Psychiatric and Mental Health Commons^™

Epigenetic Pathogenesis Of Neurological Disorders In Utero And Considerations For Genetic Counseling, Lauren Juga

Senior Honors Theses

Epigenetic modifications are a major focus of study in the pathogenesis of many disorders regarding metabolism, aging, neurodevelopment, and neurodegeneration. Epigenetic mechanisms are present throughout life but are especially vital to guiding fetal development. The precise timing of gene activation and deactivation guides stem cell differentiation through each embryonic stage. After exposure to environmental stimuli, gene expression can be altered by transcription factors, resulting in observable phenotypes and even pathology. Here, the epigenetic mechanisms responsible for the pathogenesis of neurodevelopmental and neuropsychiatric disorders are explored in response to environmental perturbations in utero. The present goal is to identify correlations between …

Mental Health Mobile Apps And The Need To Update Federal Regulations To Protect Users, Kewa Jiang

Michigan Technology Law Review

With greater societal emphasis on the need for better mental health services coupled with COVID-19 limits, mental health mobile applications have significantly risen in variety, availability, and accessibility. As more consumers use mental health mobile applications, more data is generated and collected by mobile application companies. However, consumers may have the false assumption that the data collected is protected under HIPAA or have an expectation of privacy protection higher than current regulations afford. This Note examines HIPAA, Health Breach Notification Rule, and section 5 of the Federal Trade Commission Act, as well as how these regulations fall short of protecting …

Restoring Wholeness To Psychiatry: Models Of Understanding, Gregory Brown, Lisa Durette, Timothy Ebright, Katie Cho

Psychiatry & Behavioral Health Faculty Research

Psychiatric practice is at a critical juncture in its evolution. Its identified model for understanding the complexity of individuals and their conditions has been the biopsycho-social-spiritual model since it was first proposed nearly half a century ago. In practice, this construct is being challenged by a biomedical model which asserts all psychiatric conditions can be reduced to either neurotransmitter or gene-based causation. We explore how models are used in science to approximate larger reality, with a focus on Systems Theory, which is the philosophical foundation for the bio-psycho-social-spiritual model to describe why this model is necessarily more complete than the …

Mental Health Disorders Among Post Graduate Residents In Kenya During The Covid-19 Pandemic, Sayed Karar, Jasmit Shah, Katie Du, Nidhi Leekha, Zohray Talib

Internal Medicine, East Africa

Background: Healthcare workers, including residents, are prone to various mental health disorders especially given the context of the COVID-19 pandemic. Residents, particularly, are already under undue stress due to their respective training program demands.

Methods: This cross-sectional, online survey-based study from August to November 2020 collected demographic and mental health measurements from all residents at the Aga Khan University Hospital, Nairobi. The questionnaire investigated demographic variables, information regarding direct care of COVID-19 patients, prior history of mental health and mental health outcomes using the Patient Health Questionnaire, Generalized Anxiety Disorder scale, Insomnia Severity Index, Impact of Event Scale–Revised …

Exploring The Relationship Between Student Expected Engagement And Referrals To The Behavioral Intervention Team, Makenzie R. Schiemann

USF Tampa Graduate Theses and Dissertations

Higher education administrators are tasked with supporting and retaining students with increasing needs. These needs often include emotional and mental health issues but can worsen to include suicidality and violence toward others. Traditional campus approaches for supporting students and intervening for violence, such as counseling and campus safety, have been reactionary rather than proactive. Behavioral Intervention Teams (BITs) have emerged as a mechanism for heading off violence before it occurs while also supporting students who may never engage in violence but need support. These teams were born out of the concept that violence is preventable and have grown into a …

Intelligent Malingering In The Setting Of Porphyria Variegata: A Rare Occurrence On Both Fronts, Gersham J. Rainone, Oleg E. Reznik, Mahrukh Majeed, Alina Popa

