Latent class/profile analysis in maltreatment research: a commentary on Nooner et al., Pears et al., and looking beyond

Psychosocial profiles and blood pressure control: results from the multi-ethnic study of atherosclerosis (MESA)

Growing research shows psychosocial factors are associated with blood pressure (BP) control among individuals with hypertension. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing profiles among individuals with hypertension. The association of psychosocial profiles and BP control remains unknown. To characterize the psychosocial profiles of individuals with hypertension and assess whether they are associated with BP control over 14 years. We included 2,665 MESA participants with prevalent hypertension in 2002-2004. Nine psychosocial variables representing individual, interpersonal, and neighborhood factors were included. BP control was achieved if systolic blood pressure (SBP)  < 140 mmHg and diastolic blood pressure (DBP) < 9090 mmHg. Latent profile analysis (LPA) revealed an optimal model of three psychosocial profile groups (AIC 121,229; entropy = .88) "Healthy", "Psychosocially Distressed" and "Discriminated Against". Overall, there were no significant differences in systolic and diastolic BP control combined, across the profiles. Participants in the "Discriminated Against" profile group were significantly less likely [OR= 0.60; 95% CI: 0.43, 0.84] to have their DBP < 9090 mmHg as compared to the "Healthy" profile, but this was attenuated with full covariate adjustment. Discrete psychosocial profiles exist among individuals with hypertension but were not associated with BP control after full covariate adjustment.

Patterns of dietary quality, physical activity, and sleep duration among cancer survivors and caregivers

Fruit and vegetable intake (FVI), moderate-to-vigorous physical activity (MVPA), and sleep duration are each independently associated with cancer-related and general health outcomes among cancer survivors. Past research suggests that health behaviors cluster among cancer survivors, with caregivers demonstrating similar patterns. This analysis examined co-occurrence of FVI, MVPA, and sleep duration among cancer survivors and informal cancer caregivers and identified sociodemographic and clinical correlates of health behavior engagement. Using data from the Health Information National Trends Survey (HINTS), an exploratory latent profile analysis (LPA) was conducted among those self-reporting a history of cancer or identifying as a cancer caregiver. The LPA model was fit with daily self-reported FVI (cups/d), MPVA (minutes/d) and sleep duration (hours/d). Multinomial logistic regression models were used to predict profile membership based on sociodemographic and clinical characteristics. Four health behavior profiles were identified (Least Engaged-No MVPA, Least Engaged-Low MVPA, Moderately Engaged, and Highly Engaged). The largest profile membership was Least Engaged-No MVPA, capturing 37% of the sample. Profiles were most distinguished by MVPA, with the lowest variance in sleep duration. Participants reporting higher FVI also often reported greater MVPA and longer sleep duration. Profile membership was significantly associated with age, relationship status, education, income, rurality, alcohol use, self-efficacy, psychological distress, BMI, and cancer type. This study identified four health behaviors patterns and sociodemographic correlates that distinguished those patterns among cancer survivors and caregivers drawn from a nationally representative sample. Results may help identify for whom health behavior interventions could be of greatest benefit.

Identification of postpartum symptom informedness and preparedness typologies and their associations with psychological health: A latent class analysis

BACKGROUND

Birthing parents, defined as postpartum women and people with various gender identities who give birth, commonly experience challenging postpartum symptoms. However, many report feeling uninformed and unprepared to navigate their postpartum health.

OBJECTIVE

To identify typologies of postpartum symptom informedness and preparedness using latent class analysis (LCA) and to examine the associated patient and healthcare characteristics.

METHODS

We used survey data from a large, multi-method, longitudinal research project Postnatal Safety Learning Lab. Participants were recruited using convenience sampling and enrolled between November 2020 and June 2021. LCA was used to identify subgroups of birthing parents with different symptom informedness and preparedness using 10 binary variables (N = 148). Bivariate analysis was conducted to examine the association between characteristics and each typology.

FINDINGS

The 3-class models had better fit indices and interpretability for both informedness and preparedness typologies: High, High-moderate, and Moderate-low. The sample characteristics were different by typologies. In the modified discrimination in medical settings assessment, we found higher discrimination scores in the moderate-low informedness and preparedness typologies. The moderate-low preparedness typology had a higher percentage of birthing parents who did not have private insurance, underwent cesarean section, and planned for formula or mixed infant feeding. The median PHQ-4 scores at 4 weeks postpartum were lower among those in high informedness and preparedness typologies.

CONCLUSION

In our sample, 18 to 21 % of birthing parents were in the moderate-low informedness or preparedness typologies. Future research and practice should consider providing tailored information and anticipatory guidance as a part of more equitable and supportive care.

Family structure and children's risk of child protective services re-reports

BACKGROUND

Single parent families are at higher risk of re-report to Child Protective Services (CPS) than two-parent families. Yet, how single-family homes differ in risk from two-parent families remains under researched.

OBJECTIVE

To identify heterogenous patterns of child and caregiver factors among CPS-involved families and the subsequent risk for CPS re-report based on child and family characteristics (i.e., sociodemographic information, family structure, and risk indicators).

PARTICIPANTS AND SETTING

Data were from the 2017 National Child Abuse and Neglect Data System Child File (N = 249,026).

METHODS

We conducted latent class analysis (LCA) to identify discrete patterns (i.e., classes) based on child and caregiver risk indicators (e.g., substance use, behavioral health). We then used logistic regression to examine family structure and other family characteristics and CPS indicators predicted CPS re-report for each class.

RESULTS

Results yielded five distinct classes: 1) Financial Stressors (25 % of the sample); 2) Caregiver Substance Use (16 %); 3) Complex Household Stressors (3 %); 4) Child Disabilities (4 %); and 5) Minimal Household Stressors (53 %). Family structure was significantly associated with CPS re-reports for Classes 1, 2, and 5. For Class 1, single father families had increased odds of CPS re-report compared to other family structures. For Classes 2 and 5, single father families' odds of CPS re-reports were greater than those of married families, but lower than single mother families.

CONCLUSIONS

Children growing up in single father families have different likelihoods of repeat CPS involvement compared to those in single mother and married families. Financial stressors and parental substance use within single father families should be addressed.

Childhood adversity is associated with anxiety and depression in older adults: A cumulative risk and latent class analysis

BACKGROUND

The long-lasting influence of childhood adversity on mental health is well documented; however empirical research examining how this association extends into older adults is limited. This study operationalises adversity using cumulative risk and latent class analysis (LCA) models to assess how adversity exposure and typologies may predict anxiety and depression in older adults.

METHODS

Data came from the Personality and Total Health (PATH) Through Life Project (N = 2551, age 60-66). Participants retrospectively reported their childhood experiences of domestic adversity on a 17-item scale. Mental health was measured using four validated questionnaires of depression and anxiety.

RESULTS

Linear and generalised additive models (GAM) indicated a dose-response relationship, where a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. LCA identified a four-class solution; with high adversity and high parental dysfunction being associated with poorer mental health outcomes while moderate parental dysfunction and low adversity groups scored at healthy levels. Women reported higher overall anxiety than men, but no notable interactions between ACEs and gender were observed. Patterns revealed by LCA were similar to patterns shown by the cumulative risk model.

LIMITATIONS

There is a large time gap from childhood to assessment, making our study susceptible to recall bias. Also, our findings were based on cross-sectional data, limiting causal inferences.

CONCLUSION

Childhood adversity had independent and additive contributions to depression and anxiety in older adulthood, and both cumulative risk and person-centred approaches captured this relationship.

Perinatal Health Profiles Associated With Removal From the Home and Subsequent Child Protective Services Report in Maltreated Infants

Infants face the highest risk of abuse and neglect nationally. There is a compelling need to understand the individual risk factors and needs of families of maltreated infants so that prevention efforts can be tailored for optimal effectiveness. Using linked birth certificate and CPS records data, we employed latent class analysis to identify distinct profiles of perinatal health factors associated with infant maltreatment. Classes were then regressed onto two key child welfare outcomes-removal from the home and re-report. Results indicated 10 latent classes primarily associated with supervisory neglect and presumed prenatal substance exposure. Rapid repeat pregnancy, smoking during pregnancy and inadequate prenatal care emerged as key risk factors. Presumed substance exposure was associated with high risk of removal from the home and low risk of re-report. The opposite was found for supervisory neglect. Substantial variation existed across classes and types of maltreatment, suggesting a need for tailored prevention strategies.

Can platform use patterns be an indicator of HIV-related risk and sub-group heterogeneity among men who have sex with men in Singapore: a latent class analysis

Introduction

Low-level HIV epidemic settings like Singapore face the challenge of reaching men at-risk who have less contact with programmes. We investigated patterns of meeting platform use by men seeking male sexual partners (MSM) as potential marker of risk to differentiate sub-groups for interventions.

