Direction of dependence analysis for pre-post assessments using non-Gaussian methods: a tutorial

OBJECTIVE

We introduced methods for solving causal direction of dependence between variables observed in pre- and post-psychotherapy assessments, showing how to apply them and investigate their properties via simulations. In addition, we investigated whether changes in depressive symptoms drive changes in social and occupational functioning as suggested by the phase model of psychotherapy or vice versa, or neither.

METHOD

As a Gaussian (normal-distribution) model is unidentifiable here, we used an identifiable linear non-Gaussian structural vector autoregression model, conceptualizing instantaneous effects as during-psychotherapy causation and lagged effects as pre-treatment predictors of change. We tested six alternative estimators in six simulation settings that captured different real-world scenarios, and used real psychotherapy data from 1428 adult patients (Finnish Psychotherapy Quality Registry; assessments on Patient Health Questionnaire-9 and Social and Occupational Functioning Assessment Schedule).

RESULTS

The methodology was successful in identifying causal directions in simulated data. The real-data results provided no evidence for single direction of dependence, suggesting shared or reciprocal causation.

CONCLUSIONS

A powerful new tool was presented to investigate the process of psychotherapy using observational data. Application to patient data suggested that depression symptoms and functioning may reciprocate or reflect third variables instead of one predominantly driving the other during psychotherapy.

Predicting suicide attempts among Norwegian adolescents without using suicide-related items: a machine learning approach

Introduction

Research on the classification models of suicide attempts has predominantly depended on the collection of sensitive data related to suicide. Gathering this type of information at the population level can be challenging, especially when it pertains to adolescents. We addressed two main objectives: (1) the feasibility of classifying adolescents at high risk of attempting suicide without relying on specific suicide-related survey items such as history of suicide attempts, suicide plan, or suicide ideation, and (2) identifying the most important predictors of suicide attempts among adolescents.

Methods

Nationwide survey data from 173,664 Norwegian adolescents (ages 13-18) were utilized to train a binary classification model, using 169 questionnaire items. The Extreme Gradient Boosting (XGBoost) algorithm was fine-tuned to classify adolescent suicide attempts, and the most important predictors were identified.

Results

XGBoost achieved a sensitivity of 77% with a specificity of 90%, and an AUC of 92.1% and an AUPRC of 47.1%. A coherent set of predictors in the domains of internalizing problems, substance use, interpersonal relationships, and victimization were pinpointed as the most important items related to recent suicide attempts.

Conclusion

This study underscores the potential of machine learning for screening adolescent suicide attempts on a population scale without requiring sensitive suicide-related survey items. Future research investigating the etiology of suicidal behavior may direct particular attention to internalizing problems, interpersonal relationships, victimization, and substance use.

Childhood trauma and borderline personality disorder traits: A discordant twin study

A discordant twin design was utilized to examine the potentially causal effects of childhood trauma (CT; i.e., emotional abuse, physical abuse, sexual abuse, and witnessing violence) on borderline personality disorder traits (BPD traits) in early adulthood. The participants were 2,808 twins between 17 and 23 years from the Oslo University Adolescent and Young Adult Twin Project. BPD traits were assessed by the Structured Interview for DSM-IV Personality (SIDP-IV), and CT was assessed using the Childhood Trauma Interview (CTI). BPD traits (h² = .50) and CT (h² = .33-.69) were both found to be moderately heritable. Small but statistically significant associations between CT and BPD traits were found in the total sample. After controlling for shared environmental and genetic factors in the discordant twin pairs, the analyses showed little to no evidence for causal effects of CT on BPD traits. The results indicated that the associations between CT and BPD traits stem from common genetic influences. These findings are inconsistent with the widely held assumption that CT causes the development of BPD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The longitudinal association between symptoms of posttraumatic stress and complicated grief: A random intercepts cross-lag analysis

OBJECTIVE

Knowledge about the temporal relationship between disturbed grief and symptoms of posttraumatic stress disorder (PTSD) may have important implications for clinicians working with bereaved trauma survivors. We aimed to investigate the longitudinal association between symptoms of complicated grief and PTSD in a bereaved trauma-exposed sample.

METHOD

In total, 275 bereaved survivors (M age = 19.3, SD = 4.6 years; 47.3% females) of the 2011 massacre on Utøya Island, Norway, participated in semistructured interviews 4-5 months (Time 1 [T1]), 14-15 months (Time 2 [T2]), and 30-32 months (Time 3 [T3]) posttrauma. Complicated grief was measured using the Brief Grief Questionnaire, and posttraumatic stress reactions using the University of California at Los Angeles PTSD Reaction Index. To explore associations between symptoms of complicated grief and PTSD over time, we used a random intercepts cross-lagged panel model.

