- Email: [email protected]
207. Problematic Internet Use (PIU) and Its Relationship with Suicidality in Adolescents
Biological Psychiatry
Thursday Abstracts
205. Strangulation during Sexual Assault Predicts Increased PTSD Symptoms Six Weeks after Assault Jenyth Sullivan1, Byron Maltez2, April Soward2, Teresa D'Anza3, Kathy Bell4, Lynn Galloway4, Megan Lechner5, Aryn Gieger-Sedgwick6, Michelle Metz7, Jeffrey Ho8, Catherine Rossi9, Kimberly Hurst10, Ralph Riviello11, Amanda Corzine12, Theresa Moriarty13, and Samuel McLean2 1
Institute for Trauma Recovery, University of North Carolina at Chapel Hill, 2Institute for Trauma Recovery, 3Albuquerque SANE Collaborative, 4Tulsa Forensic Nursing Services, 5 Memorial Health System, 6Crisis Center of Birmingham, 7 Denver Health, 8Hennepin County Medical Center SARS, 9 Cone Health System, 10Wayne County SAFE, 11Philadelphia SARC, 12KentuckyOne Health Safe Services, 13MedStar Health Research Institute Background: Sexual assault (SA) is common, but to date no large multisite prospective studies of SA survivors have been performed, and little data exists regarding the relationship between assault characteristics and outcomes. Methods: Women SA survivors $18 years of age who presented within 72 hours of assault to one of the 12 US sites in the Better Tomorrow Network were enrolled. Participants completed a short survey at time of the initial SANE exam and follow-up surveys at 1 week, 6 weeks, 6 months and 1 year. Assault-related characteristics were obtained from the medical record. Outcome assessments included PTSD symptom assessment (DSM-IV PCL) at six weeks. Results: To date in this ongoing study, 299 and 189 SA survivors have completed initial and full study enrollment, 96 SA survivors had medical record data extracted and entered, and 85/96 (89%) have reached/completed six-week follow-up (mean (SD) age 5 28 (9.6)). In general, among SA survivors there was little association between PTSD symptom severity at six weeks and the presence or absence of specific assault-related characteristics [drug-facilitated sexual assault (31/85, 37%), known assailant (49/85, 58%), assailant possession of weapon (9/85, 11%)], with point estimate differences in PTSD severity with or without particular assault-related characteristics being much smaller than the 10 point threshold for a clinically significant change in the PCL. Strangulation during assault (16/85, 19%) was associated with significantly higher PTSD symptoms at six weeks [57.8 (17.4) vs. 47.6 (16.8), p , 0.05]. Conclusions: Strangulation-associated SA, but not other SArelated characteristics, predict increased PTSD symptoms six weeks after assault. Supported By: R01AR064700 Keywords: PTSD, Sexual Assault, Strangulation
206. Post Traumatic Stress Disorder Outcomes at Six Months in African Americans Vs. European Americans Experiencing Motor Vehicle Collison Aditi Borde1, Michael Bien1, Sean Flannigan1, April Soward1, Michael Kurz2, Phyllis Hendry3, Erin Zimny4, Christopher Lewandowski4, Marc-Anthony Velilla5,
Kathia Damiron6, Claire Pearson7, Robert Domeier8, Sangeeta Kaushik9, James Feldman10, Mark Rosenberg11, Jeffrey Jones12, Robert Swor13, Niels Rathlev14, David Peak15, David Lee16, and Samuel McLean1 1
Institute for Trauma Recovery, University of North Carolina at Chapel Hill, 2University of Alabama Birmingham, 3 University of Florida College of Medicine – Jacksonville, 4 Henry Ford Hospital, 5Sinai Grace Hospital, 6Albert Einstein Medical Center, 7Detroit Receiving Hospital, 8St Joseph Mercy Health System, 9MedStar Washington Hospital Center, 10Boston Medical Center, 11St Joseph Healthcare System, 12Spectrum Health, 13Beaumont Hospital, 14Baystate Health, 15Massachusetts General Hospital, 16North Shore University Hospital Background: Motor vehicle collision (MVC) is one of the most common life-threatening events experienced by US civilians. To our knowledge, no prospective studies have compared PTSD outcomes in African Americans (AAs) vs. European Americans (EAs) experiencing MVC. Methods: Two sister studies enrolled AAs and EAs presenting to one of 16 emergency departments (EDs) in 9 states within 24 hours of MVC who did not require hospital admission; study protocols of the two studies were nearly identical. ED evaluation included the assessment of sociodemographic characteristics; 6-month follow-up assessment included an evaluation of PTSD symptoms (IES-R; score $33 defined clinically significant PTSD symptoms). Binomial logistic regression analysis was used to evaluate potential ethnic differences