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Precision medicine programs aim to utilize novel technologies to identify personalized treatments for children with cancer. Delivering these programs requires interdisciplinary efforts, yet the many groups involved are understudied. This study explored the experiences of a broad range of professionals delivering Australia’s first precision medicine trial for children with poor-prognosis cancer: the PRecISion Medicine for Children with Cancer (PRISM) national clinical trial of the Zero Childhood Cancer Program. We conducted semi-structured interviews with 85 PRISM professionals from eight professional groups, including oncologists, surgeons, clinical research associates, scientists, genetic professionals, pathologists, animal care technicians, and nurses. We analyzed interviews thematically. Professionals shared that precision medicine can add complexity to their role and result in less certain outcomes for families. Although many participants described experiencing a greater emotional impact from their work, most expressed very positive views about the impact of precision medicine on their profession and its future potential. Most reported navigating precision medicine without formal training. Each group described unique challenges involved in adapting to precision medicine in their profession. Addressing training gaps and meeting the specific needs of many professional groups involved in precision medicine will be essential to ensure the successful implementation of standard care.

Background: Hard-to-treat childhood cancers are those where standard treatment options do not exist and prognosis is poor. Healthcare professionals (HCPs) are responsible for communicating with families about prognosis and complex experimental treatment. We aimed to identify HCPs’ key challenges and skills required when communicating with families about hard-to-treat cancers, and their perceptions of communication-related training. Method: We interviewed Australian HCPs who had direct responsibilities in managing children/adolescents with a hard-to-treat cancer within the past 24 months. Interviews were analysed using qualitative content analysis. Results: We interviewed 10 oncologists, 7 nurses, and 3 social workers. HCPs identified several challenges for communication with families including: balancing information provision while maintaining realistic hope; managing their own uncertainty; and nurses and social workers being under-utilised during conversations with families, despite widespread preferences for multidisciplinary teamwork. HCPs perceived that making themselves available to families, empowering them to ask questions, and repeating information helped to establish and maintain trusting relationships with families. Half the HCPs reported receiving no formal training for communicating prognosis and treatment options with families of children with hard-to-treat cancers. Nurses, social workers, and junior oncologists supported the development of communication training resources, more so than senior oncologists. Conclusion(s): Resources are needed which support HCPs to communicate with families of children with hard-to-treat cancers. Such resources may be particularly beneficial for junior oncologists and other HCPs during their training, and should aim to prepare them for common challenges, and to foster greater multidisciplinary collaboration.

To investigate whether latent subgroups with distinct patterns of factors associated with self-rated successful aging can be identified in community-dwelling adults, and how such patterns obtained from analysis of quantitative data are associated with lay perspectives on successful aging obtained from qualitative responses.Cross-sectional data were collected from 1,510 community-dwelling Americans aged 21-99 years. Latent class regression was used to identify subgroups that explained the associations of self-rated successful aging with measures of physical, cognitive, and mental health as well as psychological measures related to resilience and wisdom. Natural language processing was used to extract important themes from qualitative responses to open-ended questions, including the participants' definitions of successful aging.Two latent subgroups were identified, and their main difference was that the wisdom scale was positively associated with self-rated successful aging in only one subgroup. This subgroup had significantly lower self-rated successful aging and worse scores for all health and psychological measures. In the subgroup's qualitative responses, the theme of wisdom was only mentioned by 10.6%; this proportion was not statistically different from the other subgroup, for which the wisdom scale was not statistically associated with the self-rated successful aging.Our results showed heterogeneous patterns in the factors underpinning successful aging even in community-dwelling adults. We found the existence of a latent subgroup with lower self-rated successful aging as well as worse health and psychological scores, and we suggest a potential role of wisdom in promoting successful aging for this subgroup, even though individuals may not explicitly recognize wisdom as important for successful aging.

ObjectiveThe goal of this study was to examine if mental health and psychosocial well-being differed between middle-aged (MA; 40-59 years), younger-old (YO; 60-79 years), and older-old (OO; 80+ years) adults with respect to their trends, heterogeneity, and correlates.MethodsEighteen mental health and psychosocial well-being instruments were administered to 590 adults over age 40. Cross-sectional data also included self-report-based measures of sociodemographics, cognitive functioning, physical health and activity, and body mass index.ResultsAge trends across instruments varied in magnitude and shape, but generally supported an inverted U-shaped trend in mental health and psychosocial well-being, with small increases from MA to YO age (d = 0.29) and smaller declines from YO to OO age (d = -0.17). A U-shaped association between age and mental health heterogeneity was also observed. The strongest correlates of mental health and psychosocial well-being differed by age (MA: perceived stress; YO: successful aging; OO: compassion toward others), as did the associations of a flourishing versus languishing mental health and well-being profile.ConclusionsOur findings support the "paradox of aging," whereby declines in physical and cognitive health co-occur with relatively preserved mental health and well-being. Our findings indicate that variance in mental and psychosocial health does not increase linearly with age and support careful consideration of heterogeneity in mental health and aging research. Our findings also suggest that mental health and psychosocial well-being decouple from stress-related dimensions in MA and become increasingly associated with positive, other-oriented emotions in OO, broadly supporting socioemotional theories of aging.

Schizophrenia is a devastating psychiatric illness that detrimentally affects a significant portion of the worldwide population. Aging of schizophrenia patients is associated with reduced longevity, but the potential biological factors associated with aging in this population have not yet been investigated in a global manner. To address this gap in knowledge, the present study assesses proteomics and metabolomics profiles in the plasma of subjects afflicted with schizophrenia compared to non-psychiatric control patients over six decades of life. Global, unbiased analyses of circulating blood plasma can provide knowledge of prominently dysregulated molecular pathways and their association with schizophrenia, as well as features of aging and gender in this disease. The resulting data compiled in this study represent a compendium of molecular changes associated with schizophrenia over the human lifetime. Supporting the clinical finding of schizophrenia’s association with more rapid aging, both schizophrenia diagnosis and age significantly influenced the plasma proteome in subjects assayed. Schizophrenia was broadly associated with prominent dysregulation of inflammatory and metabolic system components. Proteome changes demonstrated increased abundance of biomarkers for risk of physiologic comorbidities of schizophrenia, especially in younger individuals. These findings advance our understanding of the molecular etiology of schizophrenia and its associated comorbidities throughout the aging process.

