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Background Sexual minority status is associated with face-to-face bullying and cyberbullying victimization. However, limited studies have investigated whether such a relationship differs by sex or grade in a nationally representative sample. Methods We concatenated the national high school data from the Youth Risk Behavior Surveillance System (YRBSS) chronologically from 2015 to 2019, resulting in a sample of 32,542 high school students. We constructed models with the interaction term between sexual minority status and biological sex assigned at birth to test the effect modification by sex on both the multiplicative and additive scales. A similar method was used to test the effect modification by grade. Results Among heterosexual students, females had a higher odds of being bullied than males, while among sexual minority students, males had a higher odds of being bullied. The effect modification by sex was significant on both the multiplicative and additive scales. We also found a decreasing trend of bullying victimization as the grade increased among both heterosexual and sexual minority students. The effect modification by the grade was significant on both the multiplicative and the additive scale. Conclusions Teachers and public health workers should consider the difference in sex and grade when designing prevention programs to help sexual minority students.

Purpose There has been no comprehensive examination of how race/ethnicity and nativity intersect in explaining differences in lifetime prevalence of mental disorders among Asian, Black, Latino, and White adults. This study aims to estimate racial/ethnic differences in lifetime risk of mental disorders and examine how group differences vary by nativity. Methods Survival models were used to estimate racial/ethnic and nativity differences in lifetime risk of DSM-IV anxiety, mood, and substance use disorders in a nationally representative sample of over 20,000 respondents to four US surveys. Results Asians had the lowest lifetime prevalence of mental disorders (23.5%), followed by Blacks (37.0%), Latinos (38.8%), and Whites (45.6%). Asians and Blacks had lower lifetime risk than Whites for all disorders even after adjusting for nativity; Latinos and Whites had similar risk after adjusting for nativity. Risk of disorder onset was lowest for foreign-born respondents in years before migration. There were significant race/ethnicity and nativity interactions for mood and substance use disorders. Odds of mood disorder onset were higher for Whites with at least one US-born parent. Odds of substance use disorder onset among Asians were higher for US-born respondents; for Latinos, they were higher for those with at least one US-born parent. Conclusions Parental foreign-born nativity is associated with a low risk of mental disorders, but not uniformly across racial/ethnic groups or disorders. Exposure to the US context may be associated with greater mental disorder risk for Latinos and Whites particularly. Investigations of cultural processes, including among Whites, are needed to understand group differences.

Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders. Data were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence. Non-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels. Nativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites. •Non-Latino Whites most likely to have 12-month disorders, even with SES controls.•Link between race/ethnicity and mood disorder varied by nativity among Whites.•Race/ethnicity interacted with education, but not income, to predict prevalence.•Racial/ethnic minority groups had more persistent mood disorders than Whites.•Observed links to persistent mood and substance disorders varied by education level.

There is growing interest in using composite individualized treatment rules (ITRs) to guide depression treatment selection, but best approaches for doing this are not widely known. We develop an ITR for depression remission based on secondary analysis of a recently published trial for second-line antidepression medication selection using a cutting-edge ensemble machine learning method. Data come from the SUN(^_^)D trial, an open-label, assessor blinded pragmatic trial of previously-untreated patients with major depressive disorder from 48 clinics in Japan. Initial clinic-level randomization assigned patients to 50 or 100 mg/day sertraline. We focus on the 1549 patients who failed to remit within 3 weeks and were then rerandomized at the individual-level to continuation with sertraline, switching to mirtazapine, or combining mirtazapine with sertraline. The outcome was remission 9 weeks post-baseline. Predictors included socio-demographics, clinical characteristics, baseline symptoms, changes in symptoms between baseline and week 3, and week 3 side effects. Optimized treatment was associated with significantly increased cross-validated week 9 remission rates in both samples [5.3% (2.4%), = 0.016 50 mg/day sample; 5.1% (2.7%), = 0.031 100 mg/day sample] compared to randomization (30.1-30.8%). Optimization was also associated with significantly increased remission in both samples compared to continuation [24.7% in both: 11.2% (3.8%), = 0.002 50 mg/day sample; 11.7% (3.9%), = 0.001 100 mg/day sample]. Non-significant gains were found for optimization compared to switching or combining. An ITR can be developed to improve second-line antidepressant selection, but replication in a larger study with more comprehensive baseline predictors might produce stronger and more stable results.

