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Safren SA, Lee JS, Andersen LS, Stanton AM, Kagee A, Kirakosian N, O'Cleirigh C, Joska JA. The salience of structural barriers and behavioral health problems to ART adherence in people receiving HIV primary care in South Africa. AIDS Care 2024:1-7. [PMID: 38359349 DOI: 10.1080/09540121.2024.2308750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
Multilevel factors (individual and structural) influence adherence to antiretroviral therapy, particularly in high HIV prevalence areas such as South Africa. The present study examined the relative importance of structural barriers to HIV care and behavioral health factors, depression and alcohol use, in Khayelitsha, Cape Town, South Africa. People receiving HIV care in six primary care clinics in Khayelitsha (N = 194) completed the Center for Epidemiologic Studies Depression Scale, the Alcohol Use Disorders Identification Test, the Structural Barriers to Medication Taking questionnaire, and a qualitative rating of past-two-week adherence. Correlations were employed to examine associations among these variables, and hierarchical regression analysis was used to examine the unique effects of structural barriers over and above depression and alcohol use as predictors of adherence. Participants were primarily Black South African (99%) women (83%), and 41 years old on average. All four variables were significantly correlated. The hierarchical regression analysis showed that among behavioral health predictors, alcohol use alone significantly predicted ART adherence (b = -.032, p = .002). When structural barriers was added to the model, it was the only significant unique predictor of ART adherence (b = -1.58, p < .001). Findings highlight the need to consider structural vulnerabilities in HIV care in South Africa when developing behavioral health interventions.
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Affiliation(s)
- Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Nightingale S, Cinque P, Dravid A, Dreyer AJ, Gisslén M, Joska JA, Kwasa J, Meyer AC, Mpongo N, Nakasujja N, Pebody R, Pozniak A, Price RW, Saylor D, Thomas KGF, Underwood J, Vera JH, Winston A. Reply to 'Cognitive criteria in HIV: greater consensus is needed'. Nat Rev Neurol 2024; 20:129-130. [PMID: 38228907 DOI: 10.1038/s41582-024-00928-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Paola Cinque
- Unit of Infectious Diseases, San Raffaele Institute, Milan, Italy
| | - Ameet Dravid
- Department of Medicine, Poona Hospital and Research Centre and Noble Hospital, Pune, India
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Magnus Gisslén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Judith Kwasa
- Department of Clinical Medicine and Therapeutics, Faculty of Health Science, University of Nairobi, Nairobi, Kenya
| | - Ana-Claire Meyer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Anton Pozniak
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Deanna Saylor
- University Teaching Hospital, Lusaka, Zambia, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin G F Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jonathan Underwood
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
- HIV Clinical Trials, Winston Churchill Wing, St Mary's Hospital, London, UK
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Joska JA, Lee JS, Andersen LS, Stanton AM, O' Clereigh C, Safren S. "Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa". J Affect Disord 2023; 343:136-143. [PMID: 37797752 DOI: 10.1016/j.jad.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND People with HIV (PHW) are at greater risk of depression than the general population. Insight into the time-to-treatment-response and predictors of response to psychotherapy may improve implementation in primary care. METHODS We assessed depression treatment response among 80 participants in a trial of cognitive-behavioral therapy for adherence and depression (CBT-AD) for PWH with MDD and suboptimal antiretroviral therapy (ART) adherence. Participants self-reported depressive symptoms (CESD) at each therapy session. Clinicians assessed participants' depression (HAMD), along with potential predictors of response, every four months for one year. Latent class analyses examined classes of responders for the active and the post-treatment phases. Regression analyses identified predictors of class membership for each phase. RESULTS During the active treatment phase (CESD) we identified an early response (at session 2 and with continued trajectory of improvement) and a non-response group. There were also two classes during post-treatment (HAM-D): early responders (4-month) and late responders (12-month). Distress aversion was associated with lower likelihood of early response to CBT-AD (aOR = 0.74, 95%CI[0.56-0.90], p = .009), and social support was associated with increased likelihood of early response (aOR = 2.24, 95%CI[1.07-5.46], p = .045). LIMITATIONS Self-reported depression during the treatment phase may have resulted from social desirability bias. CONCLUSIONS Most participants responded to CBT-AD early during treatment (89 %) and had sustained improvements in depression by 4 months (80 %). Distress aversion was a risk factor for late response, and social support was protective. Future research is needed to assess the optimal dose of CBT-AD in resource limited settings.
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Affiliation(s)
- John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Conall O' Clereigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven Safren
- Department of Psychology, University of Miami, Miami, FL, USA
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Ge R, Yu Y, Qi YX, Fan YV, Chen S, Gao C, Haas SS, Modabbernia A, New F, Agartz I, Asherson P, Ayesa-Arriola R, Banaj N, Banaschewski T, Baumeister S, Bertolino A, Boomsma DI, Borgwardt S, Bourque J, Brandeis D, Breier A, Brodaty H, Brouwer RM, Buckner R, Buitelaar JK, Cannon DM, Caseras X, Cervenka S, Conrod PJ, Crespo-Facorro B, Crivello F, Crone EA, de Haan L, de Zubicaray GI, Di Giorgio A, Erk S, Fisher SE, Franke B, Frodl T, Glahn DC, Grotegerd D, Gruber O, Gruner P, Gur RE, Gur RC, Harrison BJ, Hatton SN, Hickie I, Howells FM, Pol HEH, Huyser C, Jernigan TL, Jiang J, Joska JA, Kahn RS, Kalnin AJ, Kochan NA, Koops S, Kuntsi J, Lagopoulos J, Lazaro L, Lebedeva IS, Lochner C, Martin NG, Mazoyer B, McDonald BC, McDonald C, McMahon KL, Nakao T, Nyberg L, Piras F, Portella MJ, Qiu J, Roffman JL, Sachdev PS, Sanford N, Satterthwaite TD, Saykin AJ, Schumann G, Sellgren CM, Sim K, Smoller JW, Soares J, Sommer IE, Spalletta G, Stein DJ, Tamnes CK, Thomopolous SI, Tomyshev AS, Tordesillas-Gutiérrez D, Trollor JN, van ’t Ent D, van den Heuvel OA, van Erp TGM, van Haren NEM, Vecchio D, Veltman DJ, Walter H, Wang Y, Weber B, Wei D, Wen W, Westlye LT, Wierenga LM, Williams SCR, Wright MJ, Medland S, Wu MJ, Yu K, Jahanshad N, Thompson PM, Frangou S. Normative Modeling of Brain Morphometry Across the Lifespan Using CentileBrain: Algorithm Benchmarking and Model Optimization. bioRxiv 2023:2023.01.30.523509. [PMID: 38076938 PMCID: PMC10705253 DOI: 10.1101/2023.01.30.523509] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
We present an empirically benchmarked framework for sex-specific normative modeling of brain morphometry that can inform about the biological and behavioral significance of deviations from typical age-related neuroanatomical changes and support future study designs. This framework was developed using regional morphometric data from 37,407 healthy individuals (53% female; aged 3-90 years) following a comparative evaluation of eight algorithms and multiple covariate combinations pertaining to image acquisition and quality, parcellation software versions, global neuroimaging measures, and longitudinal stability. The Multivariate Factorial Polynomial Regression (MFPR) emerged as the preferred algorithm optimized using nonlinear polynomials for age and linear effects of global measures as covariates. The MFPR models showed excellent accuracy across the lifespan and within distinct age-bins, and longitudinal stability over a 2-year period. The performance of all MFPR models plateaued at sample sizes exceeding 3,000 study participants. The model and scripts described here are freely available through CentileBrain (https://centilebrain.org/).
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Affiliation(s)
- Ruiyang Ge
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Yuetong Yu
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Yi Xuan Qi
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Yunan Vera Fan
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Shiyu Chen
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Chuntong Gao
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Faye New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Philip Asherson
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Center, King's College London, London, UK
| | - Rosa Ayesa-Arriola
- Department of Psychiatry, Marqués de Valdecilla University Hospital, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Dorret I Boomsma
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Stefan Borgwardt
- Translational Psychiatry Unit, Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Josiane Bourque
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
- Department of Child and Adolescent Psychiatry, University of Zürich, Zurich, Switzerland
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Rachel M Brouwer
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Randy Buckner
- Department of Psychology, Center for Brain Science, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dara M Cannon
- Clinical Neuroimaging Laboratory, National University of Ireland Galway, Galway, Ireland
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Simon Cervenka
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Patricia J Conrod
- Department of Psychiatry and Addiction, Université de Montréal, CHU Ste Justine, Montréal, Canada
| | - Benedicto Crespo-Facorro
- University Hospital Virgen del Rocio, Seville, Spain; Department of Psychiatry, University of Seville, Institute of Biomedicine of Seville (IBIS), Seville, Spain
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
| | - Fabrice Crivello
- Institut des Maladies Neurodégénératives, Université de Bordeaux, Bordeaux, France
| | - Eveline A Crone
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute of Psychology, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Liewe de Haan
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Greig I de Zubicaray
- School of Psychology & Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Annabella Di Giorgio
- Laboratory of Biological Psychiatry, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Susanne Erk
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Simon E Fisher
- Language and Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara Franke
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Frodl
- University Clinics and Clinics for Psychiatry, Psychotherapy and Psychosomatic Medicine, RWTH Aachen University, Aachen, Germany
| | - David C Glahn
- Department of Psychiatry, Tommy Fuss Center for Neuropsychiatric Disease Research Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dominik Grotegerd
- Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Patricia Gruner
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Australia
| | - Sean N Hatton
- Center for Multimodal Imaging and Genetics, University of California San Diego, La jolla, California, USA
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Fleur M Howells
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Hilleke E Hulshoff Pol
- Department of Psychiatry, UMC Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Chaim Huyser
- Department of Child and Adolescent Psychiatry, Academic Medical Centre/De Bascule, Amsterdam, The Netherlands
| | - Terry L Jernigan
- Center for Human Development, Departments of Cognitive Science, Psychiatry, and Radiology, University of California, San Diego, USA
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - John A Joska
- Department of Neuropsychiatry, University of Cape Town, Cape Town, South Africa
| | - René S Kahn
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrew J Kalnin
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Sanne Koops
- Department of Psychiatry and Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonna Kuntsi
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Center, King's College London, London, UK
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Luisa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Nicholas G Martin
- Queensland Institute of Medical Research, Berghofer Medical Research Institute, Brisbane, Australia
| | - Bernard Mazoyer
- Institut des Maladies Neurodégénératives, Université de Bordeaux, Bordeaux, France
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), NCBES Galway Neuroscience Centre, National University of Ireland Galway, Galway, Ireland
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Kyushu University, Fukuoka, Japan
| | - Lars Nyberg
- Department of Radiation Sciences, Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden; Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Maria J Portella
- Mental Health Research Networking Center (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital de la Santa Creu iSant Pau, Institutd' Investigació Biomèdica SantPau, Universitat Autònomade Barcelona (UAB), Barcelona, Spain
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality, Southwest University, Ministry of Education, Chongqing, PR China
- Faculty of Psychology, Southwest University, Chongqing, PR China
- Southwest University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal University, Beijing, PR China
| | - Joshua L Roffman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Nicole Sanford
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | | | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gunter Schumann
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology, and Neuroscience, Social, Genetic & Developmental Psychiatry Centre, King's College London, London, UK; Institute for Science and Technology of Brain-inspired Intelligence, Fudan University, Shanghai, PR China; Centre for Population Neuroscience and Stratified Medicine (PONS), Charite Mental Health, Department of Psychiatry and Psychotherapy, CCM, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Carl M Sellgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Kang Sim
- Institute of Mental Health, Singapore
| | - Jordan W Smoller
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jair Soares
- University of Texas Health Harris County Psychiatric Center, Houston, Texas, USA
| | - Iris E Sommer
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Dan J Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Christian K Tamnes
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Sophia I Thomopolous
- Genetics Center, Stevens Institute for Neuroimaging and Informatics, Keck USC School of Medicine, Marina del Rey, California, USA
| | | | - Diana Tordesillas-Gutiérrez
- Department of Radiology, Marqués de Valdecilla University Hospital, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Advanced Computing and e-Science, Instituto de Física de Cantabria (UC-CSIC), Santander, Spain
| | - Julian N Trollor
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Dennis van ’t Ent
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Theo GM van Erp
- Department of Psychiatry and Human Behavior, University of California, Irvine, California, USA
| | - Neeltje EM van Haren
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Yang Wang
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Bernd Weber
- Institute for Experimental Epileptology and Cognition Research, University of Bonn Germany, Bonn, Germany; University Hospital Bonn, Bonn, Germany
| | - Dongtao Wei
- Key Laboratory of Cognition and Personality, Southwest University, Ministry of Education, Chongqing, PR China
- Faculty of Psychology, Southwest University, Chongqing, PR China
| | - Wei Wen
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Lara M Wierenga
- Institute of Psychology, Leiden University, Leiden, The Netherlands; Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - Steven CR Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Margaret J Wright
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Medland
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Mon-Ju Wu
- Department of Psychiatry and Behavioral Science, University of Texas Health Science Center, Houston, Texas, USA
| | - Kevin Yu
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Neda Jahanshad
- Genetics Center, Stevens Institute for Neuroimaging and Informatics, Keck USC School of Medicine, Marina del Rey, California, USA
| | - Paul M Thompson
- Genetics Center, Stevens Institute for Neuroimaging and Informatics, Keck USC School of Medicine, Marina del Rey, California, USA
| | - Sophia Frangou
- Djavad Mowafagian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ruffieux Y, Wettstein A, Maartens G, Folb N, Mesa-Vieira C, Didden C, Tlali M, Williams C, Cornell M, Schomaker M, Johnson LF, Joska JA, Egger M, Haas AD. Life years lost associated with mental illness: A cohort study of beneficiaries of a South African medical insurance scheme. J Affect Disord 2023; 340:204-212. [PMID: 37544483 PMCID: PMC10924225 DOI: 10.1016/j.jad.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown. METHODS We analysed reimbursement claims from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders. RESULTS We followed 1,070,183 beneficiaries for a median of three years, of whom 282,926 (26.4 %) received mental health diagnoses. Men with a mental health diagnosis lost 3.83 life years (95 % CI 3.58-4.10) compared to men without. Women with a mental health diagnosis lost 2.19 life years (1.97-2.41) compared to women without. Excess mortality varied by sex and diagnosis, from 11.50 LYL (95 % CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (men: 3.42, women: 1.94). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder. LIMITATIONS Mental diagnoses are based on reimbursement claims. CONCLUSIONS Premature mortality among South African individuals with mental disorders is high. Our findings support interventions for the prevention, early detection, and treatment of physical comorbidities in this population. Targeted programs for suicide prevention and substance use treatment, particularly among men, can help reduce excess mortality from unnatural causes.
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Affiliation(s)
- Yann Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anja Wettstein
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Cristina Mesa-Vieira
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Christiane Didden
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Sociology, Ludwig-Maximilians-Universität München, Germany
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa; Department of Statistics, Ludwig-Maximilians-Universität München, Germany
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa; Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Burger JW, Andersen LS, Joska JA. Baseline concussion assessments can identify mental disorders: SCAT-5 and other screening tools in South African club rugby. PHYSICIAN SPORTSMED 2023; 51:472-481. [PMID: 36217827 DOI: 10.1080/00913847.2022.2134977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Although mental health screenings are not routinely conducted in rugby, the Sport Concussion Assessment Tool - Fifth Edition (SCAT-5) is widely performed and measures affective, cognitive, sleep, and physical symptoms. This study investigated the psychometric properties of the SCAT-5 to explore its potential as a mental health screening tool. METHODS During preseason for the 2021 Western Province Super League A in South Africa, clinicians conducted mental health assessments of 71 adult male rugby union players. The SCAT-5 Symptom Evaluation, Baron Depression Screener for Athletes (BDSA), Athlete Psychological Strain Questionnaire (APSQ), Center for Epidemiologic Studies-Depression (CES-D), and Generalized Anxiety Disorder-7 (GAD-7) were compared to each other and to fully structured diagnostic interviews by mental health professionals using the Mini International Neuropsychiatric Interview (MINI) 7.0.2. RESULTS Lifetime MINI-defined mental disorders were common, being identified in 33.8% (95% CI 22.79-46.17%). Only 4.29% of participants had a previous diagnosis. Exploratory Factor Analysis indicated a mental health construct of depression/anxiety being measured by the SCAT-5. The SCAT-5 had strong internal consistency (α = 0.94) and showed moderate convergent validity with the CES-D (r = 0.34; p = 0.008) and GAD-7 (r = 0.49; p < 0.0001). The area under the curve for the ability of the SCAT-5 to identify current disorders was 0.87 (p = 0.003), on par with the CES-D and GAD-7. CONCLUSION Since the SCAT-5 has the potential to identify depression and anxiety, it may allow mental health screening without the need for additional measures. Follow-up studies should further explore its discriminative ability in larger samples.
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Affiliation(s)
- James W Burger
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
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7
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Gandhi AR, Hyle EP, Scott JA, Lee JS, Shebl FM, Joska JA, Andersen LS, O'Cleirigh C, Safren SA, Freedberg KA. The Clinical Impact and Cost-Effectiveness of Clinic-Based Cognitive Behavioral Therapy for People With HIV, Depression, and Virologic Failure in South Africa. J Acquir Immune Defic Syndr 2023; 93:333-342. [PMID: 37079899 PMCID: PMC10287047 DOI: 10.1097/qai.0000000000003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/06/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Depression affects 25%-30% of people with HIV (PWH) in the Republic of South Africa (RSA) and is associated with both antiretroviral therapy (ART) nonadherence and increased mortality. We evaluated the cost-effectiveness of task-shifted, cognitive behavioral therapy (CBT) for PWH with diagnosed depression and virologic failure from a randomized trial in RSA. SETTING RSA. METHODS Using the Cost-Effectiveness of Preventing AIDS Complications model, we simulated both trial strategies: enhanced treatment as usual (ETAU) and ETAU plus CBT for ART adherence and depression (CBT-AD; 8 sessions plus 2 follow-ups). In the trial, viral suppression at 1 year was 20% with ETAU and 32% with CBT-AD. Model inputs included mean initial age (39 years) and CD4 count (214/μL), ART costs ($7.5-22/mo), and CBT costs ($29/session). We projected 5- and 10-year viral suppression, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs: $/QALY [discounted 3%/yr]; cost-effectiveness threshold: ≤$2545/QALY [0.5× per capita GDP]). In sensitivity analyses, we determined how input parameter variation affected cost-effectiveness. RESULTS Model-projected 5- and 10-year viral suppression were 18.9% and 8.7% with ETAU and 21.2% and 9.7% with CBT-AD, respectively. Compared with ETAU, CBT-AD would increase discounted life expectancy from 4.12 to 4.68 QALYs and costs from $6210/person to $6670/person (incremental cost-effectiveness ratio: $840/QALY). CBT-AD would remain cost-effective unless CBT-AD cost >$70/session and simultaneously improved 1-year viral suppression by ≤4% compared with ETAU. CONCLUSIONS CBT for PWH with depression and virologic failure in RSA could improve life expectancy and be cost-effective. Such targeted mental health interventions should be integrated into HIV care.
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Affiliation(s)
- Aditya R. Gandhi
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Emily P. Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for AIDS Research, Harvard University, Cambridge, MA
| | - Justine A. Scott
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Jasper S. Lee
- Harvard Medical School, Boston, MA
- Department of Psychology, University of Miami, Miami, FL
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Fatma M. Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; and
| | - Conall O'Cleirigh
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | | | - Kenneth A. Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
- Center for AIDS Research, Harvard University, Cambridge, MA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
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8
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Nightingale S, Ances B, Cinque P, Dravid A, Dreyer AJ, Gisslén M, Joska JA, Kwasa J, Meyer AC, Mpongo N, Nakasujja N, Pebody R, Pozniak A, Price RW, Sandford C, Saylor D, Thomas KGF, Underwood J, Vera JH, Winston A. Cognitive impairment in people living with HIV: consensus recommendations for a new approach. Nat Rev Neurol 2023; 19:424-433. [PMID: 37311873 DOI: 10.1038/s41582-023-00813-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/15/2023]
Abstract
Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury - including active or pretreatment legacy damage - from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and to provide a clearer framework of classification for clinical management and research studies.
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Affiliation(s)
- Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Beau Ances
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Paola Cinque
- Unit of Infectious Diseases, San Raffaele Institute, Milan, Italy
| | - Ameet Dravid
- Department of Medicine, Poona Hospital and Research Centre and Noble Hospital, Pune, India
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Magnus Gisslén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Judith Kwasa
- Department of Clinical Medicine and Therapeutics, Faculty of Health Science, University of Nairobi, Nairobi, Kenya
| | - Ana-Claire Meyer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Noeline Nakasujja
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Anton Pozniak
- Department of HIV Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Deanna Saylor
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- University Teaching Hospital, Lusaka, Zambia
| | - Kevin G F Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Jonathan Underwood
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
- Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK
- HIV Clinical Trials, Winston Churchill Wing, St Mary's Hospital, London, UK
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Joska JA. Behavioural Medicine: Strengthening approaches to address co-morbid chronic physical and mental disorders. S Afr Med J 2023; 113:8-9. [PMID: 37278265 DOI: 10.7196/samj.2023.v113i6.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 06/07/2023] Open
Abstract
South Africa is confronted with multi-morbid chronic physical and mental disorders. The relationships between these conditions are often multidirectional and result in a variety of adverse mental and physical health outcomes. The risk factors and perpetuating conditions in multi-morbidity are potentially modifiable through effective behaviour change. However, in South Africa, interventions and clinical care that address these co-occurring factors have traditionally functioned in a vacuum, created by a lack of formalised multidisciplinary collaboration. In high-income settings, the field of Behavioural Medicine was established in recognition of the importance of psychosocial factors in illness and assumes that the presence of physical concerns can be influenced by psychological and behavioural factors. The large body of evidence supporting Behavioural Medicine has afforded the field global recognition. Yet, it remains an emerging field in South Africa and on the African continent. The purpose of this paper is to contextualise the field of Behavioural Medicine in South Africa and present a way forward to establish the field in our context.
