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Journal articles on the topic 'Co-occurring symptoms'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Roos, Leslie E., Philip A. Fisher, Daniel S. Shaw, Hyoun K. Kim, Jenae M. Neiderhiser, David Reiss, Misake N. Natsuaki, and Leslie D. Leve. "Inherited and environmental influences on a childhood co-occurring symptom phenotype: Evidence from an adoption study." Development and Psychopathology 28, no. 1 (April 8, 2015): 111–25. http://dx.doi.org/10.1017/s0954579415000322.

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AbstractRisk factors for the childhood development of co-occurring internalizing and externalizing symptoms are not well understood, despite a high prevalence and poor clinical outcomes associated with this co-occurring phenotype. We examined inherited and environmental risk factors for co-occurring symptoms in a sample of children adopted at birth and their birth mothers and adoptive mothers (N = 293). Inherited risk factors (i.e., birth mothers' processing speed and internalizing symptoms) and environmental risk factors (i.e., adoptive mothers' processing speed, internalizing symptoms, and uninvolved parenting) were examined as predictors for the development of internalizing-only, externalizing-only, or co-occurring symptoms using structural equation modeling. Results suggested a unique pattern of predictive factors for the co-occurring phenotype, with risk conferred by adoptive mothers' uninvolved parenting, birth mothers' slower processing speed, and the birth mothers' slower processing speed in tandem with adoptive mothers' higher internalizing symptoms. Additional analyses indicated that when co-occurring-symptom children were incorporated into internalizing and externalizing symptom groups, differential risk factors for externalizing and internalizing symptoms emerged. The findings suggest that spurious results may be found when children with co-occurring symptoms are not examined as a unique phenotypic group.

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González-Mercado, Velda J., Jean Lim, Gary Yu, Frank Penedo, Elsa Pedro, Raul Bernabe, Maribel Tirado-Gómez, and Bradley Aouizerat. "Co-Occurrence of Symptoms and Gut Microbiota Composition Before Neoadjuvant Chemotherapy and Radiation Therapy for Rectal Cancer: A Proof of Concept." Biological Research For Nursing 23, no. 3 (February 5, 2021): 513–23. http://dx.doi.org/10.1177/1099800421991656.

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Purpose: To examine a) whether there are significant differences in gut microbial diversity and in the abundance of gut microbial taxa; and b) differences in predicted functional pathways of the gut microbiome between those participants with high co-occurring symptoms and those with low co-occurring symptoms, prior to neoadjuvant chemotherapy and radiation therapy (CRT) for rectal cancer. Methods: Rectal cancer patients (n = 41) provided stool samples for 16 S rRNA gene sequencing and symptom ratings for fatigue, sleep disturbance, and depressive symptoms prior to CRT. Descriptive statistics were computed for symptoms. Gut microbiome data were analyzed using QIIME2, LEfSe, and the R statistical package. Results: Participants with high co-occurring symptoms (n = 19) had significantly higher bacterial abundances of Ezakiella, Clostridium sensu stricto, Porphyromonas, Barnesiella, Coriobacteriales Incertae Sedis, Synergistiaceae, Echerichia-Shigella, and Turicibacter compared to those with low co-occurring symptoms before CRT (n = 22). Biosynthesis pathways for lipopolysaccharide, L-tryptophan, and colanic acid building blocks were enriched in participants with high co-occurring symptoms. Participants with low co-occurring symptoms showed enriched abundances of Enterococcus and Lachnospiraceae, as well as pathways for β-D-glucoronosides, hexuronide/hexuronate, and nicotinate degradation, methanogenesis, and L-lysine biosynthesis. Conclusion: A number of bacterial taxa and predicted functional pathways were differentially abundant in patients with high co-occurring symptoms compared to those with low co-occurring symptoms before CRT for rectal cancer. Detailed examination of bacterial taxa and pathways mediating co-occurring symptoms is warranted.

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González-Mercado, Velda J., Wendy A. Henderson, Anujit Sarkar, Jean Lim, Leorey N. Saligan, Lawrence Berk, Larry Dishaw, et al. "Changes in Gut Microbiome Associated With Co-Occurring Symptoms Development During Chemo-Radiation for Rectal Cancer: A Proof of Concept Study." Biological Research For Nursing 23, no. 1 (July 23, 2020): 31–41. http://dx.doi.org/10.1177/1099800420942830.

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Purpose: To examine a) whether there are significant differences in the severity of symptoms of fatigue, sleep disturbance, or depression between patients with rectal cancer who develop co-occurring symptoms and those with no symptoms before and at the end of chemotherapy and radiation therapy (CRT); b) differences in gut microbial diversity between those with co-occurring symptoms and those with no symptoms; and c) whether before-treatment diversity measurements and taxa abundances can predict co-occurrence of symptoms. Methods: Stool samples and symptom ratings were collected from 31 patients with rectal cancer prior to and at the end of (24–28 treatments) CRT. Descriptive statistics were computed and the Mann-Whitney U test was performed for symptoms. Gut microbiome data were analyzed using R’s vegan package software. Results: Participants with co-occurring symptoms reported greater severity of fatigue at the end of CRT than those with no symptoms. Bacteroides and Blautia2 abundances differed between participants with co-occurring symptoms and those with no symptoms. Our random forest classification (unsupervised learning algorithm) predicted participants who developed co-occurring symptoms with 74% accuracy, using specific phylum, family, and genera abundances as predictors. Conclusion: Our preliminary results point to an association between the gut microbiota and co-occurring symptoms in rectal cancer patients and serves as a first step in potential identification of a microbiota-based classifier.

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L. McCallum, Stacey, Antonina A. Mikocka-Walus, Hannah Keage, Owen Churches, and Jane Andrews. "A novel treatment resource for co-occurring symptoms." Advances in Dual Diagnosis 6, no. 4 (November 18, 2013): 155–67. http://dx.doi.org/10.1108/add-08-2013-0018.

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McCauley, James B., Rebecca Elias, and Catherine Lord. "Trajectories of co-occurring psychopathology symptoms in autism from late childhood to adulthood." Development and Psychopathology 32, no. 4 (July 17, 2020): 1287–302. http://dx.doi.org/10.1017/s0954579420000826.

