Stephen R Wisniewski

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (416)2256.19 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Severe deficiency of alpha-1 antitrypsin has a highly variable clinical presentation. The GRADS Alpha-1 Study is a prospective, multicenter, cross-sectional, study of adults > age 35 with PiZZ or PiMZ alpha-1 antitrypsin genotypes designed to better understand if microbial factors influence this heterogeneity. Clinical symptoms, pulmonary function testing, computed chest tomography, exercise capacity, and bronchoalveolar lavage (BAL) will be used to define COPD phenotypes that can be studied with an integrated systems biology approach that includes plasma proteomics; mouth, BAL, and stool microbiome and virome analysis; blood miRNA, and blood mononuclear cell RNA and DNA profiling, and relies on global genome, transcriptome, proteome, and metabolome datasets. Matched cohorts of PiZZ participants on or off augmentation therapy, PiMZ participants not on augmentation therapy, and control participants from SPIROMICS who match on FEV1 and age will be compared. The primary analysis will determine if the PiZZ individuals on augmentation therapy have a difference in lower respiratory tract microbes identified compared to matched PiZZ individuals who are not on augmentation therapy. By characterizing the microbiome in alpha-1 antitrypsin deficiency (AATD), we hope to define new phenotypes of COPD that explain some of the diversity of clinical presentations. As a unique genetic cause of COPD, AATD may inform usual COPD pathogenesis and help understand the complex interplay between the environment and genetics. Although the biologic approaches are hypothesis-generating, the results may lead to development of novel biomarkers, better understanding of COPD phenotypes, and development of novel diagnostic and therapeutic trials in AATD and COPD. Clinical Trial registered with (NCT01832220).
    Annals of the American Thoracic Society 07/2015; DOI:10.1513/AnnalsATS.201503-143OC
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    ABSTRACT: To determine the effects of symptoms and presence of confirmed influenza on intention to receive an influenza vaccine, specifically in patients recovering from a medically-attended acute (≤ 7 days' duration) respiratory illness (ARI). During the 2013-14 influenza season individuals seeking outpatient care for an ARI that included cough were tested for influenza using reverse transcription polymerase chain reaction assays (PCR) and completed surveys. Children (6 months-18 years) and adults (≥ 18 years) were grouped by their combined current season's influenza vaccination status (vaccinated/not vaccinated) and their vaccination intentions for next season (intend/do not intend). Overall, 41% (323/786) were unvaccinated at enrollment; of those, nearly half (151/323) intended to be vaccinated next season. When adjusting for demographic, health, and other factors, unvaccinated individuals who intended to be vaccinated next season were approximately 1.5 times more likely to have PCR-confirmed influenza compared with vaccinated individuals who intended to be vaccinated next season. The combined experience of not being vaccinated against influenza and seeking medical attention for an ARI seemed to influence approximately one-half of unvaccinated participants to consider influenza vaccination for next season.
    American journal of health behavior 07/2015; 39(4). DOI:10.5993/AJHB.39.4.14 · 1.31 Impact Factor
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    ABSTRACT: Postpartum depression occurs in 14.5% of women in the first 3 months after birth. This study was an 8-week acute phase randomized trial with 3 cells [transdermal estradiol (E2), sertraline (SERT), and placebo (PL)] for the treatment of postpartum major depressive disorder. However, the study was stopped after batch analysis revealed that the E2 serum concentrations were lower than prestudy projections. This paper explores our experiences that will inform future investigations of therapeutic E2 use. Explanations for the low E2 concentrations were as follows: (1) study patch nonadhesion, which did not explain the low concentrations across the entire sample. (2) Ineffective transdermal patch preparations, although 2 different patch preparations were used and no significant main effect of patch type on E2 concentrations was found. (3) Obesity, at study entry, E2-treated women had body mass index of 32.9 (7.4) [mean (SD)]. No pharmacokinetic data comparing E2 concentrations from transdermal patches in obese women versus normal weight controls are available. (4) Induction of cytochrome P450 (CYP450) 3A4 and other E2 elimination pathways in pregnancy. CYP4503A4 is induced in pregnancy and is a pathway for the metabolism of E2. Conversion to estrone and phase II metabolism via glucuronidation and sulfation, which also increase in pregnancy, are routes of E2 elimination. The time required for these pathways to normalize after delivery has not been elucidated. The observation that transdermal E2 doses greater than 100 μg/d did not increase serum concentrations was unexpected. Another hypothesis consistent with this observation is suppression of endogenous E2 secretion with increasing exogenous E2 dosing.