Childhood cancer is highly distressing for families and can place strain on parents' relationships. Parental functioning and cohesiveness are important predictors of family functioning and adaptation to stress. This qualitative study investigated the perceived impact of childhood cancer on parents' relationship with their partner, with a focus on emotional and sexual intimacy.We conducted semi-structured interviews with 48 parents (42 mothers, six fathers) of children under the age of 18 who had completed curative cancer treatment. We analysed the interviews using thematic analysis.At interview, parents were on average 40.7 years old (SD = 5.5, range: 29-55 years), and had a child who had completed cancer treatment between 3 months and 10.8 years previously (M = 22.1 months). All participants were living with their partner in a married/de facto relationship. Most parents reported that their child's cancer treatment had a negative impact on emotional and sexual intimacy with their partner, with some impacts extending to the post-treatment period. Reasons for compromised intimacy included exhaustion and physical constraints, having a shifted focus, and discord arising from different coping styles. Some parents reported that their relationship strengthened. Parents also discussed the impact of additional stressors unrelated to the child's cancer experience.Parents reported that childhood cancer had a negative impact on aspects of emotional and sexual intimacy, although relationship strengthening was also evident. It is important to identify and offer support to couples who experience ongoing relationship stress, which may have adverse effects on family functioning and psychological wellbeing into survivorship.

Objectives:Wisdom is a personality trait comprising seven components: self-reflection, pro-social behaviors, emotional regulation, acceptance of diverse perspectives, decisiveness, social advising, and spirituality. Wisdom, a potentially modifiable trait, is strongly associated with well-being. We have published a validated 28-item San Diego Wisdom Scale, the SD-WISE-28. Brief scales are necessary for use in large population-based studies and in clinical practice. The present study aimed to create an abbreviated 7-item version of the SD-WISE.Method:Participants included 2093 people, aged 20-82 years, recruited and surveyed through the online crowdsourcing platform Amazon Mechanical Turk. The participants’ mean age was 46 years, with 55% women. Participants completed the SD-WISE-28 as well as validation scales for various positive and negative constructs. Psychometric analyses (factor analysis and item response theory) were used to select one item from each of the seven SD-WISE-28 subscales.Results:We selected a combination of items that produced acceptable unidimensional model fit and good reliability (ω = 0.74). Item statistics suggested that all seven items were strong indicators of wisdom, although the association was weakest for spirituality. Analyses indicated that the 28-item and 7-item SD-WISE are both very highly correlated (r = 0.92) and produce a nearly identical pattern of correlations with demographic and validity variables.Conclusion:The SD-WISE-7, and its derived Jeste-Thomas Wisdom Index (JTWI) score, balances reliability and brevity for research applications.

Emerging evidence has linked the gut microbiome changes to schizophrenia. However, there has been limited research into the functional pathways by which the gut microbiota contributes to the phenotype of persons with chronic schizophrenia. We characterized the composition and functional potential of the gut microbiota in 48 individuals with chronic schizophrenia and 48 matched (sequencing plate, age, sex, BMI, and antibiotic use) non-psychiatric comparison subjects (NCs) using 16S rRNA sequencing. Patients with schizophrenia demonstrated significant beta-diversity differences in microbial composition and predicted genetic functional potential compared to NCs. Alpha-diversity of taxa and functional pathways were not different between groups. Random forests analyses revealed that the microbiome predicts differentiation of patients with schizophrenia from NCs using taxa (75% accuracy) and functional profiles (67% accuracy for KEGG orthologs, 70% for MetaCyc pathways). We utilized a new compositionally-aware method incorporating reference frames to identify differentially abundant microbes and pathways, which revealed that Lachnospiraceae is associated with schizophrenia. Functional pathways related to trimethylamine-N-oxide reductase and Kdo2-lipid A biosynthesis were altered in schizophrenia. These metabolic pathways were associated with inflammatory cytokines and risk for coronary heart disease in schizophrenia. Findings suggest potential mechanisms by which the microbiota may impact the pathophysiology of the disease through modulation of functional pathways related to immune signaling/response and lipid and glucose regulation to be further investigated in future studies.

Perceived younger age is associated with positive health outcomes in existing literature. Few studies have examined these associations using a wide range of variables in large sample of adults of all ages. The objective of present study was to characterize the discrepancy between chronological age (CA) and subjective age (SA) in a large sample of community-dwelling adults across the lifespan, investigate associations with mental, physical, and cognitive health, and examine how it is related to a broad array of psychosocial variables relevant to well-being. Cross-sectional data from 1,004 individuals aged 21-100+ years from the Successful AGing Evaluation (SAGE) study were used for this analysis. Data included self-report measures of physical health (SF-36 - Physical Component), mental health composite score (created using CES-D Happiness scale, Satisfaction with Life Scale, SF-36 Mental Component, Brief Symptom Inventory Anxiety Scale, Patient Health Questionnaire-9, and Perceived Stress Scale), Telephone Interview for Cognitive Status - modified (TICS-m), and validated measures of various positive psychological variables such as meaning in life and optimism. On average, SA was 11.5 years younger than CA (SD 11.3). The discrepancy increased with CA. A younger SA compared to CA was associated with better mental and physical health in all age groups and was positively associated with measures of presence of meaning in life, successful aging, optimism, personal mastery, resilience, curiosity, hope, and social support. The association between age discrepancy and cognitive functioning was not statistically significant. These findings indicate that SA is potentially valuable for the purposes of clinical assessment and intervention, and this possibility should be investigated in future research.