Methods

Latent Class Analysis (LCA) was applied to a survey sample of MSM recruited from bars/clubs, saunas and a smartphone application, using purposive sampling. The best-fit LCA model which identified homogeneous sub-groups with similar patterns of meeting platform was factored in multivariable regression to identify associations with risk behaviors on the pathway to HIV infection.

Results

Overall 1,141 MSM were recruited from bars/clubs (n = 426), saunas (n = 531), and online (n = 184). Five patterns emerged, reflecting salient platform use characteristics: Sauna-centric (SC; n = 413), App-centric (AC; n = 276), Multiple-platforms (MP; n = 123), Platform-inactive (PI; n = 257), and "Do not hook up" (DNH; n = 72) classes. Men in the SC and MP classes had high probabilities of using saunas to meet partners; SC were older and less likely to have disclosed their sexual orientation. The MP class had high probabilities of connecting across all platforms in addition to saunas and more likely to have disclosed their sexual orientation, than the PI class. Men in the SC and MP classes had twice the odds of reporting multiple sex partners (aORSC = 2.1; 95%CI: 1.33.2; aORMP = 2.2; 95%CI: 1.14.6). Single/non-partnered MSM and those using alcohol/drugs during sex had 1.7 (95%CI: 1.22.5) and 3.2 (95%CI: 2.05.1) the odds respectively, of reporting multiple sex partners. The SC and MP classes had higher odds of engaging in group sex while MSM using alcohol/drugs during sex had twice the odds of reporting group sex. Alcohol/drugs and group sex were independently associated with condomless sex (as was lower education). Group sex, alcohol/drugs during sex, disclosure of sexual orientation or being Singaporean/permanent resident were associated with recent testing for HIV.

Discussion

The five distinct risk profiles identified can help tailor differentiated HIV interventions-combined with field knowledge and other prevention-to expand HIV self-testing, Pre-Exposure Prophylaxis and other services (e.g., Mpox vaccination) to sub-groups at risk.

Profiles of Intimate Partner Violence Victimization: A Systematic Review

Person-centered approaches, such as latent class analysis (LCA) and latent profile analysis (LPA), aid the identification of subgroups within sample populations. These methods can identify the patterns of co-occurrence between different forms of intimate partner violence (IPV), providing valuable information for prevention and intervention efforts. The aim of this systematic review was to yield a summary and conduct a critical evaluation of the current research that utilizes LCA/LPA to investigate IPV victimization profiles. We provide an outline of 14 relevant studies, retrieved from searches conducted on PsycInfo, Scopus, and Eric databases. There was a large amount of variability in relation to the forms of IPV assessed, measures utilized, number of classes identified, and the sample populations recruited. However, broad similarities were revealed as there were some commonly identified classes, including the no/low violence class, the physical and psychological victimization class, and the multiple victimization class, yet the labels assigned to those classes differed across studies. A range of external criteria (risk factors and consequences) were also identified as being associated with class membership. We highlight the methodological features which may have impacted data collection and class enumeration, including the differences in sample population, the range of IPV indicators assessed, the time period from which IPV data were recorded, and whether data were collected regarding participants' current or previous relationships. Marginalized populations were underrepresented, and psychological abuse was most inconsistently operationalized. Recommendations for future research are provided, including recommendations with regard to labeling the classes for greater consistency across studies.

Patterns of indulgent parenting and adolescents' psychological development

Objective

This study aimed to extend the current literature by examining the patterns of indulgent parenting of both mothers and fathers and their associations with adolescents' basic psychological needs satisfaction, self-control, and self-efficacy.

Background

Indulgent parenting could be harmful for the development of psychological needs satisfaction and cognitive abilities when adolescents seek autonomy and gain emotional regulatory skills. Yet research is limited on investigating the patterns of indulgent parenting and their relationships to adolescents' psychological development.

Method

The sample consisted of 268 adolescents in Grades 9 to 11 from several high schools in a southeastern region of the United States. Participants took an online survey about their perceptions of parental indulgent parenting, their psychological development, and demographic information.

Results

Results from multivariate mixture modeling suggested four distinct classes of perceived maternal and paternal indulgence. Further, these classes demonstrated differential associations with adolescents' basic psychological needs satisfaction, self-control, and self-efficacy.

Conclusion

The findings revealed different patterns of perceived indulgent parenting practices. Further, these findings also highlighted the negative role of perceived behavioral indulgence on adolescents' psychological development.

Implications

Implications for interventions targeted at parenting and adolescent development were noted.

Identification of postpartum symptom subgroups and associated long-term maternal depressive symptoms and well-being

Many postpartum women experience postpartum symptoms which often occur in clusters (i.e., three or more co-occurring symptoms that are related to each other). To date, research has focused on individual symptoms, which limits our understanding of how postpartum symptom clusters manifest and influence health. This secondary analysis used the Community and Child Health Network study data (N = 1784). No patient or public directly participated or contributed to the current analysis. Guided by the Symptom Management Theory, latent class analysis was performed to identify subgroups of postpartum women with different symptom experiences using observed variables at 6 months postpartum: anxiety (MINI-anxiety), general stress (PSS-10), posttraumatic stress (PCL-C), postpartum depression (EPDS), sleep disturbance (PSQI-sleep disturbance), and sleep duration (PSQI-sleep duration). Bivariate and multiple regression analyses were conducted to examine the association between subgroups and (a) individual characteristics and (b) long-term depressive symptoms (CES-D-9) and well-being at 18 and/or 24 months postpartum. Five subgroups were selected that had better-fit indices, entropy, and interpretability. Subgroups were labeled as (1) Minimum overall, (2) Mild-moderate overall, (3) Moderate-high sleep symptoms, (4) High psychological symptoms, and (5) High overall. After adjusting for covariates, postpartum women in Subgroups 4 and 5 had higher CES-D-9 scores at 18 and 24 months and lower well-being scores at 24 months. More postpartum women in Subgroups 4 and 5 experienced a history of depression or unemployment. Clinicians should provide targeted interventions for postpartum women in high-symptom subgroups.

Co-Occurrence, Predictors, and Related Aggressive Behaviors of Cognitive and Emotional Relative Deprivation Based on Latent Class Analysis

Given the frequent occurrence of relative deprivation among adolescents and its negative effects, this study investigated relative deprivation among adolescents using a person-centered statistical technique (n = 1196; 565 girls). Latent class analysis identified three groups: low cognitive and emotional relative deprivation (Class 1, 33.78% of adolescents), high cognitive and low emotional relative deprivation (Class 2, 37.79% of adolescents), and high cognitive and emotional relative deprivation (Class 3, 28.43% of adolescents). Adolescents with low income and without parental accompaniment were more likely to be assigned to Classes 3 and 2. Compared with Class 1, Classes 3 and 2 had significant positive predictive effects on physical aggression, relational aggression, and overall aggressive behavior. The classes of relative deprivation influenced both physical and relational aggression, but not verbal aggression. Based on these findings, demographic characteristics and latent classes of relative deprivation should be considered together when developing interventions for aggressive behaviors.

Identifying at-risk marines: A person-centered approach to adverse childhood experiences, mental health, and social support

BACKGROUND

Previous research indicates an association between adverse childhood experiences (ACES) and health outcomes; however, most of these studies rely on variable-centered techniques. This study implemented a person-centered approach to provide a more nuanced understanding of these relations.

METHODS

The sample consisted of 3611 male Marines who completed two surveys, one prior to service and another during or after service. A series of latent class analyses were conducted to identify homogenous subgroups, using ACE categories as indicators. Hierarchical regressions were conducted to examine the relationships between classes, deployment experiences, depression and PTSD, and social support problems.

RESULTS

Five classes were identified: Low Adversity (48.8 %), Low Adversity - Parental Separation (PS; 33.1 %), Elevated Adversity (7.0 %), Moderate Adversity - Violence/Safety (5.7 %), and Moderate Adversity - Parental Loss (PL; 5.4 %). Several classes were associated with outcomes; in reference to Low Adversity, Moderate Adversity - PL was associated with depression and PTSD, Elevated Adversity was associated with PTSD and social support problems, and Low Adversity - PS was associated with social support problems. Experiencing moderate to high combat appeared to modify the associations between Moderate Adversity - PL and depression and PTSD.

LIMITATIONS

Study sample was limited to U.S. Marines; ACEs indicators were limited to specific categories, not allowing for a full range of potential childhood traumatic experiences.

CONCLUSIONS

Findings suggest a nuanced connection between ACEs and mental health; using specific patterns of ACEs, particularly multifaceted indicators of adversity that are inclusive of parental absence may have more utility than the sheer number of ACEs as an indicator for those who may at a heightened risk for mental health concerns.

