%0 Journal Article %J JAMA Psychiatry %D 2021 %T Discriminating Heterogeneous Trajectories of Resilience and Depression After Major Life Stressors Using Polygenic Scores. %A Schultebraucks, Katharina %A Choi, Karmel W %A Isaac R Galatzer-Levy %A George A. Bonanno %K depression %K polygenic score %K Resilience %X

Importance: Major life stressors, such as loss and trauma, increase the risk of depression. It is known that individuals show heterogeneous trajectories of depressive symptoms following major life stressors, including chronic depression, recovery, and resilience. Although common genetic variation has been associated with depression risk, genomic factors that could help discriminate trajectories of risk vs resilience following adversity have not been identified.

Objective: To assess the discriminatory accuracy of a deep neural net combining joint information from 21 psychiatric and health-related multiple polygenic scores (PGSs) for discriminating resilience vs other longitudinal symptom trajectories with use of longitudinal, genetically informed data on adults exposed to major life stressors.

Design, Setting, and Participants: The Health and Retirement Study is a longitudinal panel cohort study in US citizens older than 50 years, with data being collected once every 2 years between 1992 and 2010. A total of 2071 participants who were of European ancestry with available depressive symptom trajectory information after experiencing an index depressogenic major life stressor were included. Latent growth mixture modeling identified heterogeneous trajectories of depressive symptoms before and after major life stressors, including stable low symptoms (ie, resilience), as well as improving, emergent, and preexisting/chronic symptom patterns. Twenty-one PGSs were examined as factors distinctively associated with these heterogeneous trajectories. Local interpretable model-agnostic explanations were applied to examine PGSs associated with each trajectory. Data were analyzed using the DNN model from June to July 2020.

Exposures: Development of depression and resilience were examined in older adults after a major life stressor, such as bereavement, divorce, and job loss, or major health events, such as myocardial infarction and cancer.

Main Outcomes and Measures: Discriminatory accuracy of a deep neural net model trained for the multinomial classification of 4 distinct trajectories of depressive symptoms (Center for Epidemiologic Studies-Depression scale) based on 21 PGSs using supervised machine learning.

Results: Of the 2071 participants, 1329 were women (64.2%); mean (SD) age was 55.96 (8.52) years. Of these, 1638 (79.1%) were classified as resilient, 160 (7.75) in recovery (improving), 159 (7.7%) with emerging depression, and 114 (5.5%) with preexisting/chronic depression symptoms. Deep neural nets distinguished these 4 trajectories with high discriminatory accuracy (multiclass micro-average area under the curve, 0.88; 95% CI, 0.87-0.89; multiclass macro-average area under the curve, 0.86; 95% CI, 0.85-0.87). Discriminatory accuracy was highest for preexisting/chronic depression (AUC 0.93), followed by emerging depression (AUC 0.88), recovery (AUC 0.87), resilience (AUC 0.75).

Conclusions and Relevance: The results of the longitudinal cohort study suggest that multivariate PGS profiles provide information to accurately distinguish between heterogeneous stress-related risk and resilience phenotypes.

%B JAMA Psychiatry %V 78 %P 744-752 %G eng %N 7 %R 10.1001/jamapsychiatry.2021.0228 %0 Journal Article %J Health Psychology %D 2017 %T Do multiple health events reduce resilience when compared with single events? %A Ruth T Morin %A Isaac R Galatzer-Levy %A Maccallum, Fiona %A George A. Bonanno %K Health Shocks %K Older Adults %K Resilience %X

OBJECTIVE: The impact of multiple major life stressors is hypothesized to reduce the probability of resilience and increase rates of mortality. However, this hypothesis lacks strong empirical support because of the lack of prospective evidence. This study investigated whether experiencing multiple major health events diminishes rates of resilience and increases rates of mortality using a large population-based prospective cohort.

METHOD: There were n = 1,395 individuals sampled from the Health and Retirement Study (HRS) and examined prospectively from 2 years before 4 years after either single or multiple health events (lung disease, heart disease, stroke, or cancer). Distinct depression and resilience trajectories were identified using latent growth mixture modeling (LGMM). These trajectories were compared on rates of mortality 4 years after the health events.