BACKGROUND With the aging of populations worldwide, early detection of cognitive impairments has become a research and clinical priority, particularly to enable preventive intervention for dementia. Automated analysis of the drawing process has been studied as a promising means for lightweight, self-administered cognitive assessment. However, this approach has not been sufficiently tested for its applicability across populations. OBJECTIVE The aim of this study was to evaluate the applicability of automated analysis of the drawing process for estimating global cognition in community-dwelling older adults across populations in different nations. METHODS We collected drawing data with a digital tablet, along with Montreal Cognitive Assessment (MoCA) scores for assessment of global cognition, from 92 community-dwelling older adults in the United States and Japan. We automatically extracted 6 drawing features that characterize the drawing process in terms of the drawing speed, pauses between drawings, pen pressure, and pen inclinations. We then investigated the association between the drawing features and MoCA scores through correlation and machine learning–based regression analyses. RESULTS We found that, with low MoCA scores, there tended to be higher variability in the drawing speed, a higher pause:drawing duration ratio, and lower variability in the pen’s horizontal inclination in both the US and Japan data sets. A machine learning model that used drawing features to estimate MoCA scores demonstrated its capability to generalize from the US dataset to the Japan dataset (R2=0.35; permutation test, P CONCLUSIONS This study presents initial empirical evidence of the capability of automated analysis of the drawing process as an estimator of global cognition that is applicable across populations. Our results suggest that such automated analysis may enable the development of a practical tool for international use in self-administered, automated cognitive assessment.

Background:Aging is associated with numerous stressors that negatively impact older adults’ well-being. Resilience improves ability to cope with stressors and can be enhanced in older adults. Senior housing communities are promising settings to deliver positive psychiatry interventions due to rising resident populations and potential impact of delivering interventions directly in the community. However, few intervention studies have been conducted in these communities. We present a pragmatic stepped-wedge trial of a novel psychological group intervention intended to improve resilience among older adults in senior housing communities.Design:A pragmatic modified stepped-wedge trial design.Setting:Five senior housing communities in three states in the US.Participants:Eighty-nine adults over age 60 years residing in independent living sector of senior housing communities.Intervention:Raise Your Resilience, a manualized 1-month group intervention that incorporated savoring, gratitude, and engagement in value-based activities, administered by unlicensed residential staff trained by researchers. There was a 1-month control period and a 3-month post-intervention follow-up.Measurements:Validated self-report measures of resilience, perceived stress, well-being, and wisdom collected at months 0 (baseline), 1 (pre-intervention), 2 (post-intervention), and 5 (follow-up).Results:Treatment adherence and satisfaction were high. Compared to the control period, perceived stress and wisdom improved from pre-intervention to post-intervention, while resilience improved from pre-intervention to follow-up. Effect sizes were small in this sample, which had relatively high baseline resilience. Physical and mental well-being did not improve significantly, and no significant moderators of change in resilience were identified.Conclusion:This study demonstrates feasibility of conducting pragmatic intervention trials in senior housing communities. The intervention resulted in significant improvement in several measures despite ceiling effects. The study included several features that suggest high potential for its implementation and dissemination across similar communities nationally. Future studies are warranted, particularly in samples with lower baseline resilience or in assisted living facilities.

ObjectiveThe COVID-19 pandemic has had potentially severe psychological implications for older adults, including those in retirement communities, due to restricted social interactions, but the day-to-day experience of loneliness has received limited study. We sought to investigate sequential association, if any, between loneliness, activity, and affect.MethodsWe used ecological momentary assessment (EMA) with dynamic network analysis to investigate the affective and behavioral concomitants of loneliness in 22 residents of an independent living sector of a continuing care retirement community (mean age 80.2; range 68–93 years).ResultsParticipants completed mean 83.9% of EMA surveys (SD = 16.1%). EMA ratings of loneliness were moderately correlated with UCLA loneliness scale scores. Network models showed that loneliness was contemporaneously associated with negative affect (worried, anxious, restless, irritable). Negative (but not happy or positive) mood tended to be followed by loneliness and then by exercise or outdoor physical activity. Negative affect had significant and high inertia (stability).ConclusionsThe data suggest that EMA is feasible and acceptable to older adults. EMA-assessed loneliness was moderately associated with scale-assessed loneliness. Network models in these independent living older adults indicated strong links between negative affect and loneliness, but feelings of loneliness were followed by outdoor activity, suggesting adaptive behavior among relatively healthy adults.

We investigated subjective cognitive complaints (SCCs), as well as physical and mental health factors, including positive and negative psychological traits/states, in adults and older adults. U.S. residents (N=2,962) were recruited via the Amazon Mechanical Turk platform and completed a 90-item survey. Overall, 493/1930 (25.5%) of younger adults and 278/1032 (26.9%) of older adults endorsed SCCs. Analyses revealed worse physical and mental health characteristics in the SCC+ compared to the SCC- group, with primarily medium (Cohen’s d=0.50) to large (0.80) effect sizes. Age did not moderate relationships between SCCs and physical/mental health. Results suggest that SCCs are associated with a diverse set of negative health characteristics such as poor sleep and high body mass index, and lower levels of positive factors, including happiness and wisdom. Effect sizes of psychological correlates were at least as large as those of physical correlates, indicating that mental health is critical to consider when evaluating SCCs.

Objectives:The relationship between wisdom and fluid intelligence (Gf) is poorly understood, particularly in older adults. We empirically tested the magnitude of the correlation between wisdom and Gf to help determine the extent of overlap between these two constructs.Design:Cross-sectional study with preregistered hypotheses and well-powered analytic plan (https://osf.io/h3pjx).Setting:Memory and Aging Center at the University of California San Francisco, located in the USA.Participants:141 healthy older adults (mean age = 76 years; 56% female).Measurements:Wisdom was quantified using a well-validated self-report-based scale (San Diego Wisdom Scale or SD-WISE). Gf was assessed via composite measures of processing speed (Gf-PS) and executive functioning (Gf-EF). The relationships of SD-WISE scores to Gf-PS and Gf-EF were tested in bivariate correlational analyses and multiple regression models adjusted for demographics (age, sex, and education). Exploratory analyses evaluated the relationships between SD-WISE and age, episodic memory performance, and dorsolateral and ventromedial prefrontal cortical volumes on magnetic resonance imaging.Results:Wisdom showed a small, positive association with Gf-EF (r = 0.181 [95% CI 0.016, 0.336], p = .031), which was reduced to nonsignificance upon controlling for demographics, and no association with Gf-PS (r = 0.019 [95% CI −0.179, 0.216], p = .854). Wisdom demonstrated a small, negative correlation with age (r = −0.197 [95% CI −0.351, −0.033], p = .019), but was not significantly related to episodic memory or prefrontal volumes.Conclusions:Our findings indicate that most of the variance in wisdom (>95%) is unaccounted for by Gf. The independence of wisdom from cognitive functions that reliably show age-associated declines suggests that it may hold unique potential to bolster decision-making, interpersonal functioning, and other everyday activities in older adults.