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10
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Lee JS, Bainter SA, Tsai AC, Andersen LS, Stanton AM, Magidson JF, Kagee A, Joska JA, O'Cleirigh C, Safren SA. Intersecting Relationships of Psychosocial and Structural Syndemic Problems Among People with HIV in South Africa: Using Network Analysis to Identify Influential Problems. AIDS Behav 2023; 27:1741-1756. [PMID: 36309936 PMCID: PMC10148921 DOI: 10.1007/s10461-022-03906-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2022] [Indexed: 11/27/2022]
Abstract
In South Africa, little is known about interrelationships between syndemic problems among people with HIV (PWH). A better understanding of syndemic problems may yield important information regarding factors amenable to mitigation. We surveyed 194 PWH in Khayelitsha, outside of Cape Town, South Africa. We used network analysis to examine the frequency of 10 syndemic problems and their interrelationships. Syndemic problems among PWH in South Africa were common; 159 (82.8%) participants reported at least 2 co-occurring syndemic problems and 90 (46.9%) endorsed 4 or more. Network analysis revealed seven statistically significant associations. The most central problems were depression, substance use, and food insecurity. Three clusters of syndemics were identified: mood and violence; structural factors; and behavioral factors. Depression, substance use, and food insecurity commonly co-occur among PWH in sub-Saharan Africa and interfere with HIV outcomes. Network analysis can identify intervention targets to potentially improve HIV treatment outcomes.
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Affiliation(s)
- Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Sq, 7th Floor, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
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11
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Beath N, Subramaney U, Zingela Z, Chiliza B, Joska JA, Kotzé C, Ramlall S, Seedat S. South Africa’s Psychiatric training capacity in 2008 and in 2018. Has training capacity improved? S Afr J Psychiatr 2023. [DOI: 10.4102/sajpsychiatry.v29i0.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Background: There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country.Aim: To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018.Setting: South African medical schools with departments of psychiatry.Methods: A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years.Results: Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant.Conclusion: While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training.Contribution: This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.
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Rose AL, Ochieng YA, Jack HE, Sangraula A, Ciya N, Jacobs Y, Ndamase S, Regenauer KS, Brown I, Hines AC, Johnson K, Bassett IV, Joska JA, Magidson JF, Myers B. Patient and stakeholder perspectives on impacts of the COVID-19 pandemic on HIV and mental health care delivery in South Africa. Int J STD AIDS 2023:9564624231160581. [PMID: 36943694 PMCID: PMC10031273 DOI: 10.1177/09564624231160581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND The COVID-19 pandemic had a global impact on health systems and the delivery of health services, including for chronic conditions such as HIV. In South Africa, impacts on HIV services have widely been quantitatively described. Across different health settings, patients have also qualitatively described numerous negative impacts to their HIV care. However, patient perspectives on COVID-19 impacts to HIV care in South Africa, the largest HIV care system in the world, have been little explored to date. METHODS We conducted 29 semi-structured individual interviews with people living with HIV (n = 24) and providers (n = 5) in Cape Town, South Africa. RESULTS While most patient participants reported continued access to HIV treatment during the pandemic, many described perceiving that the quality of their care declined. Increased structural barriers were described as one contributing factor to this change. Additionally, patients described that reduced privacy in clinical interactions was a key factor negatively influencing their experience of receiving care. CONCLUSION Findings underscore the importance of ensuring patient privacy for HIV services even during the rearrangement of services in emergencies. It is also important to continue developing models to integrate community mental health services within HIV care delivery in South Africa.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, 1068University of Maryland, College Park, MD, USA
| | - Yvonne A Ochieng
- Department of Psychology, 1068University of Maryland, College Park, MD, USA
| | - Helen E Jack
- Division of General Internal Medicine, Department of Medicine, 205280University of Washington, Seattle, Washington, USA
| | - Anu Sangraula
- Department of Behavioral and Community Health, 1068University of Maryland, College Park, MD, USA
| | - Nonceba Ciya
- Alcohol, Tobacco and Other Drug Research Unit, 59097South African Medical Research Council, Parow, South Africa
| | - Yuche Jacobs
- Alcohol, Tobacco and Other Drug Research Unit, 59097South African Medical Research Council, Parow, South Africa
| | - Sibabalwe Ndamase
- Alcohol, Tobacco and Other Drug Research Unit, 59097South African Medical Research Council, Parow, South Africa
| | | | - Imani Brown
- Department of Psychology, 1068University of Maryland, College Park, MD, USA
| | - Abigail C Hines
- Department of Psychology, 1068University of Maryland, College Park, MD, USA
| | - Kim Johnson
- Alcohol, Tobacco and Other Drug Research Unit, 59097South African Medical Research Council, Parow, South Africa
| | - Ingrid V Bassett
- Division of Infectious Diseases, Medical Practice Evaluation Center, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, 37716University of Cape Town, Cape Town, South Africa
| | - Jessica F Magidson
- Department of Psychology, 1068University of Maryland, College Park, MD, USA
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, 59097South African Medical Research Council, Parow, South Africa
- Curtin EnAble Institute, 1649Curtin University, Perth, Western Australia, Australia
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13
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Ruffieux Y, Wettstein A, Maartens G, Folb N, Vieira CM, Didden C, Tlali M, Williams C, Cornell M, Schomaker M, Johnson LF, Joska JA, Egger M, Haas AD. Life-years lost associated with mental illness: a cohort study of beneficiaries of a South African medical insurance scheme. medRxiv 2023:2023.01.19.23284778. [PMID: 36711937 PMCID: PMC9882632 DOI: 10.1101/2023.01.19.23284778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown. OBJECTIVE To quantify excess mortality due to natural and unnatural causes associated with mental illness. DESIGN SETTING AND PARTICIPANTS Cohort study using reimbursement claims and vital registration of beneficiaries of a South African medical insurance scheme, aged 15-84 years and covered by medical insurance at any point between January 1, 2011, and June 30, 2020. EXPOSURES ICD-10 diagnoses of mental disorders including organic, substance use, psychotic, mood, anxiety, eating, personality, and developmental disorders. OUTCOMES Mortality from natural, unnatural, unknown and all causes, as measured by the life-years lost (LYL) metric. RESULTS We followed 1 070 183 beneficiaries (51.7% female, median age 36.1 years for a median duration of 3.0 years, of whom 282 926 (26.4%) received mental health diagnoses and 27 640 (2.6%) died. Life expectancy of people with mental health diagnoses was 3.83 years (95% CI 3.58-4.10) shorter for men and 2.19 years (1.97-2.41) shorter for women. Excess mortality varied by sex and diagnosis, ranging from 11.50 LYL (95% CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (3.42 among men and 1.94 among women). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder. CONCLUSIONS AND RELEVANCE The burden of premature mortality among persons with mental disorders in South Africa is high. Our findings support implementing interventions for prevention, early detection, and treatment of physical comorbidities among people with mental disorders. Suicide prevention and substance use treatment programmes are needed to reduce excess mortality from unnatural causes, especially among men. KEY POINTS Question: How much shorter is the life expectancy of people with mental illness compared to the general population and how many life years are lost due to natural and unnatural causes of death?Findings: The life expectancy of people with mental health diagnoses was 3.83 years shorter for men and 2.19 years shorter for women. Most excess life years lost were attributable to natural causes (3.42 among men and 1.94 among women). However, bipolar and substance use disorders were associated with considerable premature mortality from unnatural causes.Meaning: Our findings support the implementation of interventions for improving the physical health of people with mental illness and targeted suicide prevention and substance use treatment programmes.
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Affiliation(s)
- Yann Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anja Wettstein
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Cristina Mesa Vieira
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Christiane Didden
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute of Sociology, Ludwig-Maximilians-University, Munich, Germany
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Department of Statistics, Ludwig-Maximilans-Universität München, Germany
| | - Leigh F Johnson
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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14
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Munsami A, Dreyer AJ, Sibeko G, Gouse H, Nightingale S, Joska JA. Mental and cognitive healthcare training targeting primary healthcare workers providing HIV services in Africa: a scoping review. AIDS Care 2023; 35:280-288. [PMID: 35848488 DOI: 10.1080/09540121.2022.2099512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Mental health and neurocognitive functioning remain a concern among people living with HIV. Symptomatic neurocognitive impairment (NCI) and mental illness can cause difficulties in daily functioning, including problems adhering to treatment. However, many healthcare workers in resource-limited settings have limited knowledge about the relationship between HIV and NCI. A synthesis of available literature on mental health and NCI training provided to healthcare workers delivering HIV services in Africa, is lacking. We conducted a scoping review of published literature to identify training interventions which targeted healthcare workers providing careto people with HIV in Africa. Ten studies met the inclusion criteria. One study focused on NCI, two studies mentioned HIV-associated dementia and seven studies were centred on common mental health disorders. Most studies used a multi-method training approach, with pre-and post-testing as the main evaluation technique. This review highlights the gap in training interventions addressing NCI in Africa. Although there is some commitment to building capacity for mental health and NCI assessment among healthcare workers in this setting, this review suggests that there is a need for research to develop and evaluate training interventions for healthcare workers delivering HIV services in Africa.
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Affiliation(s)
- Adele Munsami
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Goodman Sibeko
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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15
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Ruhanya V, Jacobs GB, Paul RH, Joska JA, Seedat S, Nyandoro G, Glashoff RH, Engelbrecht S. HIV-1 Subtype C Vpr Amino Acid Residue 45Y and Specific Conserved Fragments Are Associated with Neurocognitive Impairment and Markers of Viral Load. AIDS Res Hum Retroviruses 2023; 39:166-175. [PMID: 36401355 DOI: 10.1089/aid.2022.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is increasing evidence that HIV-1 viral protein R (Vpr) plays an important role in the pathogenesis of cognitive impairment. We investigated the relationship between HIV-1 subtype C Vpr sequence variation and HIV-associated neurocognitive impairment as measured by global deficit score (GDS) in treatment-naive individuals. We used different bioinformatic tools and statistical models to correlate vpr variation and cognitive function. We identified a tyrosine at position 45 (45Y) as a signature for neurocognitive impairment and histidine (45H) as a signature in the non-impaired individuals. The presence of signature 45Y was associated by 3.66 times higher GDS, 525 times higher plasma viral load, 15.84 times higher proviral load, and 60% lower absolute CD4-T cell count compared with those without the signature. Additionally, we identified four conserved Vpr fragment sequences, PEDQGPQREPYNEWTLE (5-21), LGQYIY (42-47), TYGDTW (49-54), and PEDQGPQREPYNEW (5-18), that were associated with higher plasma viral load and proviral load. The implication of these findings is that variation of Vpr leads to neurocognitive impairment in HIV infection and worsens the progression of disease in general by promoting the production of provirus, promoting HIV replication and depletion of CD4+ T cells in the periphery.
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Affiliation(s)
- Vurayai Ruhanya
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
| | - Graeme Brendon Jacobs
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Robert H Paul
- Department of Psychology and Behavioral Neuroscience, University of Missouri-St Louis, University Boulevard, St Louis, Missouri, USA
| | - John A Joska
- MRC Unit of Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- MRC Unit of Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - George Nyandoro
- Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
| | - Richard Helmuth Glashoff
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service (NHLS), Tygerberg Business Unity, Cape Town, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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16
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Haas AD, Lienhard R, Didden C, Cornell M, Folb N, Boshomane TMG, Salazar-Vizcaya L, Ruffieux Y, Nyakato P, Wettstein AE, Tlali M, Davies MA, von Groote P, Wainberg M, Egger M, Maartens G, Joska JA. Mental Health, ART Adherence, and Viral Suppression Among Adolescents and Adults Living with HIV in South Africa: A Cohort Study. AIDS Behav 2023; 27:1849-1861. [PMID: 36592251 PMCID: PMC10149479 DOI: 10.1007/s10461-022-03916-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 01/03/2023]
Abstract
We followed adolescents and adults living with HIV aged older than 15 years who enrolled in a South African private-sector HIV programme to examine adherence and viral non-suppression (viral load > 400 copies/mL) of participants with (20,743, 38%) and without (33,635, 62%) mental health diagnoses. Mental health diagnoses were associated with unfavourable adherence patterns. The risk of viral non-suppression was higher among patients with organic mental disorders [adjusted risk ratio (aRR) 1.55, 95% confidence interval (CI) 1.22-1.96], substance use disorders (aRR 1.53, 95% CI 1.19-1.97), serious mental disorders (aRR 1.30, 95% CI 1.09-1.54), and depression (aRR 1.19, 95% CI 1.10-1.28) when compared with patients without mental health diagnoses. The risk of viral non-suppression was also higher among males, adolescents (15-19 years), and young adults (20-24 years). Our study highlights the need for psychosocial interventions to improve HIV treatment outcomes-particularly of adolescents and young adults-and supports strengthening mental health services in HIV treatment programmes.
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Affiliation(s)
- Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
| | - Raphael Lienhard
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Christiane Didden
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Department of Sociology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | | | - Tebatso M G Boshomane
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa.,Steve Biko Academic Hospital, Pretoria, South Africa
| | - Luisa Salazar-Vizcaya
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yann Ruffieux
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Patience Nyakato
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Anja E Wettstein
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Per von Groote
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Milton Wainberg
- Department of Psychiatry and New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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17
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Beath N, Subramaney U, Zingela Z, Chiliza B, Joska JA, Kotzé C, Ramlall S, Seedat S. South Africa's Psychiatric training capacity in 2008 and in 2018. Has training capacity improved? S Afr J Psychiatr 2023; 29:1988. [PMID: 37064747 PMCID: PMC10091166 DOI: 10.4102/sajpsychiatry.29i0.1988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/13/2022] [Indexed: 04/18/2023] Open
Abstract
Background There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country. Aim To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018. Setting South African medical schools with departments of psychiatry. Methods A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years. Results Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only sub-speciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant. Conclusion While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of training. Contribution This study is the first situational analysis of specialist and subspecialist training posts in Psychiatry in South Africa, at two time points over a 10 year period, that draws on academic heads of departments of psychiatry as respondents. The study highlights the nominal increase in funded training posts over this period, especially subspecialist training posts. The majority of Health Professions Council of South Africa (HPCSA) accredited subspecialities in Psychiatry have no funded training posts which is particularly concerning.
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Affiliation(s)
- Natalie Beath
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ugasvaree Subramaney
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zukiswa Zingela
- Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - John A. Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Carla Kotzé
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Suvra Ramlall
- Department of Psychiatry, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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18
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Andersen LS, Stanton AM, Magidson JF, Joska JA, O'Cleirigh C, Lee JS, Kagee A, Witten JA, Safren SA. Cognitive and Behavioral Contributions to Depression Severity, Quality of Life, and Functioning Among People Living With HIV in South Africa. Behav Ther 2023; 54:91-100. [PMID: 36608980 DOI: 10.1016/j.beth.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 01/28/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates. Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale-Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population. Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment. The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.
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19
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Dreyer AJ, Nightingale S, Andersen LS, Lee JS, Gouse H, Safren SA, O’Cleirigh C, Thomas KGF, Joska JA. Sex Differences in the Cognitive Performance of a South African Cohort of People With HIV and Comorbid Major Depressive Disorder. J Int Assoc Provid AIDS Care 2023; 22:23259582231203192. [PMID: 37787183 PMCID: PMC10548808 DOI: 10.1177/23259582231203192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
Women with HIV (WWH) may be more vulnerable to cognitive impairment than men with HIV (MWH), which may be explained by the direct effects of HIV or by sociodemographic and psychiatric characteristics. We recruited 105 people with HIV (PWH; 76 women) with incomplete antiretroviral therapy adherence, comorbid major depressive disorder, and socioeconomically disadvantaged backgrounds. Participants completed neuropsychological testing and measures gathering sociodemographic, medical, and psychiatric information. We compared WWH and MWH cognitive performance using unadjusted and adjusted regressions, and within each respective group, we explored predictors of cognitive performance. Results showed no significant between-sex differences in cognitive performance, both globally and within domains. Fewer years of education (β = 0.94), illiteracy (β = 4.55), and greater food insecurity (β = -0.28) predicted lower cognitive performance in WWH but not MWH. We conclude that sex differences in PWH are likely due to sample characteristics representing broader inequalities, rather than true biological differences.
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Affiliation(s)
- Anna J. Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Denmark
| | - Jasper S. Lee
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Hetta Gouse
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - Steven A. Safren
- Department of Psychology, University of Miami, , Coral Gables, FL, USA
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Harvard Medical School, Boston, MA, USA
| | - Kevin G. F. Thomas
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, South Africa
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20
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Nightingale S, Cinque P, Joska JA, Price RW, Underwood J. A new approach to cognitive impairment in people with HIV. Lancet HIV 2022; 9:e815-e817. [PMID: 36150400 DOI: 10.1016/s2352-3018(22)00267-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town 7925, South Africa.
| | - Paola Cinque
- Unit of Infectious Diseases, San Raffaele Institute, Milan, Italy
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town 7925, South Africa
| | - Richard W Price
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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21
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Stanton AM, O'Cleirigh C, Knight L, Davey DLJ, Myer L, Joska JA, Mayer KH, Bekker L, Psaros C. The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub-Saharan Africa: state of the science and research priorities. J Int AIDS Soc 2022; 25:e26026. [PMID: 36251124 PMCID: PMC9575939 DOI: 10.1002/jia2.26026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA,Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA
| | - Conall O'Cleirigh
- Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Lucia Knight
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Dvora L. Joseph Davey
- School of Public HealthUniversity of Cape TownCape TownSouth Africa,Division of Infectious Diseases, Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Landon Myer
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Kenneth H. Mayer
- Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA,HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa,Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | | - Christina Psaros
- Massachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
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22
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Myers B, Lombard CJ, Lund C, Joska JA, Levitt N, Naledi T, Petersen Williams P, van der Westhuizen C, Cuijpers P, Stein DJ, Sorsdahl KR. Comparing dedicated and designated approaches to integrating task-shared psychological interventions into chronic disease care in South Africa: a three-arm, cluster randomised, multicentre, open-label trial. Lancet 2022; 400:1321-1333. [PMID: 36244383 DOI: 10.1016/s0140-6736(22)01641-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Community health workers (CHWs) are increasingly providing task-shared psychological interventions for depression and alcohol use in primary health care in low-income and middle-income countries. We aimed to compare the effectiveness of CHWs dedicated to deliver care with CHWs designated to deliver care over and above their existing responsibilities and with treatment as usual for patients with a chronic physical disease. METHODS We did a three-arm, cluster randomised, multicentre, open-label trial done in 24 primary health-care clinics (clusters) within the Western Cape province of South Africa. Clinics were randomly assigned (1:1:1) to implement dedicated care, designated care, or treatment as usual, stratified by urban-rural status. Patients with HIV or type 1 or type 2 diabetes were eligible if they were 18 years old or older, taking antiretroviral therapy for HIV or medication to manage their diabetes, had an Alcohol Use Disorders Identification Test (AUDIT) score of eight or more or a Center for Epidemiologic Studies Depression Scale score of 16 or more, and were not receiving mental health treatment. In the intervention arms, all participants were offered three sessions of an evidence-based psychological intervention, based on motivational interviewing and problem-solving therapy, delivered by CHWs. Our primary outcomes were depression symptom severity and alcohol use severity, which we assessed separately for the intention-to-treat populations of people with HIV and people with diabetes cohorts and in a pooled cohort, at 12 months after enrolment. The Benjamini-Hochberg procedure was used to adjust for multiple testing. The trial was prospectively registered with the Pan African Clinical Trials Registry, PACTR201610001825403. FINDINGS Between May 1, 2017, and March 31, 2019, 1340 participants were recruited: 457 (34·1%) assigned to the dedicated group, 438 (32·7%) assigned to the designated group, and 445 (33·2%) assigned to the treatment as usual group. 1174 (87·6%) participants completed the 12 month assessment. Compared with treatment as usual, the dedicated group (people with HIV adjusted mean difference -5·02 [95% CI -7·51 to -2·54], p<0·0001; people with diabetes -4·20 [-6·68 to -1·72], p<0·0001) and designated group (people with HIV -6·38 [-8·89 to -3·88], p<0·0001; people with diabetes -4·80 [-7·21 to -2·39], p<0·0001) showed greater improvement on depression scores at 12 months. By contrast, reductions in AUDIT scores were similar across study groups, with no intervention effects noted. INTERPRETATION The dedicated and designated approaches to delivering CHW-led psychological interventions were equally effective for reducing depression, but enhancements are required to support alcohol reduction. This trial extends evidence for CHW-delivered psychological interventions, offering insights into how different delivery approaches affect patient outcomes. FUNDING British Medical Research Council, Wellcome Trust, UK Department for International Development, the Economic and Social Research Council, and the Global Challenges Research Fund.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global health, Stellenbosch University, Bellville, South Africa
| | - Crick Lund
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - John A Joska
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Naomi Levitt
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Tracey Naledi
- Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa; Desmond Tutu HIV Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Petal Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine R Sorsdahl
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Solanke T, Kamau F, Esterhuizen T, Maartens G, Khoo S, Joska JA, Kellermann T, Strijdom H, Decloedt EH. Concentrations of Efavirenz, Tenofovir, and Emtricitabine in Obesity: A Cross-Sectional Study. J Acquir Immune Defic Syndr 2022; 91:101-108. [PMID: 35972856 DOI: 10.1097/qai.0000000000003025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/16/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity is increasing worldwide including in people living with HIV (PLWH). Antiretroviral pharmacokinetic data in obesity are limited. OBJECTIVES To measure antiretroviral drug concentrations in obese and nonobese PLWH treated with the fixed-dose combination of efavirenz-tenofovir-emtricitabine. To determine pharmacokinetic differences across indicators of obesity and their associated immunovirological outcomes. METHODS We conducted a cross-sectional sample analysis of 2 cohort studies. We measured mid-dose efavirenz, 8-hydroxy-efavirenz, tenofovir, and emtricitabine concentrations. Antiretroviral drug concentrations were analyzed by body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR). RESULTS We performed a study of 213 participants: General obesity was detected in 20.4% using BMI and abdominal obesity in 53.6% using WC and 62.4% using WHR, respectively. The median concentrations of all antiretroviral drugs were lower among obese participants determined by BMI and WC, with efavirenz showing greater differences than tenofovir or emtricitabine. For BMI, results were most striking for efavirenz (1752.3 vs 2342.9 ng/mL, P = 0.002) with lower concentrations in obese participants. Using WC, efavirenz (1845.8 vs 2571.2 ng/mL, P < 0.001), tenofovir (65.8 vs 73.2 ng/mL, P = 0.036), and emtricitabine (159.5 vs 221.0 ng/mL, P = 0.005) concentrations were lower in obese participants. Eight-hydroxyefavirenz concentrations were similar in nonobese and obese participants for WC. Using WHR, the concentrations of all antiretroviral drugs were lower in the obese population, most strikingly for emtricitabine (173.5 vs 229.0 ng/mL, P = 0.015). There were no immunovirological associations. CONCLUSION We found lower antiretroviral concentrations in all obese groups, most strikingly in participants with abdominal obesity determined by WC. Lower drug concentrations had no immunovirological associations.