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AbstractGiven high rates of co-occurring conditions in youth and adults with autism spectrum disorder (ASD), it is critical to examine the developmental trajectories of these symptoms of psychopathology. Using data from a cohort of participants (n = 194), most of whom were first assessed for ASD in very early childhood, we investigated the trajectories of co-occurring depressive, anxiety, and attention-deficit hyperactivity disorder (ADHD) symptoms from late childhood to adulthood. Additionally, childhood predictors and adult outcomes associated with these symptom trajectories were examined. Using group-based trajectory modeling, we found two distinct classes of individuals exhibiting each of these co-occurring symptom patterns: one class exhibited fairly low symptoms across time, and one class with elevated symptoms with varied fluctuation across time (ADHD symptoms starting high but decreasing, anxiety symptoms high and stable, and depressive symptoms fluctuating but peaking at clinically significant levels in young adulthood). All high trajectory classes were associated with age 9 adaptive skills; verbal IQ predicted higher anxiety and depressive symptom classes. After accounting for verbal IQ, all high symptom trajectory classes were negative predictors of objective adult outcomes. These findings call for wide-ranging considerations of the needs of individuals across ability levels, autism symptoms, and behavioral and emotional challenges.

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Mezulis, Amy, Ann Vander Stoep, Andrea L. Stone, and Elizabeth McCauley. "A Latent Class Analysis of Depressive and Externalizing Symptoms in Nonreferred Adolescents." Journal of Emotional and Behavioral Disorders 19, no. 4 (September 14, 2010): 247–56. http://dx.doi.org/10.1177/1063426610377763.

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Both depressive and externalizing symptoms are common in adolescence and often co-occur. The purpose of this study was to examine whether adolescents’ patterns of depressive and externalizing symptoms can be differentiated into discrete classes and whether these classes are best distinguished by the number or type of symptoms. We examined whether there are naturally occurring discrete classes of adolescents characterized by depressive symptoms only, externalizing symptoms only, or co-occurring depressive and externalizing symptoms. In this study, 2,187 nonreferred, public school sixth graders self-reported depressive and externalizing symptoms, and these symptoms were analyzed with latent class analysis. Six latent classes of depressive and externalizing symptoms were identified; classes differed primarily by the number, not type, of symptoms endorsed. Youth with elevations in one symptom type were likely to have elevations in the other symptom type. Approximately 5% of adolescents displayed clinically significant elevations in both depressive and externalizing symptoms. Implications for understanding the co-occurrence of depressive and externalizing symptoms in adolescence are discussed.

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Whisenant, Meagan, Bob Wong, Sandra A. Mitchell, Susan L. Beck, and Kathi Mooney. "Symptom Trajectories Are Associated With Co-occurring Symptoms During Chemotherapy for Breast Cancer." Journal of Pain and Symptom Management 57, no. 2 (February 2019): 183–89. http://dx.doi.org/10.1016/j.jpainsymman.2018.11.010.

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Newland, Pamela, Louise Flick, Hong Xian, and Florian P. Thomas. "Symptom Co-occurrences Associated with Smoking in Individuals with Relapsing-Remitting Multiple Sclerosis." International Journal of MS Care 18, no. 4 (July 1, 2016): 163–68. http://dx.doi.org/10.7224/1537-2073.2014-028.

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Background: The impact of tobacco on the multiple sclerosis (MS) disease process and symptoms is complex and not clearly understood. Tobacco may be used to self-treat some symptoms but also seems to intensify others. Studies to date have not characterized co-occurring symptoms (symptom patterns) and their association with tobacco use. Methods: This study describes tobacco use in patients with relapsing-remitting MS and associated symptoms and symptom co-occurrences. In this cross-sectional study, 101 participants with an average age of 43 years completed a survey adapted from the Behavioral Risk Factor Surveillance System and the revised MS-Related Symptom Checklist. Data reduction was performed using factor analysis on the 43 items of the checklist, and linear regression was used to detect associations between symptom clusters (factors) and smoking. Results: Using the factor analysis result, the linear regression analysis found that tobacco use is positively associated with co-occurring symptoms and symptoms of factor 1: Mental/Emotional (anxiety, loneliness, depression, and difficulty sleeping) and factor 4: Neuro/Autonomic (urinary). Conclusions: Smoking is associated with patterns of symptoms. The study of MS and tobacco use over time will allow determination of the temporal pattern of tobacco use and MS symptoms.

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Kasckow, John W., and Sidney Zisook. "Co-Occurring Depressive Symptoms in the Older Patient with Schizophrenia." Drugs & Aging 25, no. 8 (2008): 631–47. http://dx.doi.org/10.2165/00002512-200825080-00002.

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van Donkelaar, Marjolein, Celeste Figaroa, Ellen Verhoef, Simon Fisher, Dheeraj Rai, and Beate St Pourcain. "T15EXPLORING THE GENETIC ARCHITECTURE OF CO-OCCURRING SYMPTOMS IN AUTISM." European Neuropsychopharmacology 29 (October 2019): S227. http://dx.doi.org/10.1016/j.euroneuro.2019.08.214.

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Feng, Li Rebekah, Timothy Fuss, Kristin Dickinson, Alexander Ross, and Leorey N. Saligan. "Co-Occurring Symptoms Contribute to Persistent Fatigue in Prostate Cancer." Oncology 96, no. 4 (2019): 183–91. http://dx.doi.org/10.1159/000494620.

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Bechi, Margherita, Ahmad Abu-Akel, Giulia Agostoni, Marta Bosia, Federica Cocchi, Marco Spangaro, and Roberto Cavallaro. "Functional benefits of co-occurring autistic symptoms in schizophrenia is delimited by symptom severity." Journal of Psychiatric Research 137 (May 2021): 48–54. http://dx.doi.org/10.1016/j.jpsychires.2021.02.044.

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Ered, Arielle, and Lauren M. Ellman. "Specificity of Childhood Trauma Type and Attenuated Positive Symptoms in a Non-Clinical Sample." Journal of Clinical Medicine 8, no. 10 (September 25, 2019): 1537. http://dx.doi.org/10.3390/jcm8101537.

