Global Psychiatric Epidemiology Group (GPEG)
The Global Psychiatric Epidemiology Group has three major areas of research:
- Children of parents involved with the criminal justice system;
- Children exposed to the 9/11 attack;
- International research on suicide and school mental health.
Children of Parents Involved with the Criminal Justice System
Background: Two longitudinal epidemiological investigations (N=800), known as the Stress and Justice Study (S&J), were initially funded by the National Institute of Mental Health (NIMH) and the National Institute of Drug Abuse (NIDA) to understand, over time, the impact of parental Criminal Justice System Involvement on their children’s mental health and substance use. This representative, minority sample was obtained by recruiting parents of children ages 9-14 arraigned in the Bronx Criminal Court, as well as age and gender matched controls recruited in the community. The initial studies were designed to assess parent and child psychosocial well-being, as well as the effects of related untoward consequences (such as eviction and deportation) on their child’s mental health, substance use, and development of risky behaviors leading to their potential involvement with the criminal justice system, as well as identification of protective factors and intervention points to inform public policy. In addition to a number of completed investigations, we are currently engaged in the following studies of this population.
Stress & Justice Adolescent Imaging (AIS) Study (N=150). This five-year study examines the effects of parental substance use disorder on their child’s substance use naïve, early developing cognitive control mechanisms that underlie initiation and progression of substance use and patterns of use/abuse. The study uses longitudinal multimodal MRI imaging in combination with cognitive and emotional tasks and periodic psycho-social and substance-use assessments. This study provides the potential to understand neurobehavioral development.
Sleep in High-Risk Adolescents (NHLBI; N=650). This is the first, large-scale sleep study of minority youth. Together, with the high-quality objective data collected, this four-year study is designed to test a complex and highly informative model of the relationship of important risk factors for sleep quality and its effects on important health and mental health-related outcomes. By enriching understanding of the role that sleep quality plays in the well-being of at-risk youth, this study will identify behavioral entry points for targeted and effective interventions to improve sleep and, therefore, overall functional status.
Mental Health Services in Juvenile Justice Facilities (NIDA). Rates of mental health disorders are as high as 65% among youth in juvenile justice settings, yet mental health assessment and treatment resources in these programs are not consistent with evidence-based instruments, programs, and protocols. This five-year investigation across juvenile justice settings in multiple states has focused on determining need, including the prevalence of and risk factors for mental health disorders and suicidal behavior at various points of case-processing (intake, detention, secure care), as well as measuring the effects of specific protocols designed to link youth to needed services. This research is designed to contribute to effective service linkage, resulting in lowered rates of recidivism and considerable savings.
Children exposed to the 9/11 attack
Background: Ongoing investigations are based on post-9/11 findings from our large-scale (N=8.236) epidemiological investigation of New York City’s public school children six months after that attack, which we conducted pro bono. It was evident that the psychological impact on children varied not only by level of exposure but by a host of other factors previously not considered, such as occupation and exposure of family members. Importantly, some factors outweighed the importance of proximity, long considered the most significant factor. As the first representative post-disaster study of the psychological impact on children that was not limited to typical investigation of a disaster at its epi-center or ground-zero area, this cross-sectional study generated a plethora of post-disaster contributions to future investigations, including the need to assess a wide range of disorders (we included eight) rather than just PTSD and depression, to include a broad geographic area for the sampling frame and to assess family and media exposure. This important investigation led to the PI (Hoven) testifying before the U.S. Senate and generating more than $130 million for post-9/11 mental health services in the New York City metropolitan area. In addition to completed investigations, the following studies are ongoing:
9/11 First Responder and Evacuee (FR) Study (NICHD; N=860). This longitudinal study aims to improve our understanding of the impact of 9/11 on children, especially the psychological effects on children whose parents’ work experiences are by nature stressful. Knowledge generated by this study has implications for guiding efforts to meet the needs of children who have, directly or through a family member, been subjected to rare or an infrequent mass violent event, as well as to children exposed to violence as part of daily life. This study is currently collecting the third wave of data, this time focused on the entire family, assessing family-wide consequences of direct disaster exposure of at least one family member, as well as collecting DNA samples for future study.
Stress & Well-Being (S&W) Study (National Institute of Occupational Health and Safety (NIOSH/CDC; N=1,500). This large, longitudinal epidemiological study examines the long-term outcomes for children directly exposed to the 9/11 attack by assessing their mental health, substance use and other risky behaviors, and decision-making with the intention of facilitating treatment, diagnosis and intervention, as well as to inform public policy. We have already found that psychiatric-physical illness co-morbidity is greater than either condition separately. The current follow-up wave of interviews to determine current psychological status also includes the collection of blood (being bio-banked) and a wide-range of pulmonary assessments and a limited in-home physical. This is the largest in-person assessment of children directly exposed to 9/11, with unprecedented potential to understand life-time psychiatric and physical consequences of childhood exposure to trauma.
