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Howdon, Daniel, Jochen Mierau, and Samuel Liew. "The relationship between early life urbanicity and depression in late adulthood: evidence from the Survey of Health, Ageing and Retirement in Europe." BMJ Open 9, no. 9 (September 2019): e028090. http://dx.doi.org/10.1136/bmjopen-2018-028090.
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ObjectivesWe aimed to study the association of childhood urbanicity with depressive symptoms in late adulthood.Design, setting and participantsWe used linear and logistic regressions to analyse data drawn from 20 400 respondents from the Survey of Health, Ageing and Retirement in Europe, a panel dataset incorporating a representative sample of the 50+ population in 13 European countries.Outcomes and analysisChildhood urbanicity was determined using self-reports of the respondents’ circumstances at age 10, and late-adulthood depression using the EURO-D scale. We conditioned on circumstances early in life as well as later in life, most importantly late-adulthood urbanicity. We estimated the associations using linear regression models and limited dependent variable models.ResultsA pooled regression of both men and women suggested that childhood urbanicity is associated non-monotonically with depression in late adulthood and is particularly apparent for those spending their childhoods in suburban settings. We found that individuals who spend the longest time in their childhood in a suburban home exhibit an average increase in probability of 3.4 (CI 1.1 to 5.7) percentage points in reporting four or more depressive symptoms. The association was robust to the inclusion of a host of household characteristics associated with childhood urbanicity and was independent of current urbanicity and current income. When broken down by gender, we found some evidence of associations between depressive outcomes and urban living for men, and stronger evidence of such associations with urban and suburban living for women who exhibit an increase of 5.6 (CI 2.2 to 9.0) percentage points in reporting four or more depressive symptoms.ConclusionsOur analysis reveals a relationship between childhood urbanicity and depression in late adulthood. The evidence presented on the nature of this relationship is not straightforward but is broadly suggestive of a link, differing by gender, between greater urbanicity and higher levels of depressive symptoms. The life-long nature of this association may potentially inform policy agendas aimed at improving urban and suburban living conditions.
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van der Leeuw, C., L. D. de Witte, A. Stellinga, C. van der Ley, R. Bruggeman, R. S. Kahn, J. van Os, and M. Marcelis. "Vitamin D concentration and psychotic disorder: associations with disease status, clinical variables and urbanicity." Psychological Medicine 50, no. 10 (July 22, 2019): 1680–86. http://dx.doi.org/10.1017/s0033291719001739.
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AbstractBackgroundThe association between schizophrenia and decreased vitamin D levels is well documented. Low maternal and postnatal vitamin D levels suggest a possible etiological mechanism. Alternatively, vitamin D deficiency in patients with schizophrenia is presumably (also) the result of disease-related factors or demographic risk factors such as urbanicity.MethodsIn a study population of 347 patients with psychotic disorder and 282 controls, group differences in vitamin D concentration were examined. Within the patient group, associations between vitamin D, symptom levels and clinical variables were analyzed. Group × urbanicity interactions in the model of vitamin D concentration were examined. Both current urbanicity and urbanicity at birth were assessed.ResultsVitamin D concentrations were significantly lower in patients (B = −8.05; 95% confidence interval (CI) −13.68 to −2.42; p = 0.005). In patients, higher vitamin D concentration was associated with lower positive (B = −0.02; 95% CI −0.04 to 0.00; p = 0.049) and negative symptom levels (B = −0.03; 95% CI −0.05 to −0.01; p = 0.008). Group differences were moderated by urbanicity at birth (χ2 = 6.76 and p = 0.001), but not by current urbanicity (χ2 = 1.50 and p = 0.224). Urbanicity at birth was negatively associated with vitamin D concentration in patients (B = −5.11; 95% CI −9.41 to −0.81; p = 0.020), but not in controls (B = 0.72; 95% CI −4.02 to 5.46; p = 0.765).ConclusionsLower vitamin D levels in patients with psychotic disorder may in part reflect the effect of psychosis risk mediated by early environmental adversity. The data also suggest that lower vitamin D and psychopathology may be related through direct or indirect mechanisms.
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Rodriguez, Alejandro, Laura Rodrigues, Martha Chico, Maritza Vaca, Mauricio Lima Barreto, Elizabeth Brickley, and Philip J. Cooper. "Measuring urbanicity as a risk factor for childhood wheeze in a transitional area of coastal ecuador: a cross-sectional analysis." BMJ Open Respiratory Research 7, no. 1 (November 2020): e000679. http://dx.doi.org/10.1136/bmjresp-2020-000679.
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Background The urbanisation process has been associated with increases in asthma prevalence, an observation supported largely by studies comparing urban with rural populations. The nature of this association remains poorly understood, likely because of the limitations of the urban–rural approach to understand what a multidimensional process is. Objective This study explored the relationship between the urbanisation process and asthma prevalence using a multidimensional and quantitative measure of urbanicity. Methods A cross-sectional analysis was conducted in 1843 children living in areas with diverse levels of urbanisation in the district of Quinindé, Ecuador in 2013–2015. Categorical principal components analysis was used to generate an urbanicity score derived from 18 indicators measured at census ward level based on data from the national census in 2010. Indicators represent demographic, socioeconomic, built environment and geographical dimensions of the urbanisation process. Geographical information system analysis was used to allocate observations and urban characteristics to census wards. Logistic random effects regression models were used to identify associations between urbanicity score, urban indicators and three widely used definitions for asthma. Results The prevalence of wheeze ever, current wheeze and doctor diagnosis of asthma was 33.3%, 13% and 6.9%, respectively. The urbanicity score ranged 0–10. Positive significant associations were observed between the urbanicity score and wheeze ever (adjusted OR=1.033, 95% CI 1.01 to 1.07, p=0.05) and doctor diagnosis (adjusted OR=1.06, 95% CI 1.02 to 1.1, p=0.001). For each point of increase in urbanicity score, the prevalence of wheeze ever and doctor diagnosis of asthma increased by 3.3% and 6%, respectively. Variables related to socioeconomic and geographical dimensions of the urbanisation process were associated with greater prevalence of wheeze/asthma outcomes. Conclusions Even small increases in urbanicity are associated with a higher prevalence of asthma in an area undergoing the urban transition. The use of a multidimensional urbanicity indicator has greater explanatory power than the widely used urban–rural dichotomy to improve our understanding of how the process of urbanisation affects the risk of asthma.