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Affiliation(s)
- Toyosi Solanke
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Festus Kamau
- Division of Medical Physiology, Department of Biomedical Sciences, Centre for Cardio-metabolic Research in Africa (CARMA), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tonya Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Biostatistics Unit, Stellenbosch University, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - Saye Khoo
- Department of Molecular and Clinical Pharmacology, University of Liverpool; and
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Tracy Kellermann
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Department of Biomedical Sciences, Centre for Cardio-metabolic Research in Africa (CARMA), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Sikkema KJ, Rabie S, King A, Watt MH, Mulawa MI, Andersen LS, Wilson PA, Marais A, Ndwandwa E, Majokweni S, Orrell C, Joska JA. ImpACT+, a coping intervention to improve clinical outcomes for women living with HIV and sexual trauma in South Africa: study protocol for a randomized controlled trial. Trials 2022; 23:680. [PMID: 35982485 PMCID: PMC9386207 DOI: 10.1186/s13063-022-06655-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Addressing sexual trauma in the context of HIV care is essential to improve clinical outcomes and mental health among women in South Africa. Women living with HIV (WLH) report disproportionately high levels of sexual trauma and have higher rates of posttraumatic stress disorder. Adherence to antiretroviral therapy (ART) may be difficult for traumatized women, as sexual trauma compounds the stress associated with managing HIV and is often comorbid with other mental health disorders, further compromising care engagement and adherence. ART initiation represents a unique window of opportunity for intervention to enhance motivation, increase care engagement, and address the negative effects of trauma on avoidant coping behaviors. Mental health interventions delivered by non-specialists in low- and middle-income countries have potential to treat depression, trauma, and effects of intimate partner violence among WLH. This study will examine the effectiveness of Improving AIDS Care after Trauma (ImpACT +), a task-shared, trauma-focused coping intervention, to promote viral suppression among WLH initiating ART in a South African clinic setting. Methods This study will be conducted in Khayelitsha, a peri-urban settlement situated near Cape Town, South Africa. Using a hybrid type 1 effectiveness-implementation design, we will randomize 350 WLH initiating ART to the ImpACT + experimental condition or the control condition (three weekly sessions of adapted problem-solving therapy) to examine the effectiveness of ImpACT + on viral suppression, ART adherence, and the degree to which mental health outcomes mediate intervention effects. ImpACT + participants will receive six once-a-week coping intervention sessions and six monthly maintenance sessions over the follow-up period. We will conduct mental health and bio-behavioral assessments at baseline, 4, 8, and 12 months, with care engagement data extracted from medical records. We will explore scalability using the Consolidated Framework for Implementation Research (CFIR). Discussion This trial is expected to yield important new information on psychologically informed intervention models that benefit the mental health and clinical outcomes of WLH with histories of sexual trauma. The proposed ImpACT + intervention, with its focus on building coping skills to address traumatic stress and engagement in HIV care and treatment, could have widespread impact on the health and wellbeing of individuals and communities in sub-Saharan Africa. Trial registration Clinicaltrials.gov NCT04793217. Retrospectively registered on 11 March 2021.
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Affiliation(s)
- K J Sikkema
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - S Rabie
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - A King
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - M H Watt
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - M I Mulawa
- Duke University School of Nursing and Duke Global Health Institute, Durham, NC, USA
| | - L S Andersen
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa.,Present Address, University of Copenhagen, Copenhagen, Denmark
| | - P A Wilson
- Department of Psychology, University of California, Los Angeles, USA
| | - A Marais
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - E Ndwandwa
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - S Majokweni
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - C Orrell
- Desmond Tutu HIV Foundation, University of Cape Town Medical School, Cape Town, South Africa
| | - J A Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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25
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Munsami A, Nightingale S, Sorsdahl K, Joska JA. Exploring HIV-Associated Neurocognitive Impairment in the Era of Effective Antiretroviral Therapy: A Primary Healthcare Perspective. Qual Health Res 2022; 32:1487-1497. [PMID: 35770984 PMCID: PMC9411698 DOI: 10.1177/10497323221110801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The prevalence of HIV-associated neurocognitive impairment (H-NCI) is concerning. Individuals on effective antiretroviral therapy (ART) may still be at risk for H-NCI as they experience longer life expectancies. There are, however, few professionals with knowledge and skills to identify H-NCI, in low- and middle-income countries. We explored qualitatively, primary healthcare workers' knowledge and views of H-NCI, in the era of effective ART, particularly their views toward task-sharing of H-NCI screening from specialists to mid-level or lay healthcare providers. The first phase of data collection involved two focus group discussions (FGDs) 23 primary healthcare workers from two facilities in the Western Cape participated in the FGDs. In the second phase of data collection12 individual, in-depth interviews were conducted in KwaZulu-Natal. Using thematic analysis, several key themes emerged. Although healthcare providers were unable to specifically identify H-NCI, they described several HIV disease and treatment related or mental health comorbidities that could be responsible for the symptoms. Despite healthcare workers reporting low frequencies of H-NCI, they favoured receiving training to screen for H-NCI with a view toward providing holistic care.
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Affiliation(s)
- Adele Munsami
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Sam Nightingale
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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26
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Belus JM, Joska JA, Bronsteyn Y, Rose AL, Andersen LS, Regenauer KS, Myers B, Hahn JA, Orrell C, Safren SA, Magidson JF. Gender Moderates Results of a Randomized Clinical Trial for the Khanya Intervention for Substance Use and ART Adherence in HIV Care in South Africa. AIDS Behav 2022; 26:3630-3641. [PMID: 35895150 PMCID: PMC9550692 DOI: 10.1007/s10461-022-03765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/21/2022]
Abstract
Little is known about gender effects of alcohol and drug use (AOD) among people living with HIV (PLWH) in resource-limited settings. Using multilevel models, we tested whether gender moderated the effect of Khanya, a cognitive-behavioral therapy-based intervention addressing antiretroviral (ART) adherence and AOD reduction. We enrolled 61 participants from HIV care and examined outcomes at 3- and 6-months compared to enhanced treatment as usual (ETAU). Gender significantly moderated the effect of Khanya on ART adherence (measured using electronically-monitored and biomarker-confirmed adherence), such that women in Khanya had significantly lower ART adherence compared to men in Khanya; no gender differences were found for AOD outcomes. Exploratory trajectory analyses showed men in Khanya and both genders in ETAU had significant reductions in at least one AOD outcome; women in Khanya did not. More research is needed to understand whether a gender lens can support behavioral interventions for PLWH with AOD. Trial registry ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.
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Affiliation(s)
- Jennifer M Belus
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Psychology, University of Maryland, College Park, MD, USA.
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Yosef Bronsteyn
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa.,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Steve A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
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27
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Madden VJ, Msolo N, Mqadi L, Lesosky M, Bedwell GJ, Hutchinson MR, Peter JG, Parker R, Schrepf A, Edwards RR, Joska JA. Study protocol: an observational study of distress, immune function and persistent pain in HIV. BMJ Open 2022; 12:e059723. [PMID: 36691234 PMCID: PMC9171212 DOI: 10.1136/bmjopen-2021-059723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Many people with HIV report both distress and pain. The relationship between distress and pain is bidirectional, but the mechanisms by which distress exacerbates pain are unclear. The inflammatory response to challenge (inflammatory reactivity, IR) may be a partial mediator, given that neuroimmune interactions provide a substrate for IR to also influence neurological reactivity and, thus, pain-related neural signalling. This prospective, observational, case-control study will characterise the relationships between distress, IR, pain-related signalling as captured by induced secondary hyperalgesia (SH), and pain, in people with HIV who report persistent pain (PP) (cases) or no pain (controls). METHODS AND ANALYSIS One hundred people with suppressed HIV, reporting either PP or no pain, will be assessed two or four times over 6 months. The primary outcomes are distress (Hopkins 25-item symptom checklist), IR (multiplex assay after LPS challenge), and PP (Brief Pain Inventory), assessed at the baseline timepoint, although each will also be assessed at follow-up time points. Induced SH will be assessed in a subsample of 60 participants (baseline timepoint only). To test the hypothesis that IR partly mediates the relationship between distress and pain, mediation analysis will use the baseline data from the PP group to estimate direct and indirect contributions of distress and IR to pain. To test the hypothesis that IR is positively associated with SH, data from the subsample will be analysed with generalised mixed effects models to estimate the association between IR and group membership, with SH as the dependent variable. ETHICS AND DISSEMINATION Information obtained from this study will be published in peer-reviewed journals and presented at scientific meetings. The study has been approved by the Human Research Ethics Committee of the University of Cape Town (approval number: 764/2019) and the City of Cape Town (ref: 24699). TRIAL REGISTRATION NUMBER NCT04757987.
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Affiliation(s)
- Victoria J Madden
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ncumisa Msolo
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Luyanduthando Mqadi
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Gillian J Bedwell
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mark R Hutchinson
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Grant Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Rose AL, Belus JM, Ma T, Lee JS, Wan C, De Los Reyes A, Joska JA, Andersen LS, Myers B, Magidson JF. The Relationship Between Harmful Alcohol Use and Antiretroviral Non-adherence in People Accessing HIV Treatment in Cape Town, South Africa: An Event-Level Analysis. AIDS Behav 2022; 26:2055-2066. [PMID: 35022939 DOI: 10.1007/s10461-021-03552-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
Harmful alcohol consumption can significantly compromise adherence to antiretroviral therapy (ART). Prior research has identified aggregate relationships between alcohol use and ART non-adherence, largely relying on concurrent assessment of these domains. There is relatively limited evidence on more nuanced day-level associations between alcohol use and ART non-adherence, despite potentially important clinical implications. We recruited adults with HIV treatment adherence challenges and harmful alcohol use (n = 53) from HIV care in South Africa. We examined relationships between alcohol use and same and next day ART adherence, accounting for the role of weekends/holidays and participant demographics, including gender. Results demonstrated that ART adherence was significantly worse on weekend/holiday days. Next day adherence was significantly worse in the context of weekend alcohol use and among men. These results suggest the importance of tailoring intervention strategies to support ART adherence during weekend drinking and for men engaged in heavy episodic drinking.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, USA.
| | - Jennifer M Belus
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, USA
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Tianzhou Ma
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
| | - Jasper S Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Christine Wan
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, USA
| | - Andres De Los Reyes
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, USA
| | - John A Joska
- HIV Mental Health Research Unit, University of Cape Town, Cape Town, South Africa
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Australia
- Alcohol, Tobacco, and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Drive, College Park, MD, USA
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Ruhanya V, Jacobs GB, Paul RH, Joska JA, Seedat S, Nyandoro G, Glashoff RH, Engelbrecht S. HIV-1 subtype C Tat exon-1 amino acid residue 24K is a signature for neurocognitive impairment. J Neurovirol 2022; 28:392-403. [PMID: 35394614 DOI: 10.1007/s13365-022-01073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/11/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
Variation and differential selection pressures on Tat genes have been shown to alter the biological function of the protein, resulting in pathological consequences in a number of organs including the brain. We evaluated the impact of genetic variation and selection pressure on 147 HIV-1 subtype C Tat exon 1 sequences from monocyte-depleted peripheral lymphocytes on clinical diagnosis of neurocognitive impairment. Genetic analyses identified two signature amino acid residues, lysine at codon 24 (24K) with a frequency of 43.4% and arginine at codon 29 (29R) with a frequency of 34.0% in individuals with HIV-associated neurocognitive impairment. The analyses also revealed two signature residues, asparagine, 24 N (31.9%), and histidine, 29H (21.3%), in individuals without neurocognitive impairment. Both codons, 24 and 29, were associated with high entropy but only codon 29 was under positive selection. The presence of signature K24 increased by 2.08 times the risk of neurocognitive impairment, 3.15 times higher proviral load, and 69% lower absolute CD4 T-cell count compared to those without the signature. The results support a linkage between HIV-1 C Tat N24K polymorphism, proviral load, immunosuppression, and neurocognitive impairment. The signature may induce more neurotoxic effects, which contributes to establishment and severity of HIV-associated neurocognitive impairment.
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Affiliation(s)
- Vurayai Ruhanya
- Division of Medical Virology, Stellenbosch University, Francie van Zijl Avenue, Cape Town, 8000, South Africa. .,Department of Medical Microbiology, Harare, Zimbabwe.
| | - Graeme Brendon Jacobs
- Division of Medical Virology, Stellenbosch University, Francie van Zijl Avenue, Cape Town, 8000, South Africa
| | - Robert H Paul
- Department of Psychology and Behavioral Neuroscience, University of Missouri-St Louis, University Boulevard, St Louis, USA
| | - John A Joska
- MRC Unit of Anxiety & Stress Disorders, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- MRC Unit of Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | | | - Richard H Glashoff
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service (NHLS), Tygerberg Business Unit, Cape Town, South Africa
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University, Francie van Zijl Avenue, Cape Town, 8000, South Africa.,National Health Laboratory Service (NHLS), Tygerberg Business Unit, Cape Town, South Africa
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Regenauer KS, Kleinman MB, Belus JM, Myers B, Joska JA, Magidson JF. Effects of intersecting internalized stigmas and avoidance on HIV and alcohol-related outcomes among people living with HIV in South Africa. Drug Alcohol Depend 2022; 233:109364. [PMID: 35219998 PMCID: PMC8978067 DOI: 10.1016/j.drugalcdep.2022.109364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite HIV and problematic drinking often co-occurring in South Africa (SA), limited research has examined how HIV stigma relates to alcohol outcomes, how alcohol stigma relates to HIV outcomes, and moderators of these associations. This study examined the intersection of HIV and alcohol stigmas on HIV and alcohol outcomes, and the role of avoidant behavior in moderating these relationships in SA. METHODS We assessed biomarker-verified measures of antiretroviral therapy (ART) adherence, HIV viral load (VL), and alcohol consumption, and self-reported measures of internalized HIV/alcohol stigmas, avoidant behavior, ART adherence, and problematic drinking-alcohol use that will likely lead to health or other problems-cross-sectionally among people with HIV (PWH) and problematic drinking (N = 64). We conducted regression analyses with interaction terms. FINDINGS A significant relationship was found between internalized alcohol stigma and VL suppression, with higher levels of alcohol stigma associated with a lower likelihood of suppression (OR=1.68, 95%CI[1.11-2.65], p = .02). Avoidance significantly moderated the relationship between internalized HIV stigma and problematic drinking; higher HIV stigma was associated with lower problematic drinking only at low levels of avoidance (b(SE)= -1.92(.85), p = .03). CONCLUSIONS This study is the first to examine associations between HIV and alcohol stigmas, avoidance, and both HIV and alcohol outcomes in SA. Findings contribute to our understanding of how alcohol stigma relates to biological HIV outcomes, and the role of avoidance in the relationship between internalized HIV stigma and problematic drinking. Findings may inform future clinical interventions aiming to address the impact of stigma on HIV treatment outcomes and alcohol use among PWH in SA.
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Affiliation(s)
| | - Mary B. Kleinman
- Department of Psychology, University of Maryland, College Park, United States
| | - Jennifer M. Belus
- Department of Psychology, University of Maryland, College Park, United States,Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland,University of Basel, Basel, Switzerland
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia,Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, Tygerberg, South Africa,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jessica F. Magidson
- Department of Psychology, University of Maryland, College Park, United States
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31
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Belus JM, Regenauer KS, Hutman E, Rose AL, Burnhams W, Andersen LS, Myers B, Joska JA, Magidson JF. Substance use referral, treatment utilization, and patient costs associated with problematic substance use in people living with HIV in Cape Town, South Africa. Drug Alcohol Depend Rep 2022; 2:100035. [PMID: 36845899 PMCID: PMC9948858 DOI: 10.1016/j.dadr.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/15/2021] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
Introduction Despite efforts to detect and treat problematic substance use (SU) among people living with HIV (PLWH) in South Africa, integration of HIV and SU services is limited. We sought to understand whether PLWH and problematic SU were: (a) routinely referred to SU treatment, a co-located Matrix clinic, (b) used SU treatment services when referred, and (c) the individual amount spent on SU. Methods Guided by the RE-AIM implementation science framework, we examined patient-level quantitative screening and baseline data from a pilot clinical trial for medication adherence and problematic SU. Qualitative data came from semi-structured interviews with HIV care providers (N = 8), supplemented by patient interviews (N = 15). Results None of the screened patient participants (N = 121) who were seeking HIV care and had problematic SU were engaged in SU treatment, despite the freely available co-located SU treatment program. Only 1.5% of the enrolled patient study sample (N = 66) reported lifetime referral to SU treatment. On average, patients with untreated SU spent 33.3% (SD=34.5%) of their monthly household income on substances. HIV care providers reported a lack of clarity about the SU referral process and a lack of direct communication with patients about patients' needs or interest in receiving an SU referral. Discussion SU treatment referrals and uptake were rare among PLWH reporting problematic SU, despite the high proportion of individual resources allocated to substances and the co-located Matrix site. A standardized referral policy between the HIV and Matrix sites may improve communication and uptake of SU referrals.
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Affiliation(s)
- Jennifer M. Belus
- Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland,University of Basel, Basel, Switzerland,University of Maryland, Department of Psychology, College Park, MD, USA,Corresponding author at: Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel 4051, Switzerland.
| | | | - Elizabeth Hutman
- University of Maryland, School of Public Health, College Park, MD, USA
| | - Alexandra L. Rose
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Warren Burnhams
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - Lena S. Andersen
- University of Copenhagen, Global Health Section, Department of Public Health, Copenhagen, Denmark
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa,University of Cape Town, Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
| | - John A. Joska
- University of Cape Town, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
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Joska JA, Rabie S, Sibeko G. Changing minds: A behavioural approach to vaccine hesitancy. S Afr Med J 2022; 112:13495. [PMID: 35139984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023] Open
Affiliation(s)
- John A Joska
- Behavioural Medicine Programme, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa.
