Correcting the Bias Correction for the Bootstrap Confidence Interval in Mediation Analysis

A prospective examination of sleep chronotype and future suicide intent among adults in the United Kingdom: A test of the integrated motivational volitional model of suicide

OBJECTIVES/BACKGROUND

Prior research identified a connection between evening chronotype and suicidality, but the mechanism underlying that connection is not well understood. The Integrated Motivational Volitional (IMV) Model of Suicide may provide a theoretical explanation for this link. The current project includes a three-time point longitudinal survey to examine whether 1) suicide intent likelihood varies across time, 2) chronotype affects suicide intent likelihood prospectively, and 3) defeat and entrapment explain the association between chronotype and suicide intent likelihood.

PATIENTS/METHODS

Participants (n = 187 UK adults) completed a baseline survey (demographics, chronotype (morning-eveningness; MEQ), defeat and entrapment, and perceived intent to make a future suicide attempt), and follow-up surveys (MEQ and suicide intent likelihood) 3 and 6 months later.

RESULTS

Results indicated that suicidal intent at 6-month follow-up was lower than baseline or 3-month follow-up. It was also found that strong evening chronotype at baseline is associated with increased suicidal intent 6 months later, and that defeat mediates this relationship.

CONCLUSION

Our theoretically informed findings shed light on the psychological mechanisms linking chronotype (i.e., eveningness) and future suicide intent by highlighting the role of defeat and entrapment. We propose that feelings of defeat might be derived from evening types' experiences of social jetlag (resulting from conflict between biologically driven sleep schedules and externally dictated social schedules), which consequently drives entrapment and greater future suicide intent. Within this context, defeat and entrapment may be good transdiagnostic and modifiable target variables for future intervention development.

Childhood adversity and suicidal ideation in older Korean adults: unraveling the mediating mechanisms of mental health, physical health, and social relationships

BACKGROUND

Suicide rates in older adults are much higher than those in younger age groups. Given the rapid increase in the proportion of older adults in Korea and the high suicide rate of this age group, it is worth investigating the mechanism of suicidal ideation for older adults. Generally, adverse childhood experiences are positively associated with suicidal ideation; however, it is not fully understood what mediating relationships are linked to the association between these experiences and current suicidal ideation.

METHODS

The data from 685 older Korean adults were analyzed utilizing logistic regression, path analyses, and structural equation modeling. Based on our theoretical background and the empirical findings of previous research, we examined three separate models with mental health, physical health, and social relationship mediators. After that, we tested a combined model including all mediators. We also tested another combined model with mediation via mental health moderated by physical health and social relationships.

RESULTS

The univariate logistic regression results indicated that childhood adversity was positively associated with suicidal ideation in older adults. However, multivariate logistic regression results demonstrated that the direct effect of childhood adversity became nonsignificant after accounting all variables. Three path models presented significant mediation by depression and social support in the association between childhood adversity and suicidal ideation. However, combined structural equation models demonstrated that only mediation by a latent variable of mental health problems was statistically significant. Social relationships moderated the path from mental health problems to suicidal ideation.

CONCLUSIONS

Despite several limitations, this study has clinical implications for the development of effective strategies to mitigate suicidal ideation. In particular, effectively screening the exposure to adverse childhood experiences, early identification and treatment of depressive symptoms can play a crucial role in weakening the association between childhood adversity and suicidal ideation in older adults.

Testosterone, gender identity and gender-stereotyped personality attributes

Sex/gender differences in personality associated with gender stereotyped behavior are widely studied in psychology yet remain a subject of ongoing debate. Exposure to testosterone during developmental periods is considered to be a primary mediator of many sex/gender differences in behavior. Extensions of this research has led to both lay beliefs and initial research about individual differences in basal testosterone in adulthood relating to "masculine" personality. In this study, we explored the relationships between testosterone, gender identity, and gender stereotyped personality attributes in a sample of over 400 university students (65 % female assigned at birth). Participants provided ratings of their self-perceived masculinity and femininity, resulting in a continuous measure of gender identity, and a set of agentic and communal personality attributes. A saliva sample was also provided for assay of basal testosterone. Results showed no compelling evidence that basal testosterone correlates with gender-stereotyped personality attributes or explains the relationship between sex/gender identity and these attributes, across, within, or covarying out sex assigned at birth. Contributing to a more gender diverse approach to assessing sex/gender relationships with personality and testosterone, our continuous measure of self-perceived masculinity and femininity predicted additional variance in personality beyond binary sex and showed some preliminary but weak relationships with testosterone. Results from this study cast doubt on the activational testosterone-masculinity hypothesis for explaining sex differences in gender stereotyped traits and within-sex/gender variation in attributes associated with agency and communality.