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Ventimiglia, Ilaria, and Soraya Seedat. "Current evidence on urbanicity and the impact of neighbourhoods on anxiety and stress-related disorders." Current Opinion in Psychiatry 32, no. 3 (May 2019): 248–53. http://dx.doi.org/10.1097/yco.0000000000000496.
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Zuckermann, Alexandra M. E., Mahmood R. Gohari, Margaret de Groh, Ying Jiang, and Scott T. Leatherdale. "The role of school characteristics in pre-legalization cannabis use change among Canadian youth: implications for policy and harm reduction." Health Education Research 35, no. 4 (July 5, 2020): 297–305. http://dx.doi.org/10.1093/her/cyaa018.
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Abstract Reducing youth cannabis use in Canada is a public health priority with schools of interest as a potential modifier of behavior and as a venue for prevention programming. This work aimed to provide a basis for future policy and programming by evaluating pre-legalization cannabis use change patterns in schools and the impact of school characteristics on these patterns. Average rates of cannabis use behavior change (initiation, escalation, reduction, cessation) were collected from 88 high schools located in Ontario and Alberta, Canada participating in the COMPASS prospective cohort study. There was little variability in cannabis use behaviors between schools with intra-class correlation coefficients lowest for cessation (0.02) and escalation (0.02) followed by initiation (0.03) and reduction (0.05). Modest differences were found based on school province, urbanicity and student-peer use. Cannabis ease of access rates had no significant effect. Fewer than half the schools reported offering school drug use prevention programs; these were not significantly associated with student cannabis use behaviors. In conclusion, current school-based cannabis prevention efforts do not appear sufficiently effective. Comprehensive implementation of universal prevention programs may reduce cannabis harms. Some factors (urbanicity, peer use rates) may indicate which schools to prioritize.
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Quadlin, Natasha, and Long Doan. "Sex-Typed Chores and the City: Gender, Urbanicity, and Housework." Gender & Society 32, no. 6 (July 19, 2018): 789–813. http://dx.doi.org/10.1177/0891243218787758.
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How does place structure the gendered division of household labor? Because people’s living spaces and lifestyles differ dramatically across urban, suburban, and rural areas, it follows that time spent on household chores may vary across places. In cities, for example, many households do not have vehicles or lawns, and housing units tend to be relatively small. Urban men’s and women’s time use therefore provides insight into how partners contribute to household chores when there is less structural demand for the types of tasks they typically do. We examine these dynamics using data on heterosexual married individuals from the American Time Use Survey combined with the Current Population Survey. We find that urban men spend relatively little time on male-typed chores, but they spend the same amount of time on female-typed chores as their suburban and rural counterparts. This pattern suggests that urban men do not “step up” their involvement in female-typed tasks even though they contribute little in the way of other housework. In contrast, urbanicity rarely predicts women’s time use, implying that women spend considerable time on household chores regardless of where they live. Implications for research on gender and housework are discussed.
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Amering, M. "Social factors in mental disorders - update on the evidence." European Psychiatry 26, S2 (March 2011): 2126. http://dx.doi.org/10.1016/s0924-9338(11)73829-9.
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ContextSocial determinants of mental health and mental illness are classic topics of social psychiatric research and practice.ObjectivesThe broad range as well as specific examples of different areas of this field of interest will be presented and discussed with a focus on current research needs.Key messagesThe field of social determinants of mental health and illness ranges from traditional sociological concepts such as social class and gender to recently emerging concepts such as empowerment, social capital and Amartya Sen's capabilities approach.There is ample evidence that contextual factors on the micro level, such as the role of the family, as well as those on a macro-level such as stigma and dicrimination play a vital role with regard to psychiatric disorders, their treatment and course. Also, internationally emerging policies and research into mental health promotion and prevention clearly show that interventions rely on and vary with social structures and policy strategies in different cultural and economical situations. Current special interest fields in psychiatry such as migration, urbanicity and childhood experiences renew interest into gene x environment interactions as do the dynamic and complex concepts of recovery and resilience.ConclusionsThe large existing evidence base as well as urgent current research efforts such as those into epigenetic mechanisms warrant new vigor in developing and researching variables for further research into the social determinants of mental health and illness.
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Nenadic, Igor, Lukas Weigardt, Simon Schmitt, Tina Meller, Frederike Stein, Katharina Brosch, Udo Dannlowski, Axel Krug, and Tilo Kircher. "S162. MULTI-MODAL ANALYSIS OF THE EFFECTS OF URBAN UPBRINGING ON BRAIN STRUCTURE: THE FOR2107 COHORT." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S98. http://dx.doi.org/10.1093/schbul/sbaa031.228.
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Abstract Background Urbanicity has been identified as a major environmental risk factor for schizophrenia as well as other major mental disorders. While initial structural brain imaging studies have pointed to medial and lateral prefrontal cortices being associated with urbanicity during childhood and adolescence, most of these studies have been limited to smaller samples and single analysis methods. The present study used the large ongoing FOR2107 multi-centre study cohort (Kircher et al., 2018) to analyse associations of urban upbringing. Methods We analysed a data set of n=625 healthy subjects without a current or previous psychiatric disorder (ascertained through SCID-I interviews), who underwent 3 Tesla MRI scanning, obtaining a high-resolution T1-weighted MPRAGE and a DTI scan. We subsequently also analysed a pilot samples of 42 patients with DSM-IV schizophrenia. We obtained data on urban upbringing (Lederbogen score; Lederbogen et al., 2014) for the first 15 years of life, as well as number of moves. T1 data were pre-processed using CAT12 software, using surface-based morphometric analysis of cortical thickness (CT) with 15 mm smoothing. DTI data were analysed using the TBSS approach in FSL software. We used general linear models to calculate multiple regression analyses using both linear and quadratic (non-linear) associations with urbanicity scores, followed up by analyses of correlations with number of relocations (as unspecific stress factors). Analyses of CT and DTI were each corrected for multiple comparisons using FWE. Results In the healthy subject cohort we identified a significant negative linear correlation (p=0.042 FWE cluster-level; p=0.014 peak-level) between urban upbringing scores and cortical thickness (CT) in a right precuneus / posterior cingulate cluster (x/y/z=35;-88;-15), while non-linear analysis identified an additional trend in the left occipital cortex (p=0.073 FWE cluster-level; -17;-100;15). We did not find significant effects for number of relocations/moves. DTI analysis of fractional anisotropy (FA) showed a significant association (all p<0.05 FWE-corrected) for the uncinate fasciculus and inferior fronto-occipital fasciculus. CT analysis in the schizophrenia pilot cohort showed similar effects, but in a more dorsal precuneus cluster (6;-56;45) only at uncorrected levels. Discussion Our study identified structural variation in cortical thickness in the precuneus / posterior cingulate cortex of healthy subjects, regions linked to abnormal DMN activity and stress. While the trend-level finding in schizophrenia patients was located in an adjacent cluster, our findings can be interpreted as these medial parietal lobe structure mediating this particular risk factor. Our findings argue against a more wide-spread non-specific effect, as seen in some earlier smaller studies, but points to distinct neuronal network as mediators of this particular risk. The identified brain regions are linked to stress. Unlike previous prefrontal findings, they suggest a new link to the precuneus, a central hub of the default mode network. Given that these effects were observed in clinically healthy subjects, our findings also carry implications for a better understanding of the macro-environment in adolescence.