in clinically significant PTSD symptoms, adjusting for individual sociodemographic factors. Results: A total of 1855 participants were enrolled (907 (49%) AA, 948 (51%) EA). Six-month follow-up was completed on 786/907 (87%) AA and 834/948 (88%) EA. Six months after the MVC, clinically significant MVC-related PTSD symptoms were much more common in AAs than EAs [295/786 (38%) AA vs. 122/834 (15%) EA]. After adjustment for individual sociodemographic differences (age, sex, education, income, and employment), ethnicity remained a strong predictor of increased PTSD risk (RR 5 2.074, 95% CI 1.66 to 2.59). Conclusions: These findings suggest that African Americans are at an increased risk of developing clinically significant PTSD symptoms after MVC, even after adjusting for a range of sociodemographic characteristics. Further studies are needed to better understand reasons for ethnic differences in PTSD outcomes after MVC. Supported By: R01AR060852; R01AR056328 Keywords: PTSD - Posttraumatic Stress Disorder, motor vehicle collision, Ethnicity
207. Problematic Internet Use (PIU) and Its Relationship with Suicidality in Adolescents Edith Jolin1 and Ronald Weller2 Boston University School of Medicine, 2Department of Psychiatry, University of Pennsylvania
1
Background: PIU has been associated with depression in adolescents. Suicidality is a serious, potentially life-threatening
Biological Psychiatry May 15, 2017; 81:S1–S139 www.sobp.org/journal
S85
Biological Psychiatry
Thursday Abstracts
symptom of adolescent depression. Thus, understanding the relationship of suicidality with PIU has clinical significance. Methods: PubMed, PsycINFO, and Web of Science were searched from inception through October, 2016 using the key words Internet addiction, problematic Internet use, pathological Internet use, and heavy/excessive Internet use combined with the terms suicide, suicidal ideation/attempts/ behavior. For inclusion, studies had to be in English, have at least 100 subjects, and have a mean age of 18 years or less. Effect sizes were calculated from published data. Results: 11 cross-sectional studies, 1 case control study, and 1 longitudinal study met inclusion criteria and had a total of 284,405 unique subjects. Seven studies were conducted in Asia, 4 in Europe, 1 in Australia, and 1 in the United States. PIU and suicidality were assessed using 7 and 9 different self-report measures respectively across 13 studies. 5 studies assessed suicidal ideation only, 2 studies assessed attempts only, and 6 studies assessed both. 11 crosssectional studies found a significant association between PIU and suicidality, but the case control study did not. The longitudinal study was not significant in its final analysis possibly due to a high attrition rate at follow-up. Effect sizes were typically small. Conclusions: Conclusion: Although methodology varied considerably among studies, most of these early studies supported a positive relationship between PIU and suicidality. Further longitudinal study with improved methodology is needed to determine whether PIU is causally related to suicidality. Keywords: problematic Internet use, Suicidal ideation, suicide attempts, suicidality, adolescents
208. The Contribution of Attention-Deficit/Hyperactivity Disorder Common Genetic Risk Variants to Childhood Irritability: Evidence from Clinical and Population Cohorts Olga Eyre1, Lucy Riglin1, Miriam Cooper1, Stephan Collishaw1, Joanna Martin1, Kate Langley1, Ellen Leibenluft2, Argyris Stringaris2, Ajay Thapar1, Barbara Maughan3, Michael O'Donovan1, and Anita Thapar1 1
Cardiff University, 2NIMH, 3Kings College London
Background: Severe, childhood irritability is a common feature of neurodevelopmental disorders including Attention-Deficit/ Hyperactivity Disorder (ADHD). Twin studies suggest that ADHD and irritability share genetic aetiology. However, other studies have highlighted genetic and longitudinal links between childhood irritability and later depression. This study aimed to test whether common genetic variants associated with ADHD diagnosis, indexed by polygenic risk scores (PRS), were associated with childhood irritability. Methods: Three UK samples were utilised: two populationbased (n5 14,701 and 17,000) and one clinical ADHD sample (n5696). ADHD polygenic risk scores were derived from the largest published ADHD genome-wide association data-set (5,621 cases and 13,589 controls) and generated in each sample. Associations between ADHD PRS and parent rated presence/absence of childhood irritability were examined.