Negative self-perceptions and severity of NSSI: Testing the benefits and barriers model

Nonsuicidal self-injury (NSSI) is theorized to be caused by negative associations with the self, including low self-esteem, but the mechanisms explaining why low self-esteem is related to more severe NSSI are unclear. The current study aimed to address this limitation by evaluating a mediation model, proposing that low self-esteem would relate to more severe NSSI through increasing self-punishment motivations. Data came from 468 undergraduate students with a history of NSSI who completed an online survey measuring NSSI characteristics and functions, self-esteem, and self-punishment motivations for NSSI. Mediation was tested using a structural equation model using bootstrapped 95% percentile-corrected confidence intervals in which NSSI severity was modeled as a latent variable composed of NSSI frequency, recency, and versatility of methods. The total model was significant and the indirect effect of self-esteem on NSSI severity through self-punishment motives was significant. Self-esteem also retained significant direct effects on NSSI severity, indicating partial mediation. These results provide support for the benefits and barriers model of NSSI, suggesting that negative self-views increase risk for more severe NSSI through self-punishment motivations. Clinical interventions that emphasize self-compassion and focus on modifying self-punishment motivations may help reduce NSSI behavior.

Signal-to-Noise Ratio in Estimating and Testing the Mediation Effect: Structural Equation Modeling versus Path Analysis with Weighted Composites

Mediation analysis plays an important role in understanding causal processes in social and behavioral sciences. While path analysis with composite scores was criticized to yield biased parameter estimates when variables contain measurement errors, recent literature has pointed out that the population values of parameters of latent-variable models are determined by the subjectively assigned scales of the latent variables. Thus, conclusions in existing studies comparing structural equation modeling (SEM) and path analysis with weighted composites (PAWC) on the accuracy and precision of the estimates of the indirect effect in mediation analysis have little validity. Instead of comparing the size on estimates of the indirect effect between SEM and PAWC, this article compares parameter estimates by signal-to-noise ratio (SNR), which does not depend on the metrics of the latent variables once the anchors of the latent variables are determined. Results show that PAWC yields greater SNR than SEM in estimating and testing the indirect effect even when measurement errors exist. In particular, path analysis via factor scores almost always yields greater SNRs than SEM. Mediation analysis with equally weighted composites (EWCs) also more likely yields greater SNRs than SEM. Consequently, PAWC is statistically more efficient and more powerful than SEM in conducting mediation analysis in empirical research. The article also further studies conditions that cause SEM to have smaller SNRs, and results indicate that the advantage of PAWC becomes more obvious when there is a strong relationship between the predictor and the mediator, whereas the size of the prediction error in the mediator adversely affects the performance of the PAWC methodology. Results of a real-data example also support the conclusions.

Perceiving a Stable Self-Concept Enables the Experience of Meaning in Life

We test the hypothesis that the perception of stability in one's self-concept (i.e., future self-continuity) enables the experience of meaning in life because perceiving a stable sense of self confers a sense of certainty to the self-concept. Study 1 provided initial evidence of the influence of future self-continuity on feelings of meaning in life (MIL) in a nationally representative sample. In Studies 2a and 2b, we manipulated future self-continuity by varying the expectedness of one's future self, demonstrating the causal influence of future self-continuity on self-certainty and feelings of MIL. Study 3 again manipulated future self-continuity, finding an indirect effect on feelings of meaning in life via self-certainty. Our findings thus suggest the experience of meaning in life arises from the perception of a stable sense of self. We discuss the implications for the antecedents and conceptualization of MIL as well as the nature of the self-concept.