RESULTS

The participants had lost a close friend (n = 256) and/or a family member/partner (n = 19) in the attack. We found a strong correlation between stable individual differences in symptoms of complicated grief and PTSD across the three time-points. PTSD symptoms at T2 predicted complicated grief reactions at T3, but not vice versa.

CONCLUSION

Findings suggest that targeting PTSD symptoms among trauma-exposed bereaved may hinder later development of complicated grief. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations between insecure attachment styles to parents and suicidal ideation in adolescents with depression

Objective

Suicidal ideation and depressive symptoms are often interrelated in clinical settings. Insecure attachment may be a risk factor for suicidal ideation in depressed adolescents. To our knowledge, this study is the first to examine the association between self-reported insecure attachment styles to both parents and suicidal ideation in a clinical sample of adolescents with depression.

Methods

Fifty clinically depressed adolescents (13-17 years, 84% girls) completed self-reported measures of suicidal ideation, depressive symptoms, and attachment style to parents.

Results

There was a statistically significant bivariate association between higher levels of attachment anxiety in relation to mothers and fathers and higher levels of suicidal ideation. When attachments to both parents were included in the same multivariate model, only attachment anxiety to the mother was significantly associated with the level of suicidal ideation. Self-reported depressive symptoms remained significantly associated with the level of suicidal ideation in all analyses. Younger adolescents with attachment anxiety reported higher levels of suicidal ideation than older adolescents.

Conclusion

Conclusions about directionality and causality of associations between insecure attachment and suicidal ideation are limited due to the cross-sectional design. Our findings suggest that attachment anxiety in relation to the mother and father is associated with increased levels of suicidal ideation. Implication of these findings for treatment selection is discussed.

Moderation of treatment effects by parent-adolescent conflict in a randomised controlled trial of Attachment-Based Family Therapy for adolescent depression

BACKGROUND

Conflict with parents is frequent in adolescent depression, and has been shown to predict poor treatment outcomes. Attachment Based Family Therapy (ABFT) is a manualised treatment for adolescent depression that may be robust to parent-adolescent conflict.

OBJECTIVE

To evaluate the hypothesis that parent-adolescent conflict moderates the outcome of Attachment-Based Family Therapy compared with treatment as usual.

METHODS

Data were obtained from a randomised trial comparing 16 weeks of ABFT to treatment as usual, in Norwegian Child and Adolescent Mental Health Services. Sixty adolescents with moderate to severe depression and their parents were recruited. Change in Grid-Hamilton Depression Rating Scale scores from baseline to week 16 was modelled using linear mixed models, and a three-way interaction of time, treatment allocation and a continuous measure of parent-adolescent conflict was fitted to estimate a moderator effect. The moderator model was compared to simpler models using leave-one-out cross-validation.

RESULTS

Better outcomes were predicted for Attachment-Based Family Therapy at high levels of mother-adolescent conflict, and for treatment as usual at low levels of mother-adolescent conflict, giving preliminary support to the moderator hypothesis. Findings for father-adolescent conflict were mixed. Cross-validation did not clearly support the moderator model over a simple effect of time, indicating that the replicability of these findings is uncertain.

CONCLUSION

The results suggest that parent-adolescent conflict should be further studied as a moderator of outcome in Attachment-Based Family Therapy. The trial did not meet its recruitment target and had high attrition, limiting the conclusions that may be drawn.

Erratum: Therapeutic Atmosphere in Psychotherapy Sessions. Int. J. Environ. Res. Public Health 2020, 17, 4105

The authors wish to make the following correction to their paper [...].

Therapeutic Atmosphere in Psychotherapy Sessions

There is uncertainty concerning what the active ingredients in psychotherapy are. The First Experimental Study of Transference interpretations (FEST) was a randomized controlled trial of the effects of transference work (TW) in psychodynamic psychotherapy. Women with low quality of object relations (QOR) showed a large positive effect of transference work, while men with high QOR showed a slight negative effect. The present study aimed to expand the knowledge from the FEST by investigating the therapeutic atmosphere with Structural Analysis of Social Behavior (SASB). Two-way ANOVAs were conducted to investigate differences between SASB cluster scores between subgroups. The therapeutic atmosphere was characterized by Protect–Trust, Affirm–Disclose and Control–Submit. Multilevel modeling was used to assess the relationship between a therapist variable and outcomes for men and women. Contrary to expectations, no significant differences in therapeutic atmosphere between subgroups (with or without TW in women with low QOR and men with high QOR) were observed using the process measure SASB.