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Dima D, Modabbernia A, Papachristou E, Doucet GE, Agartz I, Aghajani M, Akudjedu TN, Albajes‐Eizagirre A, Alnæs D, Alpert KI, Andersson M, Andreasen NC, Andreassen OA, Asherson P, Banaschewski T, Bargallo N, Baumeister S, Baur‐Streubel R, Bertolino A, Bonvino A, Boomsma DI, Borgwardt S, Bourque J, Brandeis D, Breier A, Brodaty H, Brouwer RM, Buitelaar JK, Busatto GF, Buckner RL, Calhoun V, Canales‐Rodríguez EJ, Cannon DM, Caseras X, Castellanos FX, Cervenka S, Chaim‐Avancini TM, Ching CRK, Chubar V, Clark VP, Conrod P, Conzelmann A, Crespo‐Facorro B, Crivello F, Crone EA, Dannlowski U, Dale AM, Davey C, de Geus EJC, de Haan L, de Zubicaray GI, den Braber A, Dickie EW, Di Giorgio A, Doan NT, Dørum ES, Ehrlich S, Erk S, Espeseth T, Fatouros‐Bergman H, Fisher SE, Fouche J, Franke B, Frodl T, Fuentes‐Claramonte P, Glahn DC, Gotlib IH, Grabe H, Grimm O, Groenewold NA, Grotegerd D, Gruber O, Gruner P, Gur RE, Gur RC, Hahn T, Harrison BJ, Hartman CA, Hatton SN, Heinz A, Heslenfeld DJ, Hibar DP, Hickie IB, Ho B, Hoekstra PJ, Hohmann S, Holmes AJ, Hoogman M, Hosten N, Howells FM, Hulshoff Pol HE, Huyser C, Jahanshad N, James A, Jernigan TL, Jiang J, Jönsson EG, Joska JA, Kahn R, Kalnin A, Kanai R, Klein M, Klyushnik TP, Koenders L, Koops S, Krämer B, Kuntsi J, Lagopoulos J, Lázaro L, Lebedeva I, Lee WH, Lesch K, Lochner C, Machielsen MWJ, Maingault S, Martin NG, Martínez‐Zalacaín I, Mataix‐Cols D, Mazoyer B, McDonald C, McDonald BC, McIntosh AM, McMahon KL, McPhilemy G, Meinert S, Menchón JM, Medland SE, Meyer‐Lindenberg A, Naaijen J, Najt P, Nakao T, Nordvik JE, Nyberg L, Oosterlaan J, de la Foz VO, Paloyelis Y, Pauli P, Pergola G, Pomarol‐Clotet E, Portella MJ, Potkin SG, Radua J, Reif A, Rinker DA, Roffman JL, Rosa PGP, Sacchet MD, Sachdev PS, Salvador R, Sánchez‐Juan P, Sarró S, Satterthwaite TD, Saykin AJ, Serpa MH, Schmaal L, Schnell K, Schumann G, Sim K, Smoller JW, Sommer I, Soriano‐Mas C, Stein DJ, Strike LT, Swagerman SC, Tamnes CK, Temmingh HS, Thomopoulos SI, Tomyshev AS, Tordesillas‐Gutiérrez D, Trollor JN, Turner JA, Uhlmann A, van den Heuvel OA, van den Meer D, van der Wee NJA, van Haren NEM, van't Ent D, van Erp TGM, Veer IM, Veltman DJ, Voineskos A, Völzke H, Walter H, Walton E, Wang L, Wang Y, Wassink TH, Weber B, Wen W, West JD, Westlye LT, Whalley H, Wierenga LM, Williams SCR, Wittfeld K, Wolf DH, Worker A, Wright MJ, Yang K, Yoncheva Y, Zanetti MV, Ziegler GC, Thompson PM, Frangou S. Subcortical volumes across the lifespan: Data from 18,605 healthy individuals aged 3-90 years. Hum Brain Mapp 2022; 43:452-469. [PMID: 33570244 PMCID: PMC8675429 DOI: 10.1002/hbm.25320] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 12/25/2022] Open
Abstract
Age has a major effect on brain volume. However, the normative studies available are constrained by small sample sizes, restricted age coverage and significant methodological variability. These limitations introduce inconsistencies and may obscure or distort the lifespan trajectories of brain morphometry. In response, we capitalized on the resources of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to examine age-related trajectories inferred from cross-sectional measures of the ventricles, the basal ganglia (caudate, putamen, pallidum, and nucleus accumbens), the thalamus, hippocampus and amygdala using magnetic resonance imaging data obtained from 18,605 individuals aged 3-90 years. All subcortical structure volumes were at their maximum value early in life. The volume of the basal ganglia showed a monotonic negative association with age thereafter; there was no significant association between age and the volumes of the thalamus, amygdala and the hippocampus (with some degree of decline in thalamus) until the sixth decade of life after which they also showed a steep negative association with age. The lateral ventricles showed continuous enlargement throughout the lifespan. Age was positively associated with inter-individual variability in the hippocampus and amygdala and the lateral ventricles. These results were robust to potential confounders and could be used to examine the functional significance of deviations from typical age-related morphometric patterns.
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Affiliation(s)
- Danai Dima
- Department of Psychology, School of Arts and Social SciencesCity University of LondonLondonUK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | | | | | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam University Medical CentreLocation VUmcAmsterdamNetherlands
- Institute of Education & Child StudiesSection Forensic Family & Youth Care, Leiden UniversityNetherlands
| | - Theophilus N. Akudjedu
- Institute of Medical Imaging and Visualisation, Department of Medical Science and Public Health, Faculty of Health and Social SciencesBournemouth UniversityPooleUK
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandDublinIreland
| | - Anton Albajes‐Eizagirre
- FIDMAG Germanes HospitalàriesMadridSpain
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
| | - Dag Alnæs
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
- Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Micael Andersson
- Department of Integrative Medical BiologyUmeå UniversityUmeåSweden
| | - Nancy C. Andreasen
- Department of Psychiatry, Carver College of MedicineThe University of IowaIowa CityIowaUSA
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityMannheimGermany
| | - Nuria Bargallo
- Imaging Diagnostic Centre, Hospital ClinicBarcelona University ClinicBarcelonaSpain
- August Pi i Sunyer Biomedical Research Institut (IDIBAPS)BarcelonaSpain
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityMannheimGermany
| | - Ramona Baur‐Streubel
- Department of Psychology, Biological Psychology, Clinical Psychology and PsychotherapyUniversity of WürzburgWurzburgGermany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Aurora Bonvino
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Dorret I. Boomsma
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Stefan Borgwardt
- Department of Psychiatry & PsychotherapyUniversity of LübeckLubeckGermany
| | - Josiane Bourque
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityMannheimGermany
| | - Alan Breier
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyAustralia
| | - Rachel M. Brouwer
- Rudolf Magnus Institute of NeuroscienceUniversity Medical Center UtrechtUtrechtNetherlands
| | - Jan K. Buitelaar
- Donders Center of Medical NeurosciencesRadboud UniversityNijmegenNetherlands
- Donders Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
| | - Geraldo F. Busatto
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Randy L. Buckner
- Department of Psychology, Center for Brain ScienceHarvard UniversityCambridgeMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Vincent Calhoun
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, USA Neurology, Radiology, Psychiatry and Biomedical EngineeringEmory UniversityAtlantaGeorgiaUSA
| | | | - Dara M. Cannon
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandDublinIreland
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityCardiffUK
| | | | - Simon Cervenka
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm RegionStockholmSweden
| | - Tiffany M. Chaim‐Avancini
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Victoria Chubar
- Department of NeuroscienceKU Leuven, Mind‐Body Research GroupLeuvenBelgium
| | - Vincent P. Clark
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
- Mind Research NetworkAlbuquerqueNew MexicoUSA
| | - Patricia Conrod
- Department of PsychiatryUniversité de MontréalMontrealCanada
| | - Annette Conzelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity of TübingenTubingenGermany
| | - Benedicto Crespo‐Facorro
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- HU Virgen del Rocio, IBiS, University of SevillaSevillaSpain
| | - Fabrice Crivello
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293Université de BordeauxTalenceFrance
| | - Eveline A. Crone
- Erasmus School of Social and Behavioural SciencesErasmus University RotterdamRotterdamNetherlands
- Faculteit der Sociale Wetenschappen, Instituut PsychologieUniversiteit LeidenLeidenNetherlands
| | - Udo Dannlowski
- Department of Psychiatry and PsychotherapyUniversity of MünsterMunsterGermany
| | - Anders M. Dale
- Center for Multimodal Imaging and Genetics, Department of Neuroscience and Department of RadiologyUniversity of California‐San DiegoLa JollaCaliforniaUSA
| | | | - Eco J. C. de Geus
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Lieuwe de Haan
- Academisch Medisch CentrumUniversiteit van AmsterdamAmsterdamNetherlands
| | - Greig I. de Zubicaray
- Faculty of Health, Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | - Anouk den Braber
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Erin W. Dickie
- Kimel Family Translational Imaging Genetics LaboratoryCampbell Family Mental Health Research Institute, CAMHTorontoCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
| | - Annabella Di Giorgio
- Biological Psychiatry Lab, Fondazione IRCCS Casa Sollievo della SofferenzaSan Giovanni Rotondo (FG)Italy
| | - Nhat Trung Doan
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Erlend S. Dørum
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental NeurosciencesTechnische Universität DresdenDresdenGermany
- Faculty of MedicineUniversitätsklinikum Carl Gustav Carus an der TU DresdenDresdenGermany
| | - Susanne Erk
- Division of Mind and Brain Research, Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Thomas Espeseth
- Department of PsychologyUniversity of OsloOsloNorway
- Bjørknes CollegeOsloNorway
| | - Helena Fatouros‐Bergman
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm RegionStockholmSweden
| | - Simon E. Fisher
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Language and Genetics DepartmentMax Planck Institute for PsycholinguisticsNijmegenNetherlands
| | - Jean‐Paul Fouche
- Department of Psychiatry and Mental HealthUniversity of Cape TownRondeboschSouth Africa
| | - Barbara Franke
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenNetherlands
- Department of PsychiatryRadboud University Medical CenterNijmegenNetherlands
| | - Thomas Frodl
- Department of Psychiatry and PsychotherapyOtto von Guericke University MagdeburgMagdeburgGermany
| | - Paola Fuentes‐Claramonte
- FIDMAG Germanes HospitalàriesMadridSpain
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
| | - David C. Glahn
- Department of Psychiatry, Tommy Fuss Center for Neuropsychiatric Disease Research Boston Children's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ian H. Gotlib
- Department of PsychologyStanford UniversityStanfordCaliforniaUSA
| | - Hans‐Jörgen Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine Greifswald, University of GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Oliver Grimm
- Department for Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum FrankfurtGoethe UniversitatFrankfurtGermany
| | - Nynke A. Groenewold
- Department of Psychiatry and Mental HealthUniversity of Cape TownRondeboschSouth Africa
- Neuroscience InstituteUniversity of Cape TownRondeboschSouth Africa
| | | | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General PsychiatryHeidelberg UniversityHeidelbergGermany
| | - Patricia Gruner
- Department of PsychiatryYale UniversityNew HavenConnecticutUSA
- Learning Based Recovery CenterVA Connecticut Health SystemNew HavenConnecticutUSA
| | - Rachel E. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Brain Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Children's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ruben C. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Brain Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Children's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tim Hahn
- Department of Psychiatry and PsychotherapyUniversity of MünsterMunsterGermany
| | - Ben J. Harrison
- Melbourne Neuropsychiatry CenterUniversity of MelbourneMelbourneAustralia
| | - Catharine A. Hartman
- Interdisciplinary Center Psychopathology and Emotion regulationUniversity Medical Center Groningen, University of GroningenGroningenNetherlands
| | - Sean N. Hatton
- Brain and Mind CentreUniversity of SydneySydneyAustralia
| | - Andreas Heinz
- Faculty of MedicineUniversitätsklinikum Carl Gustav Carus an der TU DresdenDresdenGermany
| | - Dirk J. Heslenfeld
- Departments of Experimental and Clinical PsychologyVrije Universiteit AmsterdamAmsterdamNetherlands
| | - Derrek P. Hibar
- Personalized HealthcareGenentech, IncSouth San FranciscoCaliforniaUSA
| | - Ian B. Hickie
- Brain and Mind CentreUniversity of SydneySydneyAustralia
| | - Beng‐Choon Ho
- Department of Psychiatry, Carver College of MedicineThe University of IowaIowa CityIowaUSA
| | - Pieter J. Hoekstra
- Department of PsychiatryUniversity Medical Center Groningen, University of GroningenGroningenNetherlands
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityMannheimGermany
| | - Avram J. Holmes
- Department of PsychologyYale UniversityNew HavenConnecticutUSA
| | - Martine Hoogman
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Department of Psychiatry and Mental HealthUniversity of Cape TownRondeboschSouth Africa
| | - Norbert Hosten
- Norbert Institute of Diagnostic Radiology and NeuroradiologyUniversity Medicine Greifswald, University of GreifswaldGreifswaldGermany
| | - Fleur M. Howells
- Language and Genetics DepartmentMax Planck Institute for PsycholinguisticsNijmegenNetherlands
- Department for Psychiatry, Psychosomatics and Psychotherapy, Universitätsklinikum FrankfurtGoethe UniversitatFrankfurtGermany
| | | | - Chaim Huyser
- Bascule, Academic Centre for Children and Adolescent PsychiatryDuivendrechtNetherlands
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Terry L. Jernigan
- Center for Human Development, Departments of Cognitive Science, Psychiatry, and RadiologyUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyAustralia
| | - Erik G. Jönsson
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm RegionStockholmSweden
| | - John A. Joska
- Language and Genetics DepartmentMax Planck Institute for PsycholinguisticsNijmegenNetherlands
| | - Rene Kahn
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew Kalnin
- Department of RadiologyOhio State University College of MedicineColumbusOhioUSA
| | - Ryota Kanai
- Department of NeuroinformaticsAraya, IncTokyoJapan
| | - Marieke Klein
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Department of Psychiatry and Mental HealthUniversity of Cape TownRondeboschSouth Africa
- Department of PsychiatryUniversity of California San DiegoLa JollaCaliforniaUSA
| | | | - Laura Koenders
- Department of PsychiatryUniversity of MelbourneMelbourneAustralia
| | - Sanne Koops
- Rudolf Magnus Institute of NeuroscienceUniversity Medical Center UtrechtUtrechtNetherlands
| | - Bernd Krämer
- Section for Experimental Psychopathology and Neuroimaging, Department of General PsychiatryHeidelberg UniversityHeidelbergGermany
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience, Thompson InstituteUniversity of the Sunshine CoastSunshine CoastAustralia
| | - Luisa Lázaro
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of Child and Adolescent Psychiatry and PsychologyHospital Clinic, University of BarcelonaBarcelonaSpain
| | - Irina Lebedeva
- Mental Health Research CenterRussian Academy of Medical SciencesMoskvaRussia
| | - Won Hee Lee
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Klaus‐Peter Lesch
- Department of Psychiatry, Psychosomatics and PsychotherapyJulius‐Maximilians Universität WürzburgWurzburgGermany
| | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityStellenboschSouth Africa
| | | | - Sophie Maingault
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293Université de BordeauxTalenceFrance
| | - Nicholas G. Martin
- Queensland Institute of Medical ResearchBerghofer Medical Research InstituteBrisbaneAustralia
| | - Ignacio Martínez‐Zalacaín
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of PsychiatryBellvitge University Hospital‐IDIBELL, University of BarcelonaBarcelonaSpain
| | - David Mataix‐Cols
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholm RegionStockholmSweden
| | - Bernard Mazoyer
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293Université de BordeauxTalenceFrance
| | - Colm McDonald
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandDublinIreland
| | - Brenna C. McDonald
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | | | - Katie L. McMahon
- School of Clinical Sciences, Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
| | - Genevieve McPhilemy
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandDublinIreland
| | - Susanne Meinert
- Department of Psychiatry and PsychotherapyUniversity of MünsterMunsterGermany
| | - José M. Menchón
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of PsychiatryBellvitge University Hospital‐IDIBELL, University of BarcelonaBarcelonaSpain
| | - Sarah E. Medland
- Queensland Institute of Medical ResearchBerghofer Medical Research InstituteBrisbaneAustralia
| | - Andreas Meyer‐Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityHeidelbergGermany
| | - Jilly Naaijen
- Donders Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
| | - Pablo Najt
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandDublinIreland
| | - Tomohiro Nakao
- Department of Clinical MedicineKyushu UniversityKyushuJapan
| | | | - Lars Nyberg
- Department of Integrative Medical BiologyUmeå UniversityUmeåSweden
- Department of Radiation Sciences, Umeå Center for Functional Brain ImagingUmeå UniversityUmeåSweden
| | - Jaap Oosterlaan
- Department of Clinical NeuropsychologyAmsterdam University Medical Centre, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Víctor Ortiz‐García de la Foz
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of Psychiatry, University Hospital “Marques de Valdecilla”Instituto de Investigación Valdecilla (IDIVAL)SantanderSpain
- Instituto de Salud Carlos IIIMadridSpain
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology and PsychotherapyUniversity of WürzburgWurzburgGermany
- Centre of Mental HealthUniversity of WürzburgWurzburgGermany
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Edith Pomarol‐Clotet
- FIDMAG Germanes HospitalàriesMadridSpain
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
| | - Maria J. Portella
- FIDMAG Germanes HospitalàriesMadridSpain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant PauUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Steven G. Potkin
- Department of PsychiatryUniversity of California at IrvineIrvineCaliforniaUSA
| | - Joaquim Radua
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
- August Pi i Sunyer Biomedical Research Institut (IDIBAPS)BarcelonaSpain
- Department of Psychosis Studies, Institute of PsychiatryPsychology & Neuroscience, King's College LondonLondonUK
| | - Andreas Reif
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Daniel A. Rinker
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Joshua L. Roffman
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Pedro G. P. Rosa
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Matthew D. Sacchet
- Center for Depression, Anxiety, and Stress ResearchMcLean Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyAustralia
| | | | - Pascual Sánchez‐Juan
- Department of Psychiatry, University Hospital “Marques de Valdecilla”Instituto de Investigación Valdecilla (IDIVAL)SantanderSpain
- Centro de Investigacion Biomedica en Red en Enfermedades Neurodegenerativas (CIBERNED)MadridSpain
| | | | | | - Andrew J. Saykin
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mauricio H. Serpa
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental HealthParkvilleAustralia
- Centre for Youth Mental HealthThe University of MelbourneMelbourneAustralia
| | - Knut Schnell
- Department of Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
| | - Gunter Schumann
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Centre for Population Neuroscience and Precision Medicine, Institute of PsychiatryPsychology & Neuroscience, King's College LondonLondonUK
| | - Kang Sim
- Institute of Mental HealthSingaporeSingapore
| | - Jordan W. Smoller
- Center for Genomic MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Iris Sommer
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit GroningenUniversity Medical Center GroningenGöttingenNetherlands
| | - Carles Soriano‐Mas
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of PsychiatryBellvitge University Hospital‐IDIBELL, University of BarcelonaBarcelonaSpain
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityStellenboschSouth Africa
| | | | | | - Christian K. Tamnes
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- PROMENTA Research Center, Department of PsychologyUniversity of OsloOsloNorway
| | - Henk S. Temmingh
- Language and Genetics DepartmentMax Planck Institute for PsycholinguisticsNijmegenNetherlands
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Diana Tordesillas‐Gutiérrez
- FIDMAG Germanes HospitalàriesMadridSpain
- Neuroimaging Unit, Technological FacilitiesValdecilla Biomedical Research Institute IDIVALSantanderSpain
| | - Julian N. Trollor
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyAustralia
| | - Jessica A. Turner
- College of Arts and SciencesGeorgia State UniversityAtlantaGeorgiaUSA
| | - Anne Uhlmann
- Language and Genetics DepartmentMax Planck Institute for PsycholinguisticsNijmegenNetherlands
| | - Odile A. van den Heuvel
- Department of Psychiatry, Amsterdam University Medical CentreLocation VUmcAmsterdamNetherlands
| | - Dennis van den Meer
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical MedicineUniversity of OsloOsloNorway
- Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtNetherlands
| | - Nic J. A. van der Wee
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
- Leiden Institute for Brain and CognitionLeidenNetherlands
| | - Neeltje E. M. van Haren
- Department of Child and Adolescent Psychiatry/PsychologyErasmus University Medical Center, Sophia Children's HospitalRotterdamThe Netherlands
| | - Dennis van't Ent
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Theo G. M. van Erp
- Department of PsychiatryUniversity of California at IrvineIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of California IrvineIrvineCaliforniaUSA
- Institute of Community MedicineUniversity Medicine, Greifswald, University of GreifswaldGreifswaldGermany
| | - Ilya M. Veer
- Faculty of MedicineUniversitätsklinikum Carl Gustav Carus an der TU DresdenDresdenGermany
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam University Medical CentreLocation VUmcAmsterdamNetherlands
| | - Aristotle Voineskos
- Faculty of Health, Institute of Health and Biomedical InnovationQueensland University of TechnologyBrisbaneAustralia
- Kimel Family Translational Imaging Genetics LaboratoryCampbell Family Mental Health Research Institute, CAMHTorontoCanada
| | - Henry Völzke
- Institute of Community MedicineUniversity Medicine, Greifswald, University of GreifswaldGreifswaldGermany
- German Centre for Cardiovascular Research (DZHK), partner site GreifswaldGreifswaldGermany
- German Center for Diabetes Research (DZD), partner site GreifswaldGreifswaldGermany
| | - Henrik Walter
- Faculty of MedicineUniversitätsklinikum Carl Gustav Carus an der TU DresdenDresdenGermany
| | | | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Yang Wang
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Thomas H. Wassink
- Department of Psychiatry, Carver College of MedicineThe University of IowaIowa CityIowaUSA
| | - Bernd Weber
- Institute for Experimental Epileptology and Cognition ResearchUniversity of BonnBonnGermany
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyAustralia
| | - John D. West
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Lars T. Westlye
- Biological Psychiatry Lab, Fondazione IRCCS Casa Sollievo della SofferenzaSan Giovanni Rotondo (FG)Italy
| | | | - Lara M. Wierenga
- Developmental and Educational Psychology UnitInstitute of Psychology, Leiden UniversityLeidenNetherlands
| | - Steven C. R. Williams
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Katharina Wittfeld
- Department of PsychologyStanford UniversityStanfordCaliforniaUSA
- Department of Psychiatry and PsychotherapyUniversity Medicine Greifswald, University of GreifswaldGreifswaldGermany
| | - Daniel H. Wolf
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amanda Worker
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | | | - Kun Yang
- National High Magnetic Field LaboratoryFlorida State UniversityTallahasseeFloridaUSA
| | - Yulyia Yoncheva
- Department of Child and Adolescent PsychiatryChild Study Center, NYU Langone HealthNew YorkNew YorkUSA
| | - Marcus V. Zanetti
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
- Instituto de Ensino e Pesquisa, Hospital Sírio‐LibanêsSão PauloBrazil
| | - Georg C. Ziegler
- Division of Molecular Psychiatry, Center of Mental HealthUniversity of WürzburgWurzburgGermany
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Sophia Frangou
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Psychiatry, Djavad Mowafaghian Centre for Brain HealthUniversity of British ColumbiaVancouverCanada
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34
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Wierenga LM, Doucet GE, Dima D, Agartz I, Aghajani M, Akudjedu TN, Albajes‐Eizagirre A, Alnæs D, Alpert KI, Andreassen OA, Anticevic A, Asherson P, Banaschewski T, Bargallo N, Baumeister S, Baur‐Streubel R, Bertolino A, Bonvino A, Boomsma DI, Borgwardt S, Bourque J, den Braber A, Brandeis D, Breier A, Brodaty H, Brouwer RM, Buitelaar JK, Busatto GF, Calhoun VD, Canales‐Rodríguez EJ, Cannon DM, Caseras X, Castellanos FX, Chaim‐Avancini TM, Ching CRK, Clark VP, Conrod PJ, Conzelmann A, Crivello F, Davey CG, Dickie EW, Ehrlich S, van't Ent D, Fisher SE, Fouche J, Franke B, Fuentes‐Claramonte P, de Geus EJC, Di Giorgio A, Glahn DC, Gotlib IH, Grabe HJ, Gruber O, Gruner P, Gur RE, Gur RC, Gurholt TP, de Haan L, Haatveit B, Harrison BJ, Hartman CA, Hatton SN, Heslenfeld DJ, van den Heuvel OA, Hickie IB, Hoekstra PJ, Hohmann S, Holmes AJ, Hoogman M, Hosten N, Howells FM, Hulshoff Pol HE, Huyser C, Jahanshad N, James AC, Jiang J, Jönsson EG, Joska JA, Kalnin AJ, Klein M, Koenders L, Kolskår KK, Krämer B, Kuntsi J, Lagopoulos J, Lazaro L, Lebedeva IS, Lee PH, Lochner C, Machielsen MWJ, Maingault S, Martin NG, Martínez‐Zalacaín I, Mataix‐Cols D, Mazoyer B, McDonald BC, McDonald C, McIntosh AM, McMahon KL, McPhilemy G, van der Meer D, Menchón JM, Naaijen J, Nyberg L, Oosterlaan J, Paloyelis Y, Pauli P, Pergola G, Pomarol‐Clotet E, Portella MJ, Radua J, Reif A, Richard G, Roffman JL, Rosa PGP, Sacchet MD, Sachdev PS, Salvador R, Sarró S, Satterthwaite TD, Saykin AJ, Serpa MH, Sim K, Simmons A, Smoller JW, Sommer IE, Soriano‐Mas C, Stein DJ, Strike LT, Szeszko PR, Temmingh HS, Thomopoulos SI, Tomyshev AS, Trollor JN, Uhlmann A, Veer IM, Veltman DJ, Voineskos A, Völzke H, Walter H, Wang L, Wang Y, Weber B, Wen W, West JD, Westlye LT, Whalley HC, Williams SCR, Wittfeld K, Wolf DH, Wright MJ, Yoncheva YN, Zanetti MV, Ziegler GC, de Zubicaray GI, Thompson PM, Crone EA, Frangou S, Tamnes CK. Greater male than female variability in regional brain structure across the lifespan. Hum Brain Mapp 2022; 43:470-499. [PMID: 33044802 PMCID: PMC8675415 DOI: 10.1002/hbm.25204] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/10/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022] Open
Abstract
For many traits, males show greater variability than females, with possible implications for understanding sex differences in health and disease. Here, the ENIGMA (Enhancing Neuro Imaging Genetics through Meta-Analysis) Consortium presents the largest-ever mega-analysis of sex differences in variability of brain structure, based on international data spanning nine decades of life. Subcortical volumes, cortical surface area and cortical thickness were assessed in MRI data of 16,683 healthy individuals 1-90 years old (47% females). We observed significant patterns of greater male than female between-subject variance for all subcortical volumetric measures, all cortical surface area measures, and 60% of cortical thickness measures. This pattern was stable across the lifespan for 50% of the subcortical structures, 70% of the regional area measures, and nearly all regions for thickness. Our findings that these sex differences are present in childhood implicate early life genetic or gene-environment interaction mechanisms. The findings highlight the importance of individual differences within the sexes, that may underpin sex-specific vulnerability to disorders.
