Factors associated with depression and anxiety in children with intellectual disabilities

College Students With Intellectual and Developmental Disabilities' Experiences, Conception, and Development of Emotional Wellness

This study aimed to understand the ways in which college students with intellectual and developmental disabilities (IDD) experience and develop their understanding of emotions and emotional wellness. Semi-structured interviews with college students with IDD were conducted. The research team utilized consensual qualitative research (CQR) to analyze interviews and came to consensus in generating domains, core ideas, and a cross-analysis to answer the research question, "What are the experiences of college students with IDD in developing an understanding of emotions and emotional wellness?" Findings suggest college students with IDD have experience developing and maintaining their emotional wellness, though they may experience barriers prior to and during college enrollment. Limitations and implications for future research are discussed.

Resolution of severe neurobehavioral difficulties in an individual with Primrose syndrome with sertraline

Primrose syndrome (PS) is a rare genetic disease characterized by developmental delay, intellectual disability, sensorineural hearing loss, and dysmorphic features. PS is caused by de novo pathogenic variants in the ZBTB20 gene, which encodes a transcription factor modulating neurogenesis. We describe resolution with sertraline of neurobehavioral difficulties in a 17-year-old Hispanic male with PS with de novo heterozygous c.1916G > A (p.C639Y) variant of ZBTB20. Neurobehavioral difficulties included aggression towards self and others, irritability, tearfulness, and mood liability that did not respond to behavioral interventions or aripiprazole. Treatment with sertraline, a medication indicated for psychiatric disorders including anxiety and depression, led to the resolution of neurobehavioral difficulties after 2 weeks of initiation of medication. The treatment course suggests that selective serotonin reuptake inhibitors, such as sertraline, may be a useful tool for neurobehavioral difficulties in PS over antipsychotics that are accompanied by complex side effect profiles, and suggest that anxiety is the primary cause of the neurobehavioral difficulties in this patient.

Opioid prescription patterns among commercially insured children with and without cerebral palsy

PURPOSE

This study aimed to describe opioid prescription patterns for children with vs. without cerebral palsy (CP).

METHODS

This cohort study used commercial claims from 01/01/2015-12/31/2016 and included children aged 2-18 years old with and without CP. Opioid prescription patterns (proportion exposed, number of days supplied) were described. A zero-inflated generalized linear model compared the proportion exposed to opioids in the follow-up year (2016) and, among those exposed, the number of days supplied opioids between cohorts before and after adjusting for age, gender, race, U.S. region of residence, and the number of co-occurring neurological/neurodevelopmental disabilities (NDDs).

RESULTS

A higher proportion of children with (n = 1,966) vs. without (n = 1,219,399) CP were exposed to opioids (12.1% vs. 5.3%), even among the youngest age group (2-4 years: 9.6% vs. 1.8%), and had a greater number of days supplied (median [interquartile range], 8 [5-13] vs. 6 [4-9] days; P < 0.05). Comparing children with opioid exposure with vs. without CP, a greater number of days supplied was identified for older age, Asian race/ethnicity, and without co-occurring NDDs, and a lower number of days supplied was observed for Black race/ethnicity and with ≥1 co-occurring NDDs.

CONCLUSION

Children with CP are more likely to be exposed to opioids and have a higher number of days supplied.

School Experiences and Anxiety Trajectories Among Youth with Intellectual Disabilities

This study investigated how the school experiences and personal characteristics of youth with Intellectual Disabilities (ID) contribute to their longitudinal trajectories of anxiety. To this end, we relied on a sample of 390 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged from 11 to 22 (M = 15.70), and recruited in Canada (n = 140) and Australia (n = 250). Across three yearly time points, all participants completed self-report measures of anxiety, school climate, and victimization. Our results revealed a slight normative decrease in anxiety over time and showed that experiences of school victimization were associated with higher levels of anxiety (initially and momentarily) and increases in victimization were accompanied by increases in anxiety over time. Perceptions of attending a school that fosters security and promotes learning also tended to be accompanied by lower levels of anxiety (initially and momentarily). Momentary increases in perceptions of attending a school that fosters positive peer interactions were associated with momentary decreases in anxiety, whereas momentary increases in perceptions of attending a school characterized by positive teacher-student relationships and an equitable treatment of all students both led to small momentary increases in anxiety once all other components of student school experiences were considered. The theoretical and practical implications of these results are discussed.

