Journal Digest: Autism and Minority Children; Cognitive Bias Training Reduces Alcohol Use; Pandemic Gun Buyers and Suicide; Targeted Therapy Reduces Risk of Youth Depression; Age, Impact of Drug Combo on Weight, Cholesterol

Autism Diagnosis Rates May Be Rising in Minority Children

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Rates of autism diagnosis in the United States have historically been higher among Whites and those of higher socioeconomic status. A study in PNAS now suggests this trend may have shifted in recent years, with more children who are minorities and members of families of lower socioeconomic status receiving autism diagnoses than children from other groups.

Investigators at Columbia University and colleagues analyzed California birth data from 1992 to 2016 and autism caseload data from 1998 to 2019 using state records to assess trends across different populations. Overall autism diagnosis rates rose over 600% in California between 1998 and 2018, from 0.49 cases per 1,000 children aged 3 to 6 years in 1998 to 3.49 per 1,000 children aged 3 to 6 years in 2018.

Autism diagnoses did not rise equally across demographic groups. In 1998, White, Black, and Asian children had similar rates of autism, while Hispanic children had lower rates. Starting in 2009, autism diagnoses slowed in White children, and by 2014, this group had the lowest autism incidence rates of the racial/ethnic groups examined. In contrast, autism incidence among Black and Hispanic children rose significantly.

The investigators also observed interesting trends in relation to income. Among Black and Hispanic children, the yearly rates of diagnosis were similar regardless of whether the children were enrolled in California’s Medicaid program (Medi-Cal). For White and Asian children, diagnosis became more frequent in children enrolled in Medi-Cal relative to other children after 2008.

The investigators suggested their observed trends might be due in part to the release of American Academy of Pediatrics guidelines in 2006 that recommended universal screening for autism during well-child visits coupled with state advocacy efforts in 2009 to reduce linguistic and cultural barriers for services provided by California’s Department of Developmental Services.

The findings “point to the fundamental role that access to knowledge and resources plays in driving increased autism prevalence and shifting patterns of autism cases over the past quarter century,” the authors noted.

Cognitive Bias Modification Reduces Risk of Alcohol Use Relapse

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Providing cognitive bias training to people receiving inpatient treatment for alcohol withdrawal may reduce the risk of relapse in the first two weeks following discharge, according to a study in JAMA Psychiatry. Cognitive bias modification (CBM) is a visually based computer program that trains people to subconsciously avoid alcohol-related cues.

To evaluate the effectiveness of CBM in reducing relapse in patients in treatment for alcohol withdrawal, researchers at Monash University in Melbourne, Australia, and colleagues recruited 300 adults with moderate or severe alcohol use disorder for their trial. Half the participants received up to four 15-minute sessions of CBM along with regular inpatient care, while the other half received a sham treatment (patients also looked at pictures on a computer screen, but the approach was not structured to promote alcohol avoidance). All participants were then contacted two weeks after discharge to assess their alcohol abstinence.

The two-week abstinence rates were 54.4% among participants in the CBM group and 42.5% among those in the sham group. Among participants who completed all four sessions of CBM or sham, the abstinence rates were 63.8% for the CBM group and 46.8% for the sham group. Though the CBM procedure entails viewing many alcohol-related images, the researchers found no evidence that this training increased alcohol cravings in the patients.

“CBM is a promising adjunctive intervention that directly targets key cognitive mechanisms with minimal intensity in terms of time or cognitive demands on patients,” the researchers wrote. “The low cost (requiring only a laptop and joystick, freely available software, and a few minutes of nonspecialist staff time per session) makes implementation of CBM feasible, including in low-income countries in which resources and treatment options are more limited.”

Pandemic Gun Buyers May Have More Suicidal Thoughts

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A study in the American Journal of Preventive Medicine reports that people who bought firearms during the COVID-19 pandemic are more likely to have experienced prior suicidal ideation than both people who did not own firearms and those who own firearms but did not buy any weapons during the pandemic.

“These findings indicate that individuals already at risk for death by suicide are introducing a pronounced risk factor for suicide into their homes during a time of extended social isolation, economic uncertainty, and general upheaval,” the authors wrote. People who purchased firearms during the pandemic who reported recent or lifetime suicidal ideation were more likely to use some safe storage methods than other firearm owners, which might mitigate suicide risk, they added.