Objective To examine associations of sociodemographic and clinical factors with cognitive, physical, and mental health among independent living older adults in a continuing care senior housing community (CCSHC). Methods This was a cross-sectional study at the independent living sector of a CCSHC in San Diego County, California. Participants included English-speaking adults aged 65–95 years, of which two-thirds were women. Of the 112 subjects recruited, 104 completed basic study assessments. The authors computed composite measures of cognitive, physical, and mental health. The authors also assessed relevant clinical correlates including psychosocial factors such as resilience, loneliness, wisdom, and social support. Results The CCSHC residents were similar to a randomly selected community-based sample of older adults on most standardized clinical measures. In the CCSHC, physical health correlated with both cognitive function and mental health, but there was no significant correlation between cognitive and mental health. Cognitive function was significantly associated with physical mobility, satisfaction with life, and wisdom, whereas physical health was associated with age, self-rated physical functioning, mental well-being, and resilience. Mental health was significantly associated with income, optimism, self-compassion, loneliness, and sleep disturbances. Conclusion Different psychosocial factors are significantly associated with cognitive, physical, and mental health. Longitudinal studies of diverse samples of older adults are necessary to determine risk factors and protective factors for specific domains of health. With rapidly growing numbers of older adults who require healthcare as well as supportive housing, CCSHCs will become increasingly important sites for studying and promoting the health of older adults.

This paper aims to compare mental and physical health, cognitive functioning, and selected biomarkers of aging reflecting metabolic pathology and inflammation, in outpatients with schizophrenia from two residential settings: residential care facilities (RCFs) and living with someone in a house/apartment. This cross-sectional study examined community-dwelling adults with schizophrenia either in RCFs (N = 100) or in a house/apartment with someone (N = 76), recruited for two NIH-funded studies in San Diego. Assessments included measures of mental/physical health, cognitive function, and metabolic (glycosylated hemoglobin, cholesterol) and inflammatory (C-Reactive Protein, Tumor Necrosis Factor-alpha, Interleukin-6) biomarkers of aging. General logistic models were used to analyze factors associated with residential status. RCF residents had several indicators of worse prognosis (never being married, higher daily antipsychotic dosages, increased comorbidities and higher Framingham risk for coronary heart disease) than individuals living with someone. However, RCF residents had better mental well-being and lower BMI, as well as comparable biomarkers of aging as those living with someone. While the cross-sectional nature of the study does not allow us to infer causality, it is possible that the supportive environment of RCFs may have a positive impact on mental and physical health of persons with schizophrenia. Longitudinal follow-up studies are needed to test this hypothesis.

Wisdom is an ancient concept that has gained new interest among clinical researchers as a complex trait relevant to well-being and healthy aging. As the empirical data regarding wisdom have grown, several measures have been used to assess an individual's level of wisdom. However, none of these measures has been based on a construct of wisdom with neurobiological underpinnings. We sought to develop a new scale, the San Diego Wisdom Scale (SD-WISE), which builds upon recent gains in the understanding of psychological and neurobiological models of the trait. Data were collected from 524 community-dwelling adults age 25 to 104 years as part of a structured multi-cohort study of adult lifespan. Participants were administered the SD-WISE along with two existing measures of wisdom that have been shown to have good psychometric properties. Factor analyses confirmed the hypothesized measurement model. SD-WISE total scores were reliable, demonstrated convergent and discriminant validity, and correlated, as hypothesized, negatively with emotional distress, but positively with well-being. However, the magnitudes of these associations were small, suggesting that the SD-WISE is not just a global measure of mental state. The results support the reliability and validity of SD-WISE scores. Study limitations are discussed. The SD-WISE, with good psychometric properties, a brief administration time, and a measurement model that is consistent with commonly cited content domains of wisdom based on a putative neurobiological model, may be useful in clinical practice as well as in bio-psycho-social research, especially investigations into the neurobiology of wisdom and experimental interventions to enhance wisdom.

ObjectiveThis study assessed the impact of a Leadership Fellowship, sponsored by the American Psychiatric Association (APA) and APA Foundation, on the careers of psychiatry residents and examined the influence of gender and year of Fellowship completion. This 2-year program for residents offered multiple opportunities to interact with professional leaders at various levels.MethodsA retrospective online survey of alumni of the APA Leadership Fellowship, who had completed this Fellowship between 2003 and 2019, was conducted.ResultsOut of the 93 psychiatrists who were sent the survey, 59 alumni responded (60.8% response rate). Most respondents had remained involved with organized psychiatry groups and 80% held leadership positions. Respondents reported high levels of satisfaction with the APA Fellowship experience, noting the importance of peer networking. Overall, male and female respondents were similar in their subsequent leadership positions and satisfaction with the survey. Similarly, Fellows who completed the Fellowship in 2003-2015 had responses about the experience that were largely similar to those in the 2016-2019 cohort that had not yet completed their residency.ConclusionA vast majority of alumni of the APA Leadership Fellowship had become leaders in their workplace or organized psychiatry groups. The leadership-focused career development programs for psychiatry trainees are important avenues to develop a diverse cohort of future leaders in psychiatry.

Schizophrenia is a devastating psychiatric illness that detrimentally affects a significant portion of the worldwide population. Aging of schizophrenia patients is associated with reduced longevity, but the potential biological factors associated with aging in this population have not yet been investigated in a global manner. To address this gap in knowledge, the present study assesses proteomics and metabolomics profiles in the plasma of subjects afflicted with schizophrenia compared to non-psychiatric control patients over six decades of life. Global, unbiased analyses of circulating blood plasma can provide knowledge of prominently dysregulated molecular pathways and their association with schizophrenia, as well as features of aging and gender in this disease. The resulting data compiled in this study represent a compendium of molecular changes associated with schizophrenia over the human lifetime. Supporting the clinical finding of schizophrenia's association with more rapid aging, both schizophrenia diagnosis and age significantly influenced the plasma proteome in subjects assayed. Schizophrenia was broadly associated with prominent dysregulation of inflammatory and metabolic system components. Proteome changes demonstrated increased abundance of biomarkers for risk of physiologic comorbidities of schizophrenia, especially in younger individuals. These findings advance our understanding of the molecular etiology of schizophrenia and its associated comorbidities throughout the aging process.

