Latent subtypes of manic and/or irritable episode symptoms in two population-based cohorts

Background Mood disorders are characterised by pronounced symptom heterogeneity, which presents a substantial challenge both to clinical practice and research. Identification of subgroups of individuals with homogeneous symptom profiles that cut across current diagnostic categories could provide insights in to the transdiagnostic relevance of individual symptoms, which current categorical diagnostic systems cannot impart. Aims To identify groups of people with homogeneous clinical characteristics, using symptoms of manic and/or irritable mood, and explore differences between groups in diagnoses, functional outcomes and genetic liability. Method We used latent class analysis on eight binary self-reported symptoms of manic and irritable mood in the UK Biobank and PROTECT studies, to investigate how individuals formed latent subgroups. We tested associations between the latent classes and diagnoses of psychiatric disorders, sociodemographic characteristics and polygenic risk scores. Results Five latent classes were derived in UK Biobank (N = 42 183) and were replicated in the independent PROTECT cohort (N = 4445), including ‘minimally affected’, ‘inactive restless’, active restless’, ‘focused creative’ and ‘extensively affected’ individuals. These classes differed in disorder risk, polygenic risk score and functional outcomes. One class that experienced disruptive episodes of mostly irritable mood largely comprised cases of depression/anxiety, and a class of individuals with increased confidence/creativity reported comparatively lower disruptiveness and functional impairment. Conclusions Findings suggest that data-driven investigations of psychopathological symptoms that include sub-diagnostic threshold conditions can complement research of clinical diagnoses. Improved classification systems of psychopathology could investigate a weighted approach to symptoms, toward a more dimensional classification of mood disorders.

Patterns of Self-Care Behaviors and Their Influence on Maintaining Independence: The National Health and Aging Trends Study

Importance: Few studies have addressed the combined effects of health-promoting and self-care behaviors among older adults. Thus, new research is needed to assess the potential for behavior change to prolong independence in later life.Objectives: To determine the relationships between self-care behaviors and risks of mobility and activities of daily living (ADLs) over time.Design: Longitudinal data was used from the National Health and Aging Trends Study (NHATS) cohort. Eight baseline self-care behaviors were summarized using latent class analysis. Separately, longitudinal latent classes of mobility and ADLs were created.Setting: Annual in-person interviews conducted for a nationally representative sample.Participants: The baseline study sample included 7,609 Medicare beneficiaries aged ≥65 from NHATS who were living in community or residential care settings, with a 71% response rate. The average age was 75, with 57% female, 81% white and 78% high school graduates or higher. Approximately, 80% (n = 6,064) completed 5 years of follow-up.Exposures: Favorable vs. unfavorable self-care latent classes measured at baseline.Main outcomes and Measures: Associations were measured between baseline classes and longitudinal classes of mobility and ADLs difficulty. Among decedents, 5-year associations were measured between baseline classes and years of overall, healthy, able, and healthy/able life.Results: Two habitual baseline self-care behavioral patterns (46% favorable; 54% unfavorable) and three trajectories of change in mobility and ADLs disability (maintaining independence; shifting to accommodation/difficulty; shifting to assistance) emerged over time. Participants with a favorable baseline pattern had 92% (0.90–0.94) reduced risk in shifting to assistance class and 70% (0.64–0.76) reduced risk for shifting to accommodation/difficulty class for mobility disability. Participants with a favorable baseline pattern had 86% (0.83–0.89) reduced risk in shifting to assistance class and 24% (0.11–0.36) reduced risk in shifting to accommodation/difficulty class for ADLs disability. Those with an unfavorable pattern had 2.54 times greater risk of mortality by the end of the 5-year follow-up compared to those with a favorable pattern.Conclusion: Self-care behaviors in older age represent a habitual pattern. A favorable self-care behavioral pattern decreased the risk of moving towards a more disabled profile and added years of life. Interventions should encourage self-care behaviors constituting a favorable pattern.

Latent class analysis for identification of occupational accident casualty profiles in the selected Polish manufacturing sector

The objective of the analysis is identifying profiles of occupational accident casualties as regards production companies to provide the necessary knowledge to facilitate the preparation and management of a safe work environment. Qualitative data characterizing employees injured in accidents registered in Polish wood processing plants over a period of 10 years were the subject of the research. The latent class analysis (LCA) method was employed in the investigation. This statistical modelling technique, based on the values of selected indicators (observed variables) divides the data set into separate groups, called latent classes, which enable the definition of patterns. A procedure which supports the decision as regards the number of classes was presented. The procedure considers the quality of the LCA model and the distinguishability of the classes. Moreover, a method of assessing the importance of indicators in the patterns description was proposed. Seven latent classes were obtained and illustrated by the heat map, which enabled the profiles identification. They were labelled as follows: very serious, serious, moderate, minor (three latent classes), slight. Some recommendations were made regarding the circumstances of occupational accidents with the most severe consequences for the casualties.

Youth Perspectives on Integrated Youth Services: A Discrete Choice Conjoint Experiment

Objective Integrated youth services (IYS) are an emerging model of care offering a broad range of mental health and social services for youth in one location. This study aimed to determine the IYS service characteristics most important to youth, as well as to determine whether different classes of youth have different service preferences, and if so, what defines these classes. Methods Ontario youth aged 14–29 years with mental health challenges were recruited to participate in a discrete choice experiment (DCE) survey. The DCE contained 12 attributes, each represented by 4 levels representing core characteristics of IYS models. To supplement the DCE questions, demographic information was collected and a mental health screener was administered. Preferences were examined, latent class analyses were conducted, and latent classes were compared. Results As a whole, participants endorsed the IYS model of service delivery. Among 274 youth, there were three latent classes: 1) the Focused Service (37.6%) latent class prioritized efficient delivery of mental health services. 2) The Holistic Services (30.3%) latent class prioritized a diverse array of mental health and social services delivered in a timely fashion. 3) The Responsive Services (32.1%) latent class prioritized services that matched the individual needs of the youth being served. Differences between classes were observed based on sociodemographic and clinical variables. Conclusions IYS is an acceptable model of care, in that it prioritizes components that reflect youth preferences. The differences in preference profiles of different groups of youth point to the need for flexible models of service delivery. Service design initiatives should take these preferences into account, designing services that meet the needs and preferences of a broad range of youth. Working locally to co-design services with the youth in the target population who wish to be engaged will help meet the needs of youth.

Material Hardship Among Custodial Grandparents and Grandchildren's Physical and Mental Health in COVID-19

COVID-19 has increased economic hardship for many families, including custodial grandparent-headed families. We aim to examine latent classes of material hardship among custodial grandparent-headed families, to assess predictors associated with identified classes, and to investigate associations with grandchildren’s physical and mental health outcomes during COVID-19. Data was collected from a cross-sectional survey in June 2020. The sample comprised of 362 grandparents. Latent class analysis and logistic regression were conducted. Three latent classes of material hardship were identified: Class 1 (n = 232; 64.1%) low overall hardship with high medical hardship, class 2 (n = 52; 14.4%) moderate overall hardship with high utility hardship, and class 3 (n = 78; 21.5%) severe overall hardship. Factors, such as race, household income, labor force status, financial assistance status, and trigger events to raise grandchildren, were associated with class membership. Class 2 (OR = 0.19, p < 0.05) compared to Class 1 was significantly associated with grandchildren’s physical health. Our findings suggest that material hardship is heterogeneous among custodial grandparents during COVID-19, and children in households experiencing utility hardship have a higher risk for poorer physical health outcomes. Results highlight the needs to meet grandparents’ material needs and call for future research to examine the mechanism that explains the link between material hardship and grandchildren’s outcomes.

The Effects Of Latent Classes Of Stress On Health Outcomes In Korean Middle-aged Adults: A Focus On Gender Differences

This study indicated the effect of the latent classes of stress on the physical and psychological health outcomes in Korea. Using the 2010 Korea Health Panel Study, 1,689 middle-aged adults (women: n=793, men: n=896) were analyzed to identify the latent classes of stress by gender using Latent Profile Analysis (LPA). After the determination of the number of latent classes, health outcomes (anxiety/depression and health status) were also regressed on the latent classes including covariates (age, marital status, and education level). The perceived stresses (financial diversity, disease of self or family, children’s education, and family conflicts) are classified as the 2-class model for women and the 3-class model for men. The classes of women are named ‘high stress and ‘low stress; however, the classes of men are named ‘family-related stress’, ‘disease stress’, and ‘low stress.’ The different combinations of stress are associated with anxiety/depression and health status respectively. This study will discuss the difference of latent stress classes by gender and extend the understanding of stress groups and health outcomes.

Factors Associated With Latent Classes of Exercise Motivation Among Physically Active Older Adults

The objective of this study was to estimate the latent classes of exercise motivation and to find relevant factors in older adults. The sample comprises 179 people who reported practicing physical exercise regularly. We performed Latent Class Analysis (LCA) and multinomial logistic regression. Exercise motivation was observed with six indicators: medical advice, fun, weight loss, leisure, fitness, and socializing. Independent variables of regression analysis included sociodemographic characteristics (age, gender, marital status, education, and household income), health and well-being (subjective health, and life satisfaction), and satisfaction on neighborhood environment (physical, service, and sociocultural aspects respectively). Results of LCA indicated that the three-class model yielded optimal fit indices. Class 1 (7.5%) was labeled as ‘mainly for medical advice and socializing’. Class 2 (46.5%) was labeled as ‘mainly for fun’, while class 3 (46.0%) was labeled as ‘only fitness’. Results of multinomial logistic regression showed that males, people with lower education, and higher satisfaction with their sociocultural neighborhood were more likely to be categorized as ‘mainly for fun’ group compared to the reference group (‘only for fitness’). Subjective health was marginally significant (p<.10): People with positive subjective health tend to be categorized as ‘mainly for fun’ than ‘only for fitness’ group. Satisfaction with their sociocultural neighborhood was marginally significant (p<.10) in distinguishing ‘only for fitness’ and ‘mainly for medical advice and socializing’ group. The results of this study emphasized the heterogeneity in exercise motivation. Significant factors of exercise motivation in this study implied the importance of individualized interventions to promote exercise participation.