Background Low socioeconomic status is associated with lower cognitive performance and long‐term disparities in achievement and success. However, not all children from low‐income backgrounds exhibit lower cognitive performance. Characterizing the factors that promote such resilience in youth from low‐income households is of crucial importance. Methods We used baseline data from participants in the lowest tertile of income‐to‐needs in the Adolescent Brain Cognitive Development study and machine learning to identify the factors that predict fluid and crystallized cognitive resilience among youth from low‐income backgrounds. Predictors included 164 variables across child characteristics, family and developmental history, and environment. Results Our models were reliably able to predict resilience but were substantially more accurate for crystallized cognition (AUC = 0.75) than for fluid cognition (AUC = 0.67). Key predictors included developmental factors such as birthweight and duration of breastfeeding, neighborhood‐level factors (e.g., living in concentrated privilege, enrollment in advanced placement courses), children's own temperament and mental health, and other factors such as physical activity and involvement in extracurricular activities. Conclusion Our findings highlight the importance of a multifaceted approach to promoting cognitive resilience among children from low‐income households in future intervention work. Machine learning based prediction of cognitive resilience among low income youth.

Objectives To develop a composite score for differential resilience to effects of combat‐related stressors (CRS) on persistent DSM‐IV post‐traumatic stress disorder (PTSD) among US Army combat arms soldiers using survey data collected before deployment. Methods A sample of n = 2542 US Army combat arms soldiers completed a survey shortly before deployment to Afghanistan and then again two to three and 8–9 months after redeployment. Retrospective self‐reports were obtained about CRS. Precision treatment methods were used to determine whether differential resilience to persistent PTSD in the follow‐up surveys could be developed from pre‐deployment survey data in a 60% training sample and validated in a 40% test sample. Results 40.8% of respondents experienced high CRS and 5.4% developed persistent PTSD. Significant test sample heterogeneity was found in resilience (t = 2.1, p = 0.032), with average treatment effect (ATE) of high CRS in the 20% least resilient soldiers of 17.1% (SE = 5.5%) compared to ATE = 3.8% (SE = 1.2%) in the remaining 80%. The most important predictors involved recent and lifetime pre‐deployment distress disorders. Conclusions A reliable pre‐deployment resilience score can be constructed to predict variation in the effects of high CRS on persistent PTSD among combat arms soldiers. Such a score could be used to target preventive interventions to reduce PTSD or other resilience‐related outcomes.

This study examines racial/ethnic differences in perceived need for mental health treatment, barriers to treatment receipt, and reasons for dropout. Data are from the Collaborative Psychiatric Epidemiology Studies, a pooled dataset from three U.S. nationally-representative adult samples. Among respondents with a 12-month psychiatric disorder who received no treatment (N = 1417), Asians and Latinos reported lower perceived need than Blacks and Whites, and Latinos reported the fewest attitudinal barriers. Among those with a 12-month disorder who dropped out of treatment, Asians and Latinos gave more reasons for dropping out. Significant interactions of race/ethnicity with other characteristics identified subpopulations with high unmet need.

Purpose Delaying high school start times prolongs weekday sleep. However, it is not clear if longer sleep reduces depression symptoms and if the impact of such policy change is the same across groups of adolescents. Methods We examined how gains in weekday sleep impact depression symptoms in 2,134 high school students (mean age 15.16 ± 0.35 years) from the Minneapolis metropolitan area. Leveraging a natural experiment design, we used the policy change to delay school start times as an instrument to estimate the effect of a sustained gain in weekday sleep on repeatedly measured Kandel-Davies depression symptoms. We also evaluated whether allocating the policy change to subgroups with expected benefit could improve the impact of the policy. Results Over 2 years, a sustained half-hour gain in weekday sleep expected as a result of the policy change to delay start times decreased depression symptoms by 0.78 points, 95%CI (-1.32,-0.28), or 15.6% of a standard deviation. The benefit was driven by a decrease in fatigue and sleep-related symptoms. While symptoms of low mood, hopelessness, and worry were not affected by the policy on average, older students with greater daily screen use and higher BMI experienced greater improvements in mood symptoms than would be expected on average, signaling heterogeneity. Nevertheless, universal implementation outperformed prescriptive strategies. Conclusion High school start time delays are likely to universally decrease fatigue and overall depression symptoms in adolescents. Students who benefit most with respect to mood are older, spend more time on screens and have higher BMI.