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Affiliation(s)
- Lara M Wierenga
- Institute of PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
| | - Gaelle E Doucet
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Boys Town National Research HospitalOmahaNebraskaUSA
| | - Danai Dima
- Department of Psychology, School of Arts and Social Sciences, CityUniversity of LondonLondonUK
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Moji Aghajani
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Department of Research & InnovationGGZ inGeestAmsterdamThe Netherlands
- Institute of Education and Child Studies, Forensic Family and Youth CareLeiden UniversityLeidenThe Netherlands
| | - Theophilus N Akudjedu
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland
- Institute of Medical Imaging & Visualisation, Faculty of Health & Social SciencesBournemouth UniversityBournemouthUK
| | - Anton Albajes‐Eizagirre
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - Dag Alnæs
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Kathryn I Alpert
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Alan Anticevic
- Department of PsychiatryYale UniversityNew HavenConnecticutUSA
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthUniversity of Heidelberg, Medical Faculty MannheimMannheimGermany
| | - Nuria Bargallo
- Imaging Diagnostic CenterHospital ClínicBarcelonaSpain
- Magnetic Resonance Image Core FacilityIDIBAPSBarcelonaSpain
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthUniversity of Heidelberg, Medical Faculty MannheimMannheimGermany
| | | | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Aurora Bonvino
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Dorret I Boomsma
- Department of Biological PsychologyVU University AmsterdamAmsterdamThe Netherlands
| | - Stefan Borgwardt
- Department of PsychiatryUniversity of BaselBaselSwitzerland
- Department of PsychiatryUniversity of LübeckLübeckGermany
| | - Josiane Bourque
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- CHU Sainte‐Justine Research CenterMontrealQuebecCanada
| | - Anouk den Braber
- Department of Biological PsychologyVU University AmsterdamAmsterdamThe Netherlands
- Alzheimer CenterAmsterdam UMC, Location VUMCAmsterdamThe Netherlands
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthUniversity of Heidelberg, Medical Faculty MannheimMannheimGermany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric HospitalUniversity of ZurichZurichSwitzerland
- Zurich Center for Integrative Human PhysiologyUniversity of ZurichZurichSwitzerland
- Neuroscience Centre ZurichUniversity and ETH ZurichZurichSwitzerland
| | - Alan Breier
- Department of PsychiatryIndiana University School of MedicineIndianapolisIndianaUSA
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
- Dementia Centre for Research Collaboration, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Rachel M Brouwer
- Department of Psychiatry, University Medical Center Utrecht Brain CenterUtrecht UniversityUtrechtThe Netherlands
| | - Jan K Buitelaar
- Department of Cognitive NeuroscienceRadboud University Medical CentreNijmegenThe Netherlands
- Karakter Child and Adolescent Psychiatry University CentreNijmegenThe Netherlands
| | - Geraldo F Busatto
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Vince D Calhoun
- Tri‐institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS)Georgia State, Georgia TechAtlantaGeorgiaUSA
| | - Erick J Canales‐Rodríguez
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityCardiffUK
| | - Francisco X Castellanos
- Department of Child and Adolescent PsychiatryNYU Grossman School of MedicineNew YorkNew YorkUSA
- Nathan Kline Institute for Psychiatric ResearchOrangeburgNew YorkUSA
| | - Tiffany M Chaim‐Avancini
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Christopher RK Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Vincent P Clark
- Psychology Clinical Neuroscience Center, Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
- Mind Research NetworkAlbuquerqueNew MexicoUSA
| | - Patricia J Conrod
- CHU Sainte‐Justine Research CenterMontrealQuebecCanada
- Department of PsychiatryUniversity of MontrealMontrealCanada
| | - Annette Conzelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity of TübingenTübingenGermany
- Department of Psychology (Clinical Psychology II)PFH – Private University of Applied SciencesGöttingenGermany
| | - Fabrice Crivello
- Groupe d'Imagerie NeurofonctionnelleInstitut des Maladies NeurodégénérativesBordeauxFrance
| | - Christopher G Davey
- Centre for Youth Mental HealthUniversity of MelbourneParkvilleVictoriaAustralia
- OrygenParkvilleVictoriaAustralia
| | - Erin W Dickie
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Department of PsychiatryUniversity of TorontoTorontoCanada
- Department of PsychiatryUniversity of TorontoTorontoOntarioCanada
| | - Stefan Ehrlich
- Division of Psychological & Social Medicine and Developmental Neurosciences; Technische Universität Dresden, Faculty of MedicineUniversity Hospital C.G. CarusDresdenGermany
| | - Dennis van't Ent
- Department of Biological PsychologyVU University AmsterdamAmsterdamThe Netherlands
| | - Simon E Fisher
- Language and Genetics DepartmentMax Planck Institute for PsycholinguisticsNijmegenThe Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
| | - Jean‐Paul Fouche
- Department of Psychiatry and Neuroscience InstituteUniversity of Cape TownCape TownWestern CapeSouth Africa
| | - Barbara Franke
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
- Department of PsychiatryRadboud University Medical CenterNijmegenThe Netherlands
| | - Paola Fuentes‐Claramonte
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
| | - Eco JC de Geus
- Department of Biological PsychologyVU University AmsterdamAmsterdamThe Netherlands
| | | | - David C Glahn
- Tommy Fuss Center for Neuropsychiatric Disease Research, Department of PsychiatryBoston Children's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Olin Center for Neuropsychiatric Research, Institute of LivingHartford HospitalHartfordConnecticutUSA
| | - Ian H Gotlib
- Department of PsychologyStanford UniversityStanfordCaliforniaUSA
| | - Hans J Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General PsychiatryHeidelberg University HospitalHeidelbergGermany
| | - Patricia Gruner
- Department of PsychiatryYale UniversityNew HavenConnecticutUSA
| | - Raquel E Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Brain InstituteChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Ruben C Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tiril P Gurholt
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Lieuwe de Haan
- Department of Early PsychosisAmsterdam UMCAmsterdamThe Netherlands
| | - Beathe Haatveit
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of PsychiatryThe University of Melbourne & Melbourne HealthMelbourneAustralia
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion regulationUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Sean N Hatton
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
- Department of NeurosciencesUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Dirk J Heslenfeld
- Departments of Experimental and Clinical PsychologyVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Department of Anatomy & Neurosciences, Amsterdam NeuroscienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ian B Hickie
- Brain and Mind CentreUniversity of SydneySydneyNew South WalesAustralia
| | - Pieter J Hoekstra
- Department of PsychiatryUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthUniversity of Heidelberg, Medical Faculty MannheimMannheimGermany
| | - Avram J Holmes
- Department of PsychiatryYale UniversityNew HavenConnecticutUSA
- Department of PsychologyYale UniversityNew HavenConnecticutUSA
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Martine Hoogman
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | - Norbert Hosten
- Institute of Diagnostic Radiology and NeuroradiologyUniversity Medicine GreifswaldGreifswaldGermany
| | - Fleur M Howells
- Neuroscience InstituteUniversity of Cape TownCape TownWestern CapeSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownWestern CapeSouth Africa
| | - Hilleke E Hulshoff Pol
- Department of Psychiatry, University Medical Center Utrecht Brain CenterUtrecht UniversityUtrechtThe Netherlands
| | - Chaim Huyser
- De Bascule, Academic center child and adolescent psychiatryDuivendrechtThe Netherlands
- Amsterdam UMC Department of Child and Adolescent PsychiatryAmsterdamThe Netherlands
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Anthony C James
- Department of PsychiatryWarneford HospitalOxfordUK
- Highfield UnitWarneford HospitalOxfordUK
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Erik G Jönsson
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - John A Joska
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownWestern CapeSouth Africa
| | - Andrew J Kalnin
- Department of RadiologyThe Ohio State University College of MedicineColumbusOhioUSA
| | | | - Marieke Klein
- Department of Psychiatry, University Medical Center Utrecht Brain CenterUtrecht UniversityUtrechtThe Netherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenThe Netherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenThe Netherlands
| | - Laura Koenders
- Department of Early PsychosisAmsterdam UMCAmsterdamThe Netherlands
| | - Knut K Kolskår
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
| | - Bernd Krämer
- Section for Experimental Psychopathology and Neuroimaging, Department of General PsychiatryHeidelberg University HospitalHeidelbergGermany
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience Thompson InstituteBirtinyaQueenslandAustralia
- University of the Sunshine CoastSunshine CoastQueenslandAustralia
| | - Luisa Lazaro
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
- Department of Child and Adolescent Psychiatry and PsychologyHospital ClínicBarcelonaSpain
- August Pi i Sunyer Biomedical Research Institut (IDIBAPS)BarcelonaSpain
- Department of MedicineUniversity of BarcelonaBarcelonaSpain
| | - Irina S Lebedeva
- Laboratory of Neuroimaging and Multimodal AnalysisMental Health Research CenterMoscowRussia
| | - Phil H Lee
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityCape TownWestern CapeSouth Africa
| | | | - Sophie Maingault
- Institut des maladies neurodégénérativesUniversité de BordeauxBordeauxFrance
| | - Nicholas G Martin
- Genetic EpidemiologyQIMR Berghofer Medical Research InstituteBrisbaneQueenslandAustralia
| | - Ignacio Martínez‐Zalacaín
- Department of Psychiatry, Bellvitge University HospitalBellvitge Biomedical Research Institute‐IDIBELLBarcelonaSpain
- Department of Clinical SciencesUniversity of BarcelonaBarcelonaSpain
| | - David Mataix‐Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
| | - Bernard Mazoyer
- University of BordeauxBordeauxFrance
- Bordeaux University HospitalBordeauxFrance
| | - Brenna C McDonald
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland
| | | | - Katie L McMahon
- Herston Imaging Research Facility and School of Clinical SciencesQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
- Faculty of Health, Institute of Health and Biomedical InnovationQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
| | - Genevieve McPhilemy
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine Nursing and Health SciencesNational University of Ireland GalwayGalwayIreland
| | - Dennis van der Meer
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
- School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - José M Menchón
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
- Department of Psychiatry, Bellvitge University HospitalBellvitge Biomedical Research Institute‐IDIBELLBarcelonaSpain
- Department of Clinical SciencesUniversity of BarcelonaBarcelonaSpain
| | - Jilly Naaijen
- Department of Cognitive NeuroscienceRadboud University Medical CentreNijmegenThe Netherlands
| | - Lars Nyberg
- Department of Radiation SciencesUmeå UniversityUmeåSweden
- Department of Integrative Medical BiologyUmeå UniversityUmeåSweden
| | - Jaap Oosterlaan
- Emma Children's Hospital, Amsterdam UMC University of Amsterdam and Vrije Universiteit AmsterdamEmma Neuroscience Group, Department of Pediatrics, Amsterdam Reproduction & DevelopmentAmsterdamThe Netherlands
- Clinical Neuropsychology SectionVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Yannis Paloyelis
- Department of Neuroimaging, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Paul Pauli
- Department of PsychologyUniversity of WürzburgWürzburgGermany
- Centre of Mental Health, Medical FacultyUniversity of WürzburgWürzburgGermany
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
- Lieber Institute for Brain DevelopmentJohns Hopkins Medical CampusBaltimoreMary LandUSA
| | - Edith Pomarol‐Clotet
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
| | - Maria J Portella
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
- Department of PsychiatryInstitut d'Investigació Biomèdica Sant PauBarcelonaSpain
| | - Joaquim Radua
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care ServicesStockholm County CouncilStockholmSweden
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Early Psychosis: Interventions and Clinical‐detection (EPIC) lab, Department of Psychosis StudiesInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and PsychotherapyUniversity Hospital FrankfurtFrankfur am MaintGermany
| | - Geneviève Richard
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Joshua L Roffman
- Department of PsychiatryMassachusetts General Hospital and Harvard Medical SchoolCharlestownMassachusettsUSA
| | - Pedro GP Rosa
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Matthew D Sacchet
- Center for Depression, Anxiety, and Stress ResearchMcLean Hospital, Harvard Medical SchoolBelmontMassachusettsUSA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
- Neuropsychiatric InstituteThe Prince of Wales HospitalRandwickNew South WalesAustralia
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research FoundationBarcelonaSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
| | | | - Andrew J Saykin
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
- Indiana Alzheimer Disease CenterIndianapolisIndianaUSA
| | - Mauricio H Serpa
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Kang Sim
- West Region, Institute of Mental HealthSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingapore
| | - Andrew Simmons
- Department of Neuroimaging, Institute of PsychiatryPsychology and Neurology, King's College LondonLondonUK
| | - Jordan W Smoller
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Iris E Sommer
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Carles Soriano‐Mas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)MadridSpain
- Department of Psychiatry, Bellvitge University HospitalBellvitge Biomedical Research Institute‐IDIBELLBarcelonaSpain
- Department of Psychobiology and Methodology in Health SciencesUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience InstituteUniversity of Cape TownCape TownWestern CapeSouth Africa
| | - Lachlan T Strike
- Queensland Brain InstituteUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Philip R Szeszko
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Mental Illness Research, Education and Clinical Center (MIRECC)James J. Peters VA Medical CenterNew YorkNew YorkUSA
| | - Henk S Temmingh
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownWestern CapeSouth Africa
| | - Sophia I Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Alexander S Tomyshev
- Laboratory of Neuroimaging and Multimodal AnalysisMental Health Research CenterMoscowRussia
| | - Julian N Trollor
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Anne Uhlmann
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownWestern CapeSouth Africa
- Department of Child and Adolescent Psychiatry and PsychotherapyFaculty of Medicine Carl Gustav Carus of TU DresdenDresdenGermany
| | - Ilya M Veer
- Department of Psychiatry and Psychotherapy CCM, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Dick J Veltman
- Department of Psychiatry & Amsterdam NeuroscienceAmsterdam UMC, location VUMCAmsterdamThe Netherlands
| | - Aristotle Voineskos
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Department of PsychiatryUniversity of TorontoTorontoCanada
| | - Henry Völzke
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
- DZHK (German Centre for Cardiovascular Research), partner site GreifswaldGreifswaldGermany
- DZD (German Center for Diabetes Research), partner site GreifswaldGreifswaldGermany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy CCM, Charité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität BerlinHumboldt‐Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Lei Wang
- Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Yang Wang
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Bernd Weber
- Institute for Experimental Epileptology and Cognition ResearchUniversity Hospital BonnBonnGermany
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - John D West
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Lars T Westlye
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and AddictionOslo University HospitalOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
| | - Heather C Whalley
- Division of PsychiatryUniversity of EdinburghEdinburghUK
- Division of PsychiatryRoyal Edinburgh HospitalEdinburghUK
| | | | - Katharina Wittfeld
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Daniel H Wolf
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Margaret J Wright
- Queensland Brain InstituteUniversity of QueenslandBrisbaneQueenslandAustralia
- Centre for Advanced ImagingUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Yuliya N Yoncheva
- Department of Child and Adolescent Psychiatry, NYU Child Study CenterHassenfeld Children's Hospital at NYU LangoneNew YorkNew YorkUSA
| | - Marcus V Zanetti
- Laboratory of Psychiatric Neuroimaging (LIM‐21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
- Instituto de Ensino e PesquisaHospital Sírio‐LibanêsSão PauloBrazil
| | - Georg C Ziegler
- Division of Molecular Psychiatry, Center of Mental HealthUniversity of WürzburgWürzburgGermany
| | - Greig I de Zubicaray
- Faculty of Health, Institute of Health and Biomedical InnovationQueensland University of Technology (QUT)BrisbaneQueenslandAustralia
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Eveline A Crone
- Institute of PsychologyLeiden UniversityLeidenThe Netherlands
- Leiden Institute for Brain and CognitionLeidenThe Netherlands
- Department of Psychology, Education and Child Studies (DPECS), Erasmus School of Social and Behavioral SciencesErasmus University RotterdamThe Netherlands
| | - Sophia Frangou
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Centre for Brain HealthUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Christian K Tamnes
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- PROMENTA Research Center, Department of PsychologyUniversity of OsloOsloNorway
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Frangou S, Modabbernia A, Williams SCR, Papachristou E, Doucet GE, Agartz I, Aghajani M, Akudjedu TN, Albajes‐Eizagirre A, Alnæs D, Alpert KI, Andersson M, Andreasen NC, Andreassen OA, Asherson P, Banaschewski T, Bargallo N, Baumeister S, Baur‐Streubel R, Bertolino A, Bonvino A, Boomsma DI, Borgwardt S, Bourque J, Brandeis D, Breier A, Brodaty H, Brouwer RM, Buitelaar JK, Busatto GF, Buckner RL, Calhoun V, Canales‐Rodríguez EJ, Cannon DM, Caseras X, Castellanos FX, Cervenka S, Chaim‐Avancini TM, Ching CRK, Chubar V, Clark VP, Conrod P, Conzelmann A, Crespo‐Facorro B, Crivello F, Crone EA, Dale AM, Dannlowski U, Davey C, de Geus EJC, de Haan L, de Zubicaray GI, den Braber A, Dickie EW, Di Giorgio A, Doan NT, Dørum ES, Ehrlich S, Erk S, Espeseth T, Fatouros‐Bergman H, Fisher SE, Fouche J, Franke B, Frodl T, Fuentes‐Claramonte P, Glahn DC, Gotlib IH, Grabe H, Grimm O, Groenewold NA, Grotegerd D, Gruber O, Gruner P, Gur RE, Gur RC, Hahn T, Harrison BJ, Hartman CA, Hatton SN, Heinz A, Heslenfeld DJ, Hibar DP, Hickie IB, Ho B, Hoekstra PJ, Hohmann S, Holmes AJ, Hoogman M, Hosten N, Howells FM, Hulshoff Pol HE, Huyser C, Jahanshad N, James A, Jernigan TL, Jiang J, Jönsson EG, Joska JA, Kahn R, Kalnin A, Kanai R, Klein M, Klyushnik TP, Koenders L, Koops S, Krämer B, Kuntsi J, Lagopoulos J, Lázaro L, Lebedeva I, Lee WH, Lesch K, Lochner C, Machielsen MWJ, Maingault S, Martin NG, Martínez‐Zalacaín I, Mataix‐Cols D, Mazoyer B, McDonald C, McDonald BC, McIntosh AM, McMahon KL, McPhilemy G, Meinert S, Menchón JM, Medland SE, Meyer‐Lindenberg A, Naaijen J, Najt P, Nakao T, Nordvik JE, Nyberg L, Oosterlaan J, de la Foz VO, Paloyelis Y, Pauli P, Pergola G, Pomarol‐Clotet E, Portella MJ, Potkin SG, Radua J, Reif A, Rinker DA, Roffman JL, Rosa PGP, Sacchet MD, Sachdev PS, Salvador R, Sánchez‐Juan P, Sarró S, Satterthwaite TD, Saykin AJ, Serpa MH, Schmaal L, Schnell K, Schumann G, Sim K, Smoller JW, Sommer I, Soriano‐Mas C, Stein DJ, Strike LT, Swagerman SC, Tamnes CK, Temmingh HS, Thomopoulos SI, Tomyshev AS, Tordesillas‐Gutiérrez D, Trollor JN, Turner JA, Uhlmann A, van den Heuvel OA, van den Meer D, van der Wee NJA, van Haren NEM, van 't Ent D, van Erp TGM, Veer IM, Veltman DJ, Voineskos A, Völzke H, Walter H, Walton E, Wang L, Wang Y, Wassink TH, Weber B, Wen W, West JD, Westlye LT, Whalley H, Wierenga LM, Wittfeld K, Wolf DH, Worker A, Wright MJ, Yang K, Yoncheva Y, Zanetti MV, Ziegler GC, Thompson PM, Dima D. Cortical thickness across the lifespan: Data from 17,075 healthy individuals aged 3-90 years. Hum Brain Mapp 2022; 43:431-451. [PMID: 33595143 PMCID: PMC8675431 DOI: 10.1002/hbm.25364] [Citation(s) in RCA: 97] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 12/25/2022] Open
Abstract
Delineating the association of age and cortical thickness in healthy individuals is critical given the association of cortical thickness with cognition and behavior. Previous research has shown that robust estimates of the association between age and brain morphometry require large-scale studies. In response, we used cross-sectional data from 17,075 individuals aged 3-90 years from the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to infer age-related changes in cortical thickness. We used fractional polynomial (FP) regression to quantify the association between age and cortical thickness, and we computed normalized growth centiles using the parametric Lambda, Mu, and Sigma method. Interindividual variability was estimated using meta-analysis and one-way analysis of variance. For most regions, their highest cortical thickness value was observed in childhood. Age and cortical thickness showed a negative association; the slope was steeper up to the third decade of life and more gradual thereafter; notable exceptions to this general pattern were entorhinal, temporopolar, and anterior cingulate cortices. Interindividual variability was largest in temporal and frontal regions across the lifespan. Age and its FP combinations explained up to 59% variance in cortical thickness. These results may form the basis of further investigation on normative deviation in cortical thickness and its significance for behavioral and cognitive outcomes.