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Background: Childhood traumatic experiences have been consistently associated with psychosis risk; however, the specificity of childhood trauma type to interview-based attenuated positive psychotic symptoms has not been adequately explored. Further, previous studies examining specificity of trauma to specific positive symptoms have not accounted for co-occurring trauma types, despite evidence of multiple victimization. Methods: We examined the relationship between childhood trauma (Childhood Trauma Questionnaire) with type of attenuated positive symptom, as measured by the Structured Interview for Psychosis-risk Syndromes (SIPS) among a non-clinical, young adult sample (n = 130). Linear regressions were conducted to predict each attenuated positive symptom, with all trauma types entered into the model to control for co-occurring traumas. Results: Results indicated that childhood sexual abuse was significantly associated with disorganized communication and childhood emotional neglect was significantly associated with increased suspiciousness/persecutory ideas, above and beyond the effect of other co-occurring traumas. These relationships were significant even after removing individuals at clinical high-risk (CHR) for psychosis (n = 14). Conclusions: Our results suggest that there are differential influences of trauma type on specific positive symptom domains, even in a non-clinical sample. Our results also confirm the importance of controlling for co-occurring trauma types, as results differ when not controlling for multiple traumas.

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Das, Debjani, Nicolas Cherbuin, Kaarin J. Anstey, Walter Abhayaratna, and Simon Easteal. "Regional Brain Volumes and ADHD Symptoms in Middle-Aged Adults: The PATH Through Life Study." Journal of Attention Disorders 21, no. 13 (February 24, 2014): 1073–86. http://dx.doi.org/10.1177/1087054714523316.

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Objective: We investigated whether volumetric differences in ADHD-associated brain regions are related to current symptoms of inattention and hyperactivity in healthy middle-aged adults and whether co-occurring anxiety/depression symptoms moderate these relationships. Method: ADHD Self-Report Scale and Brief Patient Health Questionnaire were used to assess current symptoms of inattention, hyperactivity, anxiety, and depression in a population-based sample ( n = 269). Brain volumes, measured using a semi-automated method, were analyzed using multiple regression and structural equation modeling to evaluate brain volume–inattention/hyperactivity symptom relationships for selected regions. Results: Volumes of the left nucleus accumbens and a region overlapping the dorsolateral prefrontal cortex were positively associated with inattention symptoms. Left hippocampal volume was negatively associated with hyperactivity symptoms. The brain volume–inattention/hyperactivity symptom associations were stronger when anxiety/depression symptoms were controlled for. Conclusion: Inattention and hyperactivity symptoms in middle-aged adults are associated with different brain regions and co-occurring anxiety/depression symptoms moderate these brain–behavior relationships.

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Gilmore, Amanda K., Sarah M. Wilson, Nancy A. Skopp, Janyce E. Osenbach, and Greg Reger. "A systematic review of technology-based interventions for co-occurring substance use and trauma symptoms." Journal of Telemedicine and Telecare 23, no. 8 (August 17, 2016): 701–9. http://dx.doi.org/10.1177/1357633x16664205.

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Introduction Technology-based mental health interventions are becoming increasingly common, and several have begun to target multiple outcomes in a single intervention. Recent developments in the treatment of co-occurring posttraumatic stress disorder and substance use disorder has led to the development and testing of technology-based interventions for these disorders. The current systematic review examined technology-based interventions designed to improve mental health outcomes among patients with co-occurring trauma symptoms and substance use. Methods Of 601 articles reviewed, 14 included a technology-based intervention for patients with these co-occurring problems. Results Seven of these studies provided preliminary evidence that technology-based interventions are likely to be efficacious in reducing either trauma symptoms or substance use. The seven remaining studies demonstrated that technology-based interventions for co-occurring trauma symptoms and substance use are feasible. Discussion This review suggests that technology-based interventions for co-occurring trauma symptoms and substance use are feasible, but more work is needed to assess efficacy using scientifically rigorous studies.

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Menzies, Victoria, Nancy Jallo, Patricia Kinser, Jo Lynne W. Robins, Kyungeh An, Carolyn Driscoll, Angela Starkweather, Jasmohan S. Bajaj, and Debra E. Lyon. "Shared Symptoms and Putative Biological Mechanisms in Chronic Liver Disease." Biological Research For Nursing 17, no. 2 (July 18, 2014): 222–29. http://dx.doi.org/10.1177/1099800414541541.

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Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver–gut–brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.

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Cooley, Mary E., and Mary Lou Siefert. "Assessment of Multiple Co-Occurring Cancer Symptoms in the Clinical Setting." Seminars in Oncology Nursing 32, no. 4 (November 2016): 361–72. http://dx.doi.org/10.1016/j.soncn.2016.08.003.

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Lin, Yufen, Sharron Docherty, Laura Porter, and Donald Bailey. "Common and Co-Occurring Symptoms Experienced by Patients With Gastric Cancer." Oncology Nursing Forum 47, no. 2 (March 1, 2020): 187–202. http://dx.doi.org/10.1188/20.onf.187-202.

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Mascendaro, Phillip M., Keith C. Herman, and Carolyn Webster-Stratton. "Parent discrepancies in ratings of young children's co-occurring internalizing symptoms." School Psychology Quarterly 27, no. 3 (September 2012): 134–43. http://dx.doi.org/10.1037/a0029320.

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Vaughn, Michael G., Stacey Freedenthal, Jeffrey M. Jenson, and Matthew O. Howard. "Psychiatric Symptoms and Substance Use Among Juvenile Offenders." Criminal Justice and Behavior 34, no. 10 (October 2007): 1296–312. http://dx.doi.org/10.1177/0093854807304624.

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The high rate of co-occurring mental health and substance abuse problems among antisocial and delinquent youth is a widely recognized problem in the juvenile justice system. Yet few studies have delineated meaningful clinical distinctions in the characteristics of offenders with co-occurring problems. Latent profile analysis was used to identify subgroups of juvenile offenders based on clinically relevant measures of psychiatric symptoms (including past traumatic experiences), lifetime substance use, and drug- and alcohol-related problems stemming from the use of psychoactive substances in a statewide population ( n = 723). Findings revealed that a four-class solution fit the data optimally. The four classes identified represented a severity-based gradient of symptom and substance use endorsement ranging from a mild subgroup ( n = 195; 27.0%), to moderately low ( n = 250; 34.6%) and high ( n = 197; 27.2%) subgroups, and finally, a severely distressed subgroup ( n = 81; 11.2%). Implications for identifying and treating young offenders with co-occurring mental health and substance abuse problems are noted.