Transformative Medicine

Malingering can be a difficult diagnosis to discern, especially in patients with well-crafted stories presenting with signs and symptoms that align directly with the literature. This can further become a challenge when a patient is malingering in the setting of a rare disease, where many complaints can be subjective in nature and not entirely testable by physical exam alone. Malingering is responsible for billions of dollars of healthcare waste every single year, and this report can serve as a guide of history elements, signs and symptoms to look out for with patients malingering in the setting of the porphyrias. It …

Nbome Toxicity And Fatalities: A Review Of The Literature, Matthew Lipow, Syed Zane Kaleem, Eduardo Espiridion

Transformative Medicine

In the decade since the introduction of the novel synthetic hallucinogen NBOMe into the consumer market, this drug has become an increasingly prevalent, yet poorly understood cause of altered mental status (AMS) resulting in hospitalization.

In this literature review, we conducted a PubMed query for mentions of NBOMe ingestion since Suzuki et al.’s publication of their 2015 review. Among English language publications published between October 2014 and June 8, 2021, were sixteen case reports and six case series detailing a total of 42 cases of NBOMe toxicity.

Notably, 26 (62%) patients experienced tachycardia, 22 (52%) had hypertension, 34 (81%) experienced …

Alzheimer's And Patient Caregiver Burnout: A Review Of The Literature, Madeline Hekeler

James Madison Undergraduate Research Journal (JMURJ)

The term “silent epidemic” is fitting for Alzheimer’s disease (AD), as its negative impact is widely felt but rarely discussed. Burnout among AD caregivers has become an epidemic of its own as caregivers experience an increase in health risks, stress, and financial burden. This literature review focuses on caregiver burnout and how imperative it is that caregivers are better supported in their role. Researchers have developed instruments to assess and intervene in caregiver burnout that have shown effectiveness among caregivers and their families.Nevertheless, further longitudinal research is warranted regarding more effective interventions, including stress management and social support mechanisms.

Unhealthy Workplace Conditions Contribute To Physician Suicide, Mariah Brennan Nanni, Alexandra Punch

Population Health Research Brief Series

Physicians have the highest suicide rate of all professions. High-stress working environments, long hours, burnout, substance use, and financial stress all contribute to high physician suicide rates. Adding fuel to the fire, COVID-19 has intensified this long-term problem. This issue brief describes the unhealthy workplace conditions that contribute to poor mental health among physicians and calls for policies that encourage physicians to seek help and rest without the fear of punishment.

Clinician Perception Of Treatment For Schizophrenia: Sensory-Based Therapy Or Medication, Sydney Hill, Alexa Almond, Kelsie Moosmann, Sara Boggs

Student Research

Purpose

The purpose of this study is to evaluate clinicians' perception of treatment and lived experience of occupational therapists treating clients diagnosed with Schizophrenia. The two identified treatment variables will be medication and sensory-based therapy and their relation to emotional regulation.

Methods

This study uses a mixed method, correlational design and data will be collected using an online Google Forms platform. Participants include licensed and registered occupational therapists who are currently treating individuals diagnosed with Schizophrenia. The survey was written to branch to relevant questions based on participants' answers. This branching method allows us to collect perception of treatment and …

Système De Gestion Des Risques Liés À La Fatigue Pour Les Policiers En Autopatrouille, Diane B. Boivin, Philippe Boudreau

Rapports de recherche scientifique

Dans les organisations à opérations continues, telles que les services d’urgence, plusieurs facteurs, d’ordre organisationnel et individuel, contribuent à générer de la fatigue physique et mentale chez les travailleurs. Le travail de nuit et rotatif occasionne une perturbation importante dans l’horaire de sommeil et d’éveil. Cette situation augmente le risque de baisse de performance, d’erreurs, d’incidents et d’accidents au travail en plus de réduire la productivité et la santé des travailleurs. Cette recherche s’insère dans une démarche paritaire ayant pour objectif de doter les services de police étudiés d’outils de gestion de la fatigue, scientifiquement validés. Ces outils leur permettront …

Development And Management Of Depression During And After Pregnancy, Alexa Bouts, Maria Patnella, Jourdan Ujlaki, Emily Wells, Hannah Lamb, Michelle Musser