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Biswas, Ayantika, and Shri Kant Singh. "Cardiovascular Diseases in Context: Multilevel Analysis of Risk Factors in India (2004–2014)." Asian Pacific Journal of Health Sciences 7, no. 3 (August 5, 2020): 59–69. http://dx.doi.org/10.21276/apjhs.2020.7.3.14.
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Cardiovascular diseases (CVDs), accounting for approximately half of all deaths owing to non-communicable diseases worldwide, have become a major public health concern. The CVD risk is high among the Indian population, as well as varies by geography. The purpose of the current study was to test the independent effects of contextual socio-economic variables, whilst adjusting for individual socio-economic variables on CVD risk factors in India. Data from the 52nd, 60th, and 71st NSSO rounds pertaining to Social Consumption related to Health have been utilized for the current study. A four-level multilevel model has been fitted to examine the measured individual, household, community, and district factors on the prevalence of CVDs.District educational attainment, household expenditure quintile, and proportion of district urbanicity have emerged as important factors with few contra-indications in terms of traditional directions of association, as opposed to extant literature. Religious and ethnic composition of the communities and districts have also been found to have an impact. In order to better manage the CVD health of the nation, there is a strong need to focus on community-level and district-level interventions, in addition to individual-level factors. Future research should investigate these factors to account for unexplained variations in CVD management.
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Baxter, A. J., K. M. Scott, T. Vos, and H. A. Whiteford. "Global prevalence of anxiety disorders: a systematic review and meta-regression." Psychological Medicine 43, no. 5 (July 10, 2012): 897–910. http://dx.doi.org/10.1017/s003329171200147x.
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BackgroundThe literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study.MethodA systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.ResultsThe prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8–10.9%) and ranged from 5.3% (3.5–8.1%) in African cultures to 10.4% (7.0–15.5%) in Euro/Anglo cultures.ConclusionsAnxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.
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Triska, Olive H., John Church, Douglas Wilson, Rick Roger, Robert Johnston, Ken Brown, and Tom W. Noseworthy. "Physicians' Perceptions of Integration in Three Western Canada Health Regions." Healthcare Management Forum 18, no. 3 (October 2005): 18–24. http://dx.doi.org/10.1016/s0840-4704(10)60364-x.
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Over the past decade, provincial governments have embarked on ambitious plans to better integrate their healthcare systems, through the introduction of regional governance and management structures. The objective of this study was to examine physicians' perceptions of the current level and facilitators/barriers to integration in three Western Canada Health Regions. Three approaches to integration were investigated: functional, clinical services, and physician system integration. Physicians perceived that functional integration within each region was questionable. Clinical services were the least integrated approach. Physician system integration was rated highest of the approaches, particularly adherence to clinical practice guidelines usage. Physicians' perspectives of integrated health delivery systems do not appear to be influenced by regional size, maturity, urbanicity or facilities. Facilitators of integration were communication among health professionals and service providers, and using a multi-disciplinary team approach in delivery of healthcare in both regions. Barriers to integration were organizational culture, access to specialists and clinical services, and health information records. On a scale of 1–5, all three regions are at the beginning of an integrated health delivery system. Three global suggestions were provided to further integration of health delivery services: physicians should be involved in decision-making process at the Board level, clinical services should be patient-centred, and physicians endorsed the use of multi-disciplinary teams.
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Shaw, Daniel S., Chardée A. Galán, Kathryn Lemery-Chalfant, Thomas J. Dishion, Kit K. Elam, Melvin N. Wilson, and Frances Gardner. "Trajectories and Predictors of Children's Early-Starting Conduct Problems: Child, Family, Genetic, and Intervention Effects." Development and Psychopathology 31, no. 5 (August 2, 2019): 1911–21. http://dx.doi.org/10.1017/s0954579419000828.
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AbstractSeveral research teams have previously traced patterns of emerging conduct problems (CP) from early or middle childhood. The current study expands on this previous literature by using a genetically-informed, experimental, and long-term longitudinal design to examine trajectories of early-emerging conduct problems and early childhood discriminators of such patterns from the toddler period to adolescence. The sample represents a cohort of 731 toddlers and diverse families recruited based on socioeconomic, child, and family risk, varying in urbanicity and assessed on nine occasions between ages 2 and 14. In addition to examining child, family, and community level discriminators of patterns of emerging conduct problems, we were able to account for genetic susceptibility using polygenic scores and the study's experimental design to determine whether random assignment to the Family Check-Up (FCU) discriminated trajectory groups. In addition, in accord with differential susceptibility theory, we tested whether the effects of the FCU were stronger for those children with higher genetic susceptibility. Results augmented previous findings documenting the influence of child (inhibitory control [IC], gender) and family (harsh parenting, parental depression, and educational attainment) risk. In addition, children in the FCU were overrepresented in the persistent low versus persistent high CP group, but such direct effects were qualified by an interaction between the intervention and genetic susceptibility that was consistent with differential susceptibility. Implications are discussed for early identification and specifically, prevention efforts addressing early child and family risk.
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Rodriguez, Victoria, Luis Alameda, Diego Quattrone, Giada Tripoli, Charlotte Gayer-Anderson, Craig Morgan, Marta Di Forti, Evangelos Vassos, and Robin Murray. "T170. GENE AND ENVIRONMENT INTERPLAY AMONG DIAGNOSTIC CATEGORIES IN THE EUGEI STUDY." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S296. http://dx.doi.org/10.1093/schbul/sbaa029.730.