Researchers at Rutgers University and colleagues collected data from an online survey of 3,494 adults, which included 2,330 people who did not own firearms and 1,164 people who owned firearms; of the latter group, 201 adults had purchased a firearm since the pandemic began. The team found that adults who purchased firearms during the pandemic had much higher rates of both lifetime suicidal ideation than other firearm owners (69% vs. 37%). Similarly, those who purchased firearms during the pandemic reported higher rates of past-year and past-month suicidal ideation compared with other firearm owners (56% vs. 24% and 25% vs. 12%, respectively). There was no difference in suicidal ideation between people who did not own firearms and those who purchased firearms prior to the pandemic.

Among the 201 adults who purchased a firearm during COVID-19, those who reported past-month or past-month suicidal ideation were significantly more likely to report using locking devices like a trigger lock than those who did not report suicidal ideation. The groups did not differ in the likelihood of using any other firearm storage methods.

“Although there was substantial variability within groups in the frequency of endorsement for various reasons for acquiring firearms during COVID-19, that variability was not apparent between groups,” the authors wrote. “Regardless of suicidal ideation, safety and protection at home were the most frequently endorsed reason for firearm acquisition.”

Targeted Therapy Can Benefit Youth at Risk of Depression

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Personalizing depression prevention therapy for at-risk youth based on the types of depression risk they face may lead to better outcomes, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers at the University of Pennsylvania and colleagues enrolled 204 youth aged 11 to 18 without current depression for this study. The youth were broken into four groups based on how they responded to questions about their cognitive risks (such as dysfunctional attitudes) and interpersonal risks (such as low peer support) for depression.

The youth were then randomly assigned to receive either a cognitive-behavioral therapy called Coping with Stress (CWS) or an interpersonal therapy for adolescents (IPT). Both behavioral therapies entailed eight weekly group sessions followed by individual booster sessions if needed. Changes in depressive symptom score, according to the Children’s Depression Inventory (CDI) and/or a depression diagnosis were assessed during an 18-month follow up.

In total, 18.7% of children receiving the CWS and 16.9% receiving the IPT developed depression. Youth who received the treatment that matched their risk profile (for example, CWS for those with high cognitive risk factors and IPT for those with high interpersonal risk factors) had significantly greater changes in CDI scores and a lower incidence of depression than youth given a mismatched therapy (10.1% vs. 25.2%).

“Taken together, the findings from [personalized depression prevention] provide initial evidence that personalization, focused on cognitive and interpersonal vulnerabilities for depression, may enhance the effects of evidence-based depression prevention programs,” the authors wrote.

Age May Impact Effects of Sertraline-Olanzapine on Weight, Cholesterol

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Older patients with psychotic depression experience less weight gain and cholesterol increases than younger patients when treated with sertraline plus olanzapine. These findings were published in the American Journal of Geriatric Psychiatry.

“Older adults are more likely to experience psychotic features during a major depressive episode than younger adults. In addition, the incidence of diabetes mellitus type 2 and hyperlipidemia increase in later life,” the authors wrote. “It is therefore important to determine whether there are age-related differences in anthropometric and metabolic outcomes associated with the treatment of psychotic depression with antipsychotic medication.”

The trial, known as STOP-PD-II, compared whether long-term treatment with sertraline plus olanzapine was more effective than sertraline plus placebo at preventing relapse of psychotic depression. In the first part of the study, all participants received open-label sertraline plus olanzapine for up to 12 weeks, and those who achieved remission entered the long-term phase of the trial.

The investigators from the University of Toronto and colleagues took a closer look at the metabolic data from those first 12 weeks in participants aged 18 to 59 and those aged 60 and older. While both younger and older participants experienced weight gain and an increase in total cholesterol levels when treated with sertraline-olanzapine versus sertraline-placebo, the increases were more pronounced in younger adults; average weight gain was 16.9 pounds for adults under age 60 and 9.5 pounds for adults 60 and over.

After reviewing the participants’ medical history, the investigators found that, on average, adults 60 and older lost 14.4 pounds between the onset of their depressive episode and enrollment in the study, whereas the weight of younger adults stayed stable.

“These findings suggest that the weight gained during the acute and stabilization treatment of psychotic depression was partial restoration of lost weight in older patients [during depressive episodes] but clinically significant excess weight in younger patients,” they wrote. ■