During the past year, we have continued to actively pursue analyses of topics relevant to the National Institute of Mental Health, Intramural Research Program mission such as anxiety disorders, attention deficit hyperactivity disorder (ADHD), mood disorders, sleep patterns and problems, service utilization, and neighborhood risk factors for mental disorders. The research yielded several peer-reviewed publications. The chief findings include: -Threshold and subthreshold forms of generalized anxiety disorder (GAD) are prevalent in adolescents with a high degree of psychiatric comorbidity, disability and impairment. The findings indicate that threshold GAD may be typified by greater severity and chronicity than subthreshold GAD, however the distress and impairment experienced by adolescents with subthreshold GAD is often comparable with that of those who meet full criteria for the disorder, and no less worthy of professional or scientific attention (Burstein et al, 2014); -Neighborhood conditions are linked with NCS-A data using geocoding. The findings of the association of neighborhood disadvantage and salivary cortisol levels suggest place of residence may influence the stress response system in U.S. adolescents (Rudolph et al, 2014); -The proportion of adolescents with bipolar disorder who received treatment is substantially low;and of those who do, many receive treatment for comorbid conditions rather than for their mood-related symptoms. These findings also highlight the sources of bias of clinical samples of youth with bipolar disorder (Khazanov et al, 2014); -There is a high risk of suicidal ideation and behavior among adults and adolescents with bulimia nervosa. The findings underscore the importance of addressing suicide risk in adolescents and adults with eating disorder symptoms (Crow et al, 2014). Public Health Impact: We have continued to provide data on the prevalence, correlates and service patterns at the phenomenologic level on a wide range of psychiatric disorders in a nationally representative sample of U.S. adolescents. Our study also demonstrated that neighborhood factors may play important roles in the development of mental disorders in adolescents. We believe that these findings provide beneficial information to inform future research and treatment interventions. As mental health treatment research is moving into the translation of lab-based findings to treatment interventions, service level data provides us with an avenue to put our previous translational research into context and further enhance subsequent interventions. While the development of interventions is important, the ultimate success of intervention is predicated on the way this intervention is integrated into the existing medical system. Service utilization studies conducted within this group provide some insight into the populations and service sectors that could benefit from targeted interventions. Future Plans: We have also actively worked on the following projects that produced several important manuscripts that are either submitted or ready for submission: -Describe the magnitude of major depressive disorder and its severe form in U.S. adolescents and examine sociodemographic correlates, comorbidity, impairment and treatment patterns (Avenevoli et al, 2014 submitted); -Examine the overall prevalence of prior mental disorders among adolescents having attained each stage of substance use (from first use to dependence) and estimate the influence of prior mental disorders in the probability of transition from earlier to later stage of use (Swendsen et al, 2014 ready for submission); -Estimate the prevalence and health correlates of insomnia symptoms and their association with comorbid mental disorders in adolescents (Blank et al, 2014 in press); -Examine physical comorbidity among adolescents with a diagnosis of ADHD (Jameson et al, 2014 submitted); -Assess utility of the new DSM-5 label for disruptive mood dysregulation disorder (DMDD) (Althoff et al, 2014 under review); -Understand the diversity of psychopathology in adolescents by using a novel approach to describe the frequency of co-occurrence of psychiatric disorders in a virtual space that spanned by factors reflecting major psychopathologic dimensions;examine whether the major psychopathological dimensions can be hierarchically organized;and determine the distribution of the latent scores of individuals in the space spanned by those dimensions (Blanco et al, 2014 submitted); -Assess the generalizability of adolescent clinical trials of major depressive disorder;given that current practice of the clinical trials likely exclude a great majority of adolescents with major depressive disorder (Blanco et al, 2014 submitted). We are also pursuing additional analyses on the following topics: 1) school start time and sleep patterns among U.S. adolescents;2) residential and school mobility and mental disorders in adolescents;3) irritability as an index of depression;and 4) comorbidity and correlates of panic disorder.

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Blanco, Carlos; Hoertel, Nicolas; Franco, Silvia et al. (2017) Generalizability of Clinical Trial Results for Adolescent Major Depressive Disorder. Pediatrics 140:
Webb-Vargas, Yenny; Rudolph, Kara E; Lenis, David et al. (2017) An imputation-based solution to using mismeasured covariates in propensity score analysis. Stat Methods Med Res 26:1824-1837
Zhang, Jihui; Paksarian, Diana; Lamers, Femke et al. (2017) Sleep Patterns and Mental Health Correlates in US Adolescents. J Pediatr 182:137-143
Hong, Hwanhee; Rudolph, Kara E; Stuart, Elizabeth A (2017) Bayesian Approach for Addressing Differential Covariate Measurement Error in Propensity Score Methods. Psychometrika 82:1078-1096
Goldstein, Benjamin I; Blanco, Carlos; He, Jian-Ping et al. (2016) Correlates of Overweight and Obesity Among Adolescents With Bipolar Disorder in the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 55:1020-1026
Rudolph, Kara E; Colson, K Ellicott; Stuart, Elizabeth A et al. (2016) Optimally combining propensity score subclasses. Stat Med 35:4937-4947
Paksarian, Diana; Rudolph, Kara E; He, Jian-Ping et al. (2015) School Start Time and Adolescent Sleep Patterns: Results From the U.S. National Comorbidity Survey--Adolescent Supplement. Am J Public Health 105:1351-7
Blanco, Carlos; Wall, Melanie M; He, Jian-Ping et al. (2015) The space of common psychiatric disorders in adolescents: comorbidity structure and individual latent liabilities. J Am Acad Child Adolesc Psychiatry 54:45-52
Blank, Madeleine; Zhang, Jihui; Lamers, Femke et al. (2015) Health correlates of insomnia symptoms and comorbid mental disorders in a nationally representative sample of US adolescents. Sleep 38:197-204
Avenevoli, Shelli; Swendsen, Joel; He, Jian-Ping et al. (2015) Major depression in the national comorbidity survey-adolescent supplement: prevalence, correlates, and treatment. J Am Acad Child Adolesc Psychiatry 54:37-44.e2

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