S86
Results: In both population-based samples the prevalence of irritability decreased from childhood (age 7) to adolescence (age 15/16) in males, and increased in females; childhood irritability was more likely to be present in males than females. ADHD PRS were associated with presence of childhood irritability in all three samples (population based samples: OR51.08, 95% CI51.01-1.14, p50.018 and OR51.13, 95% CI51.02-1.25, p50.025, clinical sample: OR51.38, 95% CI51.31-1.85, p50.030). The associations were no longer significant on reaching adolescence in the population based-samples. Conclusions: ADHD genetic risk may have pleiotropic effects on childhood irritability. Further work is needed to better understand the nature of the relationship between irritability and ADHD, including the possibility that, in childhood, irritability is a neurodevelopmental difficulty. Supported By: Wellcome Trust, Medical Research Council Keywords: ADHD, Irritability, Childhood, Polygenic Risk Score
209. Parental Age and Offspring Neurocognitive Performance in the Philadelphia Neurodevelopmental Cohort Alison Merikangas1, Monica Calkins2, Warren Bilker2, Tyler Moore2, Ruben Gur2, and Raquel Gur2 1
National Institute of Mental Health, 2University of Pennsylvania
Background: There is now abundant evidence that parental age is associated with neurodevelopmental and behavioral disorders in offspring; however, the mechanism for these associations is unknown. A potential explanation for these associations is impaired cognitive function. The aim of this research is to examine the associations between parental age and neurocognitive performance in offspring in a communitybased sample of adolescents. Methods: 8725 youths (ages 8-21 years, one child per family) from the Philadelphia Neurodevelopmental Cohort completed the University of Pennsylvania Computerized Neurocognitive Battery (CNB) that assessed the accuracy and response time of task performance across four domains (complex cognition, episodic memory, executive function, social cognition). Crude and adjusted regression models with parental age predicting offspring neurocognitive performance for demographic factors (age, sex, race of the participant) and social environment (parental education and a proxy for SES). Results: Increases in parental, maternal, and paternal ages were associated with greater accuracy and speed of all cognitive domains in unadjusted models, except for the speed of episodic memory. After adjustment for demographic factors and the social environment, the only significant associations were between maternal and parental age and the speed of complex cognition. Conclusions: To our knowledge, this is the largest study in the US to examine parental age and multiple domains of neurocognition in adolescents. These data extend previous research to a community-based sample of youth, and demonstrate that the association between parental age and neurocognitive function may reflect parental and familial environmental factors rather than biologic and genetic factors associated with increased parental age.
Biological Psychiatry May 15, 2017; 81:S1–S139 www.sobp.org/journal
Thursday Abstracts
205. Strangulation during Sexual Assault Predicts Increased PTSD Symptoms Six Weeks after Assault Jenyth Sullivan1, Byron Maltez2, April Soward2, Teresa D'Anza3, Kathy Bell4, Lynn Galloway4, Megan Lechner5, Aryn Gieger-Sedgwick6, Michelle Metz7, Jeffrey Ho8, Catherine Rossi9, Kimberly Hurst10, Ralph Riviello11, Amanda Corzine12, Theresa Moriarty13, and Samuel McLean2 1
Institute for Trauma Recovery, University of North Carolina at Chapel Hill, 2Institute for Trauma Recovery, 3Albuquerque SANE Collaborative, 4Tulsa Forensic Nursing Services, 5 Memorial Health System, 6Crisis Center of Birmingham, 7 Denver Health, 8Hennepin County Medical Center SARS, 9 Cone Health System, 10Wayne County SAFE, 11Philadelphia SARC, 12KentuckyOne Health Safe Services, 13MedStar Health Research Institute Background: Sexual assault (SA) is common, but to date no large multisite prospective studies of SA survivors have been performed, and little data exists regarding the relationship between assault characteristics and outcomes. Methods: Women SA survivors $18 years of age who presented within 72 hours of assault to one of the 12 US sites in the Better Tomorrow Network were enrolled. Participants completed a short survey at time of the initial SANE exam and follow-up surveys at 1 week, 6 weeks, 6 months and 1 year. Assault-related characteristics were obtained from the medical record. Outcome assessments included PTSD symptom assessment (DSM-IV PCL) at six weeks. Results: To date in this ongoing study, 299 and 189 SA survivors have completed initial and full study enrollment, 96 SA survivors had medical record data extracted and entered, and 85/96 (89%) have reached/completed six-week follow-up (mean (SD) age 5 28 (9.6)). In general, among SA survivors there was little association between PTSD symptom severity at six weeks and the presence or absence of specific assault-related characteristics [drug-facilitated sexual assault (31/85, 37%), known assailant (49/85, 58%), assailant possession of weapon (9/85, 11%)], with point estimate differences in PTSD severity with or without particular assault-related characteristics being much smaller than the 10 point threshold for a clinically significant change in the PCL. Strangulation during assault (16/85, 19%) was associated with significantly higher PTSD symptoms at six weeks [57.8 (17.4) vs. 47.6 (16.8), p , 0.05]. Conclusions: Strangulation-associated SA, but not other SArelated characteristics, predict increased PTSD symptoms six weeks after assault. Supported By: R01AR064700 Keywords: PTSD, Sexual Assault, Strangulation