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Affiliation(s)
- Sophia Frangou
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
- Department of Psychiatry, Djavad Mowafaghian Centre for Brain HealthUniversity of British ColumbiaVancouverCanada
| | | | - Steven C. R. Williams
- Department of NeuroimagingInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Efstathios Papachristou
- Psychology and Human DevelopmentInstitute of Education, University College LondonLondonUnited Kingdom
| | - Gaelle E. Doucet
- Institute for Human NeuroscienceBoys Town National Research HospitalOmahaNebraskaUSA
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
| | - Moji Aghajani
- Department of PsychiatryAmsterdam University Medical Centre, Vrije UniversiteitAmsterdamNetherlands
- Section Forensic Family & Youth CareInstitute of Education & Child StudiesLeiden UniversityNetherlands
| | - Theophilus N. Akudjedu
- Institute of Medical Imaging and Visualisation, Department of Medical Science and Public Health, Faculty of Health and Social SciencesBournemouth UniversityPooleUnited Kingdom
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandGalwayIreland
| | - Anton Albajes‐Eizagirre
- FIDMAG Germanes HospitalàriesBarcelonaSpain
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
| | - Dag Alnæs
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
- Division of Mental Health and AddictionInstitute of Clinical Medicine, University of OsloOsloNorway
| | | | - Micael Andersson
- Department of Integrative Medical BiologyUmeå UniversityUmeåSweden
| | - Nancy C. Andreasen
- Department of Psychiatry, Carver College of MedicineThe University of IowaIowa CityIowaUSA
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
| | - Philip Asherson
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityHeidelbergGermany
| | - Nuria Bargallo
- Imaging Diagnostic CentreHospital Clinic, Barcelona University ClinicBarcelonaSpain
- August Pi i Sunyer Biomedical Research Institut (IDIBAPS)BarcelonaSpain
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityHeidelbergGermany
| | - Ramona Baur‐Streubel
- Department of Psychology, Biological Psychology, Clinical Psychology and PsychotherapyUniversity of WürzburgWürzburgGermany
| | - Alessandro Bertolino
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Aurora Bonvino
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Dorret I. Boomsma
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Stefan Borgwardt
- Department of Psychiatry & PsychotherapyUniversity of LübeckLübeckGermany
| | - Josiane Bourque
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityHeidelbergGermany
| | - Alan Breier
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Rachel M. Brouwer
- Rudolf Magnus Institute of NeuroscienceUniversity Medical Center UtrechtUtrechtNetherlands
| | - Jan K. Buitelaar
- Donders Center of Medical NeurosciencesRadboud UniversityNijmegenNetherlands
- Donders Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
| | - Geraldo F. Busatto
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Randy L. Buckner
- Department of Psychology, Center for Brain ScienceHarvard UniversityCambridgeMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Vincent Calhoun
- Tri‐Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of TechnologyEmory University, USA Neurology, Radiology, Psychiatry and Biomedical Engineering, Emory UniversityAtlantaGeorgiaUSA
| | - Erick J. Canales‐Rodríguez
- FIDMAG Germanes HospitalàriesBarcelonaSpain
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
| | - Dara M. Cannon
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandGalwayIreland
| | - Xavier Caseras
- MRC Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityCardiffUnited Kingdom
| | | | - Simon Cervenka
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
- Stockholm Health Care ServicesStockholmSweden
| | - Tiffany M. Chaim‐Avancini
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Victoria Chubar
- Mind‐Body Research Group, Department of NeuroscienceKU LeuvenLeuvenBelgium
| | - Vincent P. Clark
- Department of PsychologyUniversity of New MexicoAlbuquerqueNew MexicoUSA
- Mind Research NetworkAlbuquerqueNew MexicoUSA
| | - Patricia Conrod
- Department of PsychiatryUniversité de MontréalMontrealCanada
| | - Annette Conzelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyUniversity of TübingenTübingenGermany
| | - Benedicto Crespo‐Facorro
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- HU Virgen del Rocio, IBiSUniversity of SevillaSevillaSpain
| | - Fabrice Crivello
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293Université de BordeauxBordeauxFrance
| | - Eveline A. Crone
- Erasmus School of Social and Behavioural SciencesErasmus University RotterdamRotterdamNetherlands
- Faculteit der Sociale Wetenschappen, Instituut PsychologieUniversiteit LeidenLeidenNetherlands
| | - Anders M. Dale
- Center for Multimodal Imaging and Genetics, Department of NeuroscienceUniversity of California‐San DiegoSan DiegoCaliforniaUSA
- Department of RadiologyUniversity of California‐San DiegoSan DiegoCaliforniaUSA
| | - Udo Dannlowski
- Department of Psychiatry and PsychotherapyUniversity of MünsterGermany
| | | | - Eco J. C. de Geus
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Lieuwe de Haan
- Academisch Medisch CentrumUniversiteit van AmsterdamAmsterdamNetherlands
| | - Greig I. de Zubicaray
- Faculty of Health, Institute of Health and Biomedical InnovationQueensland University of TechnologyQueenslandAustralia
| | - Anouk den Braber
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Erin W. Dickie
- Kimel Family Translational Imaging Genetics Laboratory, Campbell Family Mental Health Research InstituteCAMHCampbellCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
| | - Annabella Di Giorgio
- Biological Psychiatry LabFondazione IRCCS Casa Sollievo della SofferenzaSan Giovanni Rotondo (FG)Italy
| | - Nhat Trung Doan
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
| | - Erlend S. Dørum
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
- Department of PsychologyUniversity of OsloOsloNorway
- Sunnaas Rehabilitation Hospital HTNesoddenNorway
| | - Stefan Ehrlich
- Division of Psychological and Social Medicine and Developmental NeurosciencesTechnische Universität DresdenDresdenGermany
- Faculty of MedicineUniversitätsklinikum Carl Gustav Carus an der TU DresdenDresdenGermany
| | - Susanne Erk
- Division of Mind and Brain Research, Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Thomas Espeseth
- Biological Psychiatry LabFondazione IRCCS Casa Sollievo della SofferenzaSan Giovanni Rotondo (FG)Italy
- Bjørknes CollegeOsloNorway
| | - Helena Fatouros‐Bergman
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
- Stockholm Health Care ServicesStockholmSweden
| | - Simon E. Fisher
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Language and Genetics DepartmentMax Planck Institute for PsycholinguisticsNijmegenNetherlands
| | - Jean‐Paul Fouche
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Barbara Franke
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenNetherlands
- Department of PsychiatryRadboud University Medical CenterNijmegenNetherlands
| | - Thomas Frodl
- Department of Psychiatry and PsychotherapyOtto von Guericke University MagdeburgMagdeburgGermany
| | - Paola Fuentes‐Claramonte
- FIDMAG Germanes HospitalàriesBarcelonaSpain
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
| | - David C. Glahn
- Department of PsychiatryTommy Fuss Center for Neuropsychiatric Disease Research Boston Children's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Ian H. Gotlib
- Department of PsychologyStanford UniversityStanfordCaliforniaUSA
| | - Hans‐Jörgen Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine Greifswald, University of GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Oliver Grimm
- Department for Psychiatry, Psychosomatics and PsychotherapyUniversitätsklinikum Frankfurt, Goethe UniversitatFrankfurtGermany
| | - Nynke A. Groenewold
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | | | - Oliver Gruber
- Section for Experimental Psychopathology and Neuroimaging, Department of General PsychiatryHeidelberg UniversityHeidelbergGermany
| | - Patricia Gruner
- Department of PsychiatryYale UniversityNew HavenConnecticutUSA
- Learning Based Recovery CenterVA Connecticut Health SystemWest HavenConnecticutUSA
| | - Rachel E. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Brain Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Children's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ruben C. Gur
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Lifespan Brain Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Children's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tim Hahn
- Department of Psychiatry and PsychotherapyUniversity of MünsterGermany
| | - Ben J. Harrison
- Melbourne Neuropsychiatry CenterUniversity of MelbourneMelbourneAustralia
| | - Catharine A. Hartman
- Interdisciplinary Center Psychopathology and Emotion regulationUniversity Medical Center Groningen, University of GroningenGroningenNetherlands
| | - Sean N. Hatton
- Brain and Mind CentreUniversity of SydneySydneyAustralia
| | - Andreas Heinz
- Division of Mind and Brain Research, Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Dirk J. Heslenfeld
- Departments of Experimental and Clinical PsychologyVrije Universiteit AmsterdamAmsterdamNetherlands
| | - Derrek P. Hibar
- Personalized Healthcare, Genentech, Inc.South San FranciscoCaliforniaUSA
| | - Ian B. Hickie
- Brain and Mind CentreUniversity of SydneySydneyAustralia
| | - Beng‐Choon Ho
- Department of Psychiatry, Carver College of MedicineThe University of IowaIowa CityIowaUSA
| | - Pieter J. Hoekstra
- Department of PsychiatryUniversity Medical Center Groningen, University of GroningenGroningenNetherlands
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental HealthHeidelberg UniversityHeidelbergGermany
| | - Avram J. Holmes
- Department of PsychologyYale UniversityNew HavenConnecticutUSA
| | - Martine Hoogman
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenNetherlands
| | - Norbert Hosten
- Norbert Institute of Diagnostic Radiology and NeuroradiologyUniversity Medicine Greifswald, University of GreifswaldGreifswaldGermany
| | - Fleur M. Howells
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | | | - Chaim Huyser
- De Bascule, Academic Centre for Children and Adolescent PsychiatryAmsterdamNetherlands
| | - Neda Jahanshad
- Mind‐Body Research Group, Department of NeuroscienceKU LeuvenLeuvenBelgium
| | - Anthony James
- Department of PsychiatryOxford UniversityOxfordUnited Kingdom
| | - Terry L. Jernigan
- Center for Human Development, Departments of Cognitive Science, Psychiatry, and RadiologyUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Erik G. Jönsson
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
| | - John A. Joska
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Rene Kahn
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Andrew Kalnin
- Department of RadiologyOhio State University College of MedicineColumbusOhioUSA
| | - Ryota Kanai
- Department of NeuroinformaticsAraya, Inc.TokyoJapan
| | - Marieke Klein
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
- Department of Human GeneticsRadboud University Medical CenterNijmegenNetherlands
- Department of PsychiatryUniversity of California San DiegoSan DiegoCaliforniaUSA
| | | | - Laura Koenders
- Academisch Medisch CentrumUniversiteit van AmsterdamAmsterdamNetherlands
| | - Sanne Koops
- Rudolf Magnus Institute of NeuroscienceUniversity Medical Center UtrechtUtrechtNetherlands
| | - Bernd Krämer
- Section for Experimental Psychopathology and Neuroimaging, Department of General PsychiatryHeidelberg UniversityHeidelbergGermany
| | - Jonna Kuntsi
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Jim Lagopoulos
- Sunshine Coast Mind and NeuroscienceThompson Institute, University of the Sunshine CoastQueenslandAustralia
| | - Luisa Lázaro
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of Child and Adolescent Psychiatry and PsychologyHospital Clinic, University of BarcelonaBarcelonaSpain
| | - Irina Lebedeva
- Mental Health Research CenterRussian Academy of Medical SciencesMoscowRussia
| | - Won Hee Lee
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
| | - Klaus‐Peter Lesch
- Department of Psychiatry, Psychosomatics and PsychotherapyJulius‐Maximilians Universität WürzburgWürzburgGermany
| | - Christine Lochner
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityStellenboschSouth Africa
| | | | - Sophie Maingault
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293Université de BordeauxBordeauxFrance
| | - Nicholas G. Martin
- Queensland Institute of Medical ResearchBerghofer Medical Research InstituteQueenslandAustralia
| | - Ignacio Martínez‐Zalacaín
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of PsychiatryBellvitge University Hospital‐IDIBELL, University of BarcelonaBarcelonaSpain
| | - David Mataix‐Cols
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
- Stockholm Health Care ServicesStockholmSweden
| | - Bernard Mazoyer
- Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives, UMR5293Université de BordeauxBordeauxFrance
| | - Colm McDonald
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandGalwayIreland
| | - Brenna C. McDonald
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | | | - Katie L. McMahon
- School of Clinical Sciences, Institute of Health and Biomedical InnovationQueensland University of TechnologyQueenslandAustralia
| | - Genevieve McPhilemy
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandGalwayIreland
| | - Susanne Meinert
- Department of Psychiatry and PsychotherapyUniversity of MünsterGermany
| | - José M. Menchón
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of PsychiatryBellvitge University Hospital‐IDIBELL, University of BarcelonaBarcelonaSpain
| | - Sarah E. Medland
- Queensland Institute of Medical ResearchBerghofer Medical Research InstituteQueenslandAustralia
| | - Andreas Meyer‐Lindenberg
- Department of Psychiatry and PsychotherapyCentral Institute of Mental Health, Heidelberg UniversityHeidelbergGermany
| | - Jilly Naaijen
- Donders Centre for Cognitive NeuroimagingRadboud UniversityNijmegenNetherlands
- Donders Institute for Brain, Cognition and BehaviourRadboud UniversityNijmegenNetherlands
| | - Pablo Najt
- Clinical Neuroimaging Laboratory, Centre for Neuroimaging and Cognitive Genomics and NCBES Galway Neuroscience CentreNational University of IrelandGalwayIreland
| | - Tomohiro Nakao
- Department of Clinical MedicineKyushu UniversityFukuokaJapan
| | | | - Lars Nyberg
- Department of Integrative Medical BiologyUmeå UniversityUmeåSweden
- Department of Radiation SciencesUmeå Center for Functional Brain Imaging, Umeå UniversityUmeåSweden
| | - Jaap Oosterlaan
- Department of Clinical NeuropsychologyAmsterdam University Medical Centre, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Víctor Ortiz‐García de la Foz
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of PsychiatryUniversity Hospital “Marques de Valdecilla”, Instituto de Investigación Valdecilla (IDIVAL)SantanderSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
| | - Yannis Paloyelis
- Department of NeuroimagingInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology and PsychotherapyUniversity of WürzburgWürzburgGermany
- Centre of Mental HealthUniversity of WürzburgWürzburgGermany
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Edith Pomarol‐Clotet
- FIDMAG Germanes HospitalàriesBarcelonaSpain
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
| | - Maria J. Portella
- FIDMAG Germanes HospitalàriesBarcelonaSpain
- Department of PsychiatryHospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Steven G. Potkin
- Department of PsychiatryUniversity of California at IrvineIrvineCaliforniaUSA
| | - Joaquim Radua
- Centre for Psychiatric Research, Department of Clinical NeuroscienceKarolinska InstitutetSolnaSweden
- August Pi i Sunyer Biomedical Research Institut (IDIBAPS)BarcelonaSpain
- Department of Psychosis StudiesInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Andreas Reif
- Department for Psychiatry, Psychosomatics and PsychotherapyUniversitätsklinikum Frankfurt, Goethe UniversitatFrankfurtGermany
| | - Daniel A. Rinker
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
| | - Joshua L. Roffman
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Pedro G. P. Rosa
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Matthew D. Sacchet
- Center for Depression, Anxiety, and Stress ResearchMcLean Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesKensingtonNew South WalesAustralia
| | | | - Pascual Sánchez‐Juan
- Department of PsychiatryUniversity Hospital “Marques de Valdecilla”, Instituto de Investigación Valdecilla (IDIVAL)SantanderSpain
- Centro de Investigacion Biomedica en Red en Enfermedades Neurodegenerativas (CIBERNED)ValderrebolloSpain
| | | | | | - Andrew J. Saykin
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | - Mauricio H. Serpa
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Lianne Schmaal
- OrygenThe National Centre of Excellence in Youth Mental HealthMelbourneAustralia
- Centre for Youth Mental HealthThe University of MelbourneMelbourneAustralia
| | - Knut Schnell
- Department of Psychiatry and PsychotherapyUniversity Medical Center GöttingenGöttingenGermany
| | - Gunter Schumann
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
- Centre for Population Neuroscience and Precision MedicineInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Kang Sim
- Department of General PsychiatryInstitute of Mental HealthSingaporeSingapore
| | - Jordan W. Smoller
- Center for Genomic MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Iris Sommer
- Department of Biomedical Sciences of Cells and Systems, Rijksuniversiteit GroningenUniversity Medical Center GroningenGroningenNetherlands
| | - Carles Soriano‐Mas
- Mental Health Research Networking Center (CIBERSAM)MadridSpain
- Department of PsychiatryBellvitge University Hospital‐IDIBELL, University of BarcelonaBarcelonaSpain
| | - Dan J. Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityStellenboschSouth Africa
| | - Lachlan T. Strike
- Queensland Brain InstituteUniversity of QueenslandQueenslandAustralia
| | | | - Christian K. Tamnes
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
- Department of Psychiatric ResearchDiakonhjemmet HospitalOsloNorway
- PROMENTA Research Center, Department of PsychologyUniversity of OsloOsloNorway
| | - Henk S. Temmingh
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Sophia I. Thomopoulos
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | | | - Diana Tordesillas‐Gutiérrez
- FIDMAG Germanes HospitalàriesBarcelonaSpain
- Neuroimaging Unit, Technological FacilitiesValdecilla Biomedical Research Institute IDIVALCantabriaSpain
| | - Julian N. Trollor
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Jessica A. Turner
- College of Arts and SciencesGeorgia State UniversityAtlantaGeorgiaUSA
| | - Anne Uhlmann
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Odile A. van den Heuvel
- Department of PsychiatryAmsterdam University Medical Centre, Vrije UniversiteitAmsterdamNetherlands
| | - Dennis van den Meer
- Norwegian Centre for Mental Disorders Research (NORMENT)Institute of Clinical Medicine, University of OsloOsloNorway
- Division of Mental Health and AddictionInstitute of Clinical Medicine, University of OsloOsloNorway
- School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtNetherlands
| | - Nic J. A. van der Wee
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
- Leiden Institute for Brain and CognitionLeiden University Medical CenterLeidenNetherlands
| | - Neeltje E. M. van Haren
- Department of Child and Adolescent Psychiatry/PsychologyErasmus University Medical Center, Sophia Children's HospitalRotterdamThe Netherlands
| | - Dennis van 't Ent
- Department of Biological PsychologyVrije UniversiteitAmsterdamNetherlands
| | - Theo G. M. van Erp
- Department of PsychiatryUniversity of California at IrvineIrvineCaliforniaUSA
- Center for the Neurobiology of Learning and MemoryUniversity of California IrvineIrvineCaliforniaUSA
- Institute of Community MedicineUniversity Medicine, Greifswald, University of GreifswaldGreifswaldGermany
| | - Ilya M. Veer
- Division of Mind and Brain Research, Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Dick J. Veltman
- Department of PsychiatryAmsterdam University Medical Centre, Vrije UniversiteitAmsterdamNetherlands
| | - Aristotle Voineskos
- Kimel Family Translational Imaging Genetics Laboratory, Campbell Family Mental Health Research InstituteCAMHCampbellCanada
- Department of PsychiatryUniversity of TorontoTorontoCanada
| | - Henry Völzke
- Institute of Community MedicineUniversity Medicine, Greifswald, University of GreifswaldGreifswaldGermany
- German Centre for Cardiovascular Research (DZHK), partner site GreifswaldGreifswaldGermany
- German Center for Diabetes Research (DZD), partner site GreifswaldGreifswaldGermany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin BerlinBerlinGermany
| | - Esther Walton
- Department of PsychologyUniversity of BathBathUnited Kingdom
| | - Lei Wang
- Department of Psychiatry and Behavioral Sciences, Feinberg School of MedicineNorthwestern UniversityEvanstonIllinoisUSA
| | - Yang Wang
- Department of RadiologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Thomas H. Wassink
- Department of Psychiatry, Carver College of MedicineThe University of IowaIowa CityIowaUSA
| | - Bernd Weber
- Institute for Experimental Epileptology and Cognition ResearchUniversity of BonnBonnGermany
| | - Wei Wen
- Centre for Healthy Brain Ageing, School of PsychiatryUniversity of New South WalesKensingtonNew South WalesAustralia
| | - John D. West
- Department of Radiology and Imaging SciencesIndiana University School of MedicineIndianapolisIndianaUSA
| | | | - Heather Whalley
- Division of PsychiatryUniversity of EdinburghEdinburghUnited Kingdom
| | - Lara M. Wierenga
- Developmental and Educational Psychology Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
| | - Katharina Wittfeld
- Department of Psychiatry and PsychotherapyUniversity Medicine Greifswald, University of GreifswaldGreifswaldGermany
- German Center for Neurodegenerative Diseases (DZNE)Site Rostock/GreifswaldGreifswaldGermany
| | - Daniel H. Wolf
- Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amanda Worker
- Department of Psychiatry, Djavad Mowafaghian Centre for Brain HealthUniversity of British ColumbiaVancouverCanada
| | | | - Kun Yang
- National High Magnetic Field LaboratoryFlorida State UniversityTallahasseeFloridaUSA
| | - Yulyia Yoncheva
- Department of Child and Adolescent Psychiatry, Child Study CenterNYU Langone HealthNew York CityNew YorkUSA
| | - Marcus V. Zanetti
- Laboratory of Psychiatric Neuroimaging, Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
- Instituto de Ensino e PesquisaHospital Sírio‐LibanêsSão PauloBrazil
| | - Georg C. Ziegler
- Division of Molecular Psychiatry, Center of Mental HealthUniversity of WürzburgWürzburgGermany
| | | | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of MedicineUniversity of Southern CaliforniaMarina del ReyCaliforniaUSA
| | - Danai Dima
- Department of NeuroimagingInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
- Department of Psychology, School of Arts and Social SciencesCity University of LondonLondonUnited Kingdom
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Ruhanya V, Jacobs GB, Paul RH, Joska JA, Seedat S, Nyandoro G, Engelbrecht S, Glashoff RH. Plasma Cytokine Biomarker Cutoff Values for HIV-Associated Neurocognitive Impairment in Adults. Viral Immunol 2021; 34:689-696. [PMID: 34807730 DOI: 10.1089/vim.2021.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Diagnosing HIV-associated neurocognitive impairment in most high-burden, but resource-constrained, settings is difficult due to the unavailability of specialist neurologists and neuropsychologists in primary health care centers. New tests that are easy to perform, based on virological and host immune response biomarkers, may be valuable in the diagnosis of HIV-associated neurocognitive disorder. The receiver operator characteristic curve analysis was used to investigate the diagnostic accuracy of threshold/cutoff concentrations for the peripheral lymphocyte proviral load and plasma biomarkers as diagnostic candidates for neurocognitive impairment in 133 HIV-infected individuals, using global deficit scores as the clinical gold standard. Forty-five (33.83%) of the participants had HIV-associated neurocognitive impairment, with 17.29% being mildly impaired and 16.54% moderately impaired. IL-2 had the best performance as a diagnostic tool for neurocognitive impairment with sensitivity of 67% and specificity of 52%, while the lowest performance was IL-6 with 65% sensitivity and 39% specificity. MIP-1α had the highest precision for the cutoff value, as indicated by the narrow 95% confidence interval (CI) (2.23-3.27), followed by IL-2 with 95% CI (3.02-5.12). RANTES had least precision, as shown by the widest 95% CI (135-9,487.61). For clinical markers of HIV diagnosis and monitoring, the lymphocyte proviral load cutoff value of 145 genome copies/million cells had the highest accuracy with 60% sensitivity and 51% specificity. The plasma viral load had an imperfect balance of 46% sensitivity and 78% specificity. The study demonstrated low to medium diagnostic accuracy of plasma cytokine biomarker cutoff values for defining neurocognitive impairment in people living with HIV.