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Abstract Background The importance of inherited factors in the development of affective psychosis, which includes bipolar disorder and major depression disorder, is widely accepted, but the fact that monozygotic twin concordance is substantially less than 100% suggests that environmental factors (ERF) are likely to play an important role as well. While the link between a variety of ERF and schizophrenia-spectrum disorder is well established, less is known about how these ERF impact in affective psychosis. In the current study we aim to analyse the role of environmental risk factors in the expression of affective disorder compared with schizophrenia-spectrum disorder, and its interaction with the genetic risk by using polygenic risk score (PRS). Methods DNA was obtained from most participants (73.6% of 1130 cases and 78.5% of 1499 controls) among 16 European cities as part of the EUGEI case-control study. PRS for SZ, BD and MDD were built using the latest available data from the Psychiatric Genomic Consortium (PGC). Multinomial logistic regression models were used to test whether the association of genetic load (by PRSs) with different diagnostic categories based on DSMIV from OPCRIT items were greater if there was also evidence of ERF (urbanicity, migration, cannabis use and childhood trauma) through the inclusion of interaction terms between the different PRSs and the ERF. Analyses were conducted for each environmental factor separately and for a combined poly-environmental risk score based on Maudsley Environmental Score (MPES) will be calculated. Results Being 1st generation migrant was not associated with any of the diagnostic categories, nor independently nor in interaction with PRSs. Living in urban environment increases the risk of SSD (RRR=1.68, 95% CI 1.06 – 2.67), but without interacting with any genetic measure. Regarding cannabis use, having ever used cannabis is independently significantly associated with SSD (RRR=2.26, 95% CI 1.69 – 3.02) and BD (RRR=5.3, 95% CI 2.69 – 10.46), showing as well in the latter group an interaction with PRS MDD (RRR=2.3, 95% CI 1.18 – 4.49). Although daily use of cannabis strongly predicted risk of SSD and BD, having use more than once a week only increased risk for SSD. Neither having used cannabis more than once a week or daily interacted with any of the PRSs. Having been exposed to any childhood trauma was independently significantly associated with all three diagnostic groups, but did not show any significant interaction with PRSs. Lastly, despite MPES increased risk for SSD and BD, it didn’t interact significantly with any PRSs. Discussion These results suggest that despite evidence of both PRSs on one hand and urbanicity, cannabis and childhood trauma overall increase risk of belonging to any psychotic diagnostic category separately, we only found some suggestion of potential interaction between genetic vulnerability to MDD and cannabis use associated with BD. Nonetheless, due to most of the interactions showing the expected trend, analyses examining interactions between PRSs and ERF with the different diagnostic groups with bigger samples are warranted.
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Matheson, S. L., A. M. Shepherd, and V. J. Carr. "How much do we know about schizophrenia and how well do we know it? Evidence from the Schizophrenia Library." Psychological Medicine 44, no. 16 (February 20, 2014): 3387–405. http://dx.doi.org/10.1017/s0033291714000166.
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Background.True findings about schizophrenia remain elusive; many findings are not replicated and conflicting results are common. Well-conducted systematic reviews have the ability to make robust, generalizable conclusions, with good meta-analyses potentially providing the closest estimate of the true effect size. In this paper, we undertake a systematic approach to synthesising the available evidence from well-conducted systematic reviews on schizophrenia.Method.Reviews were identified by searching Medline, EMBASE, CINAHL, Current Contents and PsycINFO. The decision to include or exclude reviews, data extraction and quality assessments were conducted in duplicate. Evidence was graded as high quality if reviews contained large samples and robust results; and as moderate quality if reviews contained imprecision, inconsistency, smaller samples or study designs that may be prone to bias.Results.High- and moderate-quality evidence shows that numerous psychosocial and biomedical treatments are effective. Patients have relatively poor cognitive functioning, and subtle, but diverse, structural brain alterations, altered electrophysiological functioning and sleep patterns, minor physical anomalies, neurological soft signs, and sensory alterations. There are markers of infection, inflammation or altered immunological parameters; and there is increased mortality from a range of causes. Risk for schizophrenia is increased with cannabis use, pregnancy and birth complications, prenatal exposure to Toxoplasma gondii, childhood central nervous system viral infections, childhood adversities, urbanicity and immigration (first and second generation), particularly in certain ethnic groups. Developmental motor delays and lower intelligence quotient in childhood and adolescence are apparent.Conclusions.We conclude that while our knowledge of schizophrenia is very substantial, our understanding of it remains limited.
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MARCELIS, M., N. TAKEI, and J. VAN OS. "Urbanization and risk for schizophrenia: does the effect operate before or around the time of illness onset?" Psychological Medicine 29, no. 5 (September 1999): 1197–203. http://dx.doi.org/10.1017/s0033291799008983.
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Background. Higher level of urbanicity of place of birth and of place of residence at the time of illness onset has been shown to increase the risk for adult schizophrenia. However, because urban birth and urban residence are strongly correlated, no conclusions can be drawn about the timing of the risk-increasing effect. The current study discriminated between any effect of urbanization before and around the time of illness onset.Methods. All individuals born between 1972 and 1978 were followed up through the Dutch National Psychiatric Case Register for first admission for schizophrenia until 1995 (maximum age 23 years). Exposure status was defined by a combination of place of birth and place of residence at the time of illness onset in the three most densely populated provinces of the Netherlands (the ‘Randstad’, exposed) or in all other areas (the ‘non-Randstad’, non-exposed). The risk for schizophrenia was examined in four different exposure groups: non-exposed born and non-exposed resident (NbNr, reference category), non-exposed born and exposed resident (NbEr), exposed born and non-exposed resident (EbNr) and exposed born and exposed resident (EbEr).Results. The greatest risk for schizophrenia was found in the EbNR group, without evidence for any additive effect of urban residence (rate ratio (RR) for narrow schizophrenia in EbNr group, 2·05 (95% CI 1·18–3·57); in EbEr group, 1·96 (95% CI, 1·55–2·46)). Individuals who were not exposed at birth, but became so later in life, were not at increased risk of developing schizophrenia (RR for narrow schizophrenia in NbEr group, 0·79 (0·46–1·36)).Conclusion. The results suggest that environmental factors associated with urbanization increase the risk for schizophrenia before rather than around the time of illness onset.
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Harati, Pravara M., Janet R. Cummings, and Nicoleta Serban. "Provider-Level Caseload of Psychosocial Services for Medicaid-Insured Children." Public Health Reports 135, no. 5 (July 9, 2020): 599–610. http://dx.doi.org/10.1177/0033354920932658.