206. Post Traumatic Stress Disorder Outcomes at Six Months in African Americans Vs. European Americans Experiencing Motor Vehicle Collison Aditi Borde1, Michael Bien1, Sean Flannigan1, April Soward1, Michael Kurz2, Phyllis Hendry3, Erin Zimny4, Christopher Lewandowski4, Marc-Anthony Velilla5,
Kathia Damiron6, Claire Pearson7, Robert Domeier8, Sangeeta Kaushik9, James Feldman10, Mark Rosenberg11, Jeffrey Jones12, Robert Swor13, Niels Rathlev14, David Peak15, David Lee16, and Samuel McLean1 1
Institute for Trauma Recovery, University of North Carolina at Chapel Hill, 2University of Alabama Birmingham, 3 University of Florida College of Medicine – Jacksonville, 4 Henry Ford Hospital, 5Sinai Grace Hospital, 6Albert Einstein Medical Center, 7Detroit Receiving Hospital, 8St Joseph Mercy Health System, 9MedStar Washington Hospital Center, 10Boston Medical Center, 11St Joseph Healthcare System, 12Spectrum Health, 13Beaumont Hospital, 14Baystate Health, 15Massachusetts General Hospital, 16North Shore University Hospital Background: Motor vehicle collision (MVC) is one of the most common life-threatening events experienced by US civilians. To our knowledge, no prospective studies have compared PTSD outcomes in African Americans (AAs) vs. European Americans (EAs) experiencing MVC. Methods: Two sister studies enrolled AAs and EAs presenting to one of 16 emergency departments (EDs) in 9 states within 24 hours of MVC who did not require hospital admission; study protocols of the two studies were nearly identical. ED evaluation included the assessment of sociodemographic characteristics; 6-month follow-up assessment included an evaluation of PTSD symptoms (IES-R; score $33 defined clinically significant PTSD symptoms). Binomial logistic regression analysis was used to evaluate potential ethnic differences in clinically significant PTSD symptoms, adjusting for individual sociodemographic factors. Results: A total of 1855 participants were enrolled (907 (49%) AA, 948 (51%) EA). Six-month follow-up was completed on 786/907 (87%) AA and 834/948 (88%) EA. Six months after the MVC, clinically significant MVC-related PTSD symptoms were much more common in AAs than EAs [295/786 (38%) AA vs. 122/834 (15%) EA]. After adjustment for individual sociodemographic differences (age, sex, education, income, and employment), ethnicity remained a strong predictor of increased PTSD risk (RR 5 2.074, 95% CI 1.66 to 2.59). Conclusions: These findings suggest that African Americans are at an increased risk of developing clinically significant PTSD symptoms after MVC, even after adjusting for a range of sociodemographic characteristics. Further studies are needed to better understand reasons for ethnic differences in PTSD outcomes after MVC. Supported By: R01AR060852; R01AR056328 Keywords: PTSD - Posttraumatic Stress Disorder, motor vehicle collision, Ethnicity
207. Problematic Internet Use (PIU) and Its Relationship with Suicidality in Adolescents Edith Jolin1 and Ronald Weller2 Boston University School of Medicine, 2Department of Psychiatry, University of Pennsylvania
1
Background: PIU has been associated with depression in adolescents. Suicidality is a serious, potentially life-threatening
Biological Psychiatry May 15, 2017; 81:S1–S139 www.sobp.org/journal
S85
Biological Psychiatry
Thursday Abstracts
symptom of adolescent depression. Thus, understanding the relationship of suicidality with PIU has clinical significance. Methods: PubMed, PsycINFO, and Web of Science were searched from inception through October, 2016 using the key words Internet addiction, problematic Internet use, pathological Internet use, and heavy/excessive Internet use combined with the terms suicide, suicidal ideation/attempts/ behavior. For inclusion, studies had to be in English, have at least 100 subjects, and have a mean age of 18 years or less. Effect sizes were calculated from published data. Results: 11 cross-sectional studies, 1 case control study, and 1 longitudinal study met inclusion criteria and had a total of 284,405 unique subjects. Seven studies were conducted in Asia, 4 in Europe, 1 in Australia, and 1 in the United States. PIU and suicidality were assessed using 7 and 9 different self-report measures respectively across 13 studies. 5 studies assessed suicidal ideation only, 2 studies assessed attempts only, and 6 studies assessed both. 11 crosssectional studies found a significant association between PIU and suicidality, but the case control study did not. The longitudinal study was not significant in its final analysis possibly due to a high attrition rate at follow-up. Effect sizes were typically small. Conclusions: Conclusion: Although methodology varied considerably among studies, most of these early studies supported a positive relationship between PIU and suicidality. Further longitudinal study with improved methodology is needed to determine whether PIU is causally related to suicidality. Keywords: problematic Internet use, Suicidal ideation, suicide attempts, suicidality, adolescents
