Faculty Bibliography

Early childhood is a critical period for overall development and well-being, yet children from low-income and low-resourced families, such as Chinese American immigrant families, often have unmet mental health needs as they face additional barriers like limited English proficiency and health literacy. Cultural and linguistic adaptation is essential for equitable access to resources and care. Despite the need, early childhood mental health among Chinese American families remains significantly understudied. A digital mental health solution may pose greater access and convenience to address the mental health needs of this community. Thus, this study aims to collaboratively develop a web-based app called OurChild, which provides culturally and linguistically adapted early childhood mental health and development resources for Chinese American immigrant families in New York City. Using the Participatory Cultural Adaptation Framework for Implementation Research (PCAFIR), the project involves a multiphased participatory co-design process: 1. understanding community needs through formative research and engagement; 2. building a digital library with evidence-based and culturally tailored content; 3. designing a culturally tailored web-based app using a participatory approach; and 4. refining and validating the design through user testing. Informed by formative data from existing studies and programs; focus groups and interviews with community experts (n = 6) and parents (n = 11); user testing with parents (n = 11), and through an iterative re-design process, the app was designed to be user-friendly, culturally relevant, and evidence-based. This study described the co-design process and highlighted the lessons learned in developing culturally tailored digital health tools to promote digital health equity for underserved communities.

BACKGROUND:Children from migrant families with absent parents are more likely to have poorer physical and mental health than children from non-migrant families. The impact of labor migration on left-behind family members in South Asian countries is not well-known. This study aimed to examine the patterns of labor migration and its impact on the health and development of children and their caregivers in rural Nepal. METHODS:Baseline family data collected from a school-based violence prevention program were utilized. Parents/caregivers (N = 346) with school-aged children (aged 3 to 15 years attending nursery to primary grades) from the rural Arghakhanchi district of Nepal were included in the study. A series of descriptive and chi-square analyses were carried out to explore the pattern of labor migration and differences between labor-migrant and non-labor-migrant families. Multivariate linear and logistic regression analyses were applied to explore the correlates and moderators involved. RESULTS:Labor migration has been a common practice in rural Nepal, with an estimated 49% of families having parents working overseas, mostly in India (57%) and Gulf countries (39%) on low-skill labor jobs. Labor migration was significantly associated with left-behind caregivers' and children's mental health. Left-behind caregivers in father-only labor-migrant families reported higher levels of depression than did parents in non-labor migrant families and left-behind children from labor-migrant families reported greater anger than did children from non-labor migrant families. The impact of labor migration on families was moderated by social class. For low social-class father migrant families, left-behind children were at greater risk for developmental delay and behavioral problems, but there seems to be a protective effect for high social-class father migrant families (with lower risk of developmental delay and problem behaviors compared to all other groups). CONCLUSIONS:Labor migration has a substantial impact on the mental health of left-behind families and children. The impact of labor migration may vary by living social-cultural context. Understanding the complex dynamics of labor migration has important implications for local and global migration-related health service planning.

BACKGROUND:Depression rates are higher in women, especially during periods of hormonal fluctuation. Reproductive system disorders (RSDs), which often disrupt hormonal balance, may contribute to this mental health burden. Despite their prevalence and significant health implications, the link between RSDs and depression remains underexplored, leaving a gap in understanding these women's mental health risks. METHODS:Using Danish nationwide health registers (2005-2018), we conducted a cohort study of 2,295,824 women aged 15-49, examining depression outcomes in 265,891 women diagnosed with 24 RSDs, including endometriosis, polycystic ovary syndrome, and pain-related diagnoses. For each RSD, age-matched controls were selected. We calculated incidence rates, incidence rate ratios, and prevalence proportions of depression diagnoses or antidepressant use around RSD diagnosis. RESULTS:Across all RSD subtypes, women demonstrated higher rates of depression both before and after diagnosis, with a peak within the year following diagnosis. Incidence rate ratios within 1 year of RSD diagnosis ranged from 1.15 (95% confidence interval [CI] 1.06-1.25) to 2.09 (95% CI 1.98-2.21), depending on RSD subtype. Elevated depression prevalence was observed 3 years before diagnosis, suggesting mental health impacts may have preceded clinical RSD identification. CONCLUSIONS:This study reveals a striking association between RSDs and depression. Women with RSDs are more likely to suffer from depression, before and after RSD diagnosis, highlighting the need for integrated mental health screening and intervention. With over 10% of women affected by RSDs, addressing this overlooked mental health burden is imperative for improving well-being in a significant portion of the population.

OBJECTIVE:Autism spectrum disorder (ASD) is a neurodevelopmental condition with early-life origins. Maternal health conditions during pregnancy have been linked to autism risk, but most studies focus on single populations, limiting generalizability. We examined whether associations previously reported in a Danish registry-based study hold in a U.S. METHOD/METHODS:We analyzed electronic health records of children born between 2010 and 2017 at Kaiser Permanente Northern California (KPNC) and their mothers. Maternal diagnoses were classified as chronic or non-chronic, and associations with ASD in the child were assessed using Cox models, adjusting for sociodemographic factors, healthcare utilization, and comorbid maternal diagnoses. Methods were aligned with the Danish study for comparability. RESULTS:Among 224,353 children in the KPNC cohort, 5,448 (2.4%) were diagnosed with autism. Of the 42 maternal diagnoses significantly associated with autism in Denmark, 38 were evaluable in KPNC, and 18 remained statistically significant after adjustment. Most associations had point estimates consistent with the Danish study, particularly psychiatric and cardiometabolic conditions. CONCLUSION/CONCLUSIONS:Despite demographic and healthcare differences, 35 of the 38 associations found in the Danish study replicated qualitatively (direction of effect) in the U.S. cohort, suggesting robust cross-setting relevance. Further research is needed to explore underlying mechanisms and effect modifiers.