Conflict with Parents in Adolescent Depression: Associations with Parental Interpersonal Problems and Depressive Symptoms

Conflict with parents is common among depressed adolescents, interferes with treatment, and may increase risk of recurrence. Parental depressive symptoms have been shown to predict conflict with adolescent children, but an important role for different kinds of parental interpersonal problems, as described by interpersonal circumplex, is also plausible. This study compared parental interpersonal problems to parental depressive symptoms as predictors of parent-adolescent conflict reported by a depressed adolescent child, using multilevel linear regression, leave-one-out cross-validation and model stacking (N = 100 parents, 57 mothers and 43 fathers, of 60 different adolescents). Cross-validation and model stacking showed that including parental interpersonal problems contributes to accurate predictions. Parents reporting more interpersonal problems related to excessive dominance or submissiveness was associated with increased or decreased conflict, respectively. Parental depressive symptoms were found to be negatively associated with parent-adolescent conflict only in father-adolescent relationships.

Design efficiency in genetic association studies

Selecting the best design for genetic association studies requires careful deliberation; different study designs can be used to scan for different genetic effects, and each design has its own set of strengths and limitations. A variety of family and unrelated control configurations are amenable to genetic association analyses, including the case-control design, case-parent triads, and case-parent triads in combination with unrelated controls or control-parent triads. Ultimately, the goal is to choose the design that achieves the highest statistical power using the lowest cost. For given parameter values and genotyped individuals, designs can be compared directly by computing the power. However, a more informative and general design comparison can be achieved by studying the relative efficiency, defined as the ratio of variances of two different parameter estimators, corresponding to two separate designs. Using log-linear modeling, we derive the relative efficiency from the asymptotic variance of the parameter estimators and relate it to the concept of Pitman efficiency. The relative efficiency takes into account the fact that different designs impose different costs relative to the number of genotyped individuals. We show that while optimal efficiency for analyses of regular autosomal effects is achieved using the standard case-control design, the case-parent triad design without unrelated controls is efficient when searching for parent-of-origin effects. Due to the potential loss of efficiency, maternal genes should generally not be adjusted for in an initial genome-wide association study scan of offspring genes but instead checked post hoc. The relative efficiency calculations are implemented in our R package Haplin.

Genetics, personality and wellbeing. A twin study of traits, facets and life satisfaction

Human wellbeing is influenced by personality traits, in particular neuroticism and extraversion. Little is known about which facets that drive these associations, and the role of genes and environments. Our aim was to identify personality facets that are important for life satisfaction, and to estimate the contribution of genetic and environmental factors in the association between personality and life satisfaction. Norwegian twins (N = 1,516, age 50-65, response rate 71%) responded to a personality instrument (NEO-PI-R) and the Satisfaction With Life Scale (SWLS). Regression analyses and biometric modeling were used to examine influences from personality traits and facets, and to estimate genetic and environmental contributions. Neuroticism and extraversion explained 24%, and personality facets accounted for 32% of the variance in life satisfaction. Four facets were particularly important; anxiety and depression in the neuroticism domain, and activity and positive emotions within extraversion. Heritability of life satisfaction was 0.31 (0.22-0.40), of which 65% was explained by personality-related genetic influences. The remaining genetic variance was unique to life satisfaction. The association between personality and life satisfaction is driven mainly by four, predominantly emotional, personality facets. Genetic factors play an important role in these associations, but influence life satisfaction also beyond the effects of personality.

Do DSM-5 Section II personality disorders and Section III personality trait domains reflect the same genetic and environmental risk factors?

BACKGROUND

DSM-5 includes two conceptualizations of personality disorders (PDs). The classification in Section II is identical to the one found in DSM-IV, and includes 10 categorical PDs. The Alternative Model (Section III) includes criteria for dimensional measures of maladaptive personality traits organized into five domains. The degree to which the two conceptualizations reflect the same etiological factors is not known.

METHODS

We use data from a large population-based sample of adult twins from the Norwegian Institute of Public Health Twin Panel on interview-based DSM-IV PDs and a short self-report inventory that indexes the five domains of the DSM-5 Alternative Model plus a domain explicitly targeting compulsivity. Schizotypal, Paranoid, Antisocial, Borderline, Avoidant, and Obsessive-compulsive PDs were assessed at the same time as the maladaptive personality traits and 10 years previously. Schizoid, Histrionic, Narcissistic, and Dependent PDs were only assessed at the first interview. Biometric models were used to estimate overlap in genetic and environmental risk factors.