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Objective We estimated the caseload of providers, practices, and clinics for psychosocial services (including psychotherapy) to Medicaid-insured children to improve the understanding of the current supply of such services and to inform opportunities to increase their accessibility. Methods We used 2012-2013 Medicaid claims data and data from the 2013 National Plan and Provider Enumeration System to identify and locate therapists, psychiatrists, and mental health centers along with primary, rehabilitative, and developmental care providers in the United States who provided psychosocial services to Medicaid-insured children. We estimated the per-provider, per-location, and state-level caseloads of providers offering these services to Medicaid-insured children in 34 states with sufficiently complete data to perform this analysis, by using the most recent year of Medicaid claims data available for each state. We measured caseload by calculating the number of psychosocial visits delivered by each provider in the selected year. We compared caseloads across states, urbanicity, provider specialty (eg, psychiatry, psychology, primary care), and practice setting (eg, mental health center, single practitioner). Results We identified 63 314 providers, practices, or centers in the Medicaid claims data that provided psychosocial services to Medicaid-insured children in either 2012 or 2013. The median provider-level per-year caseload was <25 children and <250 visits across all provider types. Providers with a mental health center–related taxonomy accounted for >40% of visits for >30% of patients. Fewer than 10% of providers and locations accounted for >50% of patients and visits. Conclusions Psychosocial services are concentrated in a few locations, thereby reducing geographic accessibility of providers. Providers should be incentivized to offer care in more locations and to accept more Medicaid-insured patients.
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Olson, Julie, Joanne S. Buzaglo, Shauna McManus, Linda House, and Thomas W. LeBlanc. "Predictors of Patient-Reported Communication with Their Health Care Team about New Treatment Options for Chronic Lymphocytic Leukemia." Blood 132, Supplement 1 (November 29, 2018): 5870. http://dx.doi.org/10.1182/blood-2018-99-118996.
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Abstract Background: Chronic lymphocytic leukemia (CLL) progresses with time and, as a result, patients can be challenged by considering multiple treatment options. Importantly, over the past decade, an array of new CLL treatments have emerged, including targeted therapy and immunotherapy options. Health care teams, therefore, play an important role in discussing new treatments with patients to ensure shared decision making. A substantial proportion of patients, however, report not discussing newly approved treatment options with clinicians. Our goal was to understand the sociodemographic and clinical factors associated with doctors' likelihood of discussing new treatment options in a national sample of CLL patients. Methods: Using data from the Cancer Support Community's Cancer Experience Registry®, our analytic sample included 187 participants who report CLL as their primary diagnosis. The dependent variable in all analyses was a dichotomous, patient-reported indicator of whether or not their doctor discussed new treatment options (e.g., ibrutinib, idealisib, obinutuzumab) with them. Our independent variables included: 1) sociodemographic characteristics: age, gender, education, urbanicity, and race; 2) clinical factors: genetic risk, treatment status, years since diagnosis, CLL risk (low, intermediate or high; based on patient report of how doctor estimated their CLL may progress over time), and relapse; and 3) patient-clinician communication: patient involvement in treatment decision making, patient's consideration of financial cost of care, discussion of health care team's goals for treatment, and discussion of patient's goals for treatment. Our analyses proceeded in two steps. First, we descriptively compared patients who discuss new treatments with their doctors and those who do not using Student's t-test. Second, multivariate logistic regression models estimated likelihood of doctor discussing new treatment options by sociodemographic, clinical, and patient-provider characteristics. Multiple imputation accounted for missingness in our regression models. Results: Our sample was 48% female, 96% White, and averaged 62 years of age (SD = 10), with a mean time since diagnosis of 7 years (SD = 5). 18% of our sample reported having a deletion 17p, 22% reported having a deletion 13q, 22% were currently receiving chemotherapy, and 16% reported recurrence of their CLL. 58% of our sample reported discussing new treatment options with their doctor. Descriptively, patients who report higher frequencies of cancer recurrence, intermediate or high risk of their CLL, genetic testing results indicative of deletion 17p and deletion 13q, current chemotherapy, greater involvement in treatment decision making, and lower consideration of financial cost of care were significantly more likely to discuss new treatment options with their doctors. In multivariate models, controlling for all sociodemographic, clinical, and patient-clinician characteristics, our results highlight a greater likelihood of discussing new options among patients who have experienced a relapse of their CLL. Conclusion: Nearly half of our CLL patients did not report discussing new treatment options with their clinician, raising concerns about whether shared decision-making is really taking place in the era of novel CLL therapeutics. While those who experience a relapse are significantly more likely to discuss new treatment options, unmet needs remain. As new treatments are incorporated into standard of care, greater efforts are needed to enhance shared decision-making at all points of care. Disclosures Buzaglo: Vector Oncology: Employment.
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Zakai, Neil A., Leslie A. McClure, Pamela L. Lutsey, Aaron R. Folsom, and Mary Cushman. "Adoption of Outpatient Treatment of Deep Vein Thrombosis in the U.S.: The Reasons for Geographic and Racial Differences in Stroke Study (REGARDS)." Blood 124, no. 21 (December 6, 2014): 686. http://dx.doi.org/10.1182/blood.v124.21.686.686.