RESULTS: Findings indicated that 4 trajectories best fit the data including resilience, emergent postevent depression, chronic pre-to-post depression, and depressed prior followed by improvement. Analyses demonstrate that multiple health events do not decrease rates of resilience but do increase the severity of symptoms among those on the emergent depression trajectory. Emergent depression increased mortality compared with all others but among those in this class, rates were not different in response to single versus multiple health events.

CONCLUSIONS: Multiple major stressors do not reduce rates of resilience. The emergence of depression after health events does significantly increase risk for mortality regardless of the number of events. (PsycINFO Database Record

%B Health Psychology %V 36 %P 721-728 %G eng %N 8 %R 10.1037/hea0000481 %0 Journal Article %J Health Psychology %D 2015 %T Treatment Type and Demographic Characteristics as Predictors for Cancer Adjustment: Prospective Trajectories of Depressive Symptoms in a Population Sample %A Burton, C. L. %A Isaac R Galatzer-Levy %A George A. Bonanno %K Health Conditions and Status %K Healthcare %K Methodology %K Other %X Objective: Prospectively identifying individuals at heightened risk for depression can alleviate the disease burden of distal physical and mental health consequences after cancer onset. Our objective was to identify heterogeneous trajectories of adjustment in cancer patients, using treatment-type as a predictor. Methods: Participants were followed for 6 years within the Health and Retirement Study (HRS), a prospective population-based cohort study. The sample consisted of 1,294 middle-aged participants who were assessed once before and 3 time points after their report of an initial cancer diagnosis. In addition to self-reported depressive symptoms, subjects indicated receipt of surgical, radiological, or chemical interventions as part of their usual oncological care. Results: Four symptom trajectories were identified with Latent Growth Mixture Modeling: an increasing depression (10.5 ), chronic depression (8.0 ), depressed-improved (7.8 ), and stable-low depression (73.7 ). A conditional model using participants with available predictor data (n = 545) showed individuals in the emerging depression class were significantly more likely to have received chemo/medication therapy when compared with the remitting depression, stable-low, and chronic depression classes. Participants in the chronic and depressed-improved classes generally had worse baseline health, and the depressed-improved were also younger in age. Conclusion: Patients who exhibited increasing depressive symptoms had a greater probability of receiving chemo/medication therapy than any other adjustment trajectory group, although the majority of chemotherapy patients did not exhibit depressive symptom changes. These data underscore the diversity of ways that patients adjust to cancer, and suggest cancer treatment, baseline health, and age may influence long-term patterns of psychological adjustment. %B Health Psychology %V 34 %P 602-609 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84905632394andpartnerID=40andmd5=50975e20c6acc9448c575b737f6424e8 %N 6 %4 adjustment/cancer/chemotherapy/heterogeneity/Depressive Symptoms/Treatment effect/disease burden/psychological aspects %$ 999999 %& 602 %0 Journal Article %J Psychological Science %D 2014 %T Optimism and Death: Predicting the Course and Consequences of Depression Trajectories in Response to Heart Attack %A Isaac R Galatzer-Levy %A George A. Bonanno %K Depressive symptoms %K Health Shocks %K Heart disease %K Mortality %K Older Adults %K Optimism %X The course of depression in relation to myocardial infarction (MI), commonly known as heart attack, and the consequences for mortality are not well characterized. Further, optimism may predict both the effects of MI on depression as well as mortality secondary to MI. In the current study, we utilized a large population-based prospective sample of older adults (N = 2,147) to identify heterogeneous trajectories of depression from 6 years prior to their first-reported MI to 4 years after. Findings indicated that individuals were at significantly increased risk for mortality when depression emerged after their first-reported MI, compared with resilient individuals who had no significant post-MI elevation in depression symptomatology. Individuals with chronic depression and those demonstrating pre-event depression followed by recovery after MI were not at increased risk. Further, optimism, measured before MI, prospectively differentiated all depressed individuals from participants who were resilient. %B Psychological Science %V 25 %P 2177 - 2188 %8 Jan-12-2014 %G eng %U http://pss.sagepub.com/lookup/doi/10.1177/0956797614551750 %N 12 %! Psychological Science %R 10.1177/0956797614551750