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Bellala, G., A. Ganesan, R. Krishna, P. Saxman, C. Scott, M. Silveira, C. Given, and S. K. Bhavnani. "The Nested Structure of Cancer Symptoms." Methods of Information in Medicine 49, no. 06 (2010): 581–91. http://dx.doi.org/10.3414/me09-01-0083.

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Summary Objective: Although many cancer patients experience multiple concurrent symptoms, most studies have either focused on the analysis of single symptoms, or have used methods such as factor analysis that make a priori assumptions about how the data is structured. This article addresses both limitations by first visually exploring the data to identify patterns in the co-occurrence of multiple symptoms, and then using those insights to select and develop quantitative measures to analyze and validate the results. Methods: We used networks to visualize how 665 cancer patients reported 18 symptoms, and then quantitatively analyzed the observed patterns using degree of symptom overlap between patients, degree of symptom clustering using network modularity, clustering of symptoms based on agglomerative hierarchical clustering, and degree of nestedness of the symptoms based on the most frequently co-occurring symptoms for different sizes of symptom sets. These results were validated by assessing the statistical significance of the quantitative measures through comparison with random networks of the same size and distribution. Results: The cancer symptoms tended to co-occur in a nested structure, where there was a small set of symptoms that co-occurred in many patients, and progressively larger sets of symptoms that co-occurred among a few patients. Conclusions: These results suggest that cancer symptoms co-occur in a nested pattern as opposed to distinct clusters, thereby demonstrating the value of exploratory network analyses to reveal complex relationships between patients and symptoms. The research also extends methods for exploring symptom co-occurrence, including methods for quantifying the degree of symptom overlap and for examining nested co-occurrence in co-occur-rence data. Finally, the analysis also suggested implications for the design of systems that assist in symptom assessment and management. The main limitation of the study was that only one dataset was considered, and future studies should attempt to replicate the results in new data.

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Ip, Ka I., Jennifer M. Jester, Arnold Sameroff, and Sheryl L. Olson. "Linking Research Domain Criteria (RDoC) constructs to developmental psychopathology: The role of self-regulation and emotion knowledge in the development of internalizing and externalizing growth trajectories from ages 3 to 10." Development and Psychopathology 31, no. 04 (February 5, 2019): 1557–74. http://dx.doi.org/10.1017/s0954579418001323.

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AbstractIdentifying Research Domain Criteria (RDoC) constructs in early childhood is essential for understanding etiological pathways of psychopathology. Our central goal was to identify early emotion knowledge and self-regulation difficulties across different RDoC domains and examine how they relate to typical versus atypical symptom trajectories between ages 3 and 10. Particularly, we assessed potential contributions of children's gender, executive control, delay of gratification, and regulation of frustration, emotion recognition, and emotion understanding at age 3 to co-occurring patterns of internalizing and externalizing across development. A total of 238 3-year-old boys and girls were assessed using behavioral tasks and parent reports and reassessed at ages 5 and 10 years. Results indicated that very few children developed “pure” internalizing or externalizing symptoms relative to various levels of co-occurring symptoms across development. Four classes of co-occurring internalizing and externalizing problems were identified: low, low-moderate, rising, and severe-decreasing trajectories. Three-year-old children with poor executive control but high emotion understanding were far more likely to show severe-decreasing than low/low-moderate class co-occurring internalizing and externalizing symptom patterns. Child gender and poor executive control differentiated children in rising versus low trajectories. Implications for early intervention targeting self-regulation of executive control are discussed.

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Coid, Jeremy W., Constantinos Kallis, Mike Doyle, Jenny Shaw, and Simone Ullrich. "Shifts in positive and negative psychotic symptoms and anger: effects on violence." Psychological Medicine 48, no. 14 (February 27, 2018): 2428–38. http://dx.doi.org/10.1017/s0033291718000077.

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BackgroundChanges in positive and negative symptom profiles during acute psychotic episodes may be key drivers in the pathway to violence. Acute episodes are often preceded by fluctuations in affect before psychotic symptoms appear and affective symptoms may play a more important role in the pathway than previously recognised.MethodsWe carried out a prospective cohort study of 409 male and female patients discharged from medium secure services in England and Wales to the community. Measures were taken at baseline (pre-discharge), 6 and 12 months post-discharge using the Positive and Negative Syndrome Scale. Information on violence was obtained using the McArthur Community Violence Instrument and Police National Computer.ResultsThe larger the shift in positive symptoms the more likely violence occurred in each 6-month period. However, shifts in angry affect were the main driving factor for positive symptom shifts associated with violence. Shifts in negative symptoms co-occurred with positive and conveyed protective effects, but these were overcome by co-occurring shifts in anger. Severe but stable delusions were independently associated with violence.ConclusionsIntensification of angry affect during acute episodes of psychosis indicates the need for interventions to prevent violence and is a key driver of associated positive symptoms in the pathway to violence. Protective effects against violence exerted by negative symptoms are not clinically observable during symptom shifts because they are overcome by co-occurring anger.

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Tan, Tony Xing, Yuejia Teng, and Juliana C. Velasco. "Youth's school experience: Testing the role of symptoms of anxiety and co‐occurring symptoms of depression." Journal of Clinical Psychology 76, no. 3 (November 12, 2019): 526–38. http://dx.doi.org/10.1002/jclp.22888.

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Rosen, Tamara E., Christine J. Spaulding, Jacquelyn A. Gates, and Matthew D. Lerner. "Autism severity, co-occurring psychopathology, and intellectual functioning predict supportive school services for youth with autism spectrum disorder." Autism 23, no. 7 (March 8, 2019): 1805–16. http://dx.doi.org/10.1177/1362361318809690.