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Abstract Introduction: Outpatient treatment of deep vein thrombosis (DVT) has been shown equivalent to inpatient treatment in clinical trials and results in cost savings and increased patient-convenience. Despite the advantages, there are few studies on the national uptake of outpatient care of DVT in the U.S. and there are no national surveillance studies of DVT. Through understanding the current treatment patterns of DVT, we can design interventions to reduce health care costs and increase patient convenience. Methods: Between 2003-07, 30,239 participants ≥45 years old were enrolled in REGARDS, a nationally representative cohort recruited from the contiguous U.S. By design, 55% were female, 41% were black, and 56% lived in the southeast. Venous thrombosis (VTE) events were ascertained through 2011, with identification by telephone interview, review of reported hospitalizations, and review of deaths and validated by physician review of hospital and outpatient records. Using all available information, characteristics of the VTE event and treatment were systematically recorded. Location of residence was defined by geocoding of the address with urbanicity defined by census tract, and other risk factors were obtained through surveys, telephone interviews, or an in-home visit. We used logistic regression to determine the predictors of outpatient treatment of DVT among those with DVT. Results: Over 5 years of follow-up 379 VTE events occurred (incident and recurrent); 185 were diagnosed with a pulmonary embolism and 53 occurred as a complication of hospitalization (and not eligible for outpatient treatment) leaving 141 DVT events potentially eligible for outpatient treatment. Only 28% of DVT events (39 of 141) were treated as an outpatient. Factors significantly associated with being treated as an outpatient include younger age, female sex, white race, later year of DVT diagnosis, and living in an urban area (Table). Other risk factors with high odds ratios that were not statistically significant were living outside the southeast of the U.S. and being a high school graduate (Table). Conclusions: In a contemporary, nationally representative cohort, only 28% of DVT events were treated as an outpatient. Adverse socioeconomic status, residence in a rural area, advancing age, race, and male sex were independently associated with lower likelihood of outpatient treatment. These data highlight the low proportion of DVTs currently treated on an outpatient basis, as well as disparities in the outpatient treatment of DVT. Outpatient DVT treatment has the potential to reduce the cost of medical care for DVT in the U.S. Table: Predictors of Outpatient treatment of DVTs in the REGARDS Study Variable Prevalence of Factor (%, n) Odds of Outpatient Treatment* Age (per 10 years younger) 69 years (Median) 1.90 (1.19, 3.02) Year of VTE (per 1 year later) 2008 (Median, range 2003-11) 1.35 (1.03, 1.77) Sex (female vs male) 46.8% (66) 2.41 (1.06, 5.47) Race (white vs black) 66.0% (93) 3.29 (1.30, 8.30) Region (elsewhere vs southeast) 50.4% (71) 2.00 (0.87, 4.63) High School Graduate (yes vs no) 90.8% (128) 4.51 (0.52, 38.82) Income >$20,000 (yes vs no) 63.8% (90) 2.63 (0.87, 7.94) Living in a Urban Area (yes vs no) 75.2% (106) 4.16 (1.25, 13.79) Adjusted for age, sex, race, VTE event year and region* Disclosures No relevant conflicts of interest to declare.
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Steixner-Kumar, Agnes, Jan Seidel, Vinicius Daguano Gastaldi, Martin Begemann, and Hannelore Ehrenreich. "T81. MULTIPLE DRUG USE IN SCHIZOPHRENIA - THE ROLE OF EARLY ENVIRONMENTAL RISK ACCUMULATION AND GENETIC PREDISPOSITION." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S262—S263. http://dx.doi.org/10.1093/schbul/sbaa029.641.
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Abstract Background Drug (ab)use and substance use disorders are frequently observed in patients with psychiatric illness, but the underlying causes remain widely unknown. A number of environmental risk factors have been proposed to affect the use of one or multiple drugs in the general population and adolescents. Whereas most previous studies focused on the influence of single risk factors on the use of one or a few selected drugs, the effect of accumulated environmental risk in early life on multiple drug use remains to be studied. Similarly, evidence on genetic susceptibility to the (ab)use of a single drug, e.g. nicotine, alcohol, cocaine, is abundant, while the role of genetic predisposition for multiple drug use - in particular during early life - is yet to be explored. Thus, the current work aims to study the role of environmental as well as genetic risk factors for multiple drug abuse (‘polytoxicomania’) in a large sample of schizophrenic/schizoaffective patients. Methods Information from ~2000 schizophrenia/schizoaffective patients on (preadult) multiple drug use (> 2 drugs) and environmental risk factors was extracted from the Göttingen Research Association for Schizophrenia (GRAS) data collection – currently the largest data base of deeply phenotyped patients with schizophrenia/schizoaffective disorder or other neuropsychiatric diseases. In addition, genetic data from these patients and 2111 healthy blood donors were used in a novel genetic approach that employs multiple genome-wide association studies (GWAS) to identify genetic associations with preadult multiple drug use. Genotyping was performed on a semi-custom Axiom MyDesign Genotyping Array (Affymetrix, Santa Clara, CA, USA), based on a CEU (Caucasian residents of European ancestry from UT, USA) marker backbone. Results The accumulation of environmental risk factors, i.e. sexual abuse, physical abuse, migration, urbanicity, together with alcohol and cannabis consumption as secondary risk factors, in early life (< 18 years) were strongly associated with lifetime multiple drug use (p = 3.48 x 10^-44, extreme group comparison odds ratio (OR) = 31.8). When the sample was split into preadult and adult multiple drug users, there was a remarkable association of the number of preadult environmental risk factors with preadult multiple drug use (p = 1.12 x 10^-25, OR = 243.6). Furthermore, preadult environmental risk accumulation strongly predicted onset of multiple drug use in adulthood (> 18 years; p = 6.27 x 10^-18, OR = 19.4). The application of the novel genetic approach yielded 35 single-nucleotide variants (SNPs) that potentially confer susceptibility to preadult multiple drug use. Out of these, 14 were located in gene-coding regions. Interestingly, 9 of these genes are implicated in neuronal development/function or metabolite transport/transformation. Additional gene-based analyses identified another 4 genes relevant for metabolite transport/transformation as well as 4 genes that play a role in hypoxia signaling. Discussion The present results show that an accumulation of environmental risk factors during early life (< 18 years) is a strong predictor of multiple drug use during adolescence and later life. These findings suggest that exposure to accumulated environmental risk during early life is not only associated with violent aggression – as previously reported by our lab – but is also an important predictor of multiple drug use. Moreover, we present first evidence of a genetic susceptibility to preadult multiple drug use, which will benefit from future replication in suitable samples of patients with mental illness or the general population.
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Evans, B. E., J. van der Ende, K. Greaves-Lord, A. C. Huizink, R. Beijers, and C. de Weerth. "Urbanicity, hypothalamic-pituitary-adrenal axis functioning, and behavioral and emotional problems in children: a path analysis." BMC Psychology 8, no. 1 (February 4, 2020). http://dx.doi.org/10.1186/s40359-019-0364-2.
