Faculty Bibliography

BACKGROUND:The purpose of this review is to systematically appraise the peer-reviewed literature about the genetic and environmental determinants of psychiatric comorbidity, focusing on four of the most prevalent types of psychopathology: anxiety disorders, depression, conduct disorder and substance abuse. METHODS:We summarize existing empirical research on the relative contribution that genetic, nonshared and shared environmental factors make to the covariance between disorders, and evidence about specific genes and environmental characteristics that are associated with comorbidity. RESULTS:Ninety-four articles met the inclusion criteria and were assessed. Genetic factors play a particularly strong role in comorbidity between major depression and generalized anxiety disorder or posttraumatic stress disorder, while the non-shared environments make an important contribution to comorbidity in affective disorders. Genetic and non-shared environmental factors also make a moderate-to-strong contribution to the relationship between CD and SA. A range of candidate genes, such as 5HTTLPR, MAOA, and DRD1-DRD4, as well as others implicated in the central nervous system, has been implicated in psychiatric comorbidity. Pivotal social factors include childhood adversity/life events, family and peer social connections, and socioeconomic and academic difficulties. LIMITATIONS/CONCLUSIONS:Methodological concerns include the use of clinical case-control samples, the focus on a restricted set of individual-level environmental risk factors, and restricted follow-up times. CONCLUSIONS:Given the significant mental health burden associated with comorbid disorders, population-based research on modifiable risk factors for psychiatric comorbidity is vital for the design of effective preventive and clinical interventions.

OBJECTIVES: We assessed whether New York City's gun-related homicide rates in the 1990s were associated with a range of social determinants of homicide rates. METHODS: We used cross-sectional time-series data for 74 New York City police precincts from 1990 through 1999, and we estimated Bayesian hierarchical models with a spatial error term. Homicide rates were estimated separately for victims aged 15-24 years (youths), 25-34 years (young adults), and 35 years or older (adults). RESULTS: Decreased cocaine consumption was associated with declining homicide rates in youths (posterior median [PM] = 0.25; 95% Bayesian confidence interval [BCI] = 0.07, 0.45) and adults (PM = 0.07; 95% BCI = 0.02, 0.12), and declining alcohol consumption was associated with fewer homicides in young adults (PM = 0.14; 95% BCI = 0.02, 0.25). Receipt of public assistance was associated with fewer homicides for young adults (PM = -104.20; 95% BCI = -182.0, -26.14) and adults (PM = -28.76; 95% BCI = -52.65, -5.01). Misdemeanor policing was associated with fewer homicides in adults (PM = -0.01; 95% BCI = -0.02, -0.001). CONCLUSIONS: Substance use prevention policies and expansion of the social safety net may be able to cause major reductions in homicide among age groups that drive city homicide trends.

OBJECTIVES: We investigated the relationship between the depressive symptoms of older adults over time and the characteristics of the neighborhoods in which they live. METHODS: We surveyed a random sample of 1325 New York City residents aged 50 years or older in 2005 and conducted 808 follow-up interviews in 2007. We assessed the compositional characteristics of the respondents' neighborhoods at a census-tract level and determined the relationships between these characteristics and changes in respondents' depressive symptoms. RESULTS: In multivariable models that adjusted for individual-level covariates including income, a range of neighborhood characteristics predicted worsening depressive symptoms. Factor analysis suggested that these characteristics operated in 3 clusters: neighborhood socioeconomic influences, residential stability, and racial/ethnic composition, with positive neighborhood socioeconomic influences being significantly protective against worsening symptoms. Life stressors, personality trait neuroticism, African American race, and daily baseline contact with social networks were also associated with worsening symptoms. CONCLUSIONS: An older adult's neighborhood of residence is an important determinant of his or her mental health. Those making efforts to improve mental health among the elderly need to consider the role of residential context in improving or impairing mental health.

BACKGROUND: Homicide contributes substantially to the burden of death in the US and remains a key contributor to the gap in white-black life expectancy. It has been hypothesized that "broken-windows" policing is associated with lower homicide rates and that physical disorder may mediate this association. However, the empiric evidence is limited and conflicting. METHODS: We used pooled, cross-sectional time-series data for 74 New York City (NYC) Police Precincts between 1990 and 1999 to test the relation between neighborhood misdemeanor policing (an indicator of physical order) and homicide in NYC in the 1990s. We applied Bayesian hierarchical models, including a random effect of place, to account for serial correlations in homicide across adjacent neighborhoods. RESULTS: An increase of 5000 misdemeanor arrests in a precinct with 100,000 people was associated with a reduction of 3.5 homicides (95% credible interval = -5.00 to -1.00). However, increased misdemeanor arrests were associated with lower physical order (posterior median = -0.015 [-0.025 to -0.01]), and physical order was unrelated to homicide. CONCLUSIONS: Our study replicated prior findings suggesting that misdemeanor policing reduces homicide rates, but offered no support for the hypothesis that physical disorder is a mediator of the impact of such policing. Factors responsible for the dramatic decline in US homicides in the last decade remain unclear.