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Supportive school services are a primary service modality for youth with autism spectrum disorder. Autism spectrum disorder, as well as co-occurring psychiatric symptoms and low intellectual abilities, interfere with academic achievement and therefore influence decisions about school services. Therefore, we examined the association of parent, teacher, and clinician ratings of autism spectrum disorder and co-occurring psychiatric symptom severity and intellectual functioning with school services. In total, 283 youth with autism spectrum disorder were assessed with clinical evaluation via the Autism Diagnostic Observation Schedule and parent and teacher versions of the CASI-4R ( Child and Adolescent Symptom Inventory). Full Scale Intelligence Quotient scores were obtained from case records. Clinical and teacher evaluations of autism spectrum disorder severity predicted services and were more strongly associated with school services than parent ratings. Teacher ratings were only associated with common school services (e.g. speech/language therapy, occupational therapy, and/or social skills training) frequency at medium and high levels of clinician-rated autism spectrum disorder severity. Higher IQ and parent-rated externalizing symptoms predicted lower likelihood of receiving school services, whereas internalizing symptoms were not predictive of school services. Autism spectrum disorder symptoms may overshadow externalizing and internalizing symptoms when considering school service supports. Results highlight the importance of evaluating autism spectrum disorder severity via multiple sources, especially in cases of unclear symptom presentation, when examining correlates of school services for youth with autism spectrum disorder.

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Robea, Madalina-Andreea, Alina-Costina Luca, and Alin Ciobica. "Relationship between Vitamin Deficiencies and Co-Occurring Symptoms in Autism Spectrum Disorder." Medicina 56, no. 5 (May 20, 2020): 245. http://dx.doi.org/10.3390/medicina56050245.

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Recently, connections have been made between feeding and eating problems and autism spectrum disorder (ASD) and between autism pathophysiology and diet issues. These could explain some of the mechanisms which have not yet been discovered or are not sufficiently characterized. Moreover, there is an increased awareness for micronutrients in ASD due to the presence of gastrointestinal (GI) problems that can be related to feeding issues. For example, levels of vitamins B1, B6, B12, A and D are often reported to be low in ASD children. Thus, in the present mini review we focused on describing the impact of some vitamins deficiencies and their relevance in ASD patients.

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Kang, B., M. J. Karel, K. Corazzini, W. Pan, and E. S. McConnell. "BEHAVIORAL SYMPTOMS AMONG VETERANS WITH CO-OCCURRING POSTTRAUMATIC STRESS DISORDER AND DEMENTIA." Innovation in Aging 2, suppl_1 (November 1, 2018): 80. http://dx.doi.org/10.1093/geroni/igy023.303.

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Gummesson, Christina, Isam Atroshi, Charlotte Ekdahl, Ragnar Johnsson, and Ewald Ornstein. "Chronic upper extremity pain and co-occurring symptoms in a general population." Arthritis & Rheumatism 49, no. 5 (October 7, 2003): 697–702. http://dx.doi.org/10.1002/art.11386.

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Gros, Daniel F., Kristina J. Korte, Michael David Horner, Kathleen T. Brady, and Sudie E. Back. "Co-Occurring Traumatic Brain Injury, PTSD Symptoms, and Alcohol Use in Veterans." Journal of Psychopathology and Behavioral Assessment 38, no. 2 (September 16, 2015): 266–73. http://dx.doi.org/10.1007/s10862-015-9513-y.

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Baliatsas, Christos, Irene van Kamp, Wim Swart, Mariëtte Hooiveld, and Joris Yzermans. "Noise sensitivity: Symptoms, health status, illness behavior and co-occurring environmental sensitivities." Environmental Research 150 (October 2016): 8–13. http://dx.doi.org/10.1016/j.envres.2016.05.029.

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Whitbeck, Les B., Danny R. Hoyt, and Wa‐Ning Bao. "Depressive Symptoms and Co‐occurring Depressive Symptoms, Substance Abuse, and Conduct Problems among Runaway and Homeless Adolescents." Child Development 71, no. 3 (May 2000): 721–32. http://dx.doi.org/10.1111/1467-8624.00181.

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Smith, Kathryn E., Tyler B. Mason, Ross D. Crosby, Li Cao, Rachel C. Leonard, Chad T. Wetterneck, Brad E. R. Smith, et al. "A comparative network analysis of eating disorder psychopathology and co-occurring depression and anxiety symptoms before and after treatment." Psychological Medicine 49, no. 2 (April 15, 2018): 314–24. http://dx.doi.org/10.1017/s0033291718000867.

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AbstractBackgroundNetwork analysis is an emerging approach in the study of psychopathology, yet few applications have been seen in eating disorders (EDs). Furthermore, little research exists regarding changes in network strength after interventions. Therefore the present study examined the network structures of ED and co-occurring depression and anxiety symptoms before and after treatment for EDs.MethodParticipants from residential or partial hospital ED treatment programs (N = 446) completed assessments upon admission and discharge. Networks were estimated using regularized Graphical Gaussian Models using 38 items from the Eating Disorders Examination-Questionnaire, Quick Inventory of Depressive Symptomatology, and State-Trait Anxiety Inventory.ResultsED symptoms with high centrality indices included a desire to lose weight, guilt about eating, shape overvaluation, and wanting an empty stomach, while restlessness, self-esteem, lack of energy, and feeling overwhelmed bridged ED to depression and anxiety symptoms. Comparisons between admission and discharge networks indicated the global network strength did not change significantly, though symptom severity decreased. Participants with denser networks at admission evidenced less change in ED symptomatology during treatment.ConclusionsFindings suggest that symptoms related to shape and weight concerns and guilt are central ED symptoms, while physical symptoms, self-esteem, and feeling overwhelmed are links that may underlie comorbidities in EDs. Results provided some support for the validity of network approaches, in that admission networks conveyed prognostic information. However, the lack of correspondence between symptom reduction and change in network strength indicates that future research is needed to examine network dynamics in the context of intervention and relapse prevention.