Emotion and Memory Study (NIOSH/CDC; N=100). This cross-sectional study examines the neural circuits related to the regulation of emotion and memory that are most susceptible to the effects of psychological trauma. Using fMRI and ERP techniques, we are assessing the brain structure and function of young adults with and without anxiety disorders, who were highly exposed to the 9/11 WTC attack during childhood, comparing them to an unexposed control group. Here we are comparing groups on performance, brain structure/function and connectivity to capture differences in emotional reactivity, and in the interaction of trauma memories and regulatory processes.
Inflammation and Childhood Adversities and Trauma (I-CATs) Study (NICHD; N=1,500). Drawing on data from two waves of the S&W study described above and bio-banked blood, this study will characterize the relationship between exposure to childhood adversities and trauma (CATs) and subsequent profiles of inflammatory/immune signatures and the relationship of those signatures to long-term co-morbidities. While studies focused on physical morbidity in 9/11 exposed adults have shown elevated rates of numerous diseases, e.g., caneer, pulmonary disease, etc. no other study is focused on a representative sample of children directly exposed to 9/11 under the age of 18. This I-CATs Study will examine the key role that the immune /inflammatory system plays in the pathway from exposures to lifelong, negative health sequelae. Detecting the relevant immune signatures associated with CATs will potentially identify immune/ inflammatory system targets that could mitigate or even prevent negative health consequences.
International Studies: Suicide and School Mental Health
Background: Saving and Empowering Young Lives in Europe (SEYLE) Study was a multinational universal school-based randomized controlled trial (RCT) intervention focused on promoting healthy lifestyles and reducing suicidal behaviors (PI: D. Wasserman, funded by the European Union). The study included 168 public schools that met eligibility criteria in ten European Union countries (Austria, Estonia, France, Germany, Hungary, Ireland, Italy, Romania, Slovenia and Spain, with the coordinating site in Sweden). The target population was adolescents 15 years of age. Students (N=11,110) were assessed using self-report questionnaires at baseline, at 3- and 12-month follow-up. The study demonstrated the greatest reduction (~50%) in suicidal behaviors, to date (see Lancet 2015; 385: 1536–44; https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)61213-7.pdf), as well as the greatest reduction (~45%) in depression (in review). From GPEG, Hoven was the chief methodologist, Musa participated in sampling design; the research team has generated more than 50 publications from these data.
National Suicide Study in Guyana (NIMH; N=7,000). Suicide is on the rise in the U.S., especially among youth, but because it is a rare event it is difficult to obtain a study population with appropriate statistical power to advance current understanding. We are currently conducting a longitudinal study of suicide in Guyana, a country with the 3rd highest rate of suicide in the world. This study consists of a thorough assessment of suicide risk and protective factors. As part of this effort, we are sampling a nationally representative community cohort (N=5,000), a clinical sample of suicide attempters (N=1,600), and will conduct psychological autopsies of suicide completers (N=140). This is the largest, longitudinal study of suicide and the only one to include representative samples from the community, completers and all attempters, thus offering the potential to render significant new insights.
Children of First Responders (FR) Study in Israel (NICHD; N=280). To elucidate the impact of direct parental chronic exposure to trauma on the mental health of their children, we are examining secondary traumatization in children of First Responders who are routinely exposed to work-related traumatic events, and control (i.e., non-FR) families. In this understudied population, we have already shown that parental work-related variables are associated with their children's psychiatric outcomes, above and beyond parental psychopathology, the youth's exposures, and familial characteristics. Furthermore, based on our findings, we are assessing how to prevent and promote mental health in children and adolescents exposed to secondary traumatization because of their parental occupation.
Working in Europe to Stop Truancy Among Youth (WE-STAY). The main objectives of the WE-STAY project was to gather epidemiological information on truancy on European adolescents (N=9,000) from which to develop school-based interventions aimed at reducing truancy, thus improving mental health among students (PI: D. Wasserman; funded by the European Union). From GPEG, Hoven was the chief methodologist and Musa participated in the sample design. All evaluation and intervention materials were developed in English and translated in six languages for the six countries where the study took place (Estonia, Germany, Israel, Italy, Romania, Spain). Moreover, the materials have also been translated in Russian and Arab for large-scale distribution, as well as to serve minorities in Estonia and Israel.
Ongoing International Collaborations: Karolinska Institute; World Psychiatric Association; citiesRISE (India and Kenya); Ministry of Public Health, China; National Research Institute, Taiwan; Ukraine-Norway-Armenia (UNA) teaching program for young psychiatrists.