Pulmonary diffusing capacity for carbon monoxide and nitric oxide after COVID-19: A prospective cohort study (the SECURe study)

Many patients exhibit persistently reduced pulmonary diffusing capacity after coronavirus disease 2019 (COVID-19). In this study, dual test gas diffusing capacity for carbon monoxide and nitric oxide (DL,CO,NO) metrics and their relationship to disease severity and physical performance were examined in patients who previously had COVID-19. An initial cohort of 148 patients diagnosed with COVID-19 of all severities between March 2020 and March 2021 had a DL,CO,NO measurement performed using the single-breath method at 5.7 months follow-up. All patients with at least one abnormal DL,CO,NO metric (n = 87) were revaluated at 12.5 months follow-up. The DL,CO,NO was used to provide the pulmonary diffusing capacity for nitric oxide (DL,NO), the pulmonary diffusing capacity for carbon monoxide (DL,CO,5s), the alveolar-capillary membrane diffusing capacity and the pulmonary capillary blood volume. At both 5.7 and 12.5 months, physical performance was assessed using a 30 s sit-to-stand test and the 6 min walk test. Approximately 60% of patients exhibited a severity-dependent decline in at least one DL,CO,NO metric at 5.7 months follow-up. At 12.5 months, both DL,NO and DL,CO,5s had returned towards normal but still remained abnormal in two-thirds of the patients. Concurrently, improvements in physical performance were observed, but with no apparent relationship to any DL,CO,NO metric. The severity-dependent decline in DL,NO and DL,CO observed at 5.7 months after COVID-19 appears to be reduced consistently at 12.5 months follow-up in the majority of patients, despite marked improvements in physical performance.

The economic costs and cost-effectiveness of HIV self-testing among truck drivers in Kenya

HIV status awareness is critical for ending the HIV epidemic but remains low in high-HIV-risk and hard-to-reach sub-populations. Targeted, efficient interventions are needed to improve HIV test-uptake. We examined the incremental cost-effectiveness of offering the choice of self-administered oral HIV-testing (HIVST-Choice) compared with provider-administered testing only [standard-of-care (SOC)] among long-distance truck drivers. Effectiveness data came from a randomized-controlled trial conducted at two roadside wellness clinics in Kenya (HIVST-Choice arm, n = 150; SOC arm, n = 155). Economic cost data came from the literature, reflected a societal perspective and were reported in 2020 international dollars (I$), a hypothetical currency with equivalent purchasing power as the US dollar. Generalized Poisson and linear gamma regression models were used to estimate effectiveness and incremental costs, respectively; incremental effectiveness was reported as the number of long-distance truck drivers needing to receive HIVST-Choice for an additional HIV test-uptake. We calculated the incremental cost-effectiveness ratio (ICER) of HIVST-Choice compared with SOC and estimated 95% confidence intervals (CIs) using non-parametric bootstrapping. Uncertainty was assessed using deterministic sensitivity analysis and the cost-effectiveness acceptability curve. HIV test-uptake was 23% more likely for HIVST-Choice, with six individuals needing to be offered HIVST-Choice for an additional HIV test-uptake. The mean per-patient cost was nearly 4-fold higher in HIVST-Choice (I$39.28) versus SOC (I$10.80), with an ICER of I$174.51, 95% CI [165.72, 194.59] for each additional test-uptake. HIV self-test kit and cell phone service costs were the main drivers of the ICER, although findings were robust even at highest possible costs. The probability of cost-effectiveness approached 1 at a willingness-to-pay of I$200 for each additional HIV test-uptake. HIVST-Choice improves HIV-test-uptake among truck drivers at low willingness-to-pay thresholds, suggesting that HIV self-testing is an efficient use of resources. Policies supporting HIV self-testing in similar high risk, hard-to-reach sub-populations may expedite achievement of international targets.

Stochastic modeling of obesity status in United States adults using Markov Chains: A nationally representative analysis of population health data from 2017-2020

Importance

The prevalence of obesity among United States adults has increased from 34.9% in 2013-2014 to 42.8% in 2017-2018. Developing methods to model the increase of obesity over-time is a necessity to know how to accurately quantify its cost and to develop solutions to combat this national public health emergency.

Methods

A cross-sectional cohort study using the publicly available National Health and Nutrition Examination Survey (NHANES 2017-2020) was conducted in individuals who completed the weight questionnaire and had accurate data for both weight at the time of survey and weight 10 years ago. To model the dynamics of obesity, a Markov transition state matrix was created, which allowed for the analysis of weight transitions over time. Bootstrap simulation was incorporated to account for uncertainty and generate multiple simulated datasets, providing a more robust estimation of the prevalence and trends in obesity within the cohort.