Social Participation: A Strategy to Manage Depression in Disabled Populations

This study aimed to investigate whether social participation (SP) can decrease depressive symptom severity in disabled older adults. A total of 5,937 disabled participants (4877, 1970, 219, and 8 participants responding 1, 2, 3, 4 times, respectively), obtained from the China Health and Retirement Longitudinal Study, were enrolled in our analysis. Based on pooled Ordinary Least Square regressions, SP was associated with decreased depressive symptom severity, and this association was significant in recreational activities and interacting with friends. For brain-disabled respondents, the association was not significant. SP is effective in decreasing depressive symptom severity in disabled older populations. Diversified activities and targeted interventions should be applied to specified older disabled populations to prevent depression.

Behavioural sleep problems in children and adults with intellectual disabilities: An integrative literature review

BACKGROUND

People with intellectual disabilities are more likely to experience sleep problems, which can affect quality of life, physical health, mental health and well-being.

METHODS

An integrative literature review was conducted to investigate what is known about behavioural sleep disturbances in people with an intellectual disability. The search used the following databases: Scopus, PsycInfo and Cinahl, to find papers published since 2015.

RESULTS

Within intellectual disability research, sleep appears as a common issue due to its high prevalence, negative relationships with an individual's physical and mental health, their quality of life, and impact of sleep problems on family or carers. The growing evidence base appears to support the use of behavioural, lifestyle and pharmacological interventions to improve sleep in people with an intellectual disability.

CONCLUSION

A wide array of literature provides evidence that people with intellectual disabilities are affected by and need support with their sleep.

Anxiety, concerns and emotion regulation in individuals with Williams syndrome and Down syndrome during the COVID-19 outbreak: a global study

Individuals with neurodevelopmental conditions (NDCs) have been reported to experience increased levels of anxiety during the COVID-19 pandemic. In our study, we document how individuals with Down Syndrome (DS; N = 557; Mage = 16.52; 233 female) and Williams syndrome (WS, N = 247; Mage = 18.43; 113 female) experienced the first wave (April 2020-May 2020) of the COVID-19 pandemic across the world. Using multilevel linear mixed regressions, we studied (a) parental reported anxiety of individuals with DS and WS, (b) these individuals' specific concerns, and (c) their use and efficacy of emotion regulation (ER) strategies during the first wave of COVID-19. Predictors of anxiety, such as the age of the individual with NDC, type of condition, and time, were investigated. Individuals with WS experienced higher levels of anxiety compared to those with DS and the older the individuals with NDC were the more anxiety they experienced. In terms of concerns, group effects indicated that individuals with WS scored higher for most of the concerns. There were no gender differences in concerns, yet most of the concerns increased with age except for concerns about loss of routine, boredom, loss of institutional support and family conflict. Finally, significant group effects were found and indicated a more frequent use of a variety of adaptive and maladaptive ER strategies in individuals with WS. We did not identify group differences in the efficacy of ER strategies. Our results indicate that individuals with WS are likely to exhibit higher levels of anxiety, but also higher levels of concerns depending on their age. Similarly, individuals with WS use a variety of ER strategies more frequently but these strategies are not necessarily more efficient for them. We discuss the impact of these findings in relation to anxiety identification and support across individuals with NDCs.

ICBrainDB: An Integrated Database for Finding Associations between Genetic Factors and EEG Markers of Depressive Disorders

In this study, we collected and systemized diverse information related to depressive and anxiety disorders as the first step on the way to investigate the associations between molecular genetics, electrophysiological, behavioral, and psychological characteristics of people. Keeping that in mind, we developed an internet resource including a database and tools for primary presentation of the collected data of genetic factors, the results of electroencephalography (EEG) tests, and psychological questionnaires. The sample of our study was 1010 people from different regions of Russia. We created the integrated ICBrainDB database that enables users to easily access, download, and further process information about individual behavioral characteristics and psychophysiological responses along with inherited trait data. The data obtained can be useful in training neural networks and in machine learning construction processes in Big Data analysis. We believe that the existence of such a resource will play an important role in the further search for associations of genetic factors and EEG markers of depression.