208. The Contribution of Attention-Deficit/Hyperactivity Disorder Common Genetic Risk Variants to Childhood Irritability: Evidence from Clinical and Population Cohorts Olga Eyre1, Lucy Riglin1, Miriam Cooper1, Stephan Collishaw1, Joanna Martin1, Kate Langley1, Ellen Leibenluft2, Argyris Stringaris2, Ajay Thapar1, Barbara Maughan3, Michael O'Donovan1, and Anita Thapar1 1
Cardiff University, 2NIMH, 3Kings College London
Background: Severe, childhood irritability is a common feature of neurodevelopmental disorders including Attention-Deficit/ Hyperactivity Disorder (ADHD). Twin studies suggest that ADHD and irritability share genetic aetiology. However, other studies have highlighted genetic and longitudinal links between childhood irritability and later depression. This study aimed to test whether common genetic variants associated with ADHD diagnosis, indexed by polygenic risk scores (PRS), were associated with childhood irritability. Methods: Three UK samples were utilised: two populationbased (n5 14,701 and 17,000) and one clinical ADHD sample (n5696). ADHD polygenic risk scores were derived from the largest published ADHD genome-wide association data-set (5,621 cases and 13,589 controls) and generated in each sample. Associations between ADHD PRS and parent rated presence/absence of childhood irritability were examined.
S86
Results: In both population-based samples the prevalence of irritability decreased from childhood (age 7) to adolescence (age 15/16) in males, and increased in females; childhood irritability was more likely to be present in males than females. ADHD PRS were associated with presence of childhood irritability in all three samples (population based samples: OR51.08, 95% CI51.01-1.14, p50.018 and OR51.13, 95% CI51.02-1.25, p50.025, clinical sample: OR51.38, 95% CI51.31-1.85, p50.030). The associations were no longer significant on reaching adolescence in the population based-samples. Conclusions: ADHD genetic risk may have pleiotropic effects on childhood irritability. Further work is needed to better understand the nature of the relationship between irritability and ADHD, including the possibility that, in childhood, irritability is a neurodevelopmental difficulty. Supported By: Wellcome Trust, Medical Research Council Keywords: ADHD, Irritability, Childhood, Polygenic Risk Score
209. Parental Age and Offspring Neurocognitive Performance in the Philadelphia Neurodevelopmental Cohort Alison Merikangas1, Monica Calkins2, Warren Bilker2, Tyler Moore2, Ruben Gur2, and Raquel Gur2 1
National Institute of Mental Health, 2University of Pennsylvania
Background: There is now abundant evidence that parental age is associated with neurodevelopmental and behavioral disorders in offspring; however, the mechanism for these associations is unknown. A potential explanation for these associations is impaired cognitive function. The aim of this research is to examine the associations between parental age and neurocognitive performance in offspring in a communitybased sample of adolescents. Methods: 8725 youths (ages 8-21 years, one child per family) from the Philadelphia Neurodevelopmental Cohort completed the University of Pennsylvania Computerized Neurocognitive Battery (CNB) that assessed the accuracy and response time of task performance across four domains (complex cognition, episodic memory, executive function, social cognition). Crude and adjusted regression models with parental age predicting offspring neurocognitive performance for demographic factors (age, sex, race of the participant) and social environment (parental education and a proxy for SES). Results: Increases in parental, maternal, and paternal ages were associated with greater accuracy and speed of all cognitive domains in unadjusted models, except for the speed of episodic memory. After adjustment for demographic factors and the social environment, the only significant associations were between maternal and parental age and the speed of complex cognition. Conclusions: To our knowledge, this is the largest study in the US to examine parental age and multiple domains of neurocognition in adolescents. These data extend previous research to a community-based sample of youth, and demonstrate that the association between parental age and neurocognitive function may reflect parental and familial environmental factors rather than biologic and genetic factors associated with increased parental age.
Biological Psychiatry May 15, 2017; 81:S1–S139 www.sobp.org/journal