Tailoring dissemination strategies to increase evidence-informed policymaking for opioid use disorder treatment: study protocol

BACKGROUND

Policy is a powerful tool for systematically altering healthcare access and quality, but the research to policy gap impedes translating evidence-based practices into public policy and limits widespread improvements in service and population health outcomes. The US opioid epidemic disproportionately impacts Medicaid members who rely on publicly funded benefits to access evidence-based treatment including medications for opioid use disorder (MOUD). A myriad of misaligned policies and evidence-use behaviors by policymakers across federal agencies, state Medicaid agencies, and managed care organizations limit coverage of and access to MOUD for Medicaid members. Dissemination strategies that improve policymakers' use of current evidence are critical to improving MOUD benefits and reducing health disparities. However, no research describes key determinants of Medicaid policymakers' evidence use behaviors or preferences, and few studies have examined data-driven approaches to developing dissemination strategies to enhance evidence-informed policymaking. This study aims to identify determinants and intermediaries that influence policymakers' evidence use behaviors, then develop and test data-driven tailored dissemination strategies that promote MOUD coverage in benefit arrays.

METHODS

Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a national survey of state Medicaid agency and managed care organization policymakers to identify determinants and intermediaries that influence how they seek, receive, and use research in their decision-making processes. We will use latent class methods to empirically identify subgroups of agencies with distinct evidence use behaviors. A 10-step dissemination strategy development and specification process will be used to tailor strategies to significant predictors identified for each latent class. Tailored dissemination strategies will be deployed to each class of policymakers and assessed for their acceptability, appropriateness, and feasibility for delivering evidence about MOUD benefit design.

DISCUSSION

This study will illuminate key determinants and intermediaries that influence policymakers' evidence use behaviors when designing benefits for MOUD. This study will produce a critically needed set of data-driven, tailored policy dissemination strategies. Study results will inform a subsequent multi-site trial measuring the effectiveness of tailored dissemination strategies on MOUD benefit design and implementation. Lessons from dissemination strategy development will inform future research about policymakers' evidence use preferences and offer a replicable process for tailoring dissemination strategies.

Resilience in the face of adversity: classes of positive adaptation in trauma-exposed children and adolescents in residential care

Children and adolescents in residential care often face multiple traumatic experiences. However, some individuals show resilient adaptation. To depict this heterogeneity, the person-centered examination of different classes of adaptation is a powerful tool. Up to date, resilience was insufficiently addressed in this population. Data from 141 children and adolescents in residential care institutions in Austria regarding trauma history, psychopathology, behavioral adjustment, and protective factors were assessed with standardized self-report questionnaires. Distinct classes of adaptation after traumatic experiences were examined with Latent Class Analysis. Class differences regarding traumatic experiences and protective factors were analyzed with χ² testing. Three classes were identified [resilience (66.18%), mixed psychopathology (13.97%, mixed), high psychopathology (19.85%, high)]. Only males were classified into the resilient class and only females into the high class. The high class differed significantly from the resilient class regarding cumulative trauma history and protective factors. The mixed class did not differ from the resilient class regarding trauma history, however, they differed significantly regarding protective factors. The resilient class was associated with protective factors. Strong gender differences show the relevance of a differentiated evaluation of gender-specific protective factors and resilience indicators. Fostering protective factors may be a suitable approach for tailored intervention measures.

Identifying victimisation profiles in people with psychosis and a history of childhood trauma: a latent class analysis

Background

People with psychosis experience higher rates of childhood victimisation compared to the general population, which may impact on mental health and recovery. This study aimed to identify childhood victimisation profiles in a clinical sample to inform recommendations for routine care.

Methods

Participants were 146 adults (ages 19-65 years; M = 42.2) with schizophrenia-spectrum diagnoses reporting trauma. Childhood trauma was assessed using two retrospective measures, and a latent class analysis (LCA) was performed on four trauma types (sexual abuse, emotional abuse, physical abuse and neglect). Multinomial logistic regression investigated demographic differences between the classes.

Results

Four distinct childhood trauma classes were identified: Emotional abuse/neglect (n = 29); physical abuse (n = 14); sexual abuse (n = 19); and poly-victimisation (n = 84). There were no differences between the classes in terms of age, ethnicity, relationship status, education or current employment (relative risk (RR) = 0.85-1.27, p > 0.05). Participants in the poly-victimisation class were significantly more likely to be female (RR = 0.22-0.28, p < 0.04).

Discussion

Adults with psychosis, particularly females, are likely to report poly-victimisation in childhood. This highlights the need to comprehensively but concisely assess experiences of abuse and neglect in clinical care, in line with trauma-informed approaches.

Profiles in Dementia-Related Anxiety: A Latent Profile Analysis

OBJECTIVES

Dementia-related anxiety (DRA) is the concern about current or future cognitive decline and potential diagnosis of Alzheimer's disease or related dementias (ADRD). Existing research suggests that DRA likely develops due to diverse reasons (e.g., family ADRD history, self-perceived risk, and health-related anxiety), and approaches to managing DRA likely differ as well (e.g., future planning). This study aimed to identify profiles in DRA.

METHOD

In a cross-sectional study, a convenience sample of U.S. adults ranging in age from 18 to 82 (N = 492, Mage = 49.25, standard deviation [SDage] = 15.43) completed online assessments of characteristics associated with DRA. Latent profile analysis was used to uncover distinct DRA profiles and promote understanding of individual characteristics associated with varying levels of DRA; multinomial regression assessed if the profiles are further distinguished by covariates.

RESULTS

The resulting four-profile model reveals profile differences are largely due to DRA, self-perceived ADRD risk, and preparedness for future care needs; health-related anxiety, age, ADRD exposure, and anticipated ADRD stigma contribute to profile differences as well. Profiles of the youngest and oldest groups reported the lowest and highest levels of preparedness for future care, along with the lowest DRA and self-perceived risk. Several covariates, particularly those assessing general psychological functioning, were also related to profile membership.

DISCUSSION

The resulting profiles point to several factors associated with elevated anxiety about ADRD, which do not fully match the risk factors for ADRD.

Variability in recovery following microdiscectomy and postoperative physiotherapy for lumbar radiculopathy: A latent class trajectory analysis

OBJECTIVES

The clinical course of lumbar radiculopathy following microdiscectomy and post-operative physiotherapy varies substantially. No prior studies assessed this variability by deriving outcome trajectories. The primary aims of this study were to evaluate the variability in long-term recovery after lumbar microdiscectomy followed by post-operative physiotherapy and to identify outcome trajectories. The secondary aim was to assess whether demographic, clinical characteristics and patient-reported outcome measures routinely collected at baseline could predict poor outcome trajectories.

METHODS

We conducted a prospective cohort study with a 24-month follow-up. We included 479 patients with clinical signs and symptoms of lumbar radiculopathy confirmed by Magnetic Resonance Imaging findings, who underwent microdiscectomy and post-operative physiotherapy. Outcomes were leg pain and back pain measured with Visual Analogue Scales, and disability measured with the Roland-Morris Disability Questionnaire. Descriptive statistics were performed to present the average and the individual clinical course. A latent class trajectory analysis was conducted to identify leg pain, back pain, and disability outcome trajectories. The best number of clusters was determined using the Bayesian Information Criterion, Akaike's information criteria, entropy, and overall interpretability. Prediction models for poor outcome trajectories were assessed using multivariable logistic regression analyses.

RESULTS

Several outcome trajectories were identified. Most patients were assigned to the 'large improvement' trajectory (leg pain: 79.3%; back pain: 70.2%; disability: 59.5% of patients). Smaller proportions of patients were assigned to the 'moderate improvement' trajectory (leg pain: 7.9%; back pain: 10.6%; disability: 20.7% of patients), the 'minimal improvement' trajectory (leg pain: 4.9%, back pain: 6.7%, disability: 16.3% of patients) and the 'relapse' trajectory (leg pain: 7.9%; back pain: 12.5%; disability: 3.5%). Approximately one-third of patients (32.6%) belonged to one or more than one poor outcome trajectory. Patients with previous treatment (prior back surgery, injection therapy, and medication use) and those who had higher baseline pain and disability scores were more likely to belong to the poor outcome trajectories in comparison to the large improvement trajectories in back pain, leg pain and disability, and the moderate improvement trajectory in disability. The explained variance (Nagelkerke R2) of the prediction models ranged from 0.06 to 0.13 and the discriminative ability (Area Under the Curve) from 0.66 to 0.73.