Objective Wisdom has gained increasing interest among researchers as a personality trait relevant to well-being and mental health. We previously reported development of a new 24-item San Diego Wisdom Scale (SD-WISE), with good to excellent psychometric properties, comprised of six subscales: pro-social behaviors, emotional regulation, self-reflection (insight), tolerance for divergent values (acceptance of uncertainty), decisiveness, and social advising. There is controversy about whether spirituality is a marker of wisdom. The present cross-sectional study sought to address that question by developing a new SD-WISE subscale of spirituality and examining its associations with various relevant measures. Methods Data were collected from a national-level sample of 1,786 community-dwelling adults age 20–82 years, as part of an Amazon M-Turk cohort. Participants completed the 24-item SD-WISE along with several subscales of a commonly used Brief Multidimensional Measure of Religiousness/Spirituality, along with validated scales for well-being, resilience, happiness, depression, anxiety, loneliness, and social network. Results Using latent variable models, we developed a Spirituality subscale, which demonstrated acceptable psychometric properties including a unidimensional factor structure and good reliability. Spirituality correlated positively with age and was higher in women than in men. The expanded 28-item, 7-subscale SD-WISE total score (called the Jeste-Thomas Wisdom Index or JTWI) demonstrated acceptable psychometric properties. The Spirituality subscale was positively correlated with good mental health and well-being, and negatively correlated with poor mental health. However, compared to other components of wisdom, the Spirituality factor showed weaker (i.e., small-to-medium vs. medium-to-large) association with the SD-WISE higher-order Wisdom factor (JTWI). Conclusion Similar to other components as well as overall wisdom, spirituality is significantly associated with better mental health and well-being, and may add to the predictive utility of the total wisdom score. Spirituality is, however, a weaker contributor to overall wisdom than components like pro-social behaviors and emotional regulation. Longitudinal studies of larger and more diverse samples are needed to explore mediation effects of these constructs on well-being and health.

OBJECTIVES: There has been growing research interest in loneliness and wisdom in recent decades, but no cross-cultural comparisons of these constructs using standardized rating measures in older adults, especially the oldest-old. This was a cross-sectional study of loneliness and wisdom comparing middle-aged and oldest-old adults in Cilento, Italy and San Diego, United States. METHOD: We examined loneliness and wisdom, using the UCLA Loneliness Scale Version 3 (UCLA-3) and San Diego Wisdom Scale (SD-WISE), respectively, in four subject groups: adults aged 50–65 and those ≥90 years from Cilento, Italy (N = 212 and 47, respectively) and San Diego, California, USA (N = 138 and 85, respectively). RESULTS: After controlling for education, there were no significant group differences in levels of loneliness, while on SD-WISE the Cilento ≥90 group had lower scores compared to the other three groups. There was a strong inverse correlation between loneliness and wisdom in each of the four subject groups. Loneliness was negatively associated while wisdom was positively associated with general health, sleep quality, and happiness in most groups, with varying levels of significance. CONCLUSION: These results largely support cross-cultural validity of the constructs of loneliness and wisdom, and extend previous findings of strong inverse correlations between these two entities. Loneliness has become a growing public health problem, and the results of our study suggest that wisdom could be a protective factor against loneliness, although alternative explanations are also possible. Research on interventions to reduce loneliness by enhancing wisdom in older adults is needed.

Author(s): Van Patten, Ryan; Nguyen, Tanya T; Mahmood, Zanjbeel; Lee, Ellen E; Daly, Rebecca E; Palmer, Barton W; Wu, Tsung-Chin; Tu, Xin; Jeste, Dilip V; Twamley, Elizabeth W | Abstract: AbstractSubjective cognitive decline (SCD), or internal feelings of reduced mental capacity, is of increasing interest in the scientific, clinical, and lay community. Much of the extant literature is focused on SCD as a risk factor for Alzheimer’s disease in older adults, while less attention has been paid to non-cognitive health correlates of SCD across adulthood. Consequently, we investigated physical and mental health correlates of SCD in younger, middle-aged, and older adults. We recruited 3,407 U.S. residents through Amazon’s Mechanical Turk, an online labor market. Participants completed a 90-item self-report survey questionnaire assessing sociodemographic characteristics, physical health, sleep, depression, anxiety, loneliness, wisdom, self-efficacy, and happiness. Overall, 493/1930 (25.5%) of younger adults (18-49) and 278/1032 (26.9%) of older adults (50 or older) endorsed the SCD item. Multivariate analysis of variance and follow-upt-tests revealed worse physical and mental health characteristics in people endorsing SCD compared to those who did not, with effect sizes primarily in the medium to large range. Additionally, age did not moderate relationships between SCD and physical and mental health. Results suggest that SCD is associated with a diverse set of negative health characteristics such as poor sleep and high body mass index, and lower levels of positive factors including happiness and wisdom. Effect sizes of psychological correlates of SCD were as large as (or larger than) those of physical correlates, indicating that mental health and affective symptoms may be critical to consider when evaluating SCD. Overall, findings from this large, national U.S. sample suggest the presence of relationships between SCD and multiple psychological and perceived health factors; our results also show that SCD may be highly prevalent in both younger and older adults, suggesting that it be assessed across the adult lifespan.