Pharmacy and Wellness Review

Depression during pregnancy is common, whether it is a new onset of the disease or emerging symptoms of the already existent disease. Due to patient and prescriber concerns with antidepressant use during pregnancy, approximately three-quarters of those diagnosed with depression remain untreated. Furthermore, up to half of pregnant women with depression remain undiagnosed due to lack of recognition. As a result, both mother and fetus are at risk for negative health outcomes including substance abuse, functional impairment, increased risk of postnatal depression and poor pregnancy outcomes. Benefits must be balanced against the risks when considering pharmacologic treatment options to manage …

Intergenerational Risk And Resilience Pathways From Discrimination And Acculturative Stress To Infant Mental Health, Sabrina R. Liu, Curt A. Sandman, Elyssia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers’ exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related …

Association Between Diagnosed Anxiety And Depression And Exposure To Life Stressors During The Covid-19 Pandemic, Emily Hallgren Phd, Don E. Willis Phd, Brett Rowland Ma, James P. Selig Phd, Pearl A. Mcelfish Phd

Journal of Health Disparities Research and Practice

Research suggests that mental health disorders heighten the risk of exposure to life stressors. Drawing on a sample of 754 adults from a survey distributed at six primary care clinics, we examine whether adults who reported ever being diagnosed with depression or anxiety were more likely to experience an employment disruption, a housing disruption, and/or report more COVID-19-related stressors during the COVID-19 pandemic. Individuals who reported ever being diagnosed with depression reported a greater burden (B=.75) of COVID-19-related stressors. Those who reported ever being diagnosed with anxiety had higher odds of experiencing an employment disruption (OR=1.90) and a housing disruption …

Evaluation Of Hippocampal Allostatic Load-Associated Factors In Animal Models Of Post-Traumatic Stress Disorder: Relevance To Human Ptsd, Dennis Parker Kelley

LSU Doctoral Dissertations

Post-traumatic stress disorder (PTSD) is associated with elevated allostatic load, nearly double the risk for metabolic syndrome, reduced hippocampal volume, and contextual memory processing deficits. Emerging evidence suggests that these stress effects may predispose individuals to the development of PTSD, and there is a known relationship between chronic stress and metabolic dysfunction. In this work, we utilized two rat models of PTSD to explore these connections. We used an acute predator odor stressor to investigate the relationship between PTSD-like behaviors and mitochondrial dysfunction in the hippocampus of rats, and we observed that conditioned place avoidance was associated with reduced mitochondrial …

Association Of Trauma Center Designation With Postdischarge Survival Among Older Adults With Injuries, Molly P. Jarman, Ginger Jin, Joel S. Weissman, Arlene S. Ash, Jennifer Tjia, Ali Salim, Adil Haider, Zara Cooper

Section of General Surgery

Importance: Trauma centers improve outcomes for young patients with serious injuries. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population.
Objective: To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level.
Design, setting, and participants: This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. Data …

Adverse Childhood Experiences And Resilience In Medical School Students: A Scope Of Medical Literature, Andrea Soto Abarca, Yvette Cortino, Juan C. Lopez-Alvarenga, Maya Guevara

MEDI 9331 Scholarly Activities Clinical Years

Background: Adverse childhood experiences (ACEs) represent certain types of childhood trauma that are associated with long-term negative effects on health and wellbeing. The elevated number of ACEs can lead to depression, suicidality, alcoholism, and substance use. Factors that can protect a person from increased health risks include resilience, which is broadly defined as the ability to overcome challenges or bounce back from adversity. Few studies have analyzed the exposure of ACEs in medical students, however, there has been extensive literature on how low levels of resilience are linked to higher rates of depression, fatigue, and burnout among medical students. …

Modifying Group Interpersonal Psychotherapy For Peripartum Adolescents In Sub-Saharan African Context: Reviewing Differential Contextual And Implementation Considerations, Manasi Kumar, Helen Verdeli, Shekhar Saxena, Inge Petersen, Keng Yen Huang, Caleb Othieno, Nancy Grote, Roslyn Law, Jurgen Unutzer, Mary Mckay

Brain and Mind Institute

Background: This study describes adaptation and modification of World Health Organization (WHO) recommended group interpersonal psychotherapy (IPT-G) for depressed peripartum adolescents. The adaptation process includes accommodating contextual factors and strategies to address intervention implementation barriers, such as engagement problems with adolescents, caregivers, and providers, and stigma and dearth of mental health specialists. The modifications include and adolescent relevant iterations to the therapy format and content.

