Faculty Bibliography

BACKGROUND/UNASSIGNED:Unaccompanied migrant youths are at elevated risk for exposure to trauma and related mental health challenges, but there is minimal evidence guiding best practices. We conducted a systematic review of quantitative studies that examined mental health evaluation and treatment services for unaccompanied migrant youths resettled in the United States (US). METHODS/UNASSIGNED:In accordance with the PRISMA 2020 statement, a literature search was conducted for empirical studies in nine databases and publicly available search engines. Citation tracking also assisted in identifying additional studies, including from the gray literature. The study protocol was pre-registered (PROSPERO ID: CRD42023396805). Inclusion criteria required that studies be published between January 1, 2000 and November 11, 2024 and report quantitative results that evaluate mental health status or mental health treatment outcomes for youths (younger than 18 years) who were unaccompanied when they arrived in the US. Descriptive, narrative synthesis was used for analysis of results. Mixed Method Appraisal Tool was used to appraise study quality. RESULTS/UNASSIGNED: = 1494 children)-six cohort studies (retrospective or prospective), five cross-sectional, one non-controlled trial, and one program evaluation-met inclusion criteria. Ten evaluated mental health using diverse questionnaires and most focused on trauma-related symptoms. Three focused on mental health treatment. Findings demonstrated heterogeneous methods of evaluating mental health symptoms and implementing treatment services for unaccompanied migrant youths, although many indicated high rates of reported traumatic exposure. Most reported higher rates of trauma-related and internalizing symptoms and all treatment studies demonstrated initial promise. Likely due to difficulty in accessing unaccompanied migrant youths, most studies used convenience samples limiting generalizability of findings. CONCLUSIONS/UNASSIGNED:Rigorous studies with comprehensive collection of sociodemographic characteristics are needed to inform the development of evidence-based services that accurately detect and effectively treat mental health challenges among unaccompanied migrant youths.

BACKGROUND/UNASSIGNED:Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition with a multifactorial etiology, many aspects of which remain unclear. Emerging evidence suggests a potential association between ASD and clinical manifestations resulting from hormonal imbalances, henceforth named "steroidopathies." The present study aims to investigate the association between ASD, steroidopathies and altered steroid hormone levels. METHODS/UNASSIGNED:A cohort of 100 individuals aged 9-18 years was examined, comprising 50 autistic individuals (25 males, 25 females) compared to 50 individuals diagnosed with other neuropsychiatric disorders (20 males, 30 females). Data were collected on steroidopathies (including hirsutism, severe acne, irregular menstrual cycles, polycystic ovary syndrome, endometriosis, pubertal disorders) in participants and their first-degree relatives, as well as on maternal pregnancy and delivery complications. Blood samples were analyzed to assess hormonal profiles, including testosterone, estradiol, and vitamin D levels. A multivariate logistic regression analysis was conducted, with ASD status as the dependent variable and hormone levels, steroidopathies and other pregnancy-related conditions as independent variables. Sex and age were included as covariates. RESULTS/UNASSIGNED: = 0.0057). CONCLUSION/UNASSIGNED:These findings support the hypothesis of an association between steroidopathies and altered steroid hormone levels with ASD, suggesting that steroid hormone profiles could potentially serve as early biomarkers in future research. Furthermore, consideration of maternal endocrine health and prenatal exposures may contribute to a better understanding of ASD risk.

OBJECTIVES/OBJECTIVE:Adolescents living with HIV (ALHIV) have low viral suppression levels, with 1 in 3 ALHIV experiencing virologic failure, calling for more efforts to reverse these trends. We developed and validated a model that predicts the risk of virologic failure (VF) among ALHIV. STUDY DESIGN/METHODS:Cross-sectional study. METHODS:We used baseline data from 702 ALHIV enrolled in the Suubi + Adherence cluster-randomized clinical trial. Participants were aged 10-16 years, living with HIV and aware of their HIV status, and are living with a family. We developed a risk-prediction model for VF (viral load of ≥200 copies/mL) using sociodemographic, behavioral, psychological, economic, and treatment-related factors. LASSO logistic regression using 10-fold cross-validation with bootstrapping was used to select the predictors for the final model. Model performance was assessed by determining the discrimination using the area under the curve and calibration by drawing a calibration plot. RESULTS:Using a lambda value of 0.007, the final model had 24 predictors (and interaction terms). The predictors included the participants' age, sex, work status, stigma, depressive symptoms, adherence self-efficacy, HIV knowledge, duration with HIV, time spent on ART, communication with the caregiver, family cohesion, social support, orphanhood status, number of people in the household, HIV disclosure, years spent at the current residence, and household asset ownership. The model predicted VF with AUC of 73.8 (95 % CI: 68.3-78.0) and calibration slope of 0.985. CONCLUSIONS:We developed and validated a model to predict the risk of virologic failure among ALHIV in Uganda, demonstrating its potential utility in identifying individuals at elevated risk for VF. Future models could be refined by incorporating clinical characteristics such as CD4 count to further improve predictive accuracy.