Adverse Effects of the COVID-19 Pandemic on Movement and Play Behaviours of Children and Youth Living with Disabilities: Findings from the National Physical Activity Measurement (NPAM) Study

All children and youth require ample physical activity (PA), low levels of sedentary behaviour (SB), and adequate sleep to stay healthy. Children and youth living with disabilities (CYWD) tend to have fewer opportunities for participation in PA and outdoor play compared with their typically developing peers. In turn, CYWD are typically less active and more sedentary, on average, compared with their peers. The COVID-19 pandemic reduced opportunities for many children and youth to participate in PA and outdoor play. The purpose of this study was to assess parent-perceived changes in PA (including outdoor play), SB (including screen time), and sleep quality and quantity, due to COVID-19 and related restrictions, in a national cohort of Canadian CYWD. We recruited parents of school-aged CYWD (N = 151) in May 2020. In an online survey, parents reported their child's previous 7-day PA, SB, and sleep, as well as perceived changes in their child's movement and play behaviours due to COVID-19 and related restrictions. Parent-perceived parental support for their child's movement and play behaviours during the pandemic was also assessed. We used descriptive statistics to describe the child's movement behaviours and assessed the association between movement behaviours and parental factors using Pearson and point-biserial correlations. Few (5.3%) CYWD met PA recommendations and 13.2% met screen time recommendations during the acute period of the COVID-19 pandemic. More CYWD (66.2%) were meeting sleep recommendations. Overall, only 1.3% of CYWD were meeting the combined movement guidelines. Parent encouragement was positively associated with the child's outdoor PA (0.23), wheeling, walking, and biking (0.19), indoor PA (0.16), and family-based PA (0.26). Parental co-play was similarly positively associated with the child's outdoor PA (0.26), wheeling, walking, and biking (0.39), indoor PA (0.16), and family-based PA (0.26). Parents perceived their CYWD to be less active and more sedentary as a result of COVID-19 and the related restrictions. Parents of CYWD have an important role in encouraging healthy movement behaviours. Return to movement and play post-COVID guidelines should include tailored strategies for CYWD and their families to mitigate the negative impacts of the pandemic.

Physical Activity Levels of Adolescents and Adults With Cerebral Palsy in Urban South Africa

Background: Research in high income countries shows that people with cerebral palsy (CP) are less physically active than typically developing (TD) peers, but less is known regarding physical activity (PA) in those with CP in low-to-middle income countries. The aim of this study was to determine daily step count and levels of PA in adolescents and adults with CP living in urban South Africa, compared to TD peers, and to determine associations with sex, Gross Motor Function Classification System (GMFCS) level, body mass index and socio-economic status. Materials and Methods: This case-control study included 26 adolescents and 22 adults with CP (GMFCS Level I-V) and matched TD peers (25 and 30, respectively). Participants wore an ActiGraph GT3X for 7 consecutive days to determine step count and time (minutes per hour) spent in PA levels, including sedentary (SED), low physical activity (LPA) and moderate to vigorous physical activity (MVPA). Results: The daily step count and PA levels for ambulant adolescents with CP (GMFCS level I-III) were similar to TD peers, while this was less for adolescents classified in GMFCS level IV-V. Daily step count, SED and MVPA were similar for adults classified in GMFCS level I-II compared to TD adults, while all parameters were lower for adults using assistive devices (GMFCS level III) and non-ambulant adults (GMFCS level IV-V) compared to TD peers. Daily step count and PA levels were inversely associated with GMFCS, while no other associations were found. Conclusion: People with CP who were more mobile dependent (higher GMFCS level) were less active. However, adolescents and adults with CP classified as GMFCS levels I-II living in urban South Africa recorded similar step count and PA levels as their TD peers. This was also the case for adolescents using assistive devices, though not for those in the adult group (GMFCS level III). Furthermore, it was apparent that even the ambulant individuals with CP and TD cohorts were relatively inactive. Intervention programs for CP and TD adolescents should be aimed at finding strategies to keep adolescents physically active well into adulthood, in order to promote physical health, social and emotional well-being and independence.