OBJECTIVE Loneliness is a prevalent and serious public health problem due to its effects on health, well-being, and longevity. Understanding correlates of loneliness is critical for guiding efforts toward the development of evidence-based strategies for prevention and intervention. Considering that patterns of association between age and loneliness vary, the present study sought to examine age-related differences in risk and protective factors for loneliness. METHODS Correlates of loneliness were examined through a large web-based survey of 2,843 participants (aged 20-69 years) from across the United States from April 10, 2019, through May 10, 2019. Participants completed the 4-item UCLA Loneliness Scale, San Diego Wisdom Scale (with the following subscales measuring components of wisdom: Prosocial Behaviors, Emotional Regulation, Self-Reflection, Acceptance of Divergent Values, Decisiveness, and Social Advising), and other scales measuring psychosocial variables. Multivariate regression analyses were conducted to identify the best model of loneliness and examine potential age-related differences. RESULTS Age demonstrated a nonlinear quadratic relationship with loneliness (Wald statistic = 5.48, P = .019); levels were highest in the 20s and lowest in the 60s with another peak in the mid-40s. Across all decades, loneliness was associated with not having a spouse or partner (P < .001), sleep disturbance (P < .02), lower prosocial behaviors (P < .001), and smaller social network (P < .001). Lower social self-efficacy (P < .001) and higher anxiety (P < .005) were associated with worse loneliness in all age decades, except the 60s. Loneliness was uniquely associated with decisiveness in the 50s (P = .012) and with education (P = .046) and memory complaints (P = .013) in the 60s. CONCLUSIONS Our findings identify several potentially modifiable targets related to loneliness, including several aspects of wisdom and social self-efficacy. Differential predictors at different decades suggest a need for a personalized and nuanced prioritizing of prevention and intervention targets.

AIMS Patient-held records are becoming more commonly used in health care, particularly in chronic diseases like glaucoma. There is a lack of evidence to support their use, however. This study examines the change in knowledge scores within a group following the introduction of a newly designed glaucoma logbook. METHODS This analysis uses a test and retest method where patients undergoing treatment for glaucoma or ocular hypertension were assessed using a validated knowledge questionnaire. They were then given a personalized glaucoma logbook and their knowledge scores retested after 4 to 8 weeks. The change in knowledge score was examined using a Wilcoxon signed-rank test. RESULTS A total of 56 patients were recruited and 35 completed both questionnaires equating to a 62.5% retention rate. The analysis showed a significant increase in the knowledge score attained following introduction of the questionnaire (Z=-4.176, P

The current study examines whether proneness to shame and guilt is related to the cultural dimensions of collectivism and individualism. Two groups of participants from Ireland (n = 120) and the Un...

Author(s): Nguyen, Tanya; Kosciolek, Tomasz; Daly, Rebecca; Vazquez-Baeza, Yoshiki; Swafford, Austin; Knight, Rob; Jeste, Dilip

Objectives:This study of loneliness across adult lifespan examined its associations with sociodemographics, mental health (positive and negative psychological states and traits), subjective cognitive complaints, and physical functioning.Design:Analysis of cross-sectional dataParticipants:340 community-dwelling adults in San Diego, California, mean age 62 (SD = 18) years, range 27–101 years, who participated in three community-based studies.Measurements:Loneliness measures included UCLA Loneliness Scale Version 3 (UCLA-3), 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Scale, and a single-item measure from the Center for Epidemiologic Studies Depression (CESD) scale. Other measures included the San Diego Wisdom Scale (SD-WISE) and Medical Outcomes Survey- Short form 36.Results:Seventy-six percent of subjects had moderate-high levels of loneliness on UCLA-3, using standardized cut-points. Loneliness was correlated with worse mental health and inversely with positive psychological states/traits. Even moderate severity of loneliness was associated with worse mental and physical functioning. Loneliness severity and age had a complex relationship, with increased loneliness in the late-20s, mid-50s, and late-80s. There were no sex differences in loneliness prevalence, severity, and age relationships. The best-fit multiple regression model accounted for 45% of the variance in UCLA-3 scores, and three factors emerged with small-medium effect sizes: wisdom, living alone and mental well-being.Conclusions:The alarmingly high prevalence of loneliness and its association with worse health-related measures underscore major challenges for society. The non-linear age-loneliness severity relationship deserves further study. The strong negative association of wisdom with loneliness highlights the potentially critical role of wisdom as a target for psychosocial/behavioral interventions to reduce loneliness. Building a wiser society may help us develop a more connected, less lonely, and happier society.

OBJECTIVE To examine the relationship of presence and search for meaning in life with age, physical and mental well-being, and cognitive functioning across the adult lifespan. METHODS Cross-sectional data from 1,042 adults in the Successful AGing Evaluation (SAGE)-a multicohort study of adult community-dwelling residents of San Diego County, California-were analyzed. Presence of meaning ("Presence") and search for meaning in life ("Search") were assessed with the Meaning in Life Questionnaire. Physical and mental well-being were measured using the Short Form 36 Health Survey (SF-36). Telephone Interview for Cognitive Status-modified was employed to screen for overall cognitive function. Study data were collected from January 2013 to June 2014. RESULTS Presence of meaning exhibited an inverted U-shaped relationship whereas Search showed a U-shaped relationship with age (with Presence peaking and Search reaching the lowest point around age 60). Statistical modeling using generalized estimating equations revealed that physical well-being (SF-36 physical composite score) correlated negatively with age (P < .001) and positively with Presence (P < .001), and there was an age group x Presence interaction (P = .018), such that the relationship was stronger in subjects over age 60. Mental well-being correlated positively with age (P < .001) and Presence (P < .001) and negatively with Search (P = .002). Cognitive function correlated inversely with age (P < .001) and with Search (P < .001). Significant covariates of Presence and Search had small effect sizes, except for a medium effect size for satisfaction with life and Presence in adults over age 60 (P < .001). CONCLUSIONS Presence and search for meaning in life are important for health and well-being, though the relationships differ in adults younger and older than 60 years. Better understanding of the longitudinal relationships of meaning of life with well-being is warranted to design interventions to increase meaning of life and improve health and functioning.

Author(s): Martin, A'verria; Eglit, Graham ML; Maldonado, Yadira; Daly, Rebecca; Liu, Jinyuan; Tu, Xin; Jeste, Dilip V | Abstract: Background and objectivesNegative age stereotypes can become internalized and contribute to lower levels of physical and mental well-being in older adults, including those with serious illnesses. The main objective of this study was to examine the relationships of attitude toward own aging (ATOA) with health outcomes after controlling for resilience among older cancer survivors and comparison subjects without cancer, aged 50 years or older.MethodsWe examined data in 1,140 adults from the Successful Aging Evaluation (SAGE) study, a structured multi-cohort investigation of community-based adults selected using random digit dialing. There were 219 participants with cancer (excluding skin cancer) and 912 without cancer. ATOA was assessed with the Philadelphia Geriatric Morale Scale, and its relationship with measures of physical, cognitive, and mental health, as well as resilience was evaluated.ResultsIndividuals with cancer reported slightly more pessimistic ATOA than individuals without cancer. ATOA correlated with physical and mental health in individuals with and without cancer. Hierarchical linear multiple regression revealed that ATOA contributed significantly to the prediction of physical and mental health after controlling for socio-demographic variables and resilience.Discussion and implicationsHigher levels of positive ATOA appear to be a protective factor for health in older adults, including those with cancer. Interventions that provide education about positive aspects of aging, modify negative automatic thoughts, and promote optimism may be useful for increasing ATOA and thereby improving physical and mental health in older adults, especially those with cancer.