CONCLUSION

The clinical course of lumbar radiculopathy varied following microdiscectomy and post-operative physiotherapy, and several outcome trajectories could be identified. Although most patients were allocated to favorable trajectories, one in three patients was assigned to one or more poor outcome trajectories following microdiscectomy and post-operative physiotherapy for lumbar radiculopathy. Routinely gathered data were unable to predict the poor outcome trajectories accurately. Prior to surgery, clinicians should discuss the high variability and the distinctive subgroups that are present in the clinical course with their patients.

Adverse childhood experiences, sexual orientation, and depressive symptoms among Chinese college students: An ecological framework analysis

BACKGROUND

Extensive evidence has demonstrated that adverse childhood experiences (ACEs) predict a high risk of negative health and behavioral outcomes in later life. However, the influence of individuals' psychosocial characteristics and environmental stressors have been mostly omitted in previous research.

OBJECTIVE

This study aimed to examine the prevalence of ACEs among LGB (lesbian, gay, and bisexual) and heterosexual emerging adults, and the associations between different patterns of ACE exposure and depressive symptoms after adjusting for factors at different levels.

PARTICIPANTS AND SETTING

A representative sample of 928 college students in Xiamen city, China was recruited.

METHODS

Latent class analysis was applied to identify the patterns of ACEs. A series of regression analyses were conducted to examine the associations between ACEs and depression and whether ACEs interacted with sexual identity to influence depression, after controlling for individual characteristics, family, school, and society-level factors.

RESULTS

Over 35 % of the participants reported they had experienced at least one type of moderate to extreme childhood maltreatment, and those who identified as LGB reported a higher level of ACE exposure. Higher levels of ACE exposure based on score and clustering approaches were associated with higher risks of depression among Chinese emerging adults. However, the associations between ACEs and depression were not significantly moderated by sexual identity.

CONCLUSIONS

The findings highlighted the importance of early screening for ACEs particularly among sexual minorities and of delivering tailored interventions based on ecological backgrounds. Both the traditional scoring approach and a data-driven approach can be effective in detecting the cumulative effect of ACEs.

Discrepancies in youth self-report and case file report of maltreatment and association with internalizing and externalizing symptoms

BACKGROUND

Childhood maltreatment is a potential risk factor for the later development of psychopathology (Jaffee, 2017). However, there is no gold standard for identifying victims of child maltreatment, and when multiple informants - such as case files and youth self-report - are used, these sources often disagree (Cooley & Jackson, 2022).

OBJECTIVE

The current study aimed to explore discrepancies between youth self-report and case file report of maltreatment and examine how these discrepancies related to internalizing and externalizing symptoms.

PARTICIPANTS/SETTING

Participants were 470 youth living in foster care between the ages of 8 and 18 and their caregivers.

METHODS

Latent class analysis (LCA) was used to create novel groups based on informant discrepancies.

RESULTS

Agreement between informants was in the poor-to-fair agreement range for all types of maltreatment. Latent class analysis identified a 3-class solution with significant group differences on both externalizing (Χ² (2, N = 470) = 6.16, p = 0.05) and internalizing symptoms (Χ² (2, N = 470) = 6.10, p = 0.05). Specifically, those in the "self-report only" class had significantly higher symptoms than those in the "neither informant/case file only" class for both internalizing and externalizing behavior.

CONCLUSIONS

Case files and youth self-report of maltreatment are discrepant. Youth self-report of maltreatment history may be more closely linked to psychopathology than case file report of maltreatment. Researchers and practitioners should look to youth self-report rather than relying solely on case files when determining risk for psychopathology.

The nature and extent of child maltreatment in Denmark: Using self-report and administrative data from the 1984 birth cohort

BACKGROUND

Research on child maltreatment (CM) has few longitudinal studies that combine self-report data with objective administrative data that has been collected continuously for decades.

OBJECTIVE

To give an overview of 20 studies investigating the impact of CM in a Danish representative sample.

PARTICIPANTS AND SETTING

From the full 1984 Danish birth cohort, 2980 24-years old were randomly selected. There was an oversampling of child protection cases.

METHODS

The participants were interviewed by trained interviewers and Computer Assisting Methods were used for sensitive topics. The survey data were linked to several national registers using the Civil Registry Number for a series of studies on risk factors and outcomes. Linkage with parental data enabled parental risk factors before the birth to be analysed as well as several physical, psychological, and social events during their lifetime. These factors were studied in relation to the CM classes that were identified via the survey.

RESULTS

The maltreatment classes had both several specific and shared effects pertaining to risk factors before birth, during childhood through to early adulthood. Their problems included many arenas within health, mental and social life.

CONCLUSIONS

Data linkage studies provide an opportunity to conduct research using accurate sources of information which can be used to explore risk and protective factors. The prospective nature of this combined data facilitates temporal ordering which strengthen the conclusions based on longer-term follow-up.

Behavioral Parent Training for Preschool ADHD: Family-Centered Profiles Predict Changes in Parenting and Child Outcomes

OBJECTIVE

Behavioral parent training (BPT) is the first line of treatment for preschool-aged children with attention-deficit hyperactivity disorder (ADHD); however, clinically significant improvements are not universal. In the current study, we employ a person-centered approach to create subgroups of families based on the intersection of multiple parent, child, and family pre-treatment factors. Further, we explore the utility of pre-treatment family profiles in predicting post-treatment differences in observed parenting behavior (i.e., behavioral control, parental warmth) and clinically significant change in child ADHD and oppositional symptoms.

METHOD

Longitudinal data were collected using observational and parent-, teacher- and clinician-reported assessments from 130 parent-child dyads (Mage= 3.57, range = 3.0- 4.11, 73.8% male, 69.2% White, 25.6% Hispanic) participating in BPT.

RESULTS

Findings from the current study suggest three distinct family profiles, which consisted of one profile with high family stress (HFS) as evidenced by elevated symptomatology across parent, child, and family-level domains, a second profile with elevated parental anxiety (PA), and a final profile with elevated parental depression (PD). These family-centered profiles were differentially associated with changes in observed parenting practices. Specifically, the PD profile (39%) demonstrated minimal improvements in behavioral control and warmth following treatment. In contrast, the HFS profile (30%) only improved in behavioral control and the PA profile (31%) improved in both parenting domains following treatment. In addition, marginally significant differences in child oppositional and ADHD symptoms were observed across profiles.

CONCLUSIONS

Family-centered approaches may be useful for selecting and implementing interventions.

Latent Profile Analysis of Positive Solitude During the Recurrent Outbreak of COVID-19

The current study aimed to identify latent profiles of positive solitude during the recurrent outbreak of COVID-19 among Chinese adults. A total of 902 adults from China completed the questionnaires. We found five different profiles of positive solitude: low positive solitude group, medium-low positive solitude group, quietness positive solitude group, medium-high positive solitude group, and high positive solitude group. Positive and negative affect were significantly different from the five profiles. In addition, gender had different effects on different positive solitude profiles. The results of the study provide a new perspective to understand the positive solitude of Chinese adults during the recurrent outbreak of COVID-19 by using the people-centered approach.

Self-reported Adverse Childhood Experiences Among Custodial Grandmothers: Frequencies, Patterns, and Correlates

Given the scarce past research on custodial grandparents' early life circumstances, we investigated frequencies, patterns, and predictors of 14 adverse childhood experiences (ACEs) reported by 355 custodial grandmothers (CGMs). Predominant ACEs were bullying (54.6%), verbal abuse (51.5%), physical abuse (45.4%), and living with a substance abuser (41.1%). Only 11% of CGMs reported 0 ACEs, whereas 52.4% reported >4. Latent class analyses yielded three classes of ACE exposure: minimal (54.1%), physical/emotional abuse (25.9%), and complex (20.0%). Age was the only demographic factor related to ACE class, with the complex class being younger than the other two. MANCOVAs with age as a covariate revealed that different ACE profiles have unique impacts on CGMs' physical and psychological well-being. We conclude that ACEs are highly prevalent among CGMs and a serious public health concern. Future research addressing ACEs among CGMs is critical in order to support these caregivers and promote resilience in custodial grandfamilies.

Patterns of caregiver aggressive and nonaggressive discipline toward young children in low- and middle-income countries: A latent class approach

BACKGROUND

Caregivers use a variety of disciplinary methods to respond to undesired child behavior. Many caregivers use nonaggressive forms of discipline, such as verbal reasoning and redirection. Some caregivers use aggressive forms of discipline, such as spanking and yelling. However, most caregivers use a combination of aggressive and nonaggressive discipline. To date, a disproportionately small number of caregiver discipline studies are conducted in low- and middle-income countries (LMICs), and few studies in low-resource contexts examine aggressive and nonaggressive behaviors simultaneously.

OBJECTIVE

This study aims to elucidate caregiver patterns of 11 disciplinary behaviors used in LMICs, and examine how these patterns relate to child outcomes and household characteristics.