Results

Of the 6146 individuals who met the inclusion criteria, 3024 (49%) individuals were male and 3122 (51%) were female. There were 2252 (37%) White individuals, 1257 (20%) Hispanic individuals, 1636 (37%) Black individuals, and 739 (12%) Asian individuals. The average BMI was 30.16 (SD = 7.15), the average weight was 83.67 kilos (SD = 22.04), and the average weight change was a 3.27 kg (SD = 14.97) increase in body weight. A total of 2411 (39%) individuals lost weight, and 3735 (61%) individuals gained weight. 87 (1%) individuals were underweight (BMI <18.5), 2058 (33%) were normal weight (18.5 ≤ BMI <25), 1376 (22%) were overweight (25 ≤ BMI <30) and 2625 (43%) were in the obese category (BMI >30).

Conclusion

United States adults are at risk of transitioning from normal weight to the overweight or obese category. Markov modeling combined with bootstrap simulations can accurately model long-term weight status.

Association Between Social Support, and Depressive Symptoms Among Firefighters: The Mediating Role of Negative Coping

Background

Depressive symptoms (DS) can erode physical and mental health; social support (SS) is considered a buffer for DS and a promoter for improving coping and recovery abilities. However, there is almost no research on the mediating role of negative coping (NC) in SS and DS, especially among firefighters.

Methods

A cross-sectional survey was conducted among firefighters in Chongqing, China, and the valid data of 407 firefighters were collected through questionnaires distributed on the WeChat platform in 2020. Statistical Product and Service Solutions (SPSS) 26.0 is used for descriptive statistics and correlation analysis. Structural equation modeling was adopted to analyze the association among SS, NC, and DS. The mediation effect is also evaluated.

Results

Firefighters' detection rate of DS is 23.3%, and when they receive more SS were less likely to develop DS. NC was positively correlated with DS (β = 0.54, p < 0.001) after controlling for SS. Besides, the results of structural equation modeling showed that NC partially mediates the relationship between SS and DS (standard error = 0.039, indirect effects = 0.109, 95% confidence interval: 0.047-0.200 p < 0.001).

Conclusion

NC has a partial indirect effect between SS and DS among firefighters. SS could not only affect DS directly but also indirect work on it by affecting NC. This discovery will be a novel and meaningful part of the research on the firefighter population.

Covariate dependent Markov chains constructed with gradient boost modeling can effectively generate long-term predictions of obesity trends

IMPORTANCE

The prevalence of obesity among United States adults has increased from 30.5% in 1999 to 41.9% in 2020. However, despite the recognition of long-term weight gain as an important public health issue, there is a paucity of studies studying the long-term weight gain and building models for long-term projection.

METHODS

A retrospective, cross-sectional cohort study using the publicly available National Health and Nutrition Examination Survey (NHANES 2017-2020) was conducted in patients who completed the weight questionnaire and had accurate data for both weight at time of survey and weight ten years ago. Multistate gradient boost modeling classifiers were used to generate covariate dependent transition matrices and Markov chains were utilized for multistate modeling.

RESULTS

Of the 6146 patients that met the inclusion criteria, 3024 (49%) of patients were male and 3122 (51%) of patients were female. There were 2252 (37%) White patients, 1257 (20%) Hispanic patients, 1636 (37%) Black patients, and 739 (12%) Asian patients. The average BMI was 30.16 (SD = 7.15), the average weight was 83.67 kilos (SD = 22.04), and the average weight change was a 3.27 kg (SD = 14.97) increase in body weight (Fig. 1). A total of 2411 (39%) patients lost weight, and 3735 (61%) patients gained weight (Table 1). We observed that 87 (1%) of patients were underweight (BMI < 18.5), 2058 (33%) were normal weight (18.5 ≤ BMI < 25), 1376 (22%) were overweight (25 ≤ BMI < 30) and 2625 (43%) were obese (BMI > 30). From analysis of the transitions between normal/underweight, overweight, and obese, we observed that after 10 years, of the patients who were underweight, 65% stayed underweight, 32% became normal weight, 2% became overweight, and 2% became obese. After 10 years, of the patients who were normal weight, 3% became underweight, 78% stayed normal weight, 17% became overweight, and 2% became obese. Of the patients who were overweight, 71% stayed overweight, 0% became underweight, 14% became normal weight, and 15% became obese. Of the patients who were obese, 84% stayed obese, 0% became underweight, 1% became normal weight, and 14% became overweight.

CONCLUSIONS

United States adults are at risk of transitioning from normal weight to becoming overweight or obese. Covariate dependent Markov chains constructed with gradient boost modeling can effectively generate long-term predictions.