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Katsanou, Panagiota, Nikolaos Tentolouris, Despoina Perrea, Spyridon Katsanos, Vasiliki Ntova, Virginia Antrian, Panagiotis Konstantopoulos, and Antonios Politis. "S100B Levels in Patients with Type 2 Diabetes Mellitus and Co-Occurring Depressive Symptoms." Depression Research and Treatment 2018 (November 18, 2018): 1–8. http://dx.doi.org/10.1155/2018/5304759.

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Depression is a comorbid condition in patients with Type 2 Diabetes mellitus (T2DM). S100B, a glia derived protein, is linked to depression and has been suggested as a biomarker for depression outcomes in several populations. However, to date there is no data about S100B levels and depression in patients with T2DM. Objective. We hypothesized that S100B serum levels are increased in patients with T2DM and recently diagnosed, drug-free depressive symptoms, and could be used for the diagnosis of depression in T2DM. Methods. Overall 52 patients (62 ± 12 years, female 66, 7%) with no history of depression deriving from the Diabetes out-patient clinic of our University Hospital underwent a one-to-one interview with a psychiatrist and filled a self-assessment (Zung) questionnaire. Serum S00B levels were compared between 30 (63±12 years, female 66, 7%) diabetic patients without depressive symptoms vs 22 patients (62 ±12 years, female 68, 2%) with T2DM and depressive symptoms. Results. There was no difference in serum levels of S100B between patients with T2DM without depressive symptoms vs diabetic patients suffering from depressive symptoms (2.1 (1.9-10.9) pg/ml vs 2.4 (1.9-14.8) pg/ml, p=0. 637+). Moreover, linear regression analysis did not show any association between lnS100B levels and depressive symptoms (β = 0.084, 95% CI 0.470-0.871, and p=0.552), Zung self-assessment score (β = 0.048, 95% CI -0.024-0.033, and p=0.738), and other patients’ characteristics. Conclusions. In patients with T2DM there is no correlation between S100B serum levels and newly detected mild depressive symptoms. The brain biochemistry pathways of depression in T2DM warrant further investigation in a larger scale population.

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Bjorgaas, H. M., I. Elgen, H. K. Ryland, and M. Hysing. "Autism spectrum symptoms in children with cerebral palsy: Prevalence and co-occurring conditions." Research in Autism Spectrum Disorders 8, no. 5 (May 2014): 581–88. http://dx.doi.org/10.1016/j.rasd.2014.01.011.

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Shiri, Rahman, Leena Kaila-Kangas, Kirsi Ahola, Teija Kivekäs, Eira Viikari-Juntura, Markku Heliövaara, Helena Miranda, and Päivi Leino-Arjas. "The Relation of Co-occurring Musculoskeletal Pain and Depressive Symptoms With Work Ability." Journal of Occupational and Environmental Medicine 55, no. 11 (November 2013): 1281–85. http://dx.doi.org/10.1097/jom.0b013e3182a4ffc4.

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Tormohlen, Kayla N., Karin E. Tobin, and Carl Latkin. "Sources of Stress among Adults with Co-occurring Drug Use and Depressive Symptoms." Journal of Urban Health 96, no. 3 (August 17, 2018): 379–89. http://dx.doi.org/10.1007/s11524-018-0304-0.

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Soehner, Adriane M., Katherine A. Kaplan, and Allison G. Harvey. "Prevalence and clinical correlates of co-occurring insomnia and hypersomnia symptoms in depression." Journal of Affective Disorders 167 (October 2014): 93–97. http://dx.doi.org/10.1016/j.jad.2014.05.060.

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Rumball, Freya, Kinga Antal, Francesca Happé, and Nick Grey. "Co-occurring mental health symptoms and cognitive processes in trauma-exposed ASD adults." Research in Developmental Disabilities 110 (March 2021): 103836. http://dx.doi.org/10.1016/j.ridd.2020.103836.

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Tzang, Ruu-Fen, Yue-Cune Chang, and Chuan-Hsin Chang. "Structural Equation Modeling (SEM): Childhood Aggression and Irritable ADHD Associated with Parental Psychiatric Symptoms." International Journal of Environmental Research and Public Health 18, no. 19 (September 25, 2021): 10068. http://dx.doi.org/10.3390/ijerph181910068.

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Background: Children with attention deficit hyperactivity disorder (ADHD) co-occurring with Oppositional Defiant Disorder (ODD) further present aggressive behavior and may have a depressive parent. A child with co-occurring ADHD and ODD has differentially higher levels of behavioral and emotional difficulties. Little is known about how the irritable subtype of ADHD in children mediates the development of parental symptomatology. This study aims to elucidate the direct or indirect influence of childhood disruptive ADHD with aggressive behavior on their parental symptom using Structural Equation Modeling (SEM). Methods: A total of 231 ADHD children and their parents completed the Swanson, Nolan, and Pelham Version IV questionnaire for symptoms of ADHD, Oppositional Defiant Disorder (ODD) scale for irritable symptoms, Child Behavior Check List (CBCL) for aggression, and Symptom Checklist (SCL) for parental symptom. Results: The three-factor confirmatory factor analysis (CFA) model found symptoms of inattention, hyperactivity/impulsivity, irritable ODD, and aggression were inter-related. Mediational analyses demonstrated ODD mediates symptoms directly predicting the risk of increasing ADHD severity. Disruptive child symptoms (ADHD + ODD + aggression) may increase the risk of depression-related symptoms in the parent. When the child’s aggression increases by one standard deviation (SD), parental psychiatric symptoms increase by 0.235 SD (p < 0.001). Conclusions: By this SEM pathway analysis, there is the correlation between the disruptive, more aggressive subtype of ADHD in children/adolescents and the existence of psychopathological symptomatology of their parents. ADHD + ODD + aggression in children should be classified as an irritable subtype of ADHD, warranting early diagnosis and intensive treatment.

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Varkovitzky, Ruth L., Andrew M. Sherrill, and Greg M. Reger. "Effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Veterans With Posttraumatic Stress Disorder: A Pilot Study." Behavior Modification 42, no. 2 (August 27, 2017): 210–30. http://dx.doi.org/10.1177/0145445517724539.