Validation of a Revised Version of the Center for Epidemiologic Depression Scale for Youth with Intellectual Disabilities (CESD-ID-R)

This study proposes a revision (R) of the Center for Epidemiologic Studies Depression Scale for youth with ID (CESD-ID) in English and French. 346 youth (36.02% girls) with mild (51.26%) and moderate (48.78%) ID (11-22 years; M = 15.69), enrolled in secondary schools in Canada (French-speaking; n = 115), and Australia (English-speaking; n = 231), as well as their parents and teachers, participated in this study. Results support the reliability, factor validity, equivalence (sex, ID level, comorbidities, and country), and convergent validity (with youth-, parent-, and teacher-rated measures of depression, anxiety, and loneliness/social isolation) of the CESD-ID-R. The CESD-ID-R allows youth with ID to provide a reliable and valid assessment of their depressive mood and happiness suitable for epidemiological studies.

The Impact of Sleep Quality on Quality of Life for Autistic Adults

BACKGROUND

Although research demonstrates that autistic children are at risk of poor sleep quality, very little is known about sleep quality and its impact on quality of life in autistic adults. We investigated the relationships between sleep quality, perceived stress, and quality of life for autistic adults.

METHOD

Data were prospectively collected from both autistic adults (N=40) and non-autistic adults (N=24). Sleep Quality was measured using the Pittsburgh Sleep Quality Index, Perceived Stress was measured using the Perceived Stress Scale, and Quality of Life was measured using the Brief Version of the World Health Organization Quality of Life Scale. We ran OLS regression models to examine the association between study group, perceived stress, sleep quality, and quality of life. We tested for main effects of study group (i.e., autistic or non-autistic), sleep quality, and perceived stress, adjusting for demographic characteristics. Then, we tested the interaction between study group and sleep quality. Finally, we tested a three-way interaction between group, sleep quality, and perceived stress.

RESULTS

Autistic adults reported worse sleep quality compared to non-autistic adults. Poorer sleep quality was significantly associated with lower quality of life for all participants in the study. Findings from the three-way interaction indicated that higher perceived stress further exacerbated the relationship between poorer sleep quality and lower quality of life for autistic adults.

CONCLUSIONS

These findings suggest that interventions that target both sleep quality and stress could effectively improve quality of life for autistic adults.

The association between physical activity and mental health in children with special educational needs: A systematic review

The association between physical activity (PA) and mental health in typically developing children has been amply documented, but little is known about the corresponding association in children with special educational needs (SEN). This systematic review aimed to synthesize the evidence for the association between PA and mental health in children with SEN. A systematic literature search of five databases (PsycINFO, SPORTDiscus, PubMed, Web of Science, and CINAHL) was conducted, and the publication year was between October 2010 and February 2021. Two researchers performed abstract and full text screening and extracted the data independently. Inclusion and exclusion criteria followed the PICOS framework, and the quality of eligible studies was assessed using the McMaster critical review form. Eighteen studies that met the inclusion criteria and had quality ratings ≥ 60% were included in this review. PA was positively associated with overall psychological well-being and its subtypes (including enjoyment, self-worth, self-competence, mental wellness, and quality of life), and negatively associated with anxiety and fatigue. Body composition, age, and sex were moderators of the association. The findings of this review indicated that PA was consistently associated with mental health in children with SEN. These associations were the most powerful when PA was conducted in unstructured types such as free play and recess activities. Structured types including physical education classes were more strongly related to mental health than overall PA (combined structured and unstructured types). Future PA interventions are needed to promote mental health in children with SEN.