Partner relationships, hopelessness, and health status strongly predict maternal well-being: an approach using light gradient boosting machine

No recent study has explicitly focused on predicting the well-being of pregnant women. This study used data from an extensive online survey in Japan to examine the predictors of the subjective well-being of pregnant women. We developed and validated a light Gradient Boosting Machine (lightGBM) model using data from 400 pregnant women in 2020 to identify three factors that predict subjective well-being. The results confirmed that the model could predict subjective well-being in pregnant women with 84% accuracy. New variables that contributed significantly to this prediction were "partner help", "hopelessness," and "health status". A new lightGBM model was built with these three factors, trained and validated using data from 400 pregnant women in 2020, and predicted using data from 1791 pregnant women in 2021, with an accuracy of 88%. These factors were also significant risk factors for subjective well-being in the regression analysis adjusted for maternal age, region, parity, education level, and the presence of mental illness. Mediation analysis, with "hopelessness" as the mediator, showed that both "partner help" and "health status" directly and indirectly affected the outcome.

Examining the impact of perceived stress, anxiety, and resilience on depression among medical staff after COVID-19 quarantine: a chain mediation analysis

Introduction

The COVID-19 pandemic and subsequent quarantine measures have led to a significant impact on mental health worldwide. Medical staff, in particular, have been exposed to high levels of stress due to their frontline work during the crisis. However, there is still limited research on the psychological mechanism among medical staff after quarantine.

Methods

In this cross-sectional observational study, 150 medical staff from Shanghai YangZhi Rehabilitation Hospital, Shanghai, China, were enrolled in October 2022. SPSS 26.0 and PROCESS 4.0 model 6 were used to analyze the chain mediating effect of perceived stress, anxiety, resilience and depression among medical staff after quarantine. Anxiety and depression were compared during and after the quarantine. All scales have high validity and reliability in a Chinese population.

Results

Our findings revealed a positive correlation between perceived stress and anxiety (r = 0.60, p < 0.001) and depression (r = 0.60, p < 0.001) levels among medical staff. Conversely, resilience was found to have a negative correlation with perceived stress (r = -0.67, p < 0.001), anxiety (r = -0.57, p < 0.001) and depression (r = -0.61, p < 0.001). The score of depression during the quarantine was higher than the score after the quarantine, but the p-value is only marginally significant (p = 0.067). The score of anxiety during the quarantine was significantly higher than the score after the quarantine (p < 0.05). Moreover, the chain mediation model suggested that anxiety and resilience could mediate the association between perceived stress and depression among medical staff following quarantine. Specifically, perceived stress had no direct effect on depression (β = 0.025, t = 0.548, p = 0.59) but positively predicted anxiety (β = 0.381, t = 8.817, p < 0.001) and resilience (β = -1.302, t = -6.781, p < 0.001), which influenced depression levels indirectly through multiple pathways. The three indirect paths: the mediating role of anxiety, the mediating role of resilience, and the chain mediating role of both anxiety and resilience.

Discussion

This study emphasizes the importance of psychological interventions aimed at protecting medical staff's psychological resilience and promoting coping mechanisms to manage stress during and after crises such as the COVID-19 pandemic. Additionally, our findings suggest that both anxiety and resilience play critical roles in mitigating the detrimental effects of perceived stress on mental health and further highlight the need for continued research to better understand the complex interplay of these factors.

Influence of Maternal Adverse Childhood Experiences on Birth Outcomes in American Indian and non-Hispanic White Women

PURPOSE

Maternal adverse childhood experiences (ACEs) are an antecedent risk during prenatal and postpartum periods. We examined race-based differences of the mediating influences of antepartum health risks (prenatal depression, high blood pressure, gestational diabetes) on associations between ACEs and maternal and birth outcomes (postpartum depression, preterm birth, low birthweight) among American Indian and non-Hispanic White women.

METHODS

Public use data from the South Dakota Pregnancy Risk Assessment Monitoring System PRAMS (2017-2019) were used for this secondary analysis of postpartum women. ACEs and depression were measured based on self-report survey results. Antepartum risks and birth outcomes were extracted from birth certificate data. A moderated mediation logit model estimated direct, indirect, and moderating effects by race, controlling for maternal characteristics and perinatal risks to understand ACEs' impact on pregnancy and birth outcomes between groups.