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Effective treatment options are needed for veterans who do not participate in trauma-focused psychotherapy. Research has yet to examine the effectiveness of transdiagnostic psychotherapy in veterans with posttraumatic stress disorder (PTSD) and co-occurring psychological disorders. This pilot study examined the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a 16-week group format. We examined treatment outcomes in male and female veterans ( n = 52) in an outpatient specialty PTSD clinic at a large Veterans Affairs (VA) medical center. We hypothesized significant decreases in emotion regulation difficulty (Difficulties in Emotion Regulation Scale), PTSD symptom severity (PTSD Checklist for DSM-5), and depressive symptom severity (Patient Health Questionnaire–9). In addition, we hypothesized that reductions in emotion regulation difficulty across treatment would negatively predict PTSD and depressive symptoms at posttreatment. PTSD symptoms, depressive symptoms, and emotion regulation difficulty all evidenced significant improvements at the end of treatment relative to baseline ( ps < .001). In addition, reductions in emotion regulation across treatment were associated with lower PTSD and depressive symptoms at posttreatment ( ps < .001). This pilot study provides preliminary evidence supporting use of UP among veterans with PTSD and co-occurring disorders. Well-designed clinical trials evaluating efficacy of UP among veterans are needed.

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McGuire, Joseph F., Emily J. Ricketts, Lawrence Scahill, Sabine Wilhelm, Douglas W. Woods, John Piacentini, John T. Walkup, and Alan L. Peterson. "Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults." Psychological Medicine 50, no. 12 (August 27, 2019): 2046–56. http://dx.doi.org/10.1017/s0033291719002150.

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AbstractBackgroundAlthough behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD.MethodA total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance.ResultsAt posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39–0.42, p < 0.03–0.04) at the 6-month follow-up.ConclusionBehavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.

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Weeks, Murray, Robert J. Coplan, and Laura L. Ooi. "Cognitive biases among early adolescents with elevated symptoms of anxiety, depression, and co-occurring symptoms of anxiety-depression." Infant and Child Development 26, no. 5 (November 23, 2016): e2011. http://dx.doi.org/10.1002/icd.2011.

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Edwards, Clementine Jane, Philippa Garety, and Amy Hardy. "The relationship between depressive symptoms and negative symptoms in people with non-affective psychosis: a meta-analysis." Psychological Medicine 49, no. 15 (September 18, 2019): 2486–98. http://dx.doi.org/10.1017/s0033291719002381.

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AbstractThe negative symptoms of psychosis and depressive symptomatology share several features, e.g. low motivation, apathy and reduced activity. Understanding the associations between these two sets of symptoms will support improved assessment and the development of interventions targeting these difficulties in people with psychosis. This is the first large systematic review and meta-analysis to quantify the relationship between these two categories of symptoms, as measured in studies to date. PsycInfo, Embase and Medline were systematically searched to identify eligible studies. Inclusion criteria ensured the studies measured both depression and negative symptoms using validated measures in a sample of over 8000 participants with non-affective psychosis diagnoses. The search led to 2020 records being screened and 56 included in the meta-analysis and review. Both meta-analyses and meta-regressions were conducted to explore the main effect and potential moderating variables. A clear pattern emerges showing that higher ratings of negative symptoms are associated with higher levels of depressive symptoms, with a small effect [standardised effect size = 0.19, p < 0.05). This did not vary greatly with the measures used (SES = 0.19–0.26) and was not moderated by demographic variables or quality ratings. Interestingly, higher depressive symptoms predict a significant relationship with co-occurring negative symptoms. However, higher negative symptoms predict that it is less likely there will be a relationship with co-occurring depressive symptoms. Heterogeneity was high across these analyses. The findings support the adoption of a symptom-specific approach to understanding the interplay between negative and depressive symptoms in psychosis, to improve assessment and intervention.

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Hazan, Sabine, Kimberly D. Spradling-Reeves, Andreas Papoutsis, and Stephen J. Walker. "Shotgun Metagenomic Sequencing Identifies Dysbiosis in Triplet Sibling with Gastrointestinal Symptoms and ASD." Children 7, no. 12 (November 25, 2020): 255. http://dx.doi.org/10.3390/children7120255.

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The gut microbiome profile of a child with autism spectrum disorder (ASD) and co-occurring gastrointestinal (GI) symptoms was compared to that of her healthy triplet siblings to determine if she exhibited intestinal dysbiosis. Shotgun metagenomic sequencing was performed in individual fecal samples, and relative microbial abundance and diversity was determined. Microbial diversity was lower in sibling #3, coupled with a higher Bacteroidetes/Firmicutes ratio, a lower relative abundance of Actinobacteria, and an increased relative abundance of Proteobacteria. Our findings are suggestive of gut dysbiosis in a child with ASD and co-occurring GI symptoms, compared to her two healthy triplet siblings.

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Felton, Julia W., Michael J. Kofler, Cristina M. Lopez, Benjamin E. Saunders, and Dean G. Kilpatrick. "The emergence of co-occurring adolescent polysubstance use and depressive symptoms: A latent growth modeling approach." Development and Psychopathology 27, no. 4pt1 (January 9, 2015): 1367–83. http://dx.doi.org/10.1017/s0954579414001473.

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AbstractThis study tests competing models of the relation between depression and polysubstance use over the course of adolescence. Participants included a nationwide sample of adolescents (N = 3,604), ages 12 to 17 at study Wave 1, assessed annually for 3 years. Models were tested using cohort-sequential latent growth curve modeling to determine whether depressive symptoms at baseline predicted concurrent and age-related changes in drug use, whether drug use at baseline predicted concurrent and age-related changes in depressive symptoms, and whether initial levels of depression predicted changes in substance use significantly better than vice versa. The results suggest a transactional model such that early polysubstance use promotes early depressive symptoms, which in turn convey elevated risk for increasing polysubstance use over time, which in turn conveys additional risk for future depressive symptoms, even after accounting for gender, ethnicity, and household income. In contrast, early drug use did not portend risk for future depressive symptoms. These findings suggest a complicated pattern of interrelations over time and indicate that many current models of co-occurring polysubstance use and depressive symptoms may not fully account for these associations. Instead, the results suggest a developmental cascade, in which symptoms of one disorder promote symptoms of the other across intrapersonal domains.