PARTICIPANTS AND SETTING

Data came from the fourth and fifth rounds of UNICEF Multiple Indicator Cluster Surveys (MICS) distributed between 2009 and 2017 (N = 218,824 respondents across 63 countries). Focal children were 3-4 years old.

METHODS

Patterns of disciplinary behaviors were estimated using a multilevel latent class analysis (LCA). Multinomial regression analyses examined associations of disciplinary patterns with caregiver-reported child outcomes and household characteristics.

RESULTS

The LCA suggested caregiver discipline fell into three overall patterns: high behavioral control, moderate behavior control, and lower behavioral control. The lower behavioral control class was associated with the most advantageous child outcomes and household socio-demographic characteristics, whereas the high behavioral control class was associated with the most disadvantageous child outcomes and household characteristics.

CONCLUSIONS

Efforts should be employed to reduce aggressive behaviors and promote positive parenting among caregivers in LMICs.

Latent Profile/Class Analysis Identifying Differentiated Intervention Effects

BACKGROUND

The randomized clinical trial is generally considered the most rigorous study design for evaluating overall intervention effects. Due to patient heterogeneity, subgroup analysis is often used to identify differential intervention effects. In research of behavioral interventions, such subgroups often depend on a latent construct measured by multiple correlated observed variables.

OBJECTIVES

The purpose of this article is to illustrate latent class analysis/latent profile analysis as a helpful tool to characterize latent subgroups, conduct exploratory subgroup analysis, and identify potential differential intervention effects using clinical trial data.

METHODS

After reviewing different approaches for subgroup analysis, latent class analysis/latent profile analysis was chosen to identify heterogeneous patient groups based on multiple correlated variables. This approach is superior in this specific scenario because of its ability to control type I error, assess intersection of multiple moderators, and improve interpretability. We used a case study example to illustrate the process of identifying latent classes as potential moderators based on both clinical and perceived risk scores and then tested the differential effects of health coaching in improving health behavior for patients with elevated risk of developing coronary heart disease.

RESULTS

We identified three classes based on one clinical risk score and four perceived risk measures for individuals with high risk of developing coronary heart disease. Compared to other classes we assessed, individuals in the class with low clinical risk and low perceived risk benefit most from health coaching to improve their physical activity levels.

DISCUSSION

Latent class analysis/latent profile analysis offers a person-centered approach to identifying distinct patient profiles that can be used as moderators for subgroup analysis. This offers tremendous opportunity to identify differential intervention effects in behavioral research.

Psychosocial profiles and longitudinal achievement of optimal cardiovascular risk factor levels: the Coronary Artery Risk Development in Young Adults (CARDIA) study

Psychosocial factors are associated with the achievement of optimal cardiovascular disease risk factor (CVDRF) levels. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing psychosocial profiles among individuals with CVDRF. Further, it is unknown whether profiles are associated with achievement of CVDRF levels longitudinally. Therefore, we characterized psychosocial profiles of individuals with CVDRF and assessed whether they are associated with achievement of optimal CVDRF levels over 15 years. We included 1148 CARDIA participants with prevalent hypertension, hypercholesterolemia and/or diabetes mellitus in 2000-2001. Eleven psychosocial variables reflecting psychological health, personality traits, and social factors were included. Optimal levels were deemed achieved if: Hemoglobin A1c (HbA1c) < 7.0%, low-density lipoprotein (LDL) cholesterol < 100 mg/dl, and systolic blood pressure (SBP) < 140 mm Hg. Latent profile analysis revealed three psychosocial profile groups "Healthy", "Distressed and Disadvantaged" and "Discriminated Against". There were no significant differences in achievement of CVDRF levels of the 3 targets combined across profiles. Participants in the "Distressed and Disadvantaged" profile were less likely to meet optimal HbA1c levels compared to individuals in the "Healthy" profile after demographic adjustment. Associations were attenuated after full covariate adjustment. Distinct psychosocial profiles exist among individuals with CVDRF, representing meaningful differences. Implications for CVDRF management are discussed.

Cumulative risk, factor analysis, and latent class analysis of childhood adversity data in a nationally representative sample

BACKGROUND

Childhood adversity is a multifaceted construct that is in need of comprehensive operationalisation.

OBJECTIVE

The aim of this study was to explore the optimal method to operationalise a scale of adverse childhood experiences (ACEs).

PARTICIPANTS AND SETTING

Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Participants from three age groups (20-25, 40-45, 60-65) retrospectively reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, verbal abuse, neglect, poverty).

METHODS

We compared three approaches to operationalising the 17-item scale: a cumulative risk approach, factor analysis, and latent class analysis (LCA). The cumulative risk and dimensional models were represented by a unidimensional and two-dimensional model respectively using confirmatory factor analysis (CFA).

RESULTS

The cumulative risk approach and LCA were viable approaches to operationalising ACE data in PATH. CFA of the dimensional model produced latent factors of threat and deprivation that were highly correlated, potentially leading to problems with multicollinearity when estimating associations. LCA revealed six classes of ACEs: high adversity, low adversity, low affection, authoritarian upbringing, high parental dysfunction, and moderate parental dysfunction.

CONCLUSION

Our study found multiple latent classes within a 17-item questionnaire assessing domestic adversity. Using both the cumulative method and latent class approach may be a more informative approach when examining the relationship between ACEs and later health outcomes. Future ACE studies may benefit by considering multi-dimensional approaches to operationalising adversity.

Longitudinal Associations Between Parenting Practices and Youth Sleep Problems

OBJECTIVE

Sleep problems among youth are highly prevalent and associated with adjustment difficulties. When considering influences on youth's sleep, bidirectional links between youth's sleep health and family functioning have been suggested. Parenting practices are among the many familial factors that could be transactionally related to poor sleep in youth; however, research is lacking on potential longitudinal associations between parenting practices and sleep problems in youth. In addition, sensitive periods for this link are mostly unknown. The current study examined longitudinal relations between constellations of parenting practices and youth sleep health to identify profiles of parenting practices that are predictive of sleep problems in youth across different developmental stages.

METHOD

Participants were 292 parents (M = 36.51, SD = 7.3) of children between the ages of 3 and 14 years (M = 8.4, SD = 3.6). A person-centered approach was used to create profiles across traditionally labeled positive and negative parenting practices, as well as supportive and unsupportive parental emotion socialization strategies. Parenting profiles were then examined as longitudinal predictors of youth sleep problems.

RESULTS

Findings revealed 3 distinct parenting profiles, which were differentially associated with sleep problems in youth, with the first profile predicting the lowest levels of sleep problems and the third profile predicting the highest levels of sleep problems, particularly among peripubertal youth.

CONCLUSION

This study extends previous findings by elucidating distinct constellations of parenting practices that are differentially predictive of youth sleep problems and highlighting parenting among the various family processes that can longitudinally contribute to youth's sleep health.

The Co-Occurrence of Child Maltreatment and Intimate Partner Violence in Families: Effects on Children's Externalizing Behavior Problems

Children exposed to maltreatment are at risk of experiencing intimate partner violence (IPV) and behavioral problems. This study examined different forms of family violence that co-occur and their relationship to children's externalizing behaviors across developmental stages (early childhood, middle childhood, adolescence). Longitudinal data (N = 1,987) at baseline and 18 months and 36 months post-baseline from the NSCAW II were used. Mixture modeling was employed in which latent class models estimated subgroups of children who experienced co-occurring forms of family violence; regression models estimated which subgroups of children were at risk of externalizing behaviors. Three latent classes were identified across developmental stages: high family violence, low family violence, and child physical abuse and psychological aggression. For children in early childhood, a fourth class was identified: partner and child physical abuse and child psychological aggression. Results from regression models revealed differences in externalizing scores by class membership across developmental age groups and over time. That distinct classes of child maltreatment and IPV co-occur and differentially impact children's behavior suggests a need for strong prevention and intervention responses to address children's dual maltreatment and IPV exposure.

Patterns of childhood adversity and their associations with internalizing and externalizing problems among at-risk boys and girls

BACKGROUND

Different types of childhood adversity often cluster and overlap, underlining the importance of studying likely patterns of adversity co-occurrences and their impact on child functioning. Further sex-specific investigations of adversity co-occurrences and their associations with child mental health are warranted.

OBJECTIVE

To investigate if different sex-specific patterns of childhood adversity exist among at risk-children living in Denmark and to explore if divergent constellations of adversity are differentially associated with externalizing and internalizing problems.

PARTICIPANTS AND SETTING

Participants (N = 2198) were a sample of children ages 1-17 who have been in contact with the Danish child protection system due to suspected child abuse. The study included existing data collected as a part of child case procedures.

METHOD

Latent class analysis was used to identify patterns of adversity co-occurrences among girls and boys, respectively. Inter-class differences on age and child mental health were assessed using ANOVAs.