How Does the Cause of Infantile Hemiparesis Influence Other Conditioning Factors? A Preliminary Study in a Spanish Population

Infantile hemiparesis may be associated with significant morbidity and may have a profound impact on a child’s physical and social development. Infantile hemiparesis is associated with motor dysfunction as well as additional neurologic impairments, including sensory loss, mental retardation, epilepsy, and vision, hearing, or speech impairments. The objective of this study was to analyze the association between the cause of infantile hemiparesis and birth (gestational age), age of diagnosis, and associated disorders present in children with infantile hemiparesis aged 0 to 3 years. An observational and cross-sectional study was performed. A simple and anonymous questionnaire was created ad hoc for parents of children diagnosed with infantile hemiparesis aged between 0 and 3 years about the situation regarding the diagnosis of hemiparesis, birth, cause of hemiparesis, and presence of other associated disorders. Perinatal stroke (60.1%) was the most common cause of hemiparesis, and the most typical associated disorder was epilepsy (34.2%), with the second largest percentage in this dimension corresponding to an absence of associated disorders (20.7%). The most frequent birth was “no premature” (74.1%). The mean age of diagnosis of infantile hemiparesis was registered at 8 months (IQR: 0–36). Knowing the possible association between different conditioning factors and the cause of infantile hemiparesis facilitates the prevention of severe sequelae in children and family, implementing an early comprehensive therapeutic approach in children with infantile hemiparesis.

Attention Bias and Prodromal Anxiety Symptoms in Toddlers With Fragile X Syndrome and Down Syndrome

Early identification of behavioral risk markers for anxiety is essential to optimize long-term outcomes in children with neurodevelopmental disorders. This study analyzed attentional avoidance and its relation to anxiety and autism spectrum disorder (ASD) symptomatology during social and nonsocial fear conditions in toddlers with fragile X syndrome (FXS) and Down syndrome (DS). Toddlers with FXS and DS exhibited increased nonsocial attentional avoidance relative to typically developing (TD) toddlers. Attentional avoidance was not related to anxiety symptom severity in any group; however, higher ASD symptom severity was related to more social attentional avoidance in the FXS and TD groups. Findings suggest that there may be different underlying mechanisms driving attentional avoidance across neurodevelopmental disorders.

Adaptation of the Screen for Child Anxiety Related Emotional Disorders in Spanish with Nonspecific Intellectual Disability

Anxiety continues to be one of the most frequent disorders with typically developing children and youth. However, people with intellectual disability (ID) lack validated diagnostic tests backed by sufficient methodological rigor. Analyze the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in this clinical population, specifically in children and young Spanish with Nonspecific Intellectual Disability. Descriptive statistics and item analysis (N = 542), exploratory factorial analysis (n = 245) and confirmatory (n = 297) and scale reliability analyses were performed and evaluated the internal consistency with various indices (Cronbach's alpha and omega) and the stability of the measurement (test-retest) of the resulting scale with better goodness-of-adjustment indices. A new scale called SCARED-DI was obtained in this clinical sample with three factors and a smaller number of items (22), offering important goodness-of-fit indices (RMSEA [95% CI] 03[0.01; .04]; CFI = 0.99; TLI = 0.98; GFI = 0.88; AGFI = 0.89) and high internal consistency (α = 0.91; ω = 0.93) and adequate measurement stability (r_xx = 0.92). The importance of validating psychopathological anxiety tests for children and youth with ID in order to build good mental health is discussed, emphasizing the need to provide easy, short-duration tests on both cognitive and emotional aspects in this clinical sub-population. In addition, the results are assessed in terms of future research and practical implications. This new version of SCARED-ID represents a valid and reliable tool to evaluate the anxiety in people with intellectual disabilities.

Inflammation and fatness in adolescents with and without Down syndrome: UP & DOWN study

BACKGROUND

The main objective of this study was to describe the inflammatory status of adolescents with Down syndrome (DS) and their relationship with adiposity.

METHODS

Ninety-five adolescents with DS (44.2% girls) and a control group of 113 adolescents (47.8% girls), aged between 11 and 18 years old, from the UP & DOWN study were included in this substudy. Serum C-reactive protein, C3 and C4 complement factors, total proteins, interleukin-6, tumour necrosis factor-α, insulin, cortisol, leptin, adiponectin, galactin-3 and visfatin were analysed; homeostatic model assessment index was calculated. In order to evaluate adiposity, we measured the following body fat variables: weight, height, waist circumference and skinfold thicknesses. Birth weight was obtained by questionnaire. In addition, body mass index, waist-to-height ratio (WHtR) and body fat percentage (BF%) were calculated.