Mental disorders are increasingly understood as disorders of brain development. Large and heterogeneous samples are required to define generalizable links between brain development and psychopathology. To this end, we introduce Reproducible Brain Charts (RBC), an open resource that integrates data from 5 large studies of brain development in youth from three continents (N = 6,346). Bifactor models were used to create harmonized psychiatric phenotypes, capturing major dimensions of psychopathology. Following rigorous quality assurance, neuroimaging data were carefully curated and processed using consistent pipelines in a reproducible manner. Initial analyses of RBC emphasize the benefit of careful quality assurance and data harmonization in delineating developmental effects and associations with psychopathology. Critically, all RBC data-including harmonized psychiatric phenotypes, unprocessed images, and fully processed imaging derivatives-are openly shared without a data use agreement via the International Neuroimaging Data-sharing Initiative. Together, RBC facilitates large-scale, reproducible, and generalizable research in developmental and psychiatric neuroscience.

Recent medical advances are allowing more youth with neuromuscular disorders to live into adulthood, thus increasing the necessity to transition youth from pediatric to adult medical care. Examining salient factors and processes for successful transition planning from pediatric to adult medical care in youth with neuromuscular disorders is a nascent field of study. The current study aims to address the key quality improvement question of identifying factors to consider when planning for transition by exploring the views of youth with neuromuscular disorders, caregivers, and providers within a multidisciplinary clinic regarding current care transition practices via quantitative and qualitative approaches. Both qualitative and quantitative results highlighted patient-endorsed importance of transition and emphasized the need for future tailored supports to facilitate gleaning skills for transition. Overall, this study offers valuable insights from patients, parents, and providers about challenges and best practices involved in transition planning for young adults with neuromuscular disorders.

Iron plays a vital role in early brain development, supporting critical processes such as myelination, dendritogenesis, and neurotransmitter synthesis. The perinatal period marks a crucial transition from the intrauterine to the extrauterine environment, requiring significant brain adaptation to new stimuli and metabolic demands. However, tight spatiotemporal resolution capturing the timing and sequence of brain iron changes surrounding this critical transition has yet to be achieved. Leveraging a longitudinal perinatal cohort with 147 multi-echo MRI scans spanning from 25 to 60 post-conceptual gestational weeks, we mapped brain iron growth trajectories with R2* estimation across fetal, newborn and neonatal periods. We also examined whether sex, gestational age at birth, and birth weight influence R2* developmental trajectories. We found that parietal and superior temporal regions predominately show linear growth trajectories throughout the perinatal period across birth, while the occipital cortex, the temporal pole, inferior temporal regions and a subset of frontal regions exhibit non-linear trends. For most of the non-linear trajectories, growth rates peak around 40 weeks, highlighting the critical window of birth transition for brain R2* change. These results provide the first longitudinal insights into R2* development across birth, uncovering distinct regional growth patterns that may align with different phases of neurodevelopment.

BACKGROUND:Adolescents in low- and middle-income countries (LMICs) face significant mental health challenges, yet their perspectives are often underrepresented in the design of preventive strategies. Co-design approaches, such as human-centered design (HCD), offer a promising way to tailor interventions and implementation strategies to adolescents’ needs and local context. In LMICs, these methods require careful adaptation to address resource constraints, limited design literacy, and cultural norms. This study documents how HCD was adapted to engage adolescents in northern Ghana as co-designers of school-based mental health preventive strategies. METHODS:Guided by the first two phases of HCD, we conducted two workshops with 24 students from 12 public senior high schools in Tamale, Ghana. Workshop 1 (Inspiration) used structured, case-based discussions informed by the Consolidated Framework for Implementation Research (CFIR) to explore adolescents’ perspectives on mental health. Workshop 2 (Ideation) used interactive choice-based activities to elicit youth-generated strategies. To align with cognitive and sociocultural factors, we incorporated scaffolded facilitation, hands-on activities, and peer-led engagement. Qualitative data from facilitator notes, artifacts, and audio-confirmed summaries were synthesized using structured rapid qualitative analysis. RESULTS:Adolescents identified key mental health concerns, including stigma, peer and family influences, and fears about confidentiality. Gender-specific discussions revealed culturally rooted concerns, such as peer pressure and substance use among boys and limited support-seeking among girls. Adolescents prioritized five school strategies: teacher training, curricular integration, mentorship programs, activities that promote positive thinking and mindfulness, and entertainment-based mental health education. Youth demonstrated a conceptual shift from viewing mental health as an individual problem to a shared responsibility across schools and communities. Formation of an Adolescent Advisory Board reflected youth interest in sustained leadership and co-design. CONCLUSIONS:Contextualized co-design methods can meaningfully engage adolescents in LMIC settings and support the development of culturally grounded, feasible, and youth-prioritized mental health strategies. Structured facilitation enhances both the inclusivity and authenticity of adolescent engagement. This study contributes to implementation science by presenting a replicable co-design framework with policy relevance and providing a foundation for multilevel intervention development in resource-constrained educational systems. SUPPLEMENTARY INFORMATION:The online version contains supplementary material available at 10.1186/s12889-025-25012-0.