RESULTS

Greater variation and complexity in adversity exposure was found among girls (5 classes) compared to boys (3 classes). The female classes differed on age (p < .001, η2 = 0.06), internalizing (p < .001, η2 = 0.05), and externalizing problems (p = .002, η2 = 0.02). The male classes differed on internalizing (p < .001, η2 = 0.02) and externalizing problems (p < .001, η2 = 0.04). Overall, classes characterized by multiple adversities displayed higher scores of mental health problems compared to less exposed classes.

CONCLUSIONS

Exposure to multiple adversities is common among at-risk children. Information on different sex-specific patterns of adversity co-occurrences can guide intervention planning for affected children.

A latent class analysis of physical, emotional, and sexual abuse history among suicidal inpatients

OBJECTIVE

Physical, emotional, and sexual abuse are subtypes of childhood abuse that may persist into adulthood. This study applied latent class analysis to describe the pattern of co-occurrence of these three abuse subtypes during childhood and adulthood and examined latent class differences in psychosocial characteristics and three types of suicide attempt history (aborted, interrupted, and actual).

METHODS

Data were drawn from a high-risk sample of 115 military service members and adult beneficiaries who were psychiatrically hospitalized following a suicide-related crisis.

RESULTS

Three latent classes were identified: Multiple and Persistent Abuse (Class One: 29.6%), Childhood Physical and Persistent Emotional Abuse (Class Two: 27.0%), and Minimal Abuse (Class Three: 43.5%). Females were more likely than males to report a history of Multiple and Persistent Abuse. After controlling for gender, the Multiple and Persistent Abuse Class had higher scores of depressive symptoms and hazardous drinking, poorer sleep quality, and increased social stress than the Minimal Abuse Class. Moreover, the Multiple and Persistent Abuse Class was associated with increased likelihood of lifetime interrupted suicide attempt (Odds Ratio [OR] = 3.81, 95% CI = 1.20, 12.07) and actual suicide attempt (OR = 3.65, 95% CI = 1.23, 10.85), and had the greatest number of total actual suicide attempt (1.82 times on average).

CONCLUSION

Co-occurrence of multiple subtypes of abuse across development is associated with higher psychosocial risk and history of suicide attempt. The assessment of specific subtypes of abuse and their timing may inform case conceptualization and the management of suicide risk among psychiatric inpatients.

Differences in late adolescent psychopathology among youth with histories of co-occurring abuse and neglect experiences

BACKGROUND

Knowledge about the impacts of child abuse and neglect (CAN) experiences on late adolescent psychopathology has been limited by a failure to consider the frequent co-occurrence of CAN types and potential unique impacts of specific combinations.

OBJECTIVE

Using person-centered analyses, we aimed to identify unobserved groups of youth with similar patterns of lifetime CAN experiences before age 16 and differences in psychopathology symptom counts between groups two years later.

PARTICIPANTS AND SETTING

Participants were 919 adolescent-caregiver dyads (56% female; 56% Black, 7% Latina/o, 13% mixed/other).

METHODS

Prospective, multi-informant data, including child protective services records and caregiver and youth reports were collected, and youth completed a diagnostic interview at age 18.

RESULTS

Latent Class Analyses classified adolescents into four distinct groups based on patterns of physical neglect, supervisory neglect, and physical, sexual, and psychological abuse: "Low-Risk" (37%), "Neglect" (19%), "Abuse" (11%), and "Multi-type CAN" (33%). The Multi-type CAN class had significantly more major depressive, generalized anxiety, and nicotine use symptoms than the Low-Risk class, and more post-traumatic stress, antisocial personality, and illicit substance use symptoms, than Low-Risk and Neglect classes. The Abuse class had significantly more generalized anxiety and attention deficit/hyperactivity symptoms than the Low-Risk class, and more major depressive, antisocial personality, and illicit substance use symptoms, than Low-Risk and Neglect classes. The Neglect class did not have elevated psychopathology symptoms.

CONCLUSION

Findings highlight important differences in the associations between lifetime CAN experience patterns and psychopathology. Researchers should explore mechanisms underlying psychopathology that are impacted by different CAN experience patterns.

Predicting longitudinal service use for individuals with substance use disorders: A latent profile analysis

INTRODUCTION

Substance use disorders (SUD) are chronic conditions that often warrant coordinated medical care throughout a relapsing and remitting course. However, SUD treatment is frequently measured as a binary outcome, where individuals either receive or do not receive care following the immediate treatment seeking event. This study aimed to describe longitudinal treatment seeking behaviors by assessing service use patterns among individuals with diagnosed SUDs in a safety net hospital that offers a "no wrong door" care model. This study also examined whether certain patient subgroups were more likely to transition to service use patterns that support recovery or treatment disengagement over time.

METHODS

The team conducted a retrospective cohort study using electronic health record data from adult patients diagnosed with SUDs (n = 1157) who regularly accessed services at a safety net hospital over a five-year period. The study used latent class analysis (LCA) and latent profile analysis to empirically identify distinct treatment utilization profiles of individuals with SUDs. We used multinomial logistic regression to evaluate predictors of class membership and transitions over a five-year period.

RESULTS

The research team identified five distinct service use classes, including patients who disengaged from services (42.4%), or those who predominantly used outpatient substance use services (7.0%), mental health services (13.0%), primary care services (24.7%), or other specialty care services (13.1%). Being female and an older adult were statistically significant predictors for membership in any service use-driven status. Black patients had increased odds for "substance use service" and "primary care" service statuses over time.

CONCLUSION

LCA and latent transition analysis (LTA) methods are novel approaches for identifying profiles of patients with higher risk for health services disengagement. SUD treatment engagement strategies are needed to reach males, young adults, and individuals with non-opioid SUDs.

Impact of the COVID-19 pandemic on change in sleep patterns in an exploratory, cross-sectional online sample of 79 countries

OBJECTIVES

To describe changes in sleep patterns during the coronavirus disease 2019 (COVID-19) pandemic, develop profiles according to these patterns, and assess sociodemographic, economic, COVID-19 related, and sleep and mental health factors associated with these profiles.

DESIGN, SETTING, AND PARTICIPANTS

A 25-minute online survey was distributed worldwide through social media from 5/21/2020 to 7/1/2020.

MEASUREMENTS

Participants reported sociodemographic/economic information, the impact of the pandemic on major life domains, insomnia and depressive symptoms, and changes in sleep midpoint, time-in-bed, total sleep time (TST), sleep efficiency (SE), and nightmare and nap frequency from prior to during the pandemic. Sleep pattern changes were subjected to latent profile analysis. The identified profiles were compared to one another on all aforementioned factors using probit regression analyses.

RESULTS

The sample of 991 participants (ages: 18-80 years; 72.5% women; 60.3% residing outside of the United States) reported significantly delayed sleep midpoint, reductions in TST and SE, and increases in nightmares and naps. Over half reported significant insomnia symptoms, and almost two-thirds reported significant depressive symptoms. Latent profile analysis revealed 4 sleep pattern change profiles that were significantly differentiated by pre-pandemic sleep patterns, gender, and various COVID-19-related impacts on daily living such as severity of change in routines, and family stress and discord.

CONCLUSIONS

In an international online sample, poor sleep and depressive symptoms were widespread, and negative shifts in sleep patterns from pre-pandemic patterns were common. Differences in sleep pattern response to the COVID-19 crisis suggest potential and early targets for behavioral sleep health interventions.

Pain Profiles among Young Adult Cannabis Users: An Analysis of Antecedent Factors and Distal Outcomes

BACKGROUND

Pain is a primary reason for medical cannabis use among young adults, however little is known about the patterns of pain in this group. This study identified pain profiles among young adult cannabis users and examined related antecedents and distal outcomes.

METHODS

Past 30-day cannabis users aged 18-26, both medical cannabis patients and non-patients, were enrolled in Los Angeles in 2014-2015. A latent class analysis was used to identify pain classes based on history of chronic pain conditions and recent non-minor pain. The study assessed the predictors of membership in pain classes and examined the association of classes with recent mental health characteristics, cannabis use motives and practices.

RESULTS

Three classes were identified: Low pain (56.3%), Multiple pain (27.3%), and Nonspecific pain (16.4%). In adjusted models, lifetime insomnia was associated with membership in Multiple pain and Nonspecific pain classes versus the Low pain class. Medical cannabis patients and Hispanics/Latinos were more likely to belong to the Multiple pain class than the other classes. Regarding recent outcomes, the Multiple pain and Nonspecific pain classes were more likely than the Low pain class to use cannabis to relieve physical pain. Additionally, the Multiple pain class had a higher probability of psychological distress, self-reported medical cannabis use, consuming edibles, and using cannabis to sleep compared to one or both other classes.