RESULTS

The sample included 2,343 postpartum women. American Indian versus non-Hispanic White women had a higher mean ACE score (3.37 vs. 1.64) and substantial disparities. Race-based differences were attributed to social, economic, and health-related factors. Adjusting for proportional differences, members of both groups with ACEs demonstrated significantly increased odds of prenatal and postpartum depression. ACEs influenced postpartum depression and preterm birth through the indirect effect of prenatal depression in both races. Prenatal depression indirectly influenced the relationship between ACEs and low birthweight in non-Hispanic White women.

CLINICAL IMPLICATIONS

ACEs were associated with higher levels of prenatal depression, which may negatively influence maternal and birth outcomes in American Indian and non-Hispanic White women. Improving perinatal outcomes must emphasize psychosocial care along with medical care to address the high burden of maternal ACEs in the United States.

No Compelling Evidence that Self-Reported Personality Traits Explain Basal Testosterone and Cortisol’s Associations with Status-Relevant Behavior

Objective

A goal of behavioral neuroendocrinology is to understand how basal hormone levels relate to behavior. Studies of human participants sometimes measure self-reported personality traits, in addition to or instead of direct behavioral observation. Although personality traits often predict their respective behaviors, whether personality explains hormone-behavior relationships remains unclear.

Methods

We obtained data from eight previous studies (total N = 985) that examined baseline testosterone and cortisol as predictors of status-relevant behavior (competitiveness, dominance, risk-taking, aggression, affiliation, and social status). We tested whether the previously reported hormone-behavior relationships are mediated by self-reported personality traits (e.g., trait dominance, prestige, extraversion). As a secondary research question, we also tested whether trait dominance moderated the testosterone-behavior relationships.

Results

As expected, self-reported personality traits often predicted status-relevant behaviors, but there was little evidence that traits also correlated with basal testosterone or the testosterone × cortisol interaction. Across all eight studies, personality traits did not significantly mediate hormone-behavior relationships. Indeed, the effect sizes of the hormone-behavior relationships were robust to the inclusion of personality traits as covariates. Further, we did not find strong or consistent evidence that trait dominance moderates the testosterone-behavior association.

Conclusion

Results suggest that basal testosterone and cortisol predict status-related behavior independent of self-reported personality. We discuss how these results may have broader implications for the physiological mechanisms by which testosterone and cortisol influence behavior, a process that could be unconscious and automatic. We also discuss alternative explanations, limitations, and future directions.

Arterial stiffness for the early prediction of pre-eclampsia compared with blood pressure, uterine artery Doppler and angiogenic biomarkers: a prospective cohort study

OBJECTIVE

Our aim was to evaluate the ability of arterial stiffness parameters to predict pre-eclampsia early compared with peripheral blood pressure, uterine artery Doppler and established angiogenic biomarkers.

DESIGN

Prospective cohort study.

SETTING

Tertiary care antenatal clinics in Montreal, Canada.

POPULATION

Women with singleton high-risk pregnancies.

METHODS

In the first trimester, arterial stiffness was measured by applanation tonometry, along with peripheral blood pressure and serum/plasma angiogenic biomarkers; uterine artery Doppler was measured in the second trimester. The predictive ability of different metrics was assessed through multivariate logistic regression.

MAIN OUTCOME MEASURES

Arterial stiffness (carotid-femoral pulse wave velocity, carotid-radial pulse wave velocity) and wave reflection (augmentation index, reflected wave start time), peripheral blood pressure, ultrasound indices of velocimetry and circulating angiogenic biomarker concentrations.

RESULTS

In this prospective study, among 191 high-risk pregnant women, 14 (7.3%) developed pre-eclampsia. A first-trimester 1 m/s increase in carotid-femoral pulse wave velocity was associated with 64% increased odds (P < 0.05), and a 1-millisecond increase in time to wave reflection with 11% decreased odds for pre-eclampsia (P < 0.01). The area under the curve of arterial stiffness, blood pressure, ultrasound indices and angiogenic biomarkers was 0.83 (95% confidence interval [CI] 0.74-0.92), 0.71 (95% CI 0.57-0.86), 0.58 (95% CI 0.39-0.77), and 0.64 (95% CI 0.44-0.83), respectively. With a 5% false-positive rate, blood pressure had a sensitivity of 14% for pre-eclampsia and arterial stiffness a sensitivity of 36%.

CONCLUSIONS

Arterial stiffness predicted pre-eclampsia earlier and with greater ability than blood pressure, ultrasound indices or angiogenic biomarkers.