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Abstract Background Urbanization is steadily increasing worldwide. Previous research indicated a higher incidence of mental health problems in more urban areas, however, very little is known regarding potential mechanisms underlying this association. We examined whether urbanicity was associated with mental health problems in children directly, and indirectly via hypothalamic-pituitary-adrenal (HPA)-axis functioning. Methods Utilizing data from two independent samples of children we examined the effects of current urbanicity (n = 306, ages seven to 12 years) and early childhood urbanicity (n = 141, followed from birth through age 7 years). Children’s mothers reported on their mental health problems and their family’s socioeconomic status. Salivary cortisol samples were collected during a psychosocial stress procedure to assess HPA axis reactivity to stress, and at home to assess basal HPA axis functioning. Neighborhood-level urbanicity and socioeconomic conditions were extracted from Statistics Netherlands. Path models were estimated using a bootstrapping procedure to detect indirect effects. Results We found no evidence for a direct effect of urbanicity on mental health problems, nor were there indirect effects of urbanicity through HPA axis functioning. Furthermore, we did not find evidence for an effect of urbanicity on HPA axis functioning or effects of HPA axis functioning on mental health problems. Conclusions Possibly, the effects of urbanicity on HPA axis functioning and mental health do not manifest until adolescence. An alternative explanation is a buffering effect of high family socioeconomic status as the majority of children were from families with an average or high socioeconomic status. Further studies remain necessary to conclude that urbanicity does not affect children’s mental health via HPA axis functioning.
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Rodríguez López, Santiago, Usama Bilal, Ana F. Ortigoza, and Ana V. Diez-Roux. "Educational inequalities, urbanicity and levels of non-communicable diseases risk factors: evaluating trends in Argentina (2005–2013)." BMC Public Health 21, no. 1 (August 20, 2021). http://dx.doi.org/10.1186/s12889-021-11617-8.
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Abstract Background We investigated a) whether urbanicity is associated with individual-level non-communicable diseases (NCD) risk factors and whether urbanicity modifies trends over time in risk factors; and (b) whether educational inequalities in NCD risk factors change over time or are modified by province urbanicity. Methods We used data from three large national surveys on NCD risk factors (Encuesta Nacional de Factores de Riesgo; ENFR2005–2009-2013) conducted in urban areas of Argentina (n = 108,489). We used gender-stratified logistic random-intercept models (individuals nested within provinces) to determine adjusted associations of self-reported individual NCD risk factors (hypertension, diabetes, obesity, and current smoking) with education and urbanicity. Results In both men and women, the prevalence of obesity and diabetes increased over time but smoking decreased. Hypertension prevalence increased over time in men. Higher urbanicity was associated with higher odds of smoking and lower odds of hypertension in women but was not associated with NCD risk factors in men. Obesity increased more over time in more compared to less urbanized provinces (in men) while smoking decreased more over time in less urbanized provinces. All risk factors had a higher prevalence in persons with lower education (stronger in women than in men), except for diabetes in men and smoking in women. Educational inequalities in obesity (in men) and hypertension (in men and women) became stronger over time, while an initial inverse social gradient in smoking for women reverted and became similar to other risk factors over time. In general, the inverse associations of education with the risk factors became stronger with increasing levels of province urbanicity. Conclusion Increasing prevalence of diabetes and obesity over time and growing inequities by education highlight the need for policies aimed at reducing NCD risk factors among lower socioeconomic populations in urban environments in Argentina.
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Agaku, Israel T., Satomi Odani, Kolawole S. Okuyemi, and Brian Armour. "Disparities in current cigarette smoking among US adults, 2002–2016." Tobacco Control, May 30, 2019, tobaccocontrol—2019–054948. http://dx.doi.org/10.1136/tobaccocontrol-2019-054948.
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BackgroundTo assess disparities in current (past 30 days) cigarette smoking among US adults aged ≥ 18 years during 2002–2016.MethodsNine indicators associated with social disadvantage were analysed from the 2002 to 2016 National Survey on Drug Use and Health: education, annual family income, sex, race/ethnicity, urbanicity, serious psychological distress, health insurance, public assistance, and employment status. Using descriptive and multivariable analyses, we measured trends in smoking overall and within the assessed variables. We also evaluated effect of interactions on disparities and estimated the excess number of smokers attributable to disparities.ResultsDuring 2002–2016, current cigarette smoking prevalence declined overall (27.5%–20.7%; p trend < 0.01), and among all subgroups except Medicare insurees and American Indians/Alaska Natives (AI/ANs). Overall inequalities in cigarette smoking grew even wider or remained unchanged for several indicators during the study period. In 2016, comparing groups with the least versus the most social advantage, the single largest disparity in current smoking prevalence was seen by race/ethnicity (prevalence ratio = 5.1, AI/ANs vs Asians). Education differences alone explained 38.0% of the observed racial/ethnic disparity in smoking prevalence. Interactions were also present; compared with the population-averaged prevalence among all AI/AN individuals (34.0%), prevalence was much higher among AI/ANs with <high school diploma (53.0%), unemployed (58.0%), or with serious psychological distress (66.9%). The burden of smoking attributable to race/ethnic disparities in smoking prevalence was an estimated 27.6 million smokers.ConclusionsOverall smoking inequality increased or remained unchanged because of slower declines in smoking prevalence among disadvantaged groups. Targeted interventions among high-risk groups can narrow disparities.
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Christian, Adam, Courtney Pilkerton, Sarah Singh, Thomas K. Bias, and Stephanie J. Frisbee. "Abstract P005: Association Between County Elementary and Secondary Educational Policy With Cardiovascular Health." Circulation 131, suppl_1 (March 10, 2015). http://dx.doi.org/10.1161/circ.131.suppl_1.p005.
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BACKGROUND: Recent research recognizing the socioeconomic influence of educational attainment on population health, including cardiovascular health (CVH), suggests that modifying educational policy to improve educational outcomes could be an effective approach to improving health outcomes. Although the positive association of educational level with health status is well documented, the effect of education policy on health outcomes is not as thoroughly studied. Identifying relationships amongst educational policy and CVH could provide a target for public policy initiatives designed to positively impact population health. OBJECTIVE: The objective was to examine the potential effect of varying county educational policy on county and individual CVH outcomes. METHODS: Variables of county educational policy were expenditures per pupil, percent of total revenue from each state and local sources, and pupil teacher ratios. School district data from 1997-2005 sourced from the National Center for Education Statistics were adjusted for inflation using the U.S. Dept. of Labor Consumer Price Index as well as regional cost differences using the NCES Comparable Wage Index by school district, and grouped by county. County and individual CVH for 2011 was scored using the AHA’s CVH metric and data from the Behavioral Risk Factor Surveillance System. Linear regression models were used to compare the county means for each education policy variable with both county and individual CVH scores. RESULTS: Mean percent revenue from local sources and mean pupil teacher ratio were both shown to be positively associated with county level CVH (p=0.007 and p=0.023). Individual CVH was inversely associated with mean expenditures per pupil (p=0.023), and positively associated with mean percent revenue from local (p<0.01), mean percent revenue from state (p<0.01), and mean pupil teacher ratio (p<0.001). There was an interactive effect between mean expenditure per pupil and county urbanicity on county CVH (p<0.05), which differed in rural counties compared to the most urban. There was also an interactive effect between mean percent revenue from local and county urbanicity on county CVH (p<0.001). Although no significant effect was observed for mean expenditures per pupil on county CVH, mean expenditures per pupil was inversely related to county CVH in the most urban counties (b=-3.58e-06), and positively related to county CVH in most rural counties (b=4.62e-06). Evidence of relationships between county educational policies and resources with CVH suggests the need for continued research more thoroughly examining variables of education policy as indicators for CVH. CONCLUSION: Further clarification of these relationships will help determine if educational policy adjustments driven by health improvement initiatives would be a useful addition to current strategies aimed at improving population health.