    Journal of clinical psychopharmacology 06/2015; 35(4). DOI:10.1097/JCP.0000000000000351 · 3.24 Impact Factor
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    ABSTRACT: Background Accurate measurement of disease activity is important for optimal management of patients with rheumatoid arthritis (RA). Better understanding of similarities and differences among the available clinical and biomarker-based disease activity measures may improve their use for therapeutic decision-making. Objectives Evaluate the relationship between available disease activity indices and their association with other clinical variables. Methods A cross-sectional analysis was performed for 734 RA patients enrolled in the University of Pittsburgh Rheumatoid Arthritis Comparative Effectiveness Registry (RACER), using all first visits and excluding patients (N=6) who were receiving tocilizumab. Spearman's rank correlation and percentage agreement among 4 disease activity categories (remission, low, moderate, high) were calculated for Disease Activity Score 28 with C-reactive protein (DAS28-CRP), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Routine Assessment of Patient Index 3 (RAPID3) and the Multi-biomarker Disease Activity (MBDA) score. Univariate regression analyses were performed to assess association between each disease activity score and American College of Rheumatology (ACR) Core Data Set measures, demographics, and co-morbidities. P-values were adjusted for multiple comparisons using the Benjamini-Hochberg procedure. Results For 734 patients, mean age and disease duration were 60 and 15 years, respectively. Mean RAPID3, DAS28-CRP, SDAI, CDAI, and MBDA scores were 3.6, 3.3, 15.1, 14.1, and 41.3, respectively. Each disease activity measure was significantly correlated with the others. DAS28-CRP, CDAI, and SDAI correlated strongly with each other (r=0.92–0.99) and to a lesser degree with RAPID3 (r=0.65–0.66) and MBDA score (r=0.35–0.51). Correlation between MBDA score and RAPID3 was lowest (r=0.27). Agreement among categories between DAS28-CRP and CDAI or SDAI was 45% and 56%, respectively, and between CDAI and SDAI was 88%. Agreement between DAS28-CRP and RAPID3 or MBDA score was 47% and 44%, respectively. Agreement between RAPID3 and MBDA score was 38%. All 7 ACR Core measures were significantly associated with disease activity for each index (Figure). RAPID3 was significantly associated with all measured comorbidities and opiate use; DAS28-CRP, SDAI, and CDAI with fibromyalgia and opiate use; and MBDA score with the Deyo-Charlson comorbidity index. DAS28-CRP, SDAI, and CDAI were not significantly associated with the demographic variables. RAPID3 was significantly associated with race and BMI, and MBDA score with age and BMI. Only MBDA score was significantly associated with seropositivity and not with the Short Form Health Survey (SF12) mental composite score Conclusions Disease activity indices were significantly correlated with each other and associated with ACR core measures. However, they differed in their relationships with co-morbidities or demographics. These results suggest that disease activity may not be comprehensively assessed by any single composite measure. Disclosure of Interest Y. G. Hwang: None declared, G. Wu Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, J. Feng: None declared, J. Lyons: None declared, H. Eng: None declared, S. Wisniewski: None declared, C. Hwang Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, E. Sasso Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, O. Segurado Shareholder of: Myriad Genetics, Inc, Employee of: Crescendo Bioscience, L. Moreland: None declared
    Annals of the Rheumatic Diseases; 06/2015
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    ABSTRACT: Background Women with bipolar disorder (BD) are at high risk for postpartum affective episodes and psychosis. Although validated screening tools are available for postpartum unipolar depression, few screening tools for hypomania/mania exist. Screening tools for BD in the postpartum period are essential for improving detection and planning appropriate treatment. We evaluated whether adding the Mood Disorders Questionnaire (MDQ) to the Edinburgh Postnatal Depression Scale (EPDS) increased the identification of BD in the early postpartum period.Methods Women (N = 1,279) who delivered a live infant and screened positive on the EPDS and/or MDQ at 4–6 weeks postbirth were invited to undergo an in-home Structured Clinical Interview for DSM-IV (SCID).ResultsPositive EPDS and/or MDQ screens occurred in 12% of the sample (n = 155). In home SCID diagnostic interviews were completed in 93 (60%) of the mothers with positive screens. BD was the primary diagnosis in 37% (n = 34). Women with BD screened positive on the EPDS and/or MDQ as follows: EPDS+/MDQ+ (n = 14), EPDS+/MDQ- (n = 17), and EPDS-/MDQ+ (n = 3). The MDQ identified 50% (17/34) of the women with BD and 6 additional cases of BD when the MDQ question regarding how impaired the mother perceived herself was excluded from the screen criterion.Conclusion Addition of the MDQ to the EPDS improved the distinction of unipolar depression from bipolar depression at the level of screening in 50% of women with traditional MDQ scoring and by nearly 70% when the MDQ was scored without the impairment criterion.