Objective Although 25% of people with bipolar disorder (BD) are over age 60, there is a dearth of research on older age bipolar disorder (OABD). This report describes an initial effort to create an integrated OABD database using the U.S. National Institute of Mental Health Data Archive (NDA). Goals were to: 1) combine data from three BD studies in the United States that included overlapping data elements; 2) investigate research questions related to aims of the original studies; and 3) take an important first step toward combining existing datasets relevant to aging and BD. Methods Data were prepared and uploaded to the NDA, with a focus on data elements common to all studies. As appropriate, data were harmonized to select or collapse categories suitable for cross-walk analysis. Associations between age, BD symptoms, functioning, medication load, medication adherence, and medical comorbidities were assessed. The total sample comprised 451 individuals, mean age 57.7 (standard deviation: 13.1) years. Results Medical comorbidity was not significantly associated with either age or functioning and there did not appear to be an association between medication load, comorbidity, age, and adherence. Men and African-Americans were significantly more likely to have poor adherence. Both BD mania and depression symptoms were associated with functioning, but this differed across studies. Conclusion Despite limitations including heterogeneity in study design and samples and cross-sectional methodology, integrated datasets represent an opportunity to better understand how aging may impact the presentation and evolution of chronic mental health disorders across the lifespan.

Recent decades have seen growing empirical research in wisdom as a complex, trait-based psychological characteristic. Wisdom has been shown to possess individual and societal benefits through associations with health and well-being, but it has not yet been evaluated in people with schizophrenia (PwS). In the current study, we administered a widely used, validated 3-dimensional wisdom scale that includes three interrelated dimensions: cognitive, reflective, and affective. We examined group differences in wisdom, as well as relationships between wisdom and sociodemographics, clinical symptoms, neurocognitive and functional performance, and mental and physical health in 65 stable adult outpatients with chronic schizophrenia or schizoaffective disorder and 96 non-psychiatric comparison participants (NPCPs). Results showed that PwS had lower wisdom scores than NPCPs and that wisdom moderated relationships between diagnostic group and neurocognitive and functional performance; PwS with higher levels of wisdom demonstrated better cognitive performance than did PwS with lower levels of wisdom. In addition, wisdom was positively correlated with performances on multiple neurocognitive tasks in PwS, but not in NPCPs. Finally, reflective wisdom - representing accurate/unbiased introspection and perspective-taking - correlated with all mental health variables in PwS. Our results were limited by a cross-sectional design, but suggest that wisdom, especially reflective wisdom, may be associated with better cognitive performance and better physical and mental health in PwS. It is conceivable that interventions to enhance wisdom may have broad cognitive and mental and physical health benefits in individuals with chronic psychotic disorders.

Intestinal microbiome and gut-brain axis have been receiving increasing attention for their role in the regulation of brain/behavior and possible biological basis of psychiatric disorders. Several recent clinical studies have linked the microbiome with neuropsychiatric conditions, although the literature on schizophrenia is quite limited. This study investigated gut microbiome composition in 50 individuals, including 25 persons with chronic schizophrenia and 25 demographically-matched non-psychiatric comparison subjects (NCs). Stool samples were collected and assayed using 16S rRNA sequencing of the V4 region. Examination of unweighted UniFrac and Bray-Curtis dissimilarities revealed significant community-level separation in microbiome composition between the two subject groups. At the phylum level, Proteobacteria were found to be relatively decreased in schizophrenia subjects compared to NCs. At the genus level, Anaerococcus was relatively increased in schizophrenia while Haemophilus, Sutterella, and Clostridium were decreased. Within individuals with schizophrenia, abundance of Ruminococcaceae was correlated with lower severity of negative symptoms; Bacteroides were associated with worse depressive symptoms; and Coprococcus was related to greater risk for developing coronary heart disease. Our findings provide evidence of altered gut microbial composition in persons with chronic schizophrenia and suggest a need for larger and longitudinal studies of microbiome in schizophrenia.