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Affiliation(s)
- Vurayai Ruhanya
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa.,Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
| | - Graeme B Jacobs
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Robert H Paul
- Department of Psychology and Behavioral Neuroscience, University of Missouri-St Louis, University Boulevard, St Louis, Missouri, USA
| | - John A Joska
- MRC Unit of Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- MRC Unit of Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - George Nyandoro
- Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Richard H Glashoff
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Service (NHLS), Tygerberg Business Unity, Cape Town, South Africa
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Andersen LS, Saal W, Joska JA, Safren SA, Bantjes J, O'Cleirigh C, Witten JA, Lee JS, Kagee A. Improving Detection of Depression in People Living with HIV: Psychometric Properties of the South African Depression Scale (SADS). AIDS Behav 2021; 25:3630-3637. [PMID: 34143340 PMCID: PMC8563384 DOI: 10.1007/s10461-021-03305-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 12/26/2022]
Abstract
Most measures developed in high income countries to screen for major depressive disorder (MDD) among people living with HIV (PWH) demonstrate suboptimal psychometric properties when utilized in non-western, resource limited settings due to their high false positive rates. For standardized MDD screening to be implementable in local settings, a measure is needed that reduces diagnostic burden by being highly sensitive while limiting false positives. This study sought to evaluate the ability of the locally developed South African Depression Scale (SADS) to screen for MDD in PWH in Cape Town. The SADS was administered along with the SCID-5-RV as gold standard to 236 PWH. It demonstrated good discriminating ability in detecting MDD with an area under the curve of 0.85. A cut-off of 27 yielded 78.2% sensitivity and 54.4% PPV. Given its robust psychometric properties, routine use of the SADS in community clinics to screen at-risk PWH, combined with evidence-based depression treatment, could improve the health outcomes and well-being of PWH in South Africa.ResumenLa mayoría de las medidas desarrolladas en países de ingresos altos para detectar el trastorno depresivo mayor (TDM) entre las personas que viven con el VIH (PVV) demuestran propiedades psicométricas subóptimas cuando se utilizan en entornos no occidentales de recursos limitados debido a sus altas tasas de falsos positivos. Para que la detección de TDM estandarizada sea implementable en entornos locales, se necesita una medida que reduzca la carga diagnóstica al ser altamente sensible mientras limita los falsos positivos. Este estudio trató de evaluar la capacidad de la Escala de Depresión Sudafricana (SADS, por sus siglas en inglés) desarrollada localmente para detectar TDM en PVV en Ciudad del Cabo. El SADS se administró junto con el SCID-5-RV como el test de referencia a 236 PWH. Demostró una buena capacidad discriminatoria en la detección de TDM con un área bajo la curva de 0,85. Un corte de 27 produjo un 78,2% de sensibilidad y un 54,4% de VPP. Dadas sus sólidas propiedades psicométricas, el uso rutinario del SADS en clínicas comunitarias para detectar las PVV en riesgo, combinado con un tratamiento de depresión basado en la evidencia, podría mejorar los resultados de salud y el bienestar de las PVV en Sudáfrica.
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Affiliation(s)
- Lena Skovgaard Andersen
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa.
- Department of Public Health, Section of Global Health, University of Copenhagen,, Copenhagen, Denmark.
| | - Wylene Saal
- Centre for Social Science Research, University of Cape Town & Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, HIV Mental Health Research Unit, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Jason Bantjes
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Conall O'Cleirigh
- Department of Psychiatry, Behavioral Medicine Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Jasper S Lee
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
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Myers B, Lombard C, Joska JA, Abdullah F, Naledi T, Lund C, Petersen Williams P, Stein DJ, Sorsdahl KR. Associations Between Patterns of Alcohol Use and Viral Load Suppression Amongst Women Living with HIV in South Africa. AIDS Behav 2021; 25:3758-3769. [PMID: 33876383 PMCID: PMC8560660 DOI: 10.1007/s10461-021-03263-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
This study aimed to identify alcohol use patterns associated with viral non-suppression among women living with HIV (WLWH) and the extent to which adherence mediated these relationships. Baseline data on covariates, alcohol consumption, ART adherence, and viral load were collected from 608 WLWH on ART living in the Western Cape, South Africa. We defined three consumption patterns: no/light drinking (drinking ≤ 1/week and ≤ 4 drinks/occasion), occasional heavy episodic drinking (HED) (drinking > 1 and ≤ 2/week and ≥ 5 drinks/occasion) and frequent HED (drinking ≥ 3 times/week and ≥ 5 drinks/occasion). In multivariable analyses, occasional HED (OR 3.07, 95% CI 1.78–5.30) and frequent HED (OR 7.11, 95% CI 4.24–11.92) were associated with suboptimal adherence. Frequent HED was associated with viral non-suppression (OR 2.08, 95% CI 1.30–3.28). Suboptimal adherence partially mediated the relationship between frequent HED and viral non-suppression. Findings suggest a direct relationship between frequency of HED and viral suppression. Given the mediating effects of adherence on this relationship, alcohol interventions should be tailored to frequency of HED while also addressing adherence.
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Affiliation(s)
- B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa.
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
| | - C Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - J A Joska
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - F Abdullah
- Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa
| | - T Naledi
- Dean's Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C Lund
- Department of Psychiatry & Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - P Petersen Williams
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, PO Box 19070, Cape Town, 7505, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - D J Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council's Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa
| | - K R Sorsdahl
- Department of Psychiatry & Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
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Safren SA, O'Cleirigh C, Andersen LS, Magidson JF, Lee JS, Bainter SA, Musinguzi N, Simoni J, Kagee A, Joska JA. Treating depression and improving adherence in HIV care with task-shared cognitive behavioural therapy in Khayelitsha, South Africa: a randomized controlled trial. J Int AIDS Soc 2021; 24:e25823. [PMID: 34708929 PMCID: PMC8552453 DOI: 10.1002/jia2.25823] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/10/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Major depressive disorder, highly prevalent among people with HIV (PWH) globally, including South Africa, is associated with suboptimal adherence to antiretroviral therapy. Globally, there are insufficient numbers of mental health providers and tested depression treatments. This study's aim was to test task-shared cognitive-behavioural therapy for adherence and depression (CBT-AD) in HIV, delivered by clinic nurses in South Africa. METHODS This was a two-arm randomized controlled effectiveness trial (recruitment: 14 July 2016 to 4 June 2019, last follow 9 June 2020). One-hundred-sixty-one participants with clinical depression and virally uncontrolled HIV were recruited from primary care clinics providing HIV care, in Khayelitsha, South Africa. Arm 1 was task-shared, nurse-delivered CBT-AD; and arm 2 was enhanced treatment as usual (ETAU). Primary outcomes (baseline to 4 months) were blinded Hamilton Depression Rating Scale (HAM-D) scores, and weekly adherence via real-time monitoring (Wisepill). Secondary outcomes were adherence and depression over 4-, 8- and 12-month follow-ups, proportion of participants with undetectable viremia and continuous CD4 cell counts at 12 months. Additional analyses involved viral load and CD4 over time. RESULTS At 4 months, the HAMD scores in the CBT-AD condition improved by an estimated 4.88 points more (CI: -7.86, -1.87, p = 0.0016), and for weekly adherence, 1.61 percentage points more per week (CI: 0.64, 2.58, p = 0.001) than ETAU. Over follow-ups, CBT-AD had an estimated 5.63 lower HAMD scores (CI: -7.90, -3.36, p < 0.001) and 23.56 percentage points higher adherence (CI: 10.51, 34.21, p < 0.001) than ETAU. At 12 months, adjusted models indicated that the odds of having an undetectable viremia was 2.51 greater at 12 months (CI: 1.01, 6.66, p = 0.047), and 3.54 greater over all of the follow-ups (aOR = 3.54, CI: 1.59, 20.50; p = 0.038) for those assigned CBT-AD. CD4 was not significantly different between groups at 12 months or over time. CONCLUSIONS Task-shared, nurse-delivered, CBT-AD is effective in improving clinical depression, ART adherence and viral load for virally unsuppressed PWH. The strategy of reducing depression to allow patients with self-care components of medical illness to benefit from adherence interventions is one to extend. Implementation science trials and analyses of cost-effectiveness are needed to translate findings into clinical practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02696824 https://clinicaltrials.gov/ct2/show/NCT02696824.
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Affiliation(s)
| | - Conall O'Cleirigh
- Department of PsychologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Lena S. Andersen
- Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
| | | | - Jasper S. Lee
- Department of PsychologyUniversity of MiamiMiamiFloridaUSA
| | | | - Nicholas Musinguzi
- Department of Internal MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Jane Simoni
- Department of PsychologyUniversity of WashingtonSeattleWashingtonUSA
| | - Ashraf Kagee
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - John A. Joska
- Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
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Mgweba-Bewana L, Belus JM, Ipser J, Magidson JF, Joska JA. Examining the association of alcohol use and psychotropic medication adherence among women with severe mental illness in South Africa. Psychiatry Res 2021; 304:114127. [PMID: 34315060 DOI: 10.1016/j.psychres.2021.114127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022]
Abstract
Women with severe mental illness (SMI) in South Africa face numerous psychosocial challenges and alcohol use is widely used in this population as a coping strategy. Although hazardous alcohol use has a documented negative effect on medication adherence or chronic illness, research has mostly ignored the role of alcohol on psychotropic medication adherence in women with SMI. The primary aim of this study was to explore the association of hazardous alcohol use on psychotropic medication adherence in adult women living with SMI (N = 119), attending a psychiatric clinic for treatment in Cape Town. Medication adherence was based on self-report and hazardous alcohol use was measured with the Alcohol Use Disorders Identification Test (AUDIT). Poisson regression analyses (controlling for education, relationship status, and psychiatric hospitalisations) indicated that hazardous alcohol use was significantly associated with a greater likelihood of psychotropic medication non-adherence. Similar findings were observed for HIV medication non-adherence in the HIV-positive subsample. Study findings highlight the role of alcohol use for medication non-adherence in women with SMI and should be addressed in psychiatric care.
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Affiliation(s)
- Lihle Mgweba-Bewana
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Anzio Road Observatory, Cape Town 7925, South Africa.
| | - Jennifer M Belus
- University of Maryland, Department of Psychology, 4094 Campus Drive, College Park, MD, 20742, USA
| | - Jonathan Ipser
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Anzio Road Observatory, Cape Town 7925, South Africa
| | - Jessica F Magidson
- University of Maryland, Department of Psychology, 4094 Campus Drive, College Park, MD, 20742, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Anzio Road Observatory, Cape Town 7925, South Africa
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Ruhanya V, Jacobs GB, Naidoo S, Paul RH, Joska JA, Seedat S, Nyandoro G, Engelbrecht S, Glashoff RH. Impact of Plasma IP-10/CXCL10 and RANTES/CCL5 Levels on Neurocognitive Function in HIV Treatment-Naive Patients. AIDS Res Hum Retroviruses 2021; 37:657-665. [PMID: 33472520 DOI: 10.1089/aid.2020.0203] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Immune activation, which is accompanied by the production of proinflammatory cytokines, is a strong predictor of disease progression in HIV infection. Inflammation is critical in neuronal damage linked to HIV-associated neurocognitive disorders. We examined the relationship between plasma cytokine levels and deficits in neurocognitive function. Multiplex profiling by Luminex® technology was used to quantify 27 cytokines/chemokines from 139 plasma samples of people living with HIV (PLWH). The relationship of plasma cytokine markers, clinical parameters, and cognitive impairment, was assessed using Spearman correlations. Partial least squares regression and variable importance in projection scores were used for further evaluation of the association. Forty-nine (35.3%) participants exhibited neurocognitive impairment based on a global deficit score (GDS) of at least 0.5 and 90 (64.7%) were classified as nonimpaired. Twenty-three (16.5%) initiated on combination antiretroviral therapy for 4 weeks before cognitive assessment and 116 (83.5%) were not on treatment. We identified five proinflammatory cytokines that were significant predictors of GDS namely, IP-10 (β = 0.058; p = .007), RANTES (β = 0.049; p = .005), IL-2 (β = 0.047, p = .006), Eotaxin (β = 0.042, p = .003), and IL-7 (β = 0.039, p = .003). IP-10 and RANTES were the strongest predictors of GDS. Both cytokines correlated with plasma viral load and lymphocyte proviral load and were inversely correlated with CD4+ T cell counts. IP-10 and RANTES formed a separate cluster with highest proximity. Study findings describe novel associations among IP-10, RANTES, cognitive status, plasma viral load, and cell-associated viral load.
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Affiliation(s)
- Vurayai Ruhanya
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
- Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
| | - Graeme B. Jacobs
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Shalena Naidoo
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
| | - Robert H. Paul
- Department of Psychology and Behavioral Neuroscience, University of Missouri-St Louis, St. Louis, Missouri, USA
| | - John A. Joska
- MRC Unit of Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Soraya Seedat
- MRC Unit of Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
| | - George Nyandoro
- Department of Medical Microbiology, University of Zimbabwe, Harare, Zimbabwe
| | - Susan Engelbrecht
- Division of Medical Virology, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service (NHLS), Tygerberg Business Unit, Cape Town, South Africa
| | - Richard H. Glashoff
- National Health Laboratory Service (NHLS), Tygerberg Business Unit, Cape Town, South Africa
- Division of Medical Microbiology, Stellenbosch University, Cape Town, South Africa
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Williams ME, Stein DJ, Joska JA, Naudé PJW. Cerebrospinal fluid immune markers and HIV-associated neurocognitive impairments: A systematic review. J Neuroimmunol 2021; 358:577649. [PMID: 34280844 DOI: 10.1016/j.jneuroim.2021.577649] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/27/2021] [Accepted: 06/27/2021] [Indexed: 01/31/2023]
Abstract
HIV-1 is responsible for the development of a spectrum of cognitive impairments known as HIV-associated neurocognitive disorder (HAND). In the era of antiretroviral therapy (ART), HAND remains prevalent in people living with HIV (PLWH), despite low or undetectable viral loads. Persistent neuroinflammation likely plays an important role in the contributing biological mechanisms. Multiple cerebrospinal fluid (CSF) immune markers have been studied but it is unclear which markers most consistently correlate with neurocognitive impairment. We therefore conducted a systematic review of studies of the association of CSF immune markers with neurocognitive performance in ART-experienced PLWH. We aimed to synthesize the published data to determine consistent findings and to indicate the most noteworthy CSF markers of HAND. Twenty-nine studies were included, with 20 cross-sectional studies and 9 longitudinal studies. From the group of markers most often assayed, specific monocyte activation (higher levels of Neopterin, sCD163, sCD14) and neuroinflammatory markers (higher levels of IFN-γ, IL-1α, IL-7, IL-8, sTNFR-II and lower levels of IL-6) showed a consistent direction in association with HIV-associated neurocognitive impairment. Furthermore, significant differences exist in CSF immune markers between HIV-positive people with and without neurocognitive impairment, regardless of viral load and nadir/current CD4+ count. These markers may be useful in furthering our understanding of the neuropathology, diagnosis and prognosis of HAND. Studies using prospective designs (i.e. pre- and post-interventions), "multi-modal" methods (e.g. imaging, inflammation and neurocognitive evaluations) and utilizing a combination of the markers most commonly associated with HAND may help delineate the mechanisms of HAND.