One in six people are aged 10-19 years. Adolescence is a unique and formative time. Physical, emotional, and social changes, including exposure to poverty, abuse, or violence, can make adolescents vulnerable to mental health problems. Protecting adolescents from adversity, promoting socio-emotional learning and psychological well-being, and ensuring access to mental healthcare are critical for their health and well-being during adolescence and adulthood. Globally, it is estimated that 1 in 7 (14%) 10-19 year-olds experience mental health conditions (1), yet these remain largely unrecognized and untreated. Adolescents with mental health conditions are particularly vulnerable to social exclusion, discrimination, stigma (affecting readiness to seek help), educational difficulties, risk-taking behaviors, physical ill-health, and human rights violations.

Adolescents living with HIV (ALHIV) have low adherence to antiretroviral therapy (ART). Poverty and mental health challenges remain major drivers of this poor ART adherence. We explored the mediators of the impact of an economic empowerment intervention on ART adherence among ALHIV and assessed the moderating effects of depression. We randomized 39 clinics (702 participants) into the control or intervention groups. Participants were aged 10-16, living with HIV and taking ART. The intervention comprising matched savings account, financial literacy training, and microenterprise workshops. We fitted a sequential structural equation model to examine how the three mediators-HIV stigma, barriers to medical care, and healthcare transition readiness-influenced ART adherence at year seven. Depression was included as a moderator. At baseline, the mean age was 12 years, and only 73.0% achieved good adherence (≥ 90%). The intervention directly improved ART adherence, β = 0.060 (95% CI: 0.038, 0.081), p < 0.001. Also, there was a significant indirect effect of the intervention on ART adherence, mediated through barriers to medical care, β =  - 0.036 (95% CI: - 0.041, - 0.032), p < 0.001, and HIV stigma, β =  - 0.011 (- 0.016, - 0.007), p < 0.001. Depression reduced the effect of the intervention on ART adherence β =  - 0.114 (- 0.123, - 0.104), p < 0.001. Our results showed that providing ALHIV with financial resources improved their ART adherence; however, this was affected by depression. Therefore, programs aimed at improving outcomes in ALHIV should consider incorporating interventions that address mental health challenges in addition to poverty.

While studies have documented neural correlates of language delay in toddlers with developmental conditions, those at genetic risk for language delay, and those born premature, no studies have examined neural correlates in toddlers exhibiting early language delay without known etiology. This study examines brain morphometry in toddlers with and without early language delay. To do so, we collected magnetic resonance imaging on toddlers with language delay (LD; n=7, M_age=19.67 months, 3 female, 2 Hispanic, 4 non-caucasian) and a typically developing (TD; n=17, M_age=22.73 months, 8 female, 2 Hispanic, 3 non-caucasian) comparison group. Exploratory analyses examined group differences in total brain volume, cortical thickness, and cortical surface area using both a whole-brain and region of interest (Broca's and Wernicke's areas) approach. Results showed no gross brain anatomical differences between groups. However, there were group differences in cortical surface area in the temporal cortex (including Wernicke's area and left middle temporal gyrus, hedges' g= -.35) and Broca's area thickness. Results are reported using multiple analytic methods, age matching, and exclusion of children later diagnosed with autism. While this exploratory study has a limited sample size, it provides novel findings that can be utilized to guide hypothesis-driven imaging studies on toddler language delay.