    Depression and Anxiety 06/2015; 32(7). DOI:10.1002/da.22373 · 4.41 Impact Factor
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    ABSTRACT: Conclusive evidence is lacking regarding the benefits and risks of performing off-pump versus on-pump coronary artery bypass graft (CABG) for patients with diabetes. This study aims to compare clinical outcomes after off-pump and on-pump procedures for patients with diabetes. The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial enrolled patients with type 2 diabetes and documented coronary artery disease, 615 of whom underwent CABG during the trial. The procedural complications, 30-day outcomes, long-term clinical and functional outcomes were compared between the off-pump and on-pump groups overall and within a subset of patients matched on propensity score. On-pump CABG was performed in 444 (72%) patients, and off-pump CABG in 171 (28%). The unadjusted 30-day rate of death/myocardial infarction (MI)/stroke was significantly higher after off-pump CABG (7.0 vs 2.9%, P = 0.02) despite fewer complications (10.3 vs 20.7%, P = 0.003). The long-term risk of death [adjusted hazard ratio (aHR): 1.41, P = 0.2197] and major cardiovascular events (death, MI or stroke) (aHR: 1.47, P = 0.1061) did not differ statistically between the off-pump and on-pump patients. Within the propensity-matched sample (153 pairs), patients who underwent off-pump CABG had a higher risk of the composite outcome of death, MI or stroke (aHR: 1.83, P = 0.046); the rates of procedural complications and death did not differ significantly, and there were no significant differences in the functional outcomes. Patients with diabetes had greater risk of major cardiovascular events long-term after off-pump CABG than after on-pump CABG. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2015; DOI:10.1093/ejcts/ezv170 · 3.30 Impact Factor
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    ABSTRACT: Suicide is one of the leading causes of death in postpartum women. Identifying modifiable factors related to suicide risk in mothers after delivery is a public health priority. Our study aim was to examine associations between suicidal ideation (SI) and plausible risk factors (experience of abuse in childhood or as an adult, sleep disturbance, and anxiety symptoms) in depressed postpartum women. This secondary analysis included 628 depressed mothers at 4-6 weeks postpartum. Diagnosis was confirmed with the Structured Clinical Interview for DSM-IV. We examined SI from responses to the Edinburgh Postnatal Depression Scale-EPDS item 10; depression levels on the Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms (SIGH-ADS); plus sleep disturbance and anxiety levels with subscales from the EPDS and SIGH-ADS items on sleep and anxiety symptoms. Of the depressed mothers, 496 (79%) 'never' had thoughts of self-harm; 98 (15.6%) 'hardly ever'; and 34 (5.4%) 'sometimes' or 'quite often'. Logistic regression models indicated that having frequent thoughts of self-harm was related to childhood physical abuse (odds ratio-OR = 1.68, 95% CI = 1.00, 2.81); in mothers without childhood physical abuse, having frequent self-harm thoughts was related to sleep disturbance (OR = 1.15, 95% CI = 1.02, 1.29) and anxiety symptoms (OR = 1.11, 95% CI = 1.01, 1.23). Because women with postpartum depression can present with frequent thoughts of self-harm and a high level of clinical complexity, conducting a detailed safety assessment, that includes evaluation of childhood abuse history and current symptoms of sleep disturbance and anxiety, is a key component in the management of depressed mothers. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 05/2015; 66-67. DOI:10.1016/j.jpsychires.2015.04.021 · 3.96 Impact Factor
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    ABSTRACT: Primary care management decisions for patients with symptomatic lumbar spinal stenosis (LSS) are challenging, and nonsurgical guidance is limited by lack of evidence. To compare surgical decompression with physical therapy (PT) for LSS and evaluate sex differences. Multisite randomized, controlled trial. ( NCT00022776). Neurologic and orthopedic surgery departments and PT clinics. Surgical candidates with LSS aged 50 years or older who consented to surgery. Surgical decompression or PT. Primary outcome was physical function score on the Short Form-36 Health Survey at 2 years assessed by masked testers. The study took place from November 2000 to September 2007. A total of 169 participants were randomly assigned and stratified by surgeon and sex (87 to surgery and 82 to PT), with 24-month follow-up completed by 74 and 73 participants in the surgery and PT groups, respectively. Mean improvement in physical function for the surgery and PT groups was 22.4 (95% CI, 16.9 to 27.9) and 19.2 (CI, 13.6 to 24.8), respectively. Intention-to-treat analyses revealed no difference between groups (24-month difference, 0.9 [CI, -7.9 to 9.6]). Sensitivity analyses using causal-effects methods to account for the high proportion of crossovers from PT to surgery (57%) showed no significant differences in physical function between groups. Without a control group, it is not possible to judge success attributable to either intervention. Surgical decompression yielded similar effects to a PT regimen among patients with LSS who were surgical candidates. Patients and health care providers should engage in shared decision-making conversations that include full disclosure of evidence involving surgical and nonsurgical treatments for LSS. National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases.
    Annals of internal medicine 04/2015; 162(7):465-473. DOI:10.7326/M14-1420 · 17.81 Impact Factor
  • Journal of Allergy and Clinical Immunology 03/2015; 133(2). DOI:10.1016/j.jaip.2015.01.021 · 11.48 Impact Factor
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    ABSTRACT: One percent of women experience bipolar disorder and are likely to suffer from mood disorders during the postpartum period, potentially impacting interaction with their infants.
    Applied Nursing Research 02/2015; DOI:10.1016/j.apnr.2015.01.012 · 0.73 Impact Factor