RESULTS

Down syndrome group showed higher levels of body mass index, WHtR, waist circumference, BF% and lower birth weight than controls (P < 0.001). In the general linear model in the total sample, WHtR was positively associated with C3 and C4 (P < 0.001) as well as with leptin levels (P = 0.015). BF% was positively associated with total proteins (P = 0.093) and leptin levels (P < 0.001). DS was positively associated with total proteins (P < 0.001), C3 (P = 0.047) and C4 (P = 0.019). Despite the higher levels of adiposity found in DS group, no direct association was found between BF% and leptin levels, comparing with the control group.

CONCLUSIONS

These findings suggest that abdominal obesity should be controlled in adolescents because of its relationship with acute phase-inflammatory biomarkers but especially in DS adolescents who may show a peculiar metabolic status according to their relationship between adiposity and inflammatory biomarkers.

Sleep problems, behavior, and psychopathology in autism: inter-relationships across the lifespan

Across the lifespan, autistic individuals experience symptomatology concomitant with their diagnosis including increased rates of daytime behavior (e.g. stereotypy, self-injurious behavior, and aggression) and psychopathology (e.g. attention deficit hyperactivity disorder, anxiety, and depression). In addition to this inter-related behavior and psychopathology, autistic children, adolescents, and adults consistently exhibit a wide variety of sleep problems (e.g. insomnia, reduced total sleep time, increased sleep onset latency, night waking, etc.). Early research and current research continue to describe the inter-relatedness among these daytime behaviors, psychopathology, and sleep problems for autistic individuals. Although descriptions of these issues appear in research, only preliminary suggestions exist for the causes and contributors toward the sleep problems or the interactions of sleep problems with psychopathology, although current research suggests a possible biopsychosocial interaction.

The effect of low-trauma fracture on one-year mortality rate among privately insured adults with and without neurodevelopmental disabilities

BACKGROUND

Individuals with neurodevelopmental disabilities (NDDs) have poor development and preservation of skeletal health throughout the lifespan, and are especially vulnerable to low-trauma fracture and post-fracture health complications. However, no studies have examined if adults with NDDs have greater post-fracture mortality risk compared to adults without NDDs. The purpose of this study was to determine whether adults with NDDs have greater 12-month mortality rates following a low-trauma fracture compared to adults without NDDs.

METHODS

Data from 2011 to 2017 was leveraged from Optum Clinformatics® Data Mart; a nationwide claims database from a single private payer in the U.S. Data were extracted from adults (18+ years) with and without NDDs that sustained a low-trauma fracture between 01/01/2012-12/31/2016, as well as pre-fracture chronic diseases (i.e., cardiovascular diseases, cerebrovascular diseases, diabetes, chronic obstructive pulmonary diseases, cancer). Mortality rate was estimated for adults with and without NDDs, and the mortality rate ratio (RR) and 95% confidence interval (CI) was calculated. Cox regression was used to estimate hazard ratio (HR) and 95% CI for 1-, 3-, 6-, and 12-month post-fracture mortality rates between adults with and without NDDs after adjusting for age, sex, race, U.S. region, and pre-fracture chronic diseases.

RESULTS

Mean age (SD) at baseline was 56.7 (20.6) for adults with NDDs (n = 3749; 45.2% men) and 63.9 (19.2) for adults without NDDs (n = 585,910; 34.4% men). During the 12-month follow-up period, 182 adults with NDDs (mean age [SD] = 69.8 [14.7]; 46.2% men) and 25,456 adults without NDDs (mean age [SD] = 78.9 [9.8]; 38.3% men) died. Crude mortality rate was not different between adults with and without NDDs for any time points (e.g., 12-months: 5.40 vs. 4.96 per 100 person years; RR = 1.09; 95% CI = 0.94-1.26); however, it was greater for adults with intellectual disabilities compared to adults without NDDs (RR = 1.46; 95% CI = 1.23-1.79). After adjustments, adults with NDDs had greater post-fracture mortality rates for 3-, 6-, and 12-month time points (e.g., 12-months: HR = 1.46; 95% CI = 1.27-1.69). When stratified by the type of NDD, adults with intellectual disabilities and adults with autism spectrum disorders, but not adults with cerebral palsy, had greater 12-month post-fracture mortality risk. When stratified by fracture location, lower extremities were associated with greater crude mortality rate (RR = 1.69; 95% CI = 1.22-2.35) and adjusted mortality risk (HR = 2.41; 95% CI = 1.73-3.35), while upper extremities were associated with greater adjusted mortality risk (HR = 1.76; 95% CI = 1.23-2.50) for adults with vs. without NDDs.