CONCLUSION

Findings suggest that young adult cannabis users can be separated into distinct groups with different pain profiles. The Multiple pain profile was associated with medically-oriented cannabis use motives and practices.

Child diurnal cortisol differs based on profiles of maternal emotion socialization in high risk, low income, and racially diverse families

Young children's physiological and emotional regulation depend on supportive caregiving, especially in the context of stress and adversity. Experiences of child maltreatment become biologically embedded by shaping stress physiology. Maternal emotion socialization may have an important influence on children's limbic-hypothalamic-pituitary-adrenal (LHPA) functioning. Grounded in theories of caregiver emotion socialization, a person-centered latent profile analysis was utilized to identify profiles of maternal emotion socialization among a high risk, low income, and racially diverse group of 248 mothers and their young children (M_age  = 4.39 years, SD = 1.10). The majority of the mothers (n = 165) had a history of involvement with the Department of Child Services for substantiated cases of child maltreatment. A latent profile analysis was conducted revealing three emotion socialization profiles: disengaged, engaged, and engaged + supportive. Emotion socialization profile differences in children's diurnal cortisol levels and slope (using area under the curve with respect to ground and increase, respectively) were examined. Children's diurnal cortisol levels were higher, and slopes were flatter, when mothers used more disengaged emotion socialization strategies. Mothers who neglected their children were more likely to fit the disengaged profile than the engaged profile. Implications for the socialization of regulation in children exposed to adversity are discussed.

Using latent class analysis to empirically classify maltreatment according to the developmental timing, duration, and co-occurrence of abuse types

BACKGROUND

Individuals can have vastly different maltreatment experiences depending on the types, developmental timing, and duration of abuse. Women and men may be differentially affected by distinct abuse patterns.

OBJECTIVE

To examine whether maltreatment subgroups could be identified based on the types, developmental timing, and duration of abuse, and to determine their prevalence among a large, community-based sample. We also examined sex differences in associations of maltreatment subgroups with adverse health outcomes.

PARTICIPANTS AND SETTING

Data came from 9310 women and men (95 % White) in the United States who responded to the Growing Up Today Study questionnaire in 2007 (aged 19-27 years).

METHODS

Participants reported on physical, sexual, and emotional abuse occurring in childhood (before age 11 years) and adolescence (ages 11-17 years). We conducted latent class (LC) analyses using indicators for child and adolescent abuse. We examined associations of LCs with health outcomes using sex-stratified log-binomial models with generalized estimated equations.

RESULTS

We identified five LCs characterized by: 1) no/low abuse (59 %), 2) child physical abuse (16 %), 3) adolescent emotional abuse (9%), 4) child and adolescent physical and emotional abuse (16 %), and 5) child and adolescent sexual abuse (1%). LCs were uniquely associated adult health outcomes among both women and men. Associations of LCs with eating disorder behaviors appeared stronger for men than women.

CONCLUSIONS

Individuals experience distinct patterns of maltreatment based on the types, developmental timing, and duration of abuse. These patterns are uniquely associated with adverse health outcomes in adulthood, and can be identified using LCA.

School Burnout Inventory: Latent Profile and Item Response Theory Analyses in Undergraduate Samples

The current research reports both latent profile (person-oriented) and item response theory (IRT) analyses of the School Burnout Inventory (SBI) in United States undergraduate samples. Study 1 (n = 1,007) comprises a latent profile analysis (LPA) that identified four mutually exclusive subgroups based on patterns of school burnout responses. Covariate analyses of grade point average and negative affect suggested that school burnout profiles function similarly to variable-oriented approaches. Study 2 (n = 544) explored longitudinal patterns of school burnout among college students via use of a repeated measures LPA. Findings suggested that the profiles identified reflect a relatively stable school burnout trajectory over time. Covariate analysis of sleep quality and academic engagement demonstrated differences across profiles, but the patterns were similar to variable-oriented statistical approaches. Study 3 (n = 2,364) utilized an IRT analysis of the SBI to identify a short, efficient measure. Item information curves and graded response model item discrimination parameters identified a 4-item SBI scale (SBI-4) that offered reasonably high levels of information for assessing school burnout in comparison to the original nine-item SBI. Implications and future research are identified.

Latent class analysis risk profiles: An effective method to predict a first re-report of maltreatment?

Recurrence of child maltreatment is a significant concern causing substantial individual, family and societal cost. Variable-based approaches to identifying targets for intervention may not reflect the reality that families may experience multiple co-occurring risks. An alternative approach was tested using baseline data from the National Survey of Child and Adolescent Well-being (NSCAW) I and II to develop Latent Class Analysis models of family risk classes using variables derived from prior studies of re-reporting. The samples were collected approximately 10 years apart offering a chance to test how the approach might be impacted by demographic or policy shifts. The association between baseline classes and later re-reports was tested using both samples. A two-class model of high versus low presence of baseline risk resulted that was strongly associated with later likelihood of re-report and results were relatively stable across the two studies. Person-centered approaches may hold promise in the early identification of families that require a more comprehensive array of supports to prevent re-reports of maltreatment.

Latent Cognitive Profiles Differ Between Incipient Alzheimer's Disease and Dementia with Subcortical Vascular Lesions in a Memory Clinic Population

BACKGROUND

It is unclear if latent cognitive profiles can distinguish between dementia with subcortical vascular lesions and Alzheimer's disease (AD) at the incipient stage, and if they differ in performance from the Petersen subtypes.

OBJECTIVE

To identify latent cognitive profiles in a naturalistic population of patients from a memory clinic sample, and investigate the derived classes not only in terms of conversion to AD, but also in terms of conversion to dementia with subcortical vascular lesions. Another objective was to compare the derived classes to the Petersen subtypes.

METHODS

We performed a latent profile analysis (LPA) on standardized neuropsychological test scores from 476 memory clinic patients (age 64±8) without dementia, and analyzed progression to dementia after 2 years.

RESULTS

The LPA resulted in two classes with impaired cognition (Amnestic and Slow/Dysexecutive) and two classes with normal cognition (Normal-Low and Normal-High cognition). Belonging to the Amnestic class predicted progression to all-cause dementia and to AD; belonging to the Slow/Dysexecutive class predicted progression to all-cause dementia, AD, and dementia with subcortical vascular lesions. Of the Petersen MCI subtypes, only amnestic multi-domain MCI predicted progression to all-cause dementia, AD, and dementia with subcortical vascular lesions.

CONCLUSION

Latent cognitive profiles separated between AD and dementia with subcortical vascular lesions, while the Petersen subtypes did not. However, similar to the Petersen subtypes, LPA classes work better for ruling out progression to dementia than for case finding.

Early Childbirth Among Foster Youth: A Latent Class Analysis to Determine Subgroups at Increased Risk

CONTEXT

Research has documented elevated rates of early childbirth among adolescents who have spent time in foster care, and a better understanding is needed of the characteristics of vulnerable individuals and the circumstances of their time in care.

METHODS

California birth records for 1999-2010 were probabilistically linked to state child welfare service records spanning the same date range to identify females aged 12-19 who had spent time in foster care and had had a first birth before age 20. Latent class analysis was used to identify subgroups based on age at most recent entry into care, length of this stay and three indicators of placement instability. The probability of a first birth being related to class membership was assessed as a distal outcome, and differences across classes were assessed using chi-square tests.

RESULTS

Four distinct classes of foster youth were identified: Later Entry/High Instability (20% of individuals), Later Entry/Low Instability (43%), Earlier Entry/High Instability (12%) and Earlier Entry/Low Instability (25%). The probability of a first childbirth ranged from 31% (class 1) to 15% (class 4); classes 2 and 3 experienced moderate risk (23% and 24%, respectively). Two groups were further characterized by high rates of reentry into care, with 56% of class 1 and 41% of class 3 individuals experiencing more than one episode in care.

CONCLUSIONS

Identifiable subgroups of female foster youth are at heightened risk of early childbirth and may benefit from early intervention, enhanced support and access to reliable, ongoing sexual and reproductive health care.

Co-occurrence of adverse childhood experiences and its association with family characteristics. A latent class analysis with Dutch population data

BACKGROUND

Although adverse childhood experiences (ACEs) are relatively common among children, there is limited knowledge on the co-occurrence of such experiences.

OBJECTIVE

The current study therefore investigates co-occurrence of childhood adversity in the Netherlands and whether specific clusters are more common among certain types of families.

PARTICIPANTS AND SETTING

Representative data from the Family Survey Dutch population 2018 (N = 3,128) are employed.