Methods: A multi-stakeholder led two-stage intervention adaptation and modification process integrating mixed qualitative methods were used with pregnant and parenting adolescents, their partners, and health care workers. In-depth interviews focusing on personal, relationship, social, and …

Long-Term Safety And Efficacy Of Deutetrabenazine In Younger And Older Patients With Tardive Dyskinesia, Martha Sajatovic

Faculty Scholarship

Objectives: To assess long-term safety and efficacy of deutetrabenazine in younger (<55 years) and older (≥55 years) adult participants with tardive dyskinesia (TD). Design: Three-year, single-arm, open-label extension (OLE) study enrolling participants who completed the 12-week, pivotal ARM-TD or AIM-TD studies. Setting: Seventy-six centers in the United States and Europe. Participants: A total of 337 participants with TD (119 younger and 218 older). Intervention: Deutetrabenazine was initiated at 12 mg/day and titrated once weekly by 6 mg/day using a response-driven dosing regimen until adequate dyskinesia control was reached or a clinically significant adverse event occurred. Measurements: This post hoc analysis assessed change and percent change from baseline in total motor Abnormal Involuntary Movement Scale (AIMS) score, response rates for ≥50% AIMS improvement, Clinical Global Impression of Change (CGIC), Patient Global Impression of Change (PGIC), and safety in younger and older participants with TD. Results: After 3 years of open-label treatment, mean deutetrabenazine dose was ∼39.5 mg/day in both groups. Mean±SE changes from baseline in total motor AIMS score were –6.7 ± 0.62 and –6.5 ± 0.47 in younger and older participants, respectively (percent changes: –61.4% ± 4.10% and –54.6% ± 3.01%); 76% of younger and 62% of older participants achieved ≥50% AIMS response. Most younger and older participants achieved treatment success per CGIC (67% and 76%) and PGIC (64% and 63%). Deutetrabenazine was generally well tolerated in both groups. Conclusions: Deutetrabenazine treatment was associated with sustained improvements in total motor AIMS score, treatment success, and improved quality of life, and was well tolerated in younger and older adults with TD in this 3-year OLE study.

Correlation Between Social Media Use And Eating Disorder Symptoms: A Literature Review, Makenna Rose Burger

Kinesiology and Public Health

Importance: Social media is a pervasive influence in modern society presenting many potential public health implications.

Objective: The purpose of this literature review is to synthesize current research regarding social media and eating disorders.

Methods: Primary research was gathered from Google Scholar and OneSearch database resulting in 7 articles. Articles were examined for common themes.

Results: Common themes found in the resulting research is the prevalence of ‘thinspiration’, gamified content, and overlap of eating disorders with other mental illnesses. Several articles found a significant correlation between social media use and the severity of eating disorder symptoms. …

Hallermann-Streiff Syndrome And Psychosis: A Case Report, Tarvis Peacock, Ubaid Khokhar, Jaclyn Murphy, Zach Murphy

HCA Healthcare Journal of Medicine

Hallermann-Streiff syndrome is a rare genetic congenital disorder, with fewer than 200 cases reported to date, that is characterized by brachycephaly with frontal bossing, micrognathia, a “bird-like” beaked nose, microphthalmia with congenital cataracts, dental abnormalities, hypotrichosis, skin atrophy, and short stature. There is limited data on psychosis in individuals with Hallermann-Streiff syndrome; the information available depicts mania rather than psychosis. This case report reviews the presentation and treatment of psychosis in a 32-year-old male with Hallermann-Streiff syndrome who was involuntarily admitted to an inpatient psychiatric unit for persecutory delusions and hallucinations. The patient’s psychosis responded well to risperidone with a …