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Lin, Yufen, Sharron L. Docherty, Laura S. Porter, and Donald E. Bailey. "Symptom experience and self-management for multiple co-occurring symptoms in patients with gastric cancer: A qualitative study." European Journal of Oncology Nursing 49 (December 2020): 101860. http://dx.doi.org/10.1016/j.ejon.2020.101860.

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Zhen, Rui, Lijuan Quan, and Xiao Zhou. "Co-occurring patterns of post-traumatic stress disorder and depression among flood victims: A latent profile analysis." Journal of Health Psychology 25, no. 10-11 (March 21, 2018): 1543–55. http://dx.doi.org/10.1177/1359105318763505.

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This study examined the co-occurring patterns of post-traumatic stress disorder and depression. A sample of 187 victims completed self-report questionnaires after a major flood disaster. Results indicated four classes: low symptoms group (49.7%), mild comorbid symptoms group (24.1%), serious comorbid symptoms group (3.2%), and medium comorbid symptoms group (23.0%). Male victims were less likely and older victims were more likely to belong to the medium comorbid symptoms group; victims with more serious trauma exposure and those using more maladaptive cognition emotional regulation strategies were more likely to belong to both the mild and medium comorbid symptoms groups.

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Essex, Marilyn J., Marjorie H. Klein, Richard Miech, and Nancy A. Smider. "Timing of initial exposure to maternal major depression and children's mental health symptoms in kindergarten." British Journal of Psychiatry 179, no. 2 (August 2001): 151–56. http://dx.doi.org/10.1192/bjp.179.2.151.

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BackgroundLittle is known about the influence on child mental health symptoms of the timing of initial exposure to maternal major depression or whether the timing is associated with ‘pure’ or co-occurring internalising and externalising symptoms.AimsTo address these issues, while also taking account of child gender and family socio-economic status.MethodIn a prospective community-based study, 421 kindergarten teachers rated children's symptoms. Previous assessments of maternal major depression indicated whether children were first exposed during infancy, in the toddler/pre-school period, or never.ResultsExposure during infancy was associated with high internalising symptoms, especially when co-occurring with high externalising symptoms. Initial exposure in the toddler/pre-school years increased the risk of ‘pure’ externalising symptoms among girls.ConclusionsThe association of child mental health symptoms with the timing of initial exposure to maternal depression highlights the need for effective prevention and intervention strategies addressed to the developmental issues of each period.

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Redmond, Sean M., Andrea C. Ash, and Tiffany P. Hogan. "Consequences of Co-Occurring Attention-Deficit/Hyperactivity Disorder on Children's Language Impairments." Language, Speech, and Hearing Services in Schools 46, no. 2 (April 2015): 68–80. http://dx.doi.org/10.1044/2014_lshss-14-0045.

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Purpose Co-occurring attention-deficit/hyperactivity disorder (ADHD) and communication disorders represent a frequently encountered challenge for school-based practitioners. The purpose of the present study was to examine in more detail the clinical phenomenology of co-occurring ADHD and language impairments (LIs). Method Measures of nonword repetition, sentence recall, and tense marking were collected from 57 seven- to nine-year-old children. The performances of children with ADHD+LI status were compared with those of children with specific language impairment (SLI) and children with typical development (TD). Results ADHD status had no independent detrimental impact on the affected children's LIs (SLI = ADHD+LI < TD). A modest positive correlation was found between the severity of children's ADHD symptoms and their sentence recall performance, suggesting a tendency for affected children who had higher levels of ADHD symptoms to perform better than those children with lower levels. Conclusion These outcomes are difficult to reconcile with attention-deficit/information-processing accounts of the core deficits associated with SLI. Potential protective mechanisms associated with ADHD status are discussed.

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King, Amanda, Dorela Shuboni-Mulligan, Elizabeth Vera, Sonja Crandon, Orwa Aboud, Ramya Antony, Lisa Boris, et al. "QOLP-36. THE IMPORTANCE OF SLEEP DISTURBANCE IN PRIMARY BRAIN TUMOR (PBT) PATIENTS: CLINICAL CHARACTERISTICS & CO-OCCURRENCE WITH TUMOR-RELATED & PSYCHOLOGICAL SYMPTOMS." Neuro-Oncology 21, Supplement_6 (November 2019): vi205—vi206. http://dx.doi.org/10.1093/neuonc/noz175.856.

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Abstract Sleep disturbance (SD) is a common symptom reported by PBT patients and research has demonstrated a link between sleep and stress circadian pathways. SD can impact perceived severity of other symptoms and development of psychopathology. This study explored the prevalence of moderate-severe SD in PBT patients, identifying associated clinical characteristics and co-occurrence with other tumor-related and psychological symptoms. Demographic, clinical characteristics, MDASI-Brain Tumor, and PROMIS Depression and Anxiety Short-Forms were collected at study entry. Descriptive statistics, Chi-square tests, and independent t-tests were used to report results. The sample included 424 patients (58% male, 81% Caucasian) with a median age of 49 years (range 18–81) and 58% with high-grade gliomas. Most had received treatment with surgery, radiation or chemotherapy prior to study entry, with 44% reporting a past recurrence. Moderate-severe SD (³ 5 on a 0–10 scale) was reported in 19% of patients and was associated with younger age (mean difference = 5 years), poor KPS (OR 2.2), current steroid use (OR 2.4), and tumor progression on MRI (OR 2). Those with moderate-severe SD had a higher overall symptom burden (mean difference = 2.3) and reported more moderate-severe symptoms (8 vs. 2). Patients reporting moderate-severe SD also reported higher severity in affective and cognitive symptom domains and mood-interference, with fatigue (72%), drowsiness (59%), and distress (56%) the most frequently co-occurring symptoms. Patients with moderate-severe SD also had increased prevalence of moderate-severe anxiety (32%) and depression (23%), compared to 10% in those without SD. PBT patients with moderate-severe SD are more symptomatic and have higher incidence of mood disturbance, suggesting a key role for sleep in the development of tumor-related and psychological symptoms. Future work delineating specific pathways involving sleep disturbance and co-occurring symptoms will be foundational for designing targeted sleep interventions to improve symptom burden and quality of life.

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