Introduction Mixed affective states in bipolar disorder have been associated with increased number of mood episodes, increased suicidality, higher rates of co-occurring conditions, and poorer response to treatments. In order to better understand mixed symptomatology in bipolar disorder, here we examine the prevalence and associations of subjectively reported states of simultaneously high sadness and high energy as well as objectively rated concurrently high depressive and manic symptoms. Methods We used baseline data from an ongoing longitudinal study of subjects with Bipolar Disorder (BDs) and Healthy Controls (HCs). Our mixed-age sample (mean age 48.5, SD 7.7) included 50 BDs and 91 HCs. Baseline evaluation consisted of a 2-week burst of data collection. All subjects underwent objective tests of cognitive performance, lab tests for inflammatory markers, and BDs were assessed for suicidal ideation (SI) and suicidal behavior (SB) using Columbia-Suicide Severity Rating Scale (C-SSRS) at baseline, middle and end of the 2-week period. The proportion of ratings in which SI or SB was reported (P-SI and P-SB respectively) was used as a measure of degree of SI and SB. Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Brief Psychiatric Rating Scale (BPRS), and 36-Item Short Form Health Survey (SF-36) were administered to BD subjects at baseline. Participants were given a mobile phone and affective ratings were gathered 3 times per day for 14 days at random intervals approximating morning, mid-day, and evening. Ratings were scored on a scale of 0-7 across domains such as sad/depressed, happy, energetic, etc. Short Lived Mixed Affective States (SLMAS) were defined as instances of affective ratings with simultaneously high sadness/depression (≥4) and high energy (≥4). The proportion of total reported ratings with SLMAS (P-SLMAS) were calculated for all subjects. A group with objective mixed states (group M, N=15 [30.6%]) was defined as BDs with concurrently high HAM-D and YMRS scores (HAM-D ≥ median score of 17, YMRS ≥ median score of 6). These were compared to BD patients with both HAM-D and YMRS scores lower than median (group L; N=13 [26.5%]), with high depression/low mania (group D; N=20 [20.4%]), and with high mania/low depression (group Y; N=11 [22.4%]). We examined the association of subjective mixed affect (P-SLMAS) and objective mood state group with age, suicidality, symptom severity, cognition and inflammation and to each other using correlations and ANOVAs. Results Groups were well-matched on age and sex. In terms of subjective affective ratings, while both groups had low P-SLMAS overall, BDs had significantly higher P-SLMAS compared to HCs: 9.7% (SD 13.1%) vs 3.5% (SD 7.3%), p In the BD group, P-SLMAS was significantly correlated with BPRS total score (r=0.373, p=0.012), BPRS item-3/depression score (r=0.41, p=0.004), HAM-D total score (r=0.413, r=0.004), and SF-36 mental component score (r=-0.430, p=0.011), while no significant correlation was found with YMRS total score (r=0.079, p=0.598). Significant correlations were also noted with Cognitive Failures Questionnaire-25 score (r=0.347, p=0.048) and Brief Symptom Inventory Anxiety Scale score (r=0.349, p=0.043). These significant correlations remained significant on linear regression even when proportion of ratings with high-sadness and high-energy as separate variables were taken into consideration, indicating that these significant associations with P-SLMAS were not being driven by high-sadness or high-energy individually. No correlation was found between P-SLMAS and P-SI (r=0.104, p=0.525) and P-SB (r=0.062, r=0.668). No correlation was found between age and P-SLMAS (r=0.055, p=0.520), nor were there associations of P-SLMAS with gender, race, marital status or living situation. Furthermore, no correlation was found between P-SLMAS and objective tests of cognitive performance or inflammatory markers. In terms of objectively rated mixed states, Group M had significantly higher P-SI compared to groups L, D and Y (50% vs 0%, 21% and 5% respectively, p=0.003). Group M also had higher P-SB (10% compared to 0% for all other groups), however, this did not reach statistical significance (p=0.098). No significant difference was found between groups L, D, Y and M with regards to age and other demographic variables. No differences were found with regards to CFQ-25 score, BSIAS score, objective tests of cognitive performance, or inflammatory markers. Subjectively rated mixed affect and objectively rated mixed states were not strongly associated. P-SLMAS were not significantly different across L, D, Y and M groups (p=0.103), with groups D and M showing similarly high P-SLMAS (13.4% and 14.6% respectively) and groups L and Y showing similarly low P-SLMAS (4.5% and 4.8% respectively). Conclusions SLMAS, subjectively reported short-lived states of high sadness and high energy, are reported with greater frequency in BDs compared to HCs. SLMAS appear to be a marker of depressive pathology (akin to ‘agitated depression’) and are associated with greater symptom severity. SLMAS do not show a relationship with manic symptom severity, and therefore do not show a relationship with objectively defined mixed states. While SLMAS are not associated with suicidality, objectively rated concurrently high depressive and manic symptoms are associated with greater frequency of suicidal ideation. Future work will examine relationship with psychiatric comorbidities and treatment response. This research was funded by This work was supported by NIMH grant R01 MH103318 and the Desert-Pacific Mental Illness Research, Education, and Clinical Center.

We examined associations of cognitive, reflective, and affective dimensions of wisdom in a 2-year follow-up study of a community-based sample. Participants (51% male) were 1,441 adults aged 21 to 100 years (M = 66; SD = 21). Wisdom was assessed with 39-item 3-Dimensional Wisdom Scale. Cross-sectionally, correlations with age were small (-.17 for cognitive, and -.05 and -.08 for others). All 3 dimensions had medium size correlations (r > .3) with resilience, optimism, and personal mastery. The reflective dimension also had medium size correlations with happiness and life satisfaction, and inverse correlations with levels of perceived stress, anxiety, and depression. At 2-year follow-up, reliability change index scores indicated relatively little change in the reflective and affective scores, but a slight decline in the cognitive scores. These results suggest that wisdom is a relatively stable trait that is associated, especially its reflective dimension, with positive traits and states (e.g., resilience, happiness).

BackgroundSchizophrenia is linked with early medical comorbidity and mortality. These observations indicate possible "accelerated biological aging" in schizophrenia, although prior findings are mixed, and few such studies have examined the role of gender. One putative marker of biological aging is leukocyte telomere length (LTL), which typically shortens with age.MethodsWe assessed LTL in phenotypically well characterized 134 individuals with schizophrenia (60 women and 74 men) and 123 healthy comparison subjects (HCs) (66 women and 57 men), aged 26 to 65 years.ResultsOverall, LTL was inversely associated with age (t(249)=-6.2, p&nbsp

In 2011 the University of Wollongong Library undertook a significant review of its Resource Sharing services. This was prompted by constraints in the systems supporting this service, changes to the Library's key suppliers, Infotrieve Australia and the British Library Document Supply Service, and the need to deliver effective library services within a defined physical and budgetary environment.As a result of the review, the existing Millennium Interlibrary Loan and Ariel software hosting the service were replaced by the Relais ILL system. The most cost-effective and relevant methods for supporting the research needs of the university were achieved through subscriptions with networks characterized by strong unmediated requesting functionalities, including ArticleReach, BONUS+, and RapidILL. To expand the Library's access to international collections, a subscription to OCLC WorldCat Resource Sharing was begun.UOW Library now processes approximately 50% more requests, 76% of which are now processed to some de...

The digital environment is growing rapidly, through ubiquitous and increasingly powerful personal computing devices, and the demand for information to be accessible. Libraries and archives, as traditional providers and storehouses of content, are adapting to this changing environment by adopting new and innovative digital content delivery mechanisms to unmask their special collections. In 2012, the University of Wollongong Library implemented a comprehensive digitisation program for its unique archival and research collections. Film, photographs, documents, artworks and audio are being made available online through several platforms and delivery tools in combination, complementing the increasingly important role played by the library in supporting research, education, and community engagement. The implementation of a Digital Collections Portal has channelled Australian and international audiences to the library's digital content. Open access to collections is a key library goal, with success measured in p...