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Paige, John, Geir-Arne Fuglstad, Andrea Riebler, and Jon Wakefield. "Design- and Model-Based Approaches to Small-Area Estimation in A Low- and Middle-Income Country Context: Comparisons and Recommendations." Journal of Survey Statistics and Methodology, September 4, 2020. http://dx.doi.org/10.1093/jssam/smaa011.
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Abstract The need for rigorous and timely health and demographic summaries has provided the impetus for an explosion in geographic studies in low- and middle-income countries. Many of these studies present fine-scale pixel-level maps in an attempt to answer the needs of the current era of precision public health. However, even though household surveys with a two-stage cluster design stratified by region and urbanicity are a major source of data, cavalier approaches are taken to acknowledging the survey design. We investigate the extent to which accounting for the sample design affects the predictive performance at the aggregate level of interest for health policy decisions. We consider various commonly used models and introduce a new Bayesian cluster-level model with a discrete spatial smoothing prior. The investigation is performed through a simulation study in which realistic sampling frames are created for Kenya, based on the population and demographic information, with a survey design that mimics a Demographic Health Survey (DHS). We find that including stratification and cluster-level random effects can improve predictive performance. Spatially smoothed direct (weighted) estimates and area-level models accounting for stratification were robust to the underlying population and survey design. Continuous spatial models showed some promise in the presence of fine-scale variation; however, these models require the most “hand holding.” Subsequently, we examine how the models perform on real data, estimating the prevalence of secondary education for women aged 20–29 and neonatal mortality rates, using data from the 2014 Kenya DHS.
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Wheldon, Christopher W., and Kara P. Wiseman. "Psychological, Normative, and Environmental Barriers to Tobacco Cessation that Disproportionally Impact Sexual Minority Tobacco Users." Nicotine & Tobacco Research, December 22, 2020. http://dx.doi.org/10.1093/ntr/ntaa268.
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Abstract Introduction Sexual minority populations—particularly gay/lesbian and bisexual women—use tobacco at higher rates than their heterosexual peers. Evidence-based biopsychosocial interventions for tobacco cessation are available; however, research is lacking on the specific barriers to tobacco cessation in these populations. The purpose of this study is to describe the psychological, normative, and environmental barriers to cessation that disproportionally impact sexual minority tobacco users. Methods Data from wave 1 of the Population Assessment of Tobacco and Health was used to explore differences by sexual identity across psychosocial barriers and facilitators of tobacco cessation. The analytic sample consisted of current tobacco users (including cigarettes, e-cigarettes, cigars, cigarillos, pipes, hookah, dissolvable snus, and smokeless products). Psychosocial barriers/facilitators were modeled using logistic regression analyses, controlling for age, race/ethnicity, poverty, education, census region, and urbanicity and were stratified by sex. Models accounted for the complex study design and nonresponse. Results Substance use and internalizing/externalizing behavioral problems were more common among gay/bisexual men. Bisexual, but not gay/lesbian, women also had higher odds of these behavioral problems. Bisexual men and women reported less normative pressure to quit than their heterosexual peers (no differences in gay/lesbian tobacco users). Gay men had more environmental barriers to quit, being more likely to receive tobacco promotion materials and live with another tobacco user. Conclusions Several barriers to tobacco cessation were identified as disproportionally impacting sexual minority groups in this study; however, there were considerable differences between sexual minority men and women, as well as between gay and bisexual participants.
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Fortea, Lydia, Aleix Solanes, Edith Pomarol-Clotet, Maria Angeles Garcia-Leon, Adriana Fortea, Carla Torrent, Cristina Varo, et al. "Study Protocol—Coping With the Pandemics: What Works Best to Reduce Anxiety and Depressive Symptoms." Frontiers in Psychiatry 12 (July 2, 2021). http://dx.doi.org/10.3389/fpsyt.2021.642763.
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Background: The coronavirus disease 2019 (COVID-19) pandemic and lockdown might increase anxiety and depressive symptoms in most individuals. Health bodies recommend several coping behaviors to protect against such symptoms, but evidence on the relationship between these behaviors and symptoms mostly comes from cross-sectional studies in convenience samples. We will conduct a prospective longitudinal study of the associations between coping behaviors and subsequent anxiety and depressive symptoms during the COVID-19 pandemic in a representative sample of the Spanish general adult population.Methods: We will recruit 1,000 adult participants from all autonomous communities of Spain and with sex, age, and urbanicity distributions similar to those of their populations and assess anxiety and depressive symptoms and coping behaviors using fortnightly questionnaires and real-time methods (ecological momentary assessments) for 1 year. The fortnightly questionnaires will inquire about anxiety and depressive symptoms [General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9)] and the frequency of 10 potential coping behaviors (e.g., follow a routine) during the past 2 weeks. In addition, we will collect several variables that could confound or moderate these associations. These will include subjective well-being [International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) and Satisfaction with Life Scale (SWLS)], obsessive-compulsive symptoms [Obsessive Compulsive Inventory-Revised (OCI-R)], personality and emotional intelligence [International Personality Item Pool (IPIP) and Trait Emotional Intelligence Questionnaire Short Form (TEIQue-SF)], sociodemographic factors (e.g., work status, housing-built environment), and COVID-19 pandemic-related variables (e.g., hospitalizations or limitations in social gatherings). Finally, to analyze the primary relationship between coping behaviors and subsequent anxiety and depressive symptoms, we will use autoregressive moving average (ARMA) models.Discussion: Based on the study results, we will develop evidence-based, clear, and specific recommendations on coping behaviors during the COVID-19 pandemic and lockdown. Such suggestions might eventually help health bodies or individuals to manage current or future pandemics.