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Affiliation(s)
- Monray E Williams
- Human Metabolomics, North-West University, Potchefstroom, South Africa.
| | - Dan J Stein
- Department of Psychiatry and Mental Health, Brain Behaviour Unit, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Cape Town, South Africa; SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa; HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Petrus J W Naudé
- Department of Psychiatry and Mental Health, Brain Behaviour Unit, University of Cape Town, Cape Town, South Africa; Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Belus JM, Rose AL, Andersen LS, Joska JA, Myers B, Regenauer KS, Safren SA, Magidson JF. The role of reward and reinforcement in understanding alcohol use among adults living with HIV in South Africa. Psychol Addict Behav 2021; 35:424-431. [PMID: 33914561 PMCID: PMC9943908 DOI: 10.1037/adb0000728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Most research investigating reinforcement in alcohol use is from high-income countries. The current study sought to understand the association of different reinforcement types (alcohol-specific reward, environmental reward, behavioral activation) with multiple measures of alcohol use and cravings among individuals living with HIV in South Africa. METHOD Baseline data were obtained from a substance use clinical trial in Cape Town (N = 65). Unhealthy alcohol use was measured using the biomarker phosphatidylethanol (PEth), Alcohol Use Identification Test (AUDIT-C), average number of drinks from the timeline follow back (TLFB), and self-reported cravings. Reinforcement was measured using the proportion of income spent on alcohol (alcohol-specific reward), both subscales of the Reward Probability Index (environmental reward), and the Behavioral Activation Depression Scale (activation). Poisson and linear regression analyses were conducted. RESULTS Each percentage point increase in income spent on alcohol was significantly associated with PEth, RR = 1.004 [95% CI (1.001, 1.007)], which translates to a 13.6% increase in the relative risk of unhealthy alcohol use for the average person in the study. More alcohol-specific reward was significantly associated with higher scores on the AUDIT-C, higher average number of drinks on the TLFB, and more cravings. Higher activation was associated with lower scores on the AUDIT-C. Neither subscale of environmental reward was associated with model outcomes. CONCLUSION Greater alcohol-specific reward and less behavioral activation were associated with more frequent and unhealthy alcohol use in this setting, but not environmental reward. Findings highlight how different reinforcement types potentially influence alcohol use in a low-resource global setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Jennifer M. Belus
- University of Maryland, Department of Psychology, 4094 Campus Drive, College Park, MD, 20740, USA
| | - Alexandra L. Rose
- University of Maryland, Department of Psychology, 4094 Campus Drive, College Park, MD, 20740, USA
| | - Lena S. Andersen
- University of Cape Town, HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa
| | - John A. Joska
- University of Cape Town, HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa
| | - Bronwyn Myers
- South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Francie van Zijl Drive, Parow Valley, Cape Town, South Africa
- University of Cape Town, Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa
| | - Kristen S. Regenauer
- University of Maryland, Department of Psychology, 4094 Campus Drive, College Park, MD, 20740, USA
| | - Steve A. Safren
- University of Miami, Department of Psychology, 5665 Ponce De Leon Blvd, Coral Gables, Miami, 33124, USA
| | - Jessica F. Magidson
- University of Maryland, Department of Psychology, 4094 Campus Drive, College Park, MD, 20740, USA
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Magidson JF, Joska JA, Belus JM, Andersen LS, Regenauer KS, Rose AL, Myers B, Majokweni S, O’Cleirigh C, Safren SA. Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa. J Int AIDS Soc 2021; 24 Suppl 2:e25720. [PMID: 34164935 PMCID: PMC8222840 DOI: 10.1002/jia2.25720] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION South Africa (SA) has the highest number of people living with HIV (PLWH) globally, and a significant burden of alcohol and other drug use (AOD). Although integrating AOD treatment into HIV care may improve antiretroviral therapy (ART) adherence, this is not typically routine practice in SA or other low-resource settings. Identifying interventions that are feasible and acceptable for implementation is critical to improve HIV and AOD outcomes. METHODS A pilot randomized hybrid type 1 effectiveness-implementation trial (N = 61) was conducted to evaluate the feasibility and acceptability of Khanya, a task-shared, peer-delivered behavioral intervention to improve ART adherence and reduce AOD in HIV care in SA. Khanya was compared to enhanced treatment as usual (ETAU), a facilitated referral to on-site AOD treatment. Implementation outcomes, defined by Proctor's model, included feasibility, acceptability, appropriateness and fidelity. Primary pilot effectiveness outcomes were ART adherence at post-treatment (three months) measured via real-time electronic adherence monitoring, and AOD measured using biomarker and self-report assessments over six months. Data collection was conducted from August 2018 to April 2020. RESULTS AND DISCUSSION Ninety-one percent of participants (n = 56) were retained at six months. The intervention was highly feasible, acceptable, appropriate and delivered with fidelity (>90% of components delivered as intended by the peer). There was a significant treatment-by-time interaction for ART adherence (estimate = -0.287 [95% CI = -0.507, -0.066]), revealing a 6.4 percentage point increase in ART adherence in Khanya, and a 22.3 percentage point decline in ETAU. Both groups evidenced significant reductions in alcohol use measured using phosphatidylethanol (PEth) (F(2,101) = 4.16, p = 0.01), significantly decreased likelihood of self-reported moderate or severe AOD (F(2,104) = 7.02, p = 0.001), and significant declines in alcohol use quantity on the timeline follow-back (F(2,102) = 21.53, p < 0.001). Among individuals using drugs and alcohol, there was a greater reduction in alcohol use quantity in Khanya compared to ETAU over six months (F(2,31) = 3.28, p = 0.05). CONCLUSIONS Results of this pilot trial provide initial evidence of the feasibility and acceptability of the Khanya intervention for improving adherence in an underserved group at high risk for ongoing ART non-adherence and HIV transmission. Implementation results suggest that peers may be a potential strategy to extend task-sharing models for behavioral health in resource-limited, global settings.
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Affiliation(s)
| | - John A Joska
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | - Lena S Andersen
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | | | | | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research UnitSouth African Medical Research CouncilDivision of Addiction PsychiatryDepartment of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Sybil Majokweni
- HIV Mental Health Research UnitDivision of NeuropsychiatryDepartment of Psychiatry and Mental HealthGroote Schuur HospitalCape TownSouth Africa
| | - Conall O’Cleirigh
- Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
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Nakimuli‐Mpungu E, Musisi S, Smith CM, Von Isenburg M, Akimana B, Shakarishvili A, Nachega JB, Mills EJ, Chibanda D, Ribeiro M, V Williams A, Joska JA. Mental health interventions for persons living with HIV in low- and middle-income countries: a systematic review. J Int AIDS Soc 2021; 24 Suppl 2:e25722. [PMID: 34164926 PMCID: PMC8222847 DOI: 10.1002/jia2.25722] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Addressing the intersection between mental health and HIV is critical for the wellbeing of persons living with HIV (PLWH). This systematic review synthesized the literature on mental health interventions for PLWH in low- and middle-income countries (LMICs) to determine intervention components and explore their relationship with intervention effectiveness. METHODS We included only controlled clinical trials of interventions aiming to improve the mental health of PLWH. We conducted a search in the following databases: PubMed, CINAHL, PsycINFO and EMBASE for eligible studies describing the evaluation of interventions for mental health problems among PLWH in LMICs published through August 2020. Two reviewers independently screened references in two successive stages of title/abstract screening and then full-text screening for references meeting title/abstract criteria. RESULTS We identified a total of 30 eligible articles representing 6477 PLWH who were assigned to either the intervention arm (n = 3182) or control arm (n = 3346). The mental health interventions evaluated were psychological (n = 17, 56.67%), pharmacological (n = 6, 20.00%), combined psychological and pharmacological (n = 1, 3.33%) and complementary/alternative treatments (n = 6, 20.00%). The mental health problems targeted were depression (n = 22, 73.33 %), multiple psychological symptoms (n = 1, 3.33%), alcohol and substance use problems (n = 4, 13.33%), post-traumatic stress disorder (n = 1, 3.33%) and HIV-related neuro-cognitive impairment (n = 2, 6.67%). Studies of interventions with significant effects had significantly a higher number of active ingredients than those without significant effects [3.41 (2.24) vs. 1.84 (1.46) Mean (SD)] [Mean difference = -1.56, 95% CI = -3.03 to -0.09, p = 0.037]. CONCLUSIONS There continue to be advances in mental health interventions for PLWH with mental illness in LMICs. However, more research is needed to elucidate how intervention components lead to intervention effectiveness. We recommend scale up of culturally appropriate interventions that have been successfully evaluated in low- and middle-income countries.
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Affiliation(s)
| | - Seggane Musisi
- Department of PsychiatryCollege of Health SciencesMakerere UniversityKampalaUganda
| | - Colin M Smith
- Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamNCUSA
- Department of MedicineDuke University Medical CenterDurhamNCUSA
| | - Megan Von Isenburg
- Duke University Medical Center LibraryDuke University Medical CenterDurhamNCUSA
| | - Benedict Akimana
- The Butabika National Referral HospitalMinistry of HealthKampalaUganda
| | | | - Jean B Nachega
- Department of International Health, Bloomberg's School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
- Department of EpidemiologyPittsburgh Graduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
- Stellenbosch Center for Infectious DiseaseDepartment of MedicineStellenbosch UniversityStellenboschSouth Africa
| | - Edward J Mills
- Department of Clinical Epidemiology & BiostatisticsMcMaster UniversityHamiltonONCanada
| | - Dixon Chibanda
- Zimbabwe AIDS Prevention ProjectDepartment of Community MedicineUniversity of ZimbabweHarareZimbabwe
| | - Marcelo Ribeiro
- Reference Center for Alcohol, Tobacco and Other Drugs (CRATOD)São Paulo State Secretary of HealthSão PauloBrazil
| | - Anna V Williams
- National Addiction CentreInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonUK
| | - John A Joska
- HIV Mental Health Research UnitDepartment of PsychiatryNeuroscience InstituteUniversity of Cape TownCape TownSouth Africa
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Decloedt EH, Sinxadi PZ, Wiesner L, Joska JA, Haas DW, Maartens G. Pharmacogenetics of tenofovir and emtricitabine penetration into cerebrospinal fluid. South Afr J HIV Med 2021; 22:1206. [PMID: 34007475 PMCID: PMC8111650 DOI: 10.4102/sajhivmed.v22i1.1206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/09/2021] [Indexed: 01/31/2023] Open
Abstract
Background Blood-cerebrospinal fluid (CSF) barrier transporters affect the influx and efflux of drugs. The antiretrovirals tenofovir and emtricitabine may be substrates of blood-brain barrier (BBB) and blood-CSF barrier transporters, but data are limited regarding the pharmacogenetics and pharmacokinetics of their central nervous system (CNS) penetration. Objectives We investigated genetic polymorphisms associated with CSF disposition of tenofovir and emtricitabine. Method We collected paired plasma and CSF samples from 47 HIV-positive black South African adults who were virologically suppressed on efavirenz, tenofovir and emtricitabine. We considered 1846 single-nucleotide polymorphisms from seven relevant transporter genes (ABCC5, ABCG2, ABCB1, SLCO2B1, SCLO1A2, SLCO1B1 and ABCC4) and 782 met a linkage disequilibrium (LD)-pruning threshold. Results The geometric mean (95% confidence interval [CI]) values for tenofovir and emtricitabine CSF-to-plasma concentration ratios were 0.023 (0.021-0.026) and 0.528 (0.460-0.605), respectively. In linear regression models, the lowest p-value for association with the tenofovir CSF-to-plasma ratio was ABCB1 rs1989830 (p = 1.2 × 10-3) and for emtricitabine, it was ABCC5 rs11921035 (p = 1.4 × 10-3). None withstood correction for multiple testing. Conclusion No genetic polymorphisms were associated with plasma, CSF concentrations or CSF-to-plasma ratios for either tenofovir or emtricitabine.
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Affiliation(s)
- Eric H Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Phumla Z Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - John A Joska
- Department of Psychiatry and Mental Health, Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - David W Haas
- Department of Medicine, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States.,Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, United States
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Nightingale S, Dreyer AJ, Saylor D, Gisslén M, Winston A, Joska JA. Moving on from HAND: why we need new criteria for cognitive impairment in people with HIV and a proposed way forward. Clin Infect Dis 2021; 73:1113-1118. [PMID: 33904889 DOI: 10.1093/cid/ciab366] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Indexed: 12/31/2022] Open
Abstract
HIV-associated neurocognitive disorders (HAND) criteria are frequently used to describe cognitive impairment in people with HIV (PWH) across diverse populations globally. These criteria typically find 20-60% of PWH meet criteria for HAND, which does not tally with clinical observations in the modern era that cognitive disorders present relatively infrequently. Most with HAND have asymptomatic neurocognitive impairment (ANI), however the significance of low cognitive test performance without symptoms is uncertain. Methods underlying HAND criteria carry a false positive rate that can exceed 20%. Comorbidities, education and complex socioeconomic factors can influence cognitive test performance, further increasing the potential for misclassification. We propose a new framework to characterise cognitive impairment in PWH which requires a clinical history and acknowledges the multifactorial nature of low cognitive test performance. This framework is intended to be applicable across diverse populations globally, be more aligned with clinical observations and more closely represent HIV brain pathology.
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Affiliation(s)
- Sam Nightingale
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, South Africa
| | - Anna J Dreyer
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, South Africa
| | - Deanna Saylor
- University Teaching Hospital, Lusaka, Zambia.,Department of Neurology, Johns Hopkins University School of Medicine, USA
| | - Magnus Gisslén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Infectious Diseases, Gothenburg, Sweden
| | - Alan Winston
- Department of Infectious Disease, Imperial College London, London, UK.,Clinical Trials, Winston Churchill Wing, St Mary's Hospital, London, UK
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, South Africa
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McCreesh-Toselli S, Torline J, Gouse H, Robbins RN, Mellins CA, Remien RH, Rowe J, Peton N, Rabie S, Joska JA. Staff Perceptions of Preimplementation Barriers and Facilitators to a Mobile Health Antiretroviral Therapy Adherence Counseling Intervention in South Africa: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e23280. [PMID: 33821806 PMCID: PMC8058692 DOI: 10.2196/23280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/04/2021] [Accepted: 02/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background South Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records. Objective This study aims to explore, at a large Cape Town–based nonprofit HIV care organization, the staff’s perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling. Methods Masivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35%) and 3 focus groups (participants in 2 focus groups: 4/20, 20%; participants in 1 focus group: 3/20, 15%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention. Results Several potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app’s appeal to older clients. Conclusions mHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting.
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Affiliation(s)
- Siobhan McCreesh-Toselli
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - John Torline
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - Hetta Gouse
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - Reuben N Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, United States
| | - Jessica Rowe
- The Columbia Center for New Media Teaching and Learning, Columbia University, New York, NY, United States
| | - Neshaan Peton
- City of Cape Town Metropolitan Municipality, Cape Town, South Africa
| | - Stephan Rabie
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Observatory, South Africa
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Gouse H, Masson CJ, Henry M, Thomas KGF, Robbins RN, Kew G, London L, Joska JA, Marcotte TD. The Impact of HIV-Associated Neurocognitive Impairment on Driving Performance in Commercial Truck Drivers. AIDS Behav 2021; 25:689-698. [PMID: 32910354 DOI: 10.1007/s10461-020-03033-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Driving ability can be diminished amongst people with HIV with associated neurocognitive impairment (NCI). We explore the relationship between HIV status, NCI and driving ability in professional truck drivers. Forty male professional drivers (20 HIV-positive; mean age = 39.20 ± 7.05) completed a neuropsychological test battery, two driving simulator tasks that assessed driving ability, and a driving history and habits questionnaire. A higher proportion of HIV-positive drivers exhibited impaired overall cognitive performance (p ≤ 0.001). Overall, drivers with NCI (defined as z ≤ 1.00) were more likely than those without NCI to crash (p = 0.002). There were no significant between-group (HIV-positive versus HIV-negative) differences with regard to self-reported on-road driving events. Professional drivers with NCI, as measured on a driving simulator, are at increased risk of making driving errors under high-risk conditions compared to their neurocognitively normal counterparts. These data should inform driver health management with regard to annual medical screening and surveillance.
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Affiliation(s)
- H Gouse
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - C J Masson
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Henry
- Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - K G F Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - R N Robbins
- HIV Center for Clinical and Behavioral Science, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - G Kew
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - L London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J A Joska
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - T D Marcotte
- HIV Neurovehavioral Research Program, Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Nir TM, Fouche JP, Ananworanich J, Ances BM, Boban J, Brew BJ, Chaganti JR, Chang L, Ching CRK, Cysique LA, Ernst T, Faskowitz J, Gupta V, Harezlak J, Heaps-Woodruff JM, Hinkin CH, Hoare J, Joska JA, Kallianpur KJ, Kuhn T, Lam HY, Law M, Lebrun-Frénay C, Levine AJ, Mondot L, Nakamoto BK, Navia BA, Pennec X, Porges EC, Salminen LE, Shikuma CM, Surento W, Thames AD, Valcour V, Vassallo M, Woods AJ, Thompson PM, Cohen RA, Paul R, Stein DJ, Jahanshad N. Association of Immunosuppression and Viral Load With Subcortical Brain Volume in an International Sample of People Living With HIV. JAMA Netw Open 2021; 4:e2031190. [PMID: 33449093 PMCID: PMC7811179 DOI: 10.1001/jamanetworkopen.2020.31190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Despite more widely accessible combination antiretroviral therapy (cART), HIV-1 infection remains a global public health challenge. Even in treated patients with chronic HIV infection, neurocognitive impairment often persists, affecting quality of life. Identifying the neuroanatomical pathways associated with infection in vivo may delineate the neuropathologic processes underlying these deficits. However, published neuroimaging findings from relatively small, heterogeneous cohorts are inconsistent, limiting the generalizability of the conclusions drawn to date. OBJECTIVE To examine structural brain associations with the most commonly collected clinical assessments of HIV burden (CD4+ T-cell count and viral load), which are generalizable across demographically and clinically diverse HIV-infected individuals worldwide. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study established the HIV Working Group within the Enhancing Neuro Imaging Genetics Through Meta Analysis (ENIGMA) consortium to pool and harmonize data from existing HIV neuroimaging studies. In total, data from 1295 HIV-positive adults were contributed from 13 studies across Africa, Asia, Australia, Europe, and North America. Regional and whole brain segmentations were extracted from data sets as contributing studies joined the consortium on a rolling basis from November 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURES Volume estimates for 8 subcortical brain regions were extracted from T1-weighted magnetic resonance images to identify associations with blood plasma markers of current immunosuppression (CD4+ T-cell counts) or detectable plasma viral load (dVL) in HIV-positive participants. Post hoc sensitivity analyses stratified data by cART status. RESULTS After quality assurance, data from 1203 HIV-positive individuals (mean [SD] age, 45.7 [11.5] years; 880 [73.2%] male; 897 [74.6%] taking cART) remained. Lower current CD4+ cell counts were associated with smaller hippocampal (mean [SE] β = 16.66 [4.72] mm3 per 100 cells/mm3; P < .001) and thalamic (mean [SE] β = 32.24 [8.96] mm3 per 100 cells/mm3; P < .001) volumes and larger ventricles (mean [SE] β = -391.50 [122.58] mm3 per 100 cells/mm3; P = .001); in participants not taking cART, however, lower current CD4+ cell counts were associated with smaller putamen volumes (mean [SE] β = 57.34 [18.78] mm3 per 100 cells/mm3; P = .003). A dVL was associated with smaller hippocampal volumes (d = -0.17; P = .005); in participants taking cART, dVL was also associated with smaller amygdala volumes (d = -0.23; P = .004). CONCLUSIONS AND RELEVANCE In a large-scale international population of HIV-positive individuals, volumes of structures in the limbic system were consistently associated with current plasma markers. Our findings extend beyond the classically implicated regions of the basal ganglia and may represent a generalizable brain signature of HIV infection in the cART era.
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Affiliation(s)
- Talia M. Nir
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jean-Paul Fouche
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jintanat Ananworanich
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
- South East Asian Research Collaboration in HIV, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- AIGHD, University of Amsterdam, Amsterdam, the Netherlands
| | - Beau M. Ances
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Jasmina Boban
- Faculty of Medicine, Department of Radiology, University of Novi Sad, Novi Sad, Serbia
| | - Bruce J. Brew
- Department of Neurology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Department of Immunology, St Vincent’s Hospital, St Vincent’s Health Australia and University of New South Wales, Sydney, New South Wales, Australia
- Peter Duncan Neurosciences Unit, St Vincent’s Centre for Applied Medical Research, Sydney, New South Wales, Australia
| | - Joga R. Chaganti
- Department of Medical Imaging, St Vincent’s Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Linda Chang
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Neurology, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R. K. Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Lucette A. Cysique
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas Ernst
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Faskowitz
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Vikash Gupta
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Jaroslaw Harezlak
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington
| | | | - Charles H. Hinkin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Jacqueline Hoare
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Kalpana J. Kallianpur
- Hawaii Center for AIDS, University of Hawaii, Honolulu
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, University of Hawaii, Honolulu
| | - Taylor Kuhn
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Hei Y. Lam
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Meng Law
- Department of Radiology, Alfred Health, Monash University, Melbourne, Victoria, Australia
| | - Christine Lebrun-Frénay
- Neurology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | | | - Lydiane Mondot
- Department of Radiology, UR2CA, Centre Hospitalier Universitaire Pasteur 2, Université Nice Côte d’Azur, Nice, France
| | - Beau K. Nakamoto
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Manoa, Honolulu
| | - Bradford A. Navia
- Infection Unit, School of Public Health, Tufts University Medical School, Boston, Massachusetts
| | - Xavier Pennec
- Cote d’Azur University, Sophia Antipolis, France
- Epione Team, Inria, Sophia Antipolis Mediterrannee, Sophia Antipolis, France
| | - Eric C. Porges
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Lauren E. Salminen
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | | | - Wesley Surento
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - April D. Thames
- Department of Psychology, University of Southern California, Los Angeles
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Global Brain Health Institute, San Francisco, California
| | - Matteo Vassallo
- Internal Medicine/Infectious Diseases, Centre Hospitalier de Cannes, Cannes, France
| | - Adam J. Woods
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Paul M. Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
| | - Ronald A. Cohen
- Center for Cognitive Aging and Memory, Department of Clinical and Health Psychology, McKnight Brain Institute, University of Florida, Gainesville
| | - Robert Paul
- Psychological Sciences, Missouri Institute of Mental Health, University of Missouri, St Louis
| | - Dan J. Stein
- SA MRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey
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