e46 Abstracts / Comprehensive Psychiatry 50 (2014) e45–e59

Depression and distress in Blacks and Whites in the U.S.: Results of asystematic review

Barnes David MDepartment of Epidemiology, Columbia University, New York, NY, USA

Background: The literature frequently notes inconsistent findings in Black–White mental health comparisons in the U.S.: a lower prevalence ofpsychiatric disorder, particularly major depression, in Blacks compared withWhites, coupled with higher psychological distress. From the vantage pointof social stress theory, these findings represent a double paradox. Socialstress theory, the dominant framework for interpreting associations betweensocial location and mental health, predicts worse mental health indisadvantaged versus advantaged groups by virtue of their greater stressorexposure and fewer coping resources. Given the stark social, economic, andpolitical divides between Blacks and Whites in the U.S., Black–Whitemental health comparisons are a strong test of the theory. Blacks' lowerprevalence of psychiatric disorder in general and depression in particularrepresents the first paradox. The divergence of depression-distress findingsin Black–White comparisons is a second paradox, given that depression anddistress are correlated. These paradoxes have emerged only from limitedreviews of the findings, however, indicating the need for a systematicliterature review. Systematic mapping of Black–White depression anddistress findings could provide the empirical foundation for developingmethodological and substantive hypotheses to explain both paradoxes,ultimately reinforcing or diminishing our confidence in social stress theory.This study is the first systematic review of the literature documenting Black–White comparisons of major depression prevalence and distress in nationallyrepresentative household samples of the adult U.S. population.Methods: Following Cochrane guidelines, a search of PubMed andPsycInfo databases yielded 17,892 unique articles for potential inclusionin the review. Title and abstract reviews resulted in 87 articles for fullreview, 26 of which satisfied inclusion criteria. A secondary literaturereview will be conducted of these 26 articles' reference lists. Results fromincluded papers will be reported by outcome (major depression or distress),and then subdivided by measure used and outcome timeframe.Results to date: In the preliminary 26 articles, Blacks had a lowerprevalence of major depression than Whites in 8 of 9 comparisons, 7 ofwhich were statistically significant and Blacks had higher distress levels thanWhites in 17 of 19 comparisons, 7 of which were statistically significant.Conclusions: Preliminary results from this systematic review supportobservations in the literature that Blacks generally have a lower prevalenceof major depression but higher levels of distress than Whites. Thissystematically documented discordant pattern could provide the basis fornovel hypotheses to explain the double paradox.

http://dx.doi.org/10.1016/j.comppsych.2014.08.004

Investigating dimensionality and measurement bias of DSM-5 alcoholuse disorder in a representative sample of the largest metropolitan areain South America

Castaldelli-Maia JM a,b, AndradeAGa,b, VianaMCc,Martins SSd, Andrade LH a

aSão Paulo, SP, BrazilbSanto André, SP, BrazilcVitória, ES, BrazildNew York, NY, USA

Background: Given the recent launch of a new diagnostic classification(DSM-5) for alcohol use disorders (AUD), we aimed to investigate itsdimensionality and possible measurement bias in past year alcohol userswho had at least 1 drink per week in the 12 months prior to the interview.Data came from São Paulo Megacity Project collected between 2005 and2007, which is part of World Mental Health Surveys.Methods: Firstly, exploratory factor analysis (EFA) was carried out to testfor the best dimensional structure for DSM-5 AUD. Then, item responsetheory (IRT) was employed to investigate the severity and discrimination

properties of each criterion of DSM-5 AUD. Finally, differential functioningof the 11 DSM-5 AUD criteria were investigated by the socio-demographicvariables income, gender, age, employment status, marital status andeducation. All analyses were performed in Mplus software taking intoaccount complex survey design features.Results: A one-dimensional model had the best fit in EFA. IRT resultsshowed that “Time spent” and “Activities given up” has the highestdiscrimination and severity properties. Moreover, “Larger/Longer” distin-guished from the other criteria and had the lowest value of severity, but anaverage value of discrimination. Some direct effects of socio-demographicvariables were found only on “Social/Interpersonal”, “Larger/Longer”, and“Activities given up.”Conclusion: This study reinforces a DSM-5 AUD continuum. Furthermore,the DSM-5 AUD criteria had a quite different severity and discriminationprofiles, and some direct effects of income and employment status werefound. These are valuable information for professionals working withtreatment and prevention of alcohol disorders.

http://dx.doi.org/10.1016/j.comppsych.2014.08.005

Emotion processing across the schizotypy continuum

Demmin DL, Darcy T, Vohra H, Hasletine B, Gooding W, Shean GDDepartment of Psychology, The College of William and Mary,Williamsburg, VA

