Population-Based Epidemiologic Research

National Institute Of Mental Health

Investigators

Linked publications & trials

Abstract

We continue to leverage the National Comorbidity Survey (NCS-A) for its rich information on risk factors to expand the scientific knowledge base that can be used to inform prevention efforts. We examined the association between empirically-derived profiles of mood and anxiety syndromes with physical conditions in a nationally-representative sample of US adolescents (Stapp et al, 2021), and detected consistent associations between mood and anxiety profiles and physical conditions. We found that heart problems and pain-related conditions such as back pain and headache were differentially associated with specific mood-anxiety profiles. Findings suggest that subtyping depression and anxiety inclusive of subthreshold syndromes and patterns of clustering may facilitate etiologic and intervention work in multimorbidity. We also collaborated on a publication with our colleagues from Lausanne, Switzerland using data from an ongoing high-risk family study of mood disorders. Here, we assessed the associations of parental bipolar disorder (BD) and major depressive disorder (MDD) with individual or shared family environmental factors, including traumatic events on offspring, parental separation, family cohesion/parent attitudes, and tested if these factors were mediators of the association between exposure to parental mood disorders and the onset of these disorders in offspring (Moulin et al, 2022). While the findings did not indicate a role for environmental factors in the parent-to-child transmission of BD, traumatic events partially mediate the parent-child transmission of early-onset MDD. This finding, along with our research reported above and in our Family Study program, documents the importance of specificity and comorbidity in the etiology of mood and anxiety disorders. A substantial proportion of our work this year was devoted to harnessing data available through our connection with researchers at the Child Mind Institute (CMI), with whom we collaborate on publications from the Healthy Brain Network (HBN) study. Through collaborations with CMI, we helped establish the CRISIS Consortium and developed and validated a survey to measure the mental, physical, and behavioral health impacts of the pandemic (Coronavirus Health Impact Survey, CRISIS; www.crisissurvey.org). This survey has subsequently been used in numerous research studies and translated into multiple languages. We have conducted several projects that leverage these rich data to study important questions regarding the effects of the COVID-19 pandemic on youth mental and behavioral health, and we plan to incorporate the CRISIS into our new data collection plans within the Family Study program. Over the last year we examined data from a longitudinal cohort study where CRISIS was collected at 3 pandemic time points (April 2020, May 2020, and November 2020) for adults and children in the US and UK (Nikolaidis et al, 2022/2021). We studied the influence of predictors of mental health symptoms after the initial phase of the pandemic and evaluated the prospective influence of life change stress, personal COVID-19 impact, prior mental health, worry about COVID-19, state-level indicators of pandemic threat, and socio-demographic factors. For both adults and children, the most informative predictors of mood symptoms at follow-up were prior mood and perceived mental health, worries about COVID, and sources of life change, and for children, lifestyle change stress regarding friendships being more predictive of mood outcomes than worries about COVID. Further research on patterns of pandemic experience may elucidate modifiable targets for treatment and prevention. We also used CRISIS data collected through HBN approximately 1 year after the initial pandemic to study associations between mental disorders and COVID-19 risk-mitigation practices among youth aged 5-21 (Conway et al, 2022). We found that youth with anxiety disorders were more likely to avoid high-risk exposure settings, and those with ADHD (combined type) were less likely to follow hygiene practices. In contrast, mask wearing was not associated with youth mental disorders. Findings suggested that education and monitoring of risk-mitigation strategies in certain subgroups of youth may reduce risk of exposure to COVID-19 and other contagious diseases, and highlight the need for greater attention to vaccine prioritization for individuals with ADHD. Finally, we published an invited commentary discussing the importance of psychiatric epidemiology to understand links between military service and mental health (Merikangas & Conway, 2021). We evaluated the initial findings from the Canadian Armed Forces Members and Veterans Mental Health Follow-up Survey (CAFVMHS), the first longitudinal survey of Canadian military and veterans that tracked a representative sample of Canadian military personnel. The most important conclusion of this rich series of studies was their clear documentation that military personnel and veterans in Canada are at heightened risk for experiencing traumatic events both before and after deployment that strongly increased the risk for mental disorders. Aside from noting key methodological strengths and limitations, we called for prioritizing research to inform effective intervention to help improve mental health across the world, including the health of our military personnel, veterans, and their loved ones. Public Health Impact: The investigation of risk factors during development, which the NCS-A makes possible, is extremely important in mental health because many cases of psychiatric disorder first arise during or prior to young adulthood and because brain development is implicated in the etiology of many psychiatric disorders. Our studies of physical-mental comorbidity and sleep in adolescents and adults complement our family study work on the importance of physiological systems and behavioral rhythms in mental health and contribute to scientific understanding of psychiatric disorder etiology and opportunities for prevention. Our work to understand the core clinical domains underlying BD complements our other research programs and will ultimately aid in treatment and prevention by informing disorder etiology. Our recently established CRISIS Consortium and continued collaboration with HBN will further our opportunity to conduct research aimed at reducing the adverse consequences of the COVID-19 pandemic and other influences on mental health problems among youth, which may have life-long positive benefit. Future Plans: We plan to continue our activity in the CRISIS Consortium and the HBN study with intensive analysis of collected data on clinical features, risk factors, and impairment. We are also helping to design and implement a prospective follow-up of select HBN participants that will provide longitudinal information on patterns of symptoms, behaviors, and risk across time during development. We also expect to continue publishing population-based studies related the themes of: 1) the intersection between physical and mental health, 2) the relationship between health behaviors such as sleep and activity and psychiatric disorders, 3) the influence of environmental and social exposures among children and youth; 4) associations between sleep, physical activity and mood disorders; and 5) subtypes of depression, mania and their core components.