CONCLUSIONS

Among privately insured adults with NDDs, low-trauma fracture is associated with greater mortality risk within 1 year of the fracture event, even after adjusting for pre-fracture chronic diseases. Study findings suggest the need for earlier fracture prevention strategies and improved post-fracture healthcare management.

Reconstruction and Analysis of Gene Networks of Human Neurotransmitter Systems Reveal Genes with Contentious Manifestation for Anxiety, Depression, and Intellectual Disabilities

Background: The study of the biological basis of anxiety, depression, and intellectual disabilities in humans is one of the most actual problems of modern neurophysiology. Of particular interest is the study of complex interactions between molecular genetic factors, electrophysiological properties of the nervous system, and the behavioral characteristics of people. The neurobiological understanding of neuropsychiatric disorders requires not only the identification of genes that play a role in the molecular mechanisms of the occurrence and course of diseases, but also the understanding of complex interactions that occur between these genes. A systematic study of such interactions obviously contributes to the development of new methods of diagnosis, prevention, and treatment of disorders, as the orientation to allele variants of individual loci is not reliable enough, because the literature describes a number of genes, the same alleles of which can be associated with different, sometimes extremely different variants of phenotypic traits, depending on the genetic background, of their carriers, habitat, and other factors. Results: In our study, we have reconstructed a series of gene networks (in the form of protein–protein interactions networks, as well as networks of transcription regulation) to build a model of the influence of complex interactions of environmental factors and genetic risk factors for intellectual disability, depression, and other disorders in human behavior. Conclusion: A list of candidate genes whose expression is presumably associated with environmental factors and has potentially contentious manifestation for behavioral and neurological traits is identified for further experimental verification.

Economic burden of paediatric-onset disabilities among young and middle-aged adults in the USA: a cohort study of privately insured beneficiaries

OBJECTIVE

Individuals with paediatric-onset disabilities (PoDs) have complex healthcare needs and are susceptible to adverse health outcomes, which may impose a higher strain on healthcare resources. The burden of healthcare resource utilisation and costs attributed to the population of adults with PoDs is not clearly established. The objective here was to compare healthcare resource utilisation and costs between adults with versus without PoDs.

DESIGN

Cohort.

SETTING

Data were from the 2016 Optum Clinformatics Data Mart, a de-identified nationwide claims database of beneficiaries from a single private payer in the USA.

PARTICIPANTS

International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes were used to identify beneficiaries with PoDs that were between 18 and 64 years of age.

PRIMARY AND SECONDARY OUTCOME MEASURES

Annual all-cause healthcare resource utilisation and total healthcare costs were compared between adults with and without PoDs before and after adjusting for sociodemographics and several costly non-communicable diseases.

RESULTS

Adults with PoDs (n=121 446) had greater annual mean counts of service utilisation for all service types (eg, inpatient, outpatient, emergency visits) compared with adults without PoDs (n=5 415 475) before and after adjustments (all p<0.001). Adults with PoDs had greater unadjusted total standardised reimbursement costs (US$26 702 vs US$8464; mean difference=US$18 238; cost ratio (CR)=3.16; 95% CI=3.13 to 3.18) and total patient out-of-pocket costs (US$2226 vs US$1157; mean difference=US$1069; CR=1.88; 95%CI=1.86 to 1.89). After adjustments, total standardised reimbursement costs were 2.32 times higher (95% CI=2.30 to 2.34) and total patient out-of-pocket costs were 1.65 times higher (95% CI=1.64 to 1.66) compared with adults without PoDs.

CONCLUSION

Adults with PoDs had greater healthcare utilisation and costs, even after accounting for costly diseases. Future research is needed to identify the cost drivers for adults with PoDs.