METHOD

We estimate Latent Class Analysis (LCA) models to investigate co-occurrence of ACEs. As ACEs we examine maltreatment, household dysfunction, demographic family events, as well as financial and chronic health problems. Gradual measures for maltreatment and financial problems are studied to make it possible to differentiate with regard to the severity of experiences.

RESULTS

Our results show that four ACE clusters may be identified: 'Low ACE', 'Moderate ACE: Household dysfunction', 'Moderate ACE: Maltreatment' and 'High ACE'. Regression analyses indicated that mother's age at first childbirth and the number of siblings were related to experiencing childhood adversity. We found limited evidence for ACEs to be related to a family's socioeconomic position.

CONCLUSION

The found clusters of ACEs reflect severity of childhood adversity, but also the types of adversity a child experienced. For screening and prevention of childhood adversity as well as research on its consequences, it is relevant to acknowledge this co-occurrence of types and severity of adversity.

Sexual Orientation Trajectories Based on Sexual Attractions, Partners, and Identity: A Longitudinal Investigation From Adolescence Through Young Adulthood Using a U.S. Representative Sample

Defining sexual minority status longitudinally over critical developmental periods is essential for understanding the roots of health disparities. Theory supports multidimensional continuums, but current research often examines single measures of sexual activity, sexual attractions, or self-labeled identity separately. Here, a new typology of longitudinal latent classes describes dynamic multidimensional processes continuing from late adolescence (ages 16 to 18) through the late 20s. Using Add Health data (N = 6,864), longitudinal latent class analysis (LLCA), a person-centered approach, showed significant differences between the orientation experiences of males and females (invariance tests led to stratification by sex). The male LLCA model predicted four classes: straight males (87.4%), minimal sexual expression males (6.5%), mostly straight and bi males (3.8%), and emerging gay males (2.4%). The female LLCA model predicted five classes: straight females (73.8%), minimal sexual expression females (7%), mostly straight discontinuous females (10.2%), emerging bi females (7.5%), and emerging lesbian females (1.5%). Some classes represent generally consistent indicators across dimensions over time, while other classes describe more emerging or discontinuous trajectories. Substantial changes were common not only from late adolescence to the early 20s but also from the early 20s to the late 20s, indicating that sexual orientation development continues throughout emerging adulthood.

Childhood Maltreatment and Lifetime Suicidal Behaviors Among New Soldiers in the US Army: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

OBJECTIVE

Understanding suicide risk is a priority for the US military. We aimed to estimate associations of childhood maltreatment with pre-enlistment suicidal behaviors in new Army soldiers.

METHODS

Cross-sectional survey data from 38,237 soldiers reporting for basic training from April 2011 through November 2012 were analyzed. Scales assessing retrospectively reported childhood abuse and neglect were derived and subjected to latent class analysis, which yielded 5 profiles: No Maltreatment, Episodic Emotional Maltreatment, Frequent Emotional/Physical Maltreatment, Episodic Emotional/Sexual Abuse, and Frequent Emotional/Physical/Sexual Maltreatment. Discrete-time survival analysis was used to estimate associations of maltreatment profiles with suicidal behaviors (assessed with a modified Columbia-Suicide Severity Rating Scale), adjusting for sociodemographics and mental disorders.

RESULTS

Nearly 1 in 5 new soldiers was classified as experiencing childhood maltreatment. Relative to No Maltreatment, all multivariate maltreatment profiles were associated (P values < .001) with elevated odds of lifetime suicidal ideation (adjusted odds ratios [AORs] = 3.10-4.93), plan (AORs = 3.75-10.77), attempt (AORs = 3.60-15.95), and onset of plan among those with ideation (AORs = 1.40-3.10). Several profiles also predicted attempts among those with plans (AORs = 2.01-2.47), and Frequent Emotional/Physical/Sexual Maltreatment predicted unplanned attempts among ideators (AOR = 5.32). Adjustment for mental disorders attenuated but did not eliminate these associations.

CONCLUSIONS

Childhood maltreatment is strongly associated with suicidal behavior among new soldiers, even after adjusting for intervening mental disorders. Among soldiers with lifetime ideation, certain maltreatment profiles are associated with elevated odds of subsequently planning and/or attempting suicide. Focus on childhood maltreatment might reveal avenues for risk reduction among new soldiers.

Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy

PURPOSE

Sleep disturbance and cancer-related fatigue (CRF) are among the most commonly reported symptoms associated with breast cancer and its treatment. This study identified symptom cluster groups of breast cancer patients based on multidimensional assessment of sleep disturbance and CRF prior to and during chemotherapy.

METHODS

Participants were 152 women with stage I-IIIA breast cancer. Data were collected before chemotherapy (T1) and during the final week of the fourth chemotherapy cycle (T2). Latent profile analysis was used to derive groups of patients at each timepoint who scored similarly on percent of the day/night asleep per actigraphy, the Pittsburgh Sleep Quality Index global score, and the five subscales of the Multidimensional Fatigue Symptom Inventory-Short Form. Bivariate logistic regression evaluated if sociodemographic/medical characteristics at T1 were associated with group membership at each timepoint.

RESULTS

Three groups (Fatigued with sleep complaints, Average, Minimal symptoms) were identified at T1, and five groups (Severely fatigued with poor sleep, Emotionally fatigued with average sleep, Physically fatigued with average sleep, Average, Minimal symptoms) at T2. The majority of individuals in a group characterized by more severe symptoms at T1 were also in a more severe symptom group at T2. Sociodemographic/medical variables at T1 were significantly associated with group membership at T1 and T2.

CONCLUSIONS

This study identified groups of breast cancer patients with differentially severe sleep disturbance and CRF symptom profiles prior to and during chemotherapy. Identifying groups with different symptom management needs and distinguishing groups by baseline sociodemographic/medical variables can identify patients at risk for greater symptom burden.

Collectivism Is Associated With Greater Neurocognitive Fluency in Older Adults

Neuropsychological research has been limited in the representation of cultural diversity due to various issues, raising questions regarding the applicability of findings to diverse populations. Nonetheless, culture-dependent differences in fundamental psychological processes have been demonstrated. One of the most basic of these, self-construal (individualism, collectivism), is central to how many other differences are interpreted. Self-construals may have possible consequences on social interactions, emotions, motivation, and cognition. This study aimed to evaluate the impact of self-construal on neurocognitive functions in older adults. A total of 86 community-dwelling older adults 60 years and older were assessed with three common self-report measures of self-construal along individualism and collectivism (IC). A cognitive battery was administered to assess verbal and non-verbal fluency abilities. Latent profile analysis (LPA) was used to categorize individuals according to IC, and one-way analyses of covariance (ANCOVA), including relevant covariates (e.g., ethnicity, gender, linguistic abilities), were used to compare neurocognitive functions between individualists and collectivists. Collectivists outperformed individualists on left frontally-mediated measures of verbal fluency (action, phonemic) after controlling for relevant covariates, F_(1,77) = 6.942, p = 0.010, η² = 0.061. Groups did not differ on semantic fluency, non-verbal fluency, or attention/working memory (all ps > 0.05). These findings suggest a cognitive advantage in collectivists for verbal processing speed with an additional contribution of left frontal processes involved in lexicosemantic retrieval. Self-construal may provide a meaningful descriptor for diverse samples in neuropsychological research and may help explain other cross-cultural differences.

Identifying maltreatment subgroups with patterns of maltreatment subtype and chronicity: A latent class analysis approach

Maltreatment experiences are complex, and it is difficult to characterize the heterogeneity in types of maltreatment. Subtypes, such as emotional maltreatment, sexual abuse, physical abuse, and neglect commonly co-occur and may persist across development. Therefore, treating individual maltreatment subtypes as independently occurring is not representative of the nature of maltreatment as it occurs in children's lives. Latent class analysis (LCA) is employed herein to identify subgroups of maltreated children based on commonalities in maltreatment subtype and chronicity. In a sample of 674 low-income urban children, 51.6% of whom experienced officially documented maltreatment, our analyses identified four classes of children, with three distinct classes based on maltreatment subtypes and chronicity, and one group of children who did not experience maltreatment. The largest class of maltreated children identified was the chronic, multi-subtype maltreatment class (57% of maltreated children); a second class was characterized by only neglect in a single developmental period (31% of maltreated children), and the smallest class was characterized by a single subtype of maltreatment (emotional maltreatment, physical, or sexual abuse) occurring in a single developmental period (12% of maltreated children). Characterization of these groups confirms the overlapping nature of maltreatment subtypes. There were notable differences between latent classes on child behavioral and socio-emotional outcomes measured by child self-report and camp counselors report during a one-week summer camp. The largest differences were between the non-maltreated class and the chronic maltreatment class. Children who experienced chronic, multi-subtype maltreatment showed higher levels of externalizing behavior, emotion dysregulation, depression, and anxiety.