Women Just Wanna Have Time: Wellness Innovation Research, Jessica Long, Julia Simon, Victoria Demartelly, Candice Norcott, Adrianne Dade

Journal of Wellness

Introduction: Studies show that the stress that resident physicians endure, particularly female residents, can have a negative impact on one’s overall well-being. Many interventional studies have explored the impact that mindfulness, meditation, and exercise have on stress, a negative influencer of well-being. The purpose of this study was to demonstrate how short, self-led mindfulness, meditation, and movement exercises impacted OB/GYN residents at a university-based program.

Methods: Participants voluntarily enrolled in a self-led program (fall 2019 – spring 2020) encompassing movement, mindfulness, and meditative activities, for which they received instructions by email detailing six 21-day cycles (requiring 15 minutes of daily …

A Systematic Review To Propose An Evidence-Based Nutrition Protocol In Depression, Camilla A. Mirkin, Nicole Koci

NSU REACH and IPE Day

Background: Rates of depression have been rising steadily over the last several decades with more than 264 million people affected, making it one of the top three burdens globally. The pandemic has brought on a greater risk of depression. Forty-two percent of individuals surveyed in December 2020 by the US Census Bureau reported depressive symptoms. Many factors, including poor diet quality, play a role in the development of depression during traumatic events like the pandemic. A low-quality dietary pattern has been associated with obesity, low-grade chronic inflammation, dysbiosis, increased cortisol levels and monoamine neurotransmitter deficiency. Among others, these factors have …

Effect Of Computer-Assisted Cognitive Behavior Therapy Vs Usual Care On Depression Among Adults In Primary Care: A Randomized Clinical Trial, Jesse H. Wright, Jesse J. Owen, Tracy D. Eells, Becky F. Antle, Laura B. Bishop, Renee Girdler, Lesley M. Harris, R. Brent Wright, Michael J. Wells, Rangaraj Gopalraj, Michael E. Pendleton, Shehzad Ali

Counseling Psychology: Faculty Scholarship

Importance Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression.

Objectives To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment.

Design, Setting, …

Ambient Air Pollution Exposure And Increasing Depressive Symptoms In Older Women: The Mediating Role Of The Prefrontal Cortex And Insula, Andrew J. Petkus, Susan M. Resnick, Xinhui Wang, Daniel P. Beavers, Mark A. Espeland, Margaret Gatz, Tara Gruenewald, Joshua Millstein, Helena C. Chui, Joel D. Kaufman, Joann E. Manson, Gregory A. Wellenius, Eric A. Whitsel, Keith Widaman, Diana Younan, Jiu-Chiuan Chen

Psychology Faculty Articles and Research

Exposures to fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) have been associated with the emergence of depressive symptoms in older adulthood, although most studies used cross-sectional outcome measures. Elucidating the brain structures mediating the adverse effects can strengthen the causal role between air pollution and increasing depressive symptoms. We evaluated whether smaller volumes of brain structures implicated in late-life depression mediate associations between ambient air pollution exposure and changes in depressive symptoms. This prospective study included 764 community-dwelling older women (aged 81.6 ± 3.6 in 2008–2010) from the Women's Health Initiative Memory Study (WHIMS) Magnetic …

Compounding Inequalities: Adolescent Psychosocial Wellbeing And Resilience Among Refugee And Host Communities In Jordan During The Covid-19 Pandemic, Nicola Jones, Sarah Baird, Bassam Abu Hamad, Zulfiqar Ahmed Bhutta, Erin Oakley, Manisha Shah, Jude Sajdi, Kathryn M. Yount

Department of Paediatrics and Child Health

Purpose: The COVID-19 pandemic and associated risk-mitigation strategies have altered the social contexts in which adolescents in low- and middle-income countries live. Little is known, however, about the impacts of the pandemic on displaced populations, and how those impacts differ by gender and life stage. We investigate the extent to which the pandemic has compounded pre-existing social inequalities among adolescents in Jordan, and the role support structures play in promoting resilience.
Methods: Our analysis leverages longitudinal quantitative survey data and in-depth qualitative interviews, collected before and after the onset of COVID-19, with over 3,000 Syrian refugees, stateless Palestinians and vulnerable …

Mental Health Problems And Service Gaps Experienced By Pregnant Adolescents And Young Women In Sub-Saharan Africa: A Systematic Review, Joan Mutahi, Anna Larsen, Pim Cuijpers, Stefan Swartling Peterson, Jurgen Unutzer, Mary Mckay, Grace John-Stewart, Teresa Jewell, John Kinuthia, Manasi Kumar

Brain and Mind Institute

Background: Pregnant adolescent girls and young women (AGYW, aged 12–24 years) are at high risk for mental health problems, particularly in the Sub-Saharan African (SSA) region.

Methods: We performed a systematic review of mental health studies among pregnant AGYW in SSA published between January 1, 2007 and December 31, 2020 in PubMed, Embase, CINAHL, PsycInfo, and Global Index Medicus following PRISMA guidelines (PROSPERO: CRD42021230980). We used Bronfenbrenner's bioecological model to frame and synthesize results from included studies.

Findings: Our search yielded 945 articles from which 18 studies were included (N = 8 quantitative, N = 9 qualitative, …

Harmful Alcohol Use Among Healthcare Workers At The Beginning Of The Covid-19 Pandemic In Kenya, Florence Jaguga, Edith Kamaru Kwobah, Ann Mwangi, Kirtika Patel, Thomas Mwogi, Robert Kiptoo, Lukoye Atwoli

Internal Medicine, East Africa

Background: Healthcare workers play a key role in responding to pandemics like the on-going COVID-19 one. Harmful alcohol use among them could result in inefficiencies in health service delivery. This is particularly concerning in sub-Saharan Africa where the health workforce is already constrained. The aim of this study is to document the burden and correlates of harmful alcohol use among healthcare workers at the beginning of the COVID-19 pandemic in Kenya with the aim of informing policy and practice.

Methods: This study was a cross-sectional analysis of data obtained from a parent online survey that investigated the burden …

An Interventional Pilot Of Customized Adherence Enhancement Combined With Long-Acting Injectable Antipsychotic Medication (Cae-L) For Poorly Adherent Patients With Chronic Psychotic Disorder In Tanzania, Christopher J. Burant, Carol E. Blixen, Kristin A. Cassidy, Jennifer B. Levin, Martha Sajatovic

Faculty Scholarship

Background: Chronic psychotic disorders (CPD) impose a particularly significant burden in resource-limited settings. Combining long-acting antipsychotic medication (LAI) with a customized adherence enhancement intervention (CAE-L) has potential to advance care. Methods: Nineteen adults ≥ age 18 with CPD who self-reported missing ≥20% of antipsychotic medication within the last month were stabilized on oral haloperidol prior to transitioning to monthly haloperidol decanote for 25 weeks. Outcome evaluations were conducted at baseline and Week 25. Primary outcomes were oral medication adherence assessed via the Tablet Routines Questionnaire (TRQ) and LAI injection frequency. Secondary outcomes included CPD symptoms measured by the Brief Psychiatric …

Optimism And Lipid Profiles In Midlife: A 15-Year Study Of Black And White Adults, Farah Qureshi, Jackie Soo, Ying Chen, Brita Roy, Donald Lloyd-Jones, Laura D. Kubzansky, Julia K. Boehm

Psychology Faculty Articles and Research

Introduction

Optimism is associated with better cardiovascular health, yet little is known about the underlying mechanisms and whether protective relationships are consistently observed across diverse groups. This study examines optimism's association with lipid profiles over time and separately among Black and White men and women.

Methods

Data were from 3,206 middle-aged adults in the Coronary Artery Risk Development in Young Adults study. Optimism was measured in 2000–2001 using the Revised Life Orientation Test. Triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol measurements were obtained at 5-year intervals through 2015–2016. Linear mixed models evaluated relationships between optimism and …