OBJECTIVE/UNASSIGNED:We used resting-state functional magnetic resonance imaging to identify changes in brain functional connectivity (FC) associated with Organizational Skills Training (OST). METHOD/UNASSIGNED:In an open, waitlist-controlled, randomized clinical trial (NCT04108273), 51 children aged 8-12 years with deficient organizational skills were assigned to immediate tele-health OST treatment (twice weekly, 10 weeks) or waitlist. We obtained Children's Organizational Skills Scale-Parent version (COSS-P) scores and examined FC changes between dorsal anterior cingulate cortex (dACC) and preregistered subcortical anterior ventral striatum (aVS) regions-of-interest. RESULTS/UNASSIGNED: < 0.05). Analyses were then performed with two additional analytic pipelines, neither of which detected any significant effects. CONCLUSION/UNASSIGNED:Although improvements in organizational deficits were associated with increased FC within a circuit linking dACC and the default mode network region of the aVS in one analysis, the direction was the opposite of predicted and results did not replicate. Thus, we highlight the tentativeness of our findings; we have de-identified all the data and made it available for investigators to examine and to combine with other datasets in mega- and meta-analyses. Future studies should also include alternative control conditions and larger samples. CLINICAL TRIAL REGISTRATION/UNASSIGNED:https://clinicaltrials.gov/study/NCT04108273?cond=NCT04108273&rank=1.

BACKGROUND/UNASSIGNED:Although historical writings, anthropological accounts, and experimental studies document associations between psilocybin use and religion, no prospective experimental study has investigated how the effects of psilocybin are experienced and interpreted by religious clergy. This exploratory study evaluated the overall safety and the acute and enduring effects of psilocybin in clergy. METHODS/UNASSIGNED:= 16) at 6 months after screening using self-report measures. The effects of psilocybin were also assessed on session days and 4 and 16 months after the second psilocybin session in the 24 participants who completed both sessions. RESULTS/UNASSIGNED:The primary outcome assessment at 6 months after screening showed that, compared with the delayed control group, participants who had received psilocybin reported significantly greater positive changes in their religious practices, attitudes about their religion, and effectiveness as a religious leader, as well as in their non-religious attitudes, moods, and behavior. Follow-up assessments showed that positive changes in religious and non-religious attitudes and behavior were sustained through 16 months after the second psilocybin session. At that time, participants rated at least one of their psilocybin experiences to be among the top five most spiritually significant (96%), profoundly sacred (92%), psychologically insightful (83%), and psychologically meaningful (79%) of their lives. Furthermore, 42% rated one of their experiences to be the single most profound of their lifetime. At 16-months follow-up, most (79%) strongly endorsed that the experiences had positive effects on their religious practices (e.g., prayer or meditation) and their daily sense of the sacred, and most (71%) reported positive changes in their appreciation of religious traditions other than their own. Although no serious adverse events were reported, 46% rated a psilocybin experience as among the top five most psychologically challenging of their lives. CONCLUSIONS/UNASSIGNED:In this population of clergy, psilocybin administration was safe and increased multiple domains of overall psychological well-being including positive changes in religious attitudes and behavior as well as their vocation as a religious leader. The study was limited by a waitlist control design, homogenous sample, and the use of some unvalidated outcome measures. Further research with more rigorous control conditions and diverse samples is needed.

Allostatic load provides a valuable framework for examining how cumulative stress impacts multiple physiological systems simultaneously, making it a powerful tool for understanding the mechanisms through which stress contributes to adverse pregnancy outcomes. This multisystem perspective is especially important during pregnancy, a period characterized by heightened vulnerability to stress and significant physiological changes that can themselves contribute to allostatic load. Although the impact of allostatic load during pregnancy is well documented, the mechanisms and moderators involved by trimester remain unclear, particularly given wide variation in social, cultural, and structural determinants of maternal health worldwide. In this review, we discuss the progress that has been made over the past two decades in studying prenatal allostatic load and describe the clinical implications of this by highlighting sensitive periods of interest throughout gestation. Despite these advances, key questions remain regarding the intergenerational transmission of risk, the specificity of findings to the pregnancy period, and the role of factors that often accompany elevated allostatic load, such as poor sleep, limited social support, systemic inequities, and comorbid mental or physical health conditions, which may manifest differently across global contexts. Most existing studies have been conducted in high-income settings, yet the burden of adverse pregnancy outcomes is greatest in low- and middle-income countries, where structural, environmental, and social stressors are pervasive. Expanding this framework to include diverse global contexts is essential for understanding how social inequities and chronic stressors shape maternal physiology worldwide. We discuss these issues and offer directions for future research, including the goal of developing a standardized metric for measuring allostatic load - one that we believe will advance the field's understanding of how prenatal allostatic load markers by trimester relate to maternal and infant outcomes.