OBJECTIVE: To characterize the influence of the residential neighborhood of older adults on the prevalence of disability. METHODS: We combined Census data on disability in older adults living in New York City with environmental information from a comprehensive geospatial database. We used factor analysis to derive dimensions of compositional and physical neighborhood characteristics and linear regression to model their association with levels of disability. Measures of neighborhood collective efficacy were added to these models to explore the impact of the social environment. RESULTS: Low neighborhood socioeconomic status, residential instability, living in areas with low proportions of foreign born and high proportions of Black residents, and negative street characteristics were associated with higher prevalence of both "physical" disability and "going outside the home" disability. High crime levels were additionally associated with physical disability, although this relationship disappeared when misdemeanor arrests were removed from the crime variable. Low levels of collective efficacy were associated with more going-outside-the-home disability, with racial/ethnic composition dropping out of this model to be replaced by an interaction term. CONCLUSION: The urban environment may have a substantial impact on whether an older adult with a given level of functional impairment is able to age actively and remain independent.

OBJECTIVES/OBJECTIVE:We sought to identify neighborhood-level resources associated with lower levels of aggression and delinquency among youths aged 9-15 years at baseline after accounting for risk factors and other types of resources. METHODS:Data were derived from the Project on Human Development in Chicago Neighborhoods, which focused on 2226 ethnically diverse, urban youths, their caregivers, and the 80 neighborhoods in which they resided at baseline. RESULTS:Living in a neighborhood with a higher concentration of organizations or services serving young people and adults was associated with lower levels of aggression (odds ratio [OR]=0.9; 95% confidence interval [CI]=0.8, 1.0); living in such a neighborhood also moderated family, peer, and mentor resources. For example, the presence of well-behaved peers was associated with lower levels of aggression among youths living in neighborhoods where the concentration of organizations and services was at least 1 standard deviation above the mean; the association was less strong among youths living in neighborhoods with organizations and services 1 standard deviation below the mean or less. CONCLUSIONS:Certain family, peer, and mentoring resources may confer benefits only in the presence of neighborhood resources. Increasing neighborhood resources should be considered in interventions designed to reduce urban youths' involvement in violence.

Alcohol use increased in the New York City (NYC) metropolitan area in the first months after the 11 September 2001 terrorist attacks. AIMS: To investigate alcohol use trajectories in the NYC metropolitan area in the 3 years after 11 September and examine the relative contributions of acute exposure to the attacks and ongoing stressors to these trajectories. DESIGN: We used a population-based cohort of adults recruited through a random-digit-dial telephone survey in 2002; participants completed three follow-up interviews over 30 months. SETTING: The NYC metropolitan area. PARTICIPANTS: A total of 2752 non-institutionalized adult residents of NYC. MEASUREMENTS: We used growth mixture models to assess trajectories in levels of total alcohol consumption and bingeing in the past 30 days, and predictors of these trajectories. FINDINGS: We identified five trajectories of alcohol consumption levels and three bingeing trajectories. Predictors of higher levels of use over time included ongoing stressors, traumatic events and lower income. Ongoing exposure to stressors and low income also play a central role in bingeing trajectories. CONCLUSIONS: While point-in-time mass traumatic events may matter in the short term, their contribution subsides over time. Accumulated stressors and traumatic events, in contrast, lead to higher levels of consumption among respondents already vulnerable to high alcohol use. Interventions to mitigate post-disaster stressors may have substantial benefit in reducing alcohol abuse in the medium- to long term.

BACKGROUND: Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited. METHODS: We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models. RESULTS: Predictors of posttraumatic stress over time included ongoing stressors (odds ratio [OR] = 1.91 per 1 unit increase in number of stressors, [95% confidence interval = 1.55-2.36]) and traumatic events (OR = 1.92 per 1 unit increase in number of traumatic events [CI = 1.71-2.22]), social support (compared with high levels, OR = 1.71 for medium [1.09-2.52]; OR = 1.57 for low [1.08-2.35]), low income (OR = 0.87 per $10,000 increase [0.81-0.92]), female sex (1.60 [1.11-2.23]), and Latino ethnicity (compared with white, OR = 1.74 [1.05-2.97]). CONCLUSIONS: These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.

OBJECTIVE:To assess the relationships between individual victimization and neighborhood-level violence on subsequent violent perpetration by adolescent girls in a community-based sample. DESIGN/METHODS:Longitudinal, multilevel analysis of data collected by the Project on Human Development in Chicago Neighborhoods. Three in-home interviews were conducted approximately 24 months apart between November 1995 and January 2002 with youth and their caregivers. Community-level data also were collected in 1995 from a random sample of Chicago residents. Hierarchical regression models and propensity scores were used. SETTING/METHODS:Families and neighborhoods in Chicago. PARTICIPANTS/METHODS:Population-based sample of 637 girls, ages 9 to 15 years at baseline, and the neighborhoods in which they resided. This sample is diverse in race/ethnicity, socioeconomic status, family structure, and neighborhood characteristics. MAIN OUTCOME MEASURE/METHODS:Self-reports of violent behavior in the 12 months before the third interview. RESULTS:At baseline, 38% of the girls reported perpetrating at least 1 violent behavior in the prior 12 months, 28% reported past year violent behavior at the first follow-up interview, and 14% reported past year violent behavior at the third interview. The odds of violent behavior were 2.2 times higher among girls who reported prior violent victimization, after prior confounding factors and baseline violent behavior were controlled (95% confidence interval, 1.3- 4.4). Homicides and concentrated poverty in girls' neighborhoods also were associated with aggression by girls. CONCLUSIONS:Improving safety in communities and homes may reduce rates of violent perpetration by adolescent girls. Study results suggest that, to facilitate identification of and healing among adolescent survivors of violence, practitioners should recognize perpetration of violence as potential sequelae of prior violent victimization.