The prevalence of mental disorders among Black, Latino, and Asian adults is lower than among Whites. Factors that explain these differences are largely unknown. We examined whether racial/ethnic differences in exposure to traumatic events (TEs) or vulnerability to trauma-related psychopathology explained the lower rates of psychopathology among racial/ethnic minorities. We estimated the prevalence of TE exposure and associations with onset of DSM-IV depression, anxiety and substance disorders and with lifetime post-traumatic stress disorder (PTSD) in the Collaborative Psychiatric Epidemiology Surveys, a national sample (N = 13 775) with substantial proportions of Black (35.9%), Latino (18.9%), and Asian Americans (14.9%). TE exposure varied across racial/ethnic groups. Asians were most likely to experience organized violence - particularly being a refugee - but had the lowest exposure to all other TEs. Blacks had the greatest exposure to participation in organized violence, sexual violence, and other TEs, Latinos had the highest exposure to physical violence, and Whites were most likely to experience accidents/injuries. Racial/ethnic minorities had lower odds ratios of depression, anxiety, and substance disorder onset relative to Whites. Neither variation in TE exposure nor vulnerability to psychopathology following TEs across racial/ethnic groups explained these differences. Vulnerability to PTSD did vary across groups, however, such that Asians were less likely and Blacks more likely to develop PTSD following TEs than Whites. Lower prevalence of mental disorders among racial/ethnic minorities does not appear to reflect reduced vulnerability to TEs, with the exception of PTSD among Asians. This highlights the importance of investigating other potential mechanisms underlying racial/ethnic differences in psychopathology.

Adolescence is a time marked by physiological change and dynamic socioemotional development. It is also a period of changes to sleep patterns and a sharp increase in incident psychiatric conditions. Nationally representative data on high school students shows a rise in persistent feelings of depression and anxiety and alarming increases in suicidal ideation and attempts in the past decade. The work presented in this dissertation examines influences of early life adversity, pubertal timing, and sleep on adolescent psychiatric health and suggests an effective structural intervention to interrupt the chain of vulnerability to distress psychopathology among youth. Specifically, this dissertation aims to examine: 1) which developmental phenotypes most saliently mediate the relationship between early life adverse experiences and adolescent psychopathology; 2) how pubertal timing impacts sleep and depressed mood over the course of adolescence; and 3) how a structural policy to delay high school start times affects adolescent depression symptoms by prolonging weeknight sleep. The first study (Chapter 2) utilized an extensively characterized longitudinal sample of children to examine relative contributions of cognitive, affective, and developmental phenotypes as mediating mechanisms linking early-life adversity to adolescent psychopathology. While there is rich literature describing theory and evidence for consequences of early-life adversity, an empirical approach has not been to date applied to select mediators with the strongest relationships to dimensions of adversity – threat and deprivation – and adolescent externalizing and internalizing psychopathology symptoms. We used a high-dimensional mediation algorithm to narrow in on the strongest mechanisms from a set of 15 phenotypes. Blunted reward sensitivity mediated threat’s relationship to internalizing psychopathology. Early pubertal timing emerged as a robust predictor of greater internalizing and externalizing symptoms prospectively, although associations between pubertal timing and adversity expected based on prior literature were not identified. The second study (Chapter 3) interrogated the relationship between pubertal timing and depression symptoms, and examined sleep, which fundamentally changes during puberty, as a potential mechanism. We demonstrated temporal differences in associations between pubertal timing and depressed mood by sex but identified a sex-invariant mechanism by which earlier pubertal stage (specifically, more advanced pubic hair development, or adrenarche) impacts depression symptoms in late adolescence via a sustained loss of weeknight sleep duration. In the final study (Chapter 4), we leveraged a natural experiment of a high school start time delay to evaluate the effect of extended weeknight sleep duration on depressed mood over two years of follow-up. The delay decreased overall depression symptoms, in large part due to a substantial improvement in the fatigue and sleep-related cluster of symptoms. While the delay policy had no overall impact on the cluster of low mood and worry symptoms, we identified significant heterogeneity in the policy’s effect. Older students, who were heavier and aiming to lose weight, who exercised less, spent more time on screens, and consumed more caffeine saw greater improvements in mood than would be expected on average. Nonetheless, universal delay policy adoption was notably superior to attempts to optimize the policy to subgroups who benefit most, identifying the policy to delay high school start time as a potential structural intervention to safeguard adolescent mental health.The work assembled in this dissertation contributes to the epidemiologic literature on developmental risk factors for adolescent psychopathology by focusing largely on the impacts of pubertal timing and sleep health – understudied risk factors for depression symptoms in adolescent years. Together, the three studies suggest that structurally safeguarding adequate weeknight sleep duration in adolescence may improve population-level depression outcomes.