RESULTS

When measured concurrently, there was 100% genetic overlap between the maladaptive trait domains and Paranoid, Schizotypal, Antisocial, Borderline, and Avoidant PDs. For OCPD, 43% of the genetic variance was shared with the domains. Genetic correlations between the individual domains and PDs ranged from +0.21 to +0.91.

CONCLUSION

The pathological personality trait domains, which are part of the Alternative Model for classification of PDs in DSM-5 Section III, appears to tap, at an aggregate level, the same genetic risk factors as the DSM-5 Section II classification for most of the PDs.

Impact of induced joy on literacy in children: does the nature of the task make a difference?

This research examined whether induced joy influences fifth graders' performance in literacy tasks. Children were asked to recall a joyful experience, used as a joy induction, before completing either a grammar (Study 1) or textual comprehension task (Study 2). The grammar task involved understanding at the surface level and retrieval of appropriate declarative and procedural knowledge, but limited elaboration unlike the textual comprehension task, which tackled inference generation. By differentiating tasks based on depth of processing required for completion we aimed at testing the validity of two concurrent hypotheses: that of a facilitating effect and that of a detrimental effect of induced joy. Compared to controls, joy induced children showed better performance on the grammar task - specifically children with lower language ability. No differences across groups emerged as a function of joy induction on the text comprehension task. Results are discussed with respect to emotion effects on cognition.

Structure of genetic and environmental risk factors for symptoms of DSM-IV borderline personality disorder

IMPORTANCE

Previous studies have indicated that the psychopathological dimensions of borderline personality disorder (BPD) are influenced by a unitary liability factor. However, to our knowledge, the underlying etiological nature of the individual criteria for BPD as defined by the DSM-IV has not been explored.

OBJECTIVE

To determine the structure of genetic and environmental risk factors for the symptoms of BPD.

DESIGN, SETTING, AND PARTICIPANTS

Multivariate twin study with BPD criteria assessed by personal interview within a general community setting. Participants included 2794 young adults from the Norwegian Institute of Public Health Twin Panel.

MAIN OUTCOMES AND MEASURES

The 9 criteria for BPD assessed by the Structured Interview for DSM-IV Personality.

RESULTS

A common pathway model dominated by 1 highly heritable (55%) general BPD factor that strongly influenced all 9 BPD criteria (standardized path coefficients, 0.53-0.79) fit the data best. The model also included 2 additional common liability factors, mainly influencing criteria reflecting the affective and interpersonal dimensions. Both of these were mostly influenced by environmental liability factors (heritability, 29.3% and 2.2%). With 1 exception (criterion 2, unstable and intense relationships), the specific criteria were strongly influenced by environmental factors. Five of the 9 criterion-specific genetic effects were either 0 or negligible.

CONCLUSIONS AND RELEVANCE

These results indicate that most of the genetic effects on the individual BPD criteria derive from 1 highly heritable general BPD factor, whereas the environmental influences were mostly criterion specific.

Major depression and life satisfaction: a population-based twin study

BACKGROUND

The extent to which positive and negative indicators of mental health share etiological influences has been studied to a limited degree only. This study examines the genetic and environmental influences on association between liability to lifetime DSM-IV Major Depressive Disorder (MDD) and dispositional life satisfaction (LS).

METHODS

Two-wave questionnaire data on LS (assessed 6 years apart) and lifetime MDD obtained by structured clinical interviews in a population-based sample of adult twins were analysed using structural equation modelling in Mx.

RESULTS

The prevalence of lifetime MDD was estimated to be 11.1% and 15.8% in males and females, respectively. Individuals fulfilling the criteria for MDD reported significantly lower levels of LS. The co-variation in MDD and dispositional LS was found to be accounted for by genetic and unique environmental influences only. The phenotypic correlation was estimated to be 0.36, of which genetic influences accounted for 74% and environmental factors the remaining 26%. The correlation between genetic factors for MDD and LS was estimated to be -0.55 and the correlation between unique environmental factors to be -0.22. Heritability was estimated to 0.34 and 0.72 for MDD and LS, respectively.

LIMITATIONS

The sample consists of twins only and there are limitations associated with the twin design.

CONCLUSIONS

Whereas genetic influences on vulnerability to lifetime MDD are considerably shared with liability to (low) LS, environmental influences are more distinct. Thus, environmental factors associated with risk of MDD do not strongly impact on dispositional LS, and conversely, environmental factors influencing dispositional LS do not strongly buffer against MDD.