Background: Previous research has revealed emotional processing deficitsin individuals with schizophrenia. More recently, these impairments havealso been identified in individuals at risk for developing schizophrenia,though at attenuated levels. The purpose of the current study is to betterdefine the pattern of emotional functioning across the schizotypy continuum,by examining differences between individuals with varying degrees ofsymptom severity.Methods: Heart rate data were collected from 49 undergraduate studentswhile viewing film clips eliciting positive, negative, and neutral emotions.Following each viewing, participants rated the film's emotional. Relation-ships between individual schizotypal traits, symptom domains as classifiedby the Schizotypal Personality Questionnaire-Brief (Cognitive-Perceptual,Disorganized, and Interpersonal), and overall symptom scores wereexamined on the basis of heart rate and affective reactions.Results: Results revealed differences in heart rate activity and affect ratingsacross symptom domains, as well as an overall difference in heart rateactivity and affect ratings among high and low schizotypy trait levels for thevarious film types.Conclusion: These findings are indicative of abnormalities in emotionprocessing as individuals exhibit different levels of schizotypal symptom-atology. These results may provide support for the revised DSM-5Schizotypal Personality Disorder criteria, which emphasizes the continuousquality of personality pathology.

http://dx.doi.org/10.1016/j.comppsych.2014.08.006

TMS over the left dorsolateral prefrontal cortex increases GABAconcentration in the ventromedial prefrontal cortex inmajor depression

Dubin M, Mao X, Gordon R, Kang G, Liston C, Shungu DWeill Cornell Medical College, New York, NY, USA

Background: The antidepressant mechanisms of left dorsolateral prefrontalTMS are poorly understood but may involve projections to downstreamtargets in the ventromedial prefrontal cortex (VMPFC). TMS modulatesactivity and functional connectivity within the VMPFC, but it is unknownwhether TMS has specific effects on particular neuronal subtypes. Inhibitoryinterneurons are a potential therapeutic target. GABA levels are reduced indepressives and normalize with electroconvulsive and SSRI therapies, and

e47Abstracts / Comprehensive Psychiatry 50 (2014) e45–e59

TMS potentiates GABAB-neurotransmission acutely in motor cortex. Wehypothesized that TMS would increase VMPFC GABA concentrationin depressives.Methods: We treated 26 currently depressed, antidepressant-resistantpatients with 25 daily treatments of 10 Hz TMS over a left dorsolateralprefrontal cortex (DLPFC) stimulation site and measured symptom severityweekly with the HAMD-17. We measured GABA levels in the VMPFC asratios to the voxel water (W) signal using the standard J-editing MRStechnique on a 3 T-GE scanner. Scans were acquired within 3-days prior tobeginning and 3-days after completing treatment.Results: Using repeated measures ANCOVA, co-varying for VMPFCgray-matter volume, we found that GABA levels increased by 9.7%(F(1,24) = 4.904, p = 0.037) from before to after TMS. This increase wasgreater in TMS-responders than in TMS-nonresponders. GLX, a measure ofglutamate concentration, was unaffected.Conclusions: These results show that repetitive left dorsolateral prefrontalTMS acts to selectively increase GABA but not glutamate concentrations inthe VMPFC in depressives. These results have the potential to furtherelucidate the connection between impaired VMPFC function and depres-sion. They also suggest that TMS may act in part by altering the balance ofexcitation and inhibition in the medial prefrontal cortex.

http://dx.doi.org/10.1016/j.comppsych.2014.08.007

Explaining the link between childhood maltreatment and course ofalcohol and nicotine dependence: The role of personality pathology

Elliott JCa, Goodwin RDa, Stohl Ma, Wall MMa, Keyes KMa, Skodol AEa,b,Krueger RFc, Grant BFd, Hasin DSaaNew York, NYbTucson, AZcMinneapolis, MNdRockville, MD

Background: Among those with substance dependence, persistent caseshave the greatest risk for adverse medical and psychosocial consequences.We have shown that a history of childhood maltreatment increases the riskfor persistent alcohol and nicotine dependence (Elliott et al., in press), butthe pathway underlying this association is unknown. Personality disordersmay offer an explanation, as borderline personality disorder (BPD),schizotypal personality disorder (SPD), and antisocial personality disorder(ASPD) are associated with a history of childhood maltreatment (Afifi et al.,2011), and also predict persistence of alcohol and nicotine dependence(Hasin et al., 2011). We therefore investigated these three personalitydisorders as mediators of the associations between childhood maltreatmentand the persistence of alcohol and nicotine dependence over three years.Methods: The sample included participants in the National EpidemiologicSurvey on Alcohol and Related Conditions (NESARC) who participated in a3-year follow-up interview and who had baseline diagnoses of (a) alcoholdependence (n = 1,172) or (b) nicotine dependence (n = 4,017). Partici-pants were assessed for DSM-IV diagnoses (including substance depen-dence and personality disorders), and childhood maltreatment experiences(physical, sexual, and emotional abuse, and physical neglect) with theAlcohol Use Disorder and Associated Disabilities Interview Schedule(AUDADIS-IV). Two sets of mediator models were run. First, the threepersonality disorders were each assessed as mediators in separate models.Second, the three personality disorders were tested simultaneously.Results: When modeled individually, the indirect effects of childhoodmaltreatment on persistence of alcohol dependence through BPD, SPD, andASPD symptoms were all significant (p b 0.0001), with BPD symptomsdemonstrating the largest indirect effect. The same results were found for thepersistence of nicotine dependence (p b 0.0001). When all three personalitydisorders were modeled simultaneously, BPD and ASPD indirect effectsremained significant predictors of the persistence of both alcohol andnicotine dependence (p b 0.01), while the indirect effects for SPD were nolonger significant.

Conclusion: The relationship between childhood maltreatment and alcoholand nicotine persistence is explained in part by personality pathology (notablyborderline and antisocial symptoms). This role of personality pathology isconsistent with the emotional reactivity, disrupted modulation of negativeemotions, and poor coping strategies associated with a history of childhoodmaltreatment, all of which may impede remission from dependence. Providersworking with individuals with alcohol and nicotine dependence who weremaltreated in childhood should attend to personality pathology, which mayinterfere with successful remission from substance dependence.

http://dx.doi.org/10.1016/j.comppsych.2014.08.008

Maternal health during pregnancy: The impact of depression andobesity on infant temperament and behavior

Finik J, Huynh N, Ly J, Nomura YQueens College, Flushing, New York, USA

Background: Current research supports the growing sentiment that in-uteroexposure to maternal metabolic syndromes, such as obesity, increases therisk of suboptimal development in infants. The current study attempts toevaluate the comparative impact of depression in obese and non-obesemothers, which may aid in creating more effective intervention to decreasepredisposition to metabolic and neurobehavioral dysregulation among theoffspring later in life.Methods: Study participants (n = 132) receiving prenatal care at MountSinai Medical Center in New York City, were administered the EdinburghPostnatal Depression Scale (EPDS) during their first trimester, and onceagain during a post-partum assessment. Women were also administered theInfant Behavior Questionnaire-Revised (IBQ-R), at six months post-partum,which prompted mothers to rate their infant's temperament and behavior.Pre-pregnancy BMI was obtained via patient electronic medical chart.Depression status was indicated by a score on the EPDS of 10 or above.Obesity categorization followed the BMI standards of, b25 as within normal,between N25 and b30 considered overweight, and N30 obese. The impact ofdepression and obesity on infant temperament was tested using a GeneralLinear Model (GLM), adjusting for a priori-determined potential con-founders (maternal age, race, education, and sex of child).Results: Several significant associations suggest a magnified impact ofdepression and obesity comorbidity during pregnancy on infant neurobehav-ioral development. Offspring born to mothers with comorbid depression andobesity, as compared to the mothers with either or neither of the twoconditions, scored significantly higher on negative temperament scores withthe following scales: duration (p = .002), low pleasure (p = .007), perceptualsensitivity (p = .026), and vocal reactivity (p = .024). Moreover, offspring ofdepressed mothers of normal weight or overweight, exhibited better andsimilar temperament outcomes on additional scales, when compared tooffspring born to mothers with comorbid depression and obesity.Conclusion: Results indicate a significantly negative impact of mothershaving both depression and obesity on the temperament and behavior of theiroffspring, whereas we observed less risk of suboptimal development in infantsborn to overweight as opposed to obese mothers, upon comparing withoffspring of normal weight mothers. While preliminary, the current study mayaid in designing preventative care to alleviate the potential long-lasting impactof maternal metabolic and mental health on optimal infant development.

http://dx.doi.org/10.1016/j.comppsych.2014.08.009

Advanced paternal age and risk of psychotic-like symptomsin offspring

Foutz J, Mezuk BVirginia Commonwealth University, Richmond, VA, USA

Background: Although schizophrenia is a rare disorder, psychotic-likesymptoms are reported by up to 15% of the general population, and may