Objective-The authors sought to identify clinical predictors of new-onset suicidal behavior in children of parents with a history of mood disorder and suicidal behavior.Method-In a prospective study of offspring of parents with mood disorders, 365 offspring (average age, 20 years) of 203 parents were followed for up to 6 years. Offspring with incident suicide attempts or emergency referrals for suicidal ideation or behavior ("incident events") were compared with offspring without such events on demographic and clinical characteristics. Multivariate analyses were conducted to examine predictors of incident events and predictors of time to incident event.Results-Offspring of probands who had made suicide attempts, compared with offspring of parents with mood disorders who had not made attempts, had a higher rate of incident suicide attempts (4.1% versus 0.6%, relative risk=6.5) as well as overall suicidal events (8.3% versus 1.9%, relative risk=4.4). Mood disorder and self-reported impulsive aggression in offspring and a history of sexual abuse and self-reported depression in parents predicted earlier time to, and greater hazard of, an incident suicidal event.Conclusions-In offspring of parents with mood disorders, precursors of early-onset suicidal behavior include mood disorder and impulsive aggression as well as parental history of suicide attempt, sexual abuse, and self-reported depression. These results suggest that efforts to prevent the familial transmission of early-onset suicidal behavior by targeting these domains could reduce the morbidity of suicidal behavior in high-risk youths.The literature on suicide demonstrates, on the basis of adoption, twin, and family studies, that suicidal behavior aggregates in families and that the familial transmission of suicidal behavior cannot be explained by the transmission of major psychiatric disorders alone (1). However, nearly all of these family genetic studies are cross-sectional, which means that little is known about the precursors of suicidal behavior that place offspring of suicidal individuals at increased risk of suicidal behavior and the causal models to explain how suicidal behavior is transmitted from parent to child.Nevertheless, the literature provides clues as to the mechanisms and precursors of familial transmission of suicidal behavior. Longitudinal community studies show that precursors of youthful suicidal behavior include depression, suicidal ideation, behavioral symptoms, child NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript maltreatment, and family history of suicidal behavior (2-4). Cross-sectional studies have shown that the familial aggregation for suicidal behavior is related to the trait of impulsive aggression. Higher levels of impulsive aggression in those who attempt or compete suicide are associated with greater family aggregation for suicidal behavior (5, 6), and higher levels of impulsive aggression in parents are associated with child suicidal behavior (7). In one cross-sectional study, the famili...

Objective. To explore the feasibility, fidelity, safety, and preliminary outcomes of a physical therapist-administered physical activity (PA) intervention after total knee replacement (TKR).Methods. People who had undergone a unilateral TKR and were receiving outpatient physical therapy (PT) were randomized to a control or intervention group. Both groups received standard PT for TKR. The intervention included being provided with a Fitbit Zip, step goals, and 1 phone call a month for 6 months after discharge from PT. Feasibility was measured by rates of recruitment and retention, safety was measured by the frequency of adverse events, and fidelity was measured by adherence to the weekly steps/day goal created by the physical therapist and participant monitoring of steps/day. An Actigraph GT3X measured PA, which was quantified as steps/day and minutes/week of engaging in moderate-to-vigorous PA. Our preliminary outcome was the difference in PA 6 months after discharge from PT between the control and intervention groups.Results. Of the 43 individuals who were enrolled, 53.4% were women, the mean ± SD age was 67.0 ± 7.0 years, and the mean ± SD body mass index was 31.5 ± 5.9 kg/m 2 . For both the control and intervention groups, the recruitment and retention rates were 64% and 83.7%, respectively, and adherence to the intervention ranged from 45% to 60%. No study-related adverse events occurred. The patients in the intervention group accumulated a mean 1,798 more steps/day (95% confidence interval [95% CI] 240, 3,355) and spent 73.4 more minutes/week (95% CI -14.1, 160.9) engaging in moderate-to-vigorous PA at 6 months than those in the control group.Conclusion. A physical therapist-administered PA intervention is feasible and safe, demonstrates treatment fidelity, and may increase PA after TKR. Future research is needed to establish the effectiveness of the intervention.ClinicalTrials.gov identifier: NCT02724137.

This study examined Expressed Emotion in the families of children and adolescents who were: (1) in a current episode of Major Depressive Disorder (MDD), (2) in remission from a past episode of MDD, (3) at high familial risk for developing MDD, and (4) low-risk controls. Participants were 109 mother-child dyads (children ages 8-19). Expressed emotion was assessed using the Five Minute Speech Sample. Psychiatric follow-ups were conducted annually following the Five Minute Speech Sample assessment. Mothers of children with a current or remitted episode of MDD and at high risk for MDD were more likely to be rated high on Criticism than mothers of controls. There were no differences in critical expressed emotion among mothers of children in the current, remitted, or highrisk for depression groups. Higher initial critical expressed emotion was associated with a greater likelihood of having a future onset of a depressive episode in high-risk and depressed participants. Diagnostic groups did not differ in Emotional Overinvolvement. Findings suggest that expressed emotion that is critical in nature may be a relatively stable characteristic feature of the family environments of children with and at high-risk for depression, and may be important in understanding the onset and clinical course of child adolescent depressive disorders.Depression during childhood and adolescence is a frequent and recurrent problem that is associated with disruptions in emotional, social and occupational functioning into adulthood and increased rates of attempted and completed suicides (Bardone, Moffitt, Caspi, & Dickson, 1996;Rohde, Lewinsohn, & Seeley, 1994;Weissman et al., 1999). Most adolescents with depression will go on to have recurrent episodes and persistent social impairment between episodes (Puig- Antich et al., 1985b;Weissman et al., 1999). In order to improve upon existing prevention and intervention programs, a better understanding of the contextual factors that contribute to the onset, maintenance, and recurrence of depressive episodes in children and adolescents is crucial.The development and maintenance of depressive disorders in childhood and adolescence involves the interplay among inherited and acquired biological characteristics and the individual's social environment (Cicchetti & Toth, 1998). In particular, features of the family environment appear to play an important role in child adolescent depression (for reviews see Kaslow, Deering, & Racusin, 1994;Sheeber, Hyman, & Davis, 2001). Interpersonal theories of depression emphasize high levels of rejection in the environments of depressed individuals (Coyne, 1976). Consistent with interpersonal theories, a growing body of literature suggests Please address correspondence to Jennifer S. Silk, Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213. Phone: 412-383-8136. Fax: 412-383-5426. Email: silkj@upmc.edu. that the families of children and adolescents with depressive disorders are characterized by low levels o...

Purpose The purpose of this study is to examine the characteristics and health outcomes of college students with type 1 diabetes mellitus (T1DM) as it relates to membership in a local university-based diabetes student organization. Methods This descriptive, correlational research design is a secondary analysis of data. The sample consisted of nationally representative young adults in college (n = 317) between 18 and 30 years of age who were diagnosed with T1DM. Data were collected during April 2017 using a secure electronic diabetes management survey to inquire about self-reported barriers to diabetes management, hypoglycemia, and diabetic ketoacidosis of members of a diabetes organization. Results Students were evenly distributed from freshman to senior year of college with a slight decrease at the graduate level. Students who were affiliated members of a student-led diabetes student organization were less likely to report increased levels of isolation, depressive symptoms, and anxiety related to their diabetes than were general members. Conclusion Participation in a university-based diabetes student organization on campus and connecting with other college students with diabetes may have health benefits. In conclusion, the current study underscores the potential importance of peer-led, diabetes-specific support for adolescents emerging into adulthood.

The risk for post-traumatic osteoarthritis is elevated after anterior cruciate ligament reconstruction (ACLR), and may be especially high among individuals with aberrant walking mechanics, such as medial tibiofemoral joint underloading 6 months postoperatively. Rehabilitation training programs have been proposed as one strategy to address aberrant gait mechanics. We developed the anterior cruciate ligament specialized post-operative return-to-sports (ACL-SPORTS) randomized control trial to test the effect of 10 post-operative training sessions consisting of strength, agility, plyometric, and secondary prevention exercises (SAPP) or SAPP plus perturbation (SAPP + PERT) training on gait mechanics after ACLR. A total of 40 male athletes (age 23 ± 7 years) after primary ACLR were randomized to SAPP or SAPP + PERT training and tested at three distinct, post-operative time points: 1) after impairment resolution (Pre-training); 2) following 10 training sessions (Post-training); and 3) 2 years after ACLR. Knee kinematic and kinetic variables as well as muscle and joint contact forces were calculated via inverse dynamics and a validated electromyography-informed musculoskeletal model. There were no significant improvements from Pre-training to Post-training in either intervention group. Smaller peak knee flexion angles, extension moments, extensor muscle forces, medial compartment contact forces, and tibiofemoral contact forces were present across group and time, however the magnitude of interlimb differences were generally smaller and likely not meaningful 2 years postoperatively. Neither SAPP nor SAPP + PERT training appears effective at altering gait mechanics in men in the short-term; however, meaningful gait asymmetries mostly resolved between post-training and 2 years after ACLR regardless of intervention group. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2364-2372, 2018.