways and contralateral prefrontal regions (superior and middle frontal/dorsolateral prefrontal cortex), association pathways connecting dorsolateral prefrontal cortex with insular, striatal and thalamic regions, and association pathways connecting the parietal, temporal and occipital lobes and the thalamus. Discussion This study demonstrated a discernable pattern of compromised white matter structural integrity underlying late-life depressive symptoms within older Black adults.
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Affiliation(s)
- Debra A. Fleischman
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Konstantinos Arfanakis
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL, United States
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Preventive Medicine, Rush University Medical Center, Chicago IL, United States
| | - Shengwei Zhang
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
| | - Melissa Lamar
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - S. Duke Han
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Family Medicine and Neurology, Keck School of Medicine, Los Angeles, CA, United States
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
- School of Gerontology, University of Southern California, Los Angeles, CA, United States
| | - Victoria N. Poole
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Namhee Kim
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
| | | | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
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Denckla CA, Averkamp NM, Slopen N, Espinosa Dice AL, Williams D, Shear MK, Koenen KC. Social Determinants Associated With Exposure to Childhood Parental Bereavement and Subsequent Risk for Psychiatric Disorders. JAMA Netw Open 2022; 5:e2239616. [PMID: 36315141 PMCID: PMC9623444 DOI: 10.1001/jamanetworkopen.2022.39616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
IMPORTANCE Prevalence of childhood parental death varies by race and ethnicity and socioeconomic status, yet whether similar variation persists in the association with lifetime psychiatric disorder is unknown. OBJECTIVE To assess whether race and ethnicity and parental educational attainment are associated with the risk of death of a parent; to determine whether the risk for lifetime psychiatric disorder associated with death of a parent was moderated by race and ethnicity and highest parental educational attainment; and to examine a potential intersection of race and ethnicity with parental educational attainment in the risk of lifetime psychiatric disorder associated with death of a parent. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the National Comorbidity Study: Adolescent Supplement (NCS-A), 2001 to 2004. Participants included youth aged 13 to 18 years, restricted to Black, Hispanic, and White youth due to power limitations. Data were analyzed from February 26, 2021, to April 21, 2022. EXPOSURE Death of a parent during childhood. MAIN OUTCOMES AND MEASURES The primary study outcome was any lifetime Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric disorder, assess via assessed via structured clinical interviews. RESULTS Among 9501 youth (mean [SD] age, 15.2 [1.5] years; 50.9% female), including 511 youth who had experienced parental death and 8990 youth who had not, the cumulative hazard of parental death by age 18 years was approximately doubled for Hispanic (10.1%; 95% CI, 6.9%-14.7%) and Black (14.0%; 95% CI, 10.6%-18.4%) youth compared with White youth (6.0%; 95% CI, 4.7%-7.8%). Similar patterns were noted by parental educational attainment: the cumulative hazard of parental death for youth of parents with less educational attainment was nearly double (10.1%; 95% CI, 8.1%-12.6%) compared with youth of parents with more education (6.6%; 95% CI, 5.2%-8.4%). Death of a parent was positively and significantly associated with risk of any lifetime psychiatric disorder (aOR, 1.34; 95% CI, 1.03-1.75) compared with youth who had not experienced death of a parent. However, this association was not moderated by race and ethnicity (aOR, 1.05; 95% CI, 0.58-1.92) or parental educational attainment (aOR, 1.19; 95%, 0.70-2.04), although power analyses suggest that larger sample sizes are needed. CONCLUSIONS AND RELEVANCE In this cross-sectional study, Black and Hispanic youth experienced elevated parental death compared with White youth, yet the risk for any lifetime psychiatric disorder after parental death was not significantly moderated by race and ethnicity or parental education. Both individual- and population-level interventions may be needed to address the increased risk of psychiatric disorders, although additional studies with larger sample sizes are needed.
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Affiliation(s)
- Christy A Denckla
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Natalie M Averkamp
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | | | - David Williams
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts
- Department of Sociology, Harvard University Faculty of Arts and Sciences, Cambridge, Massachusetts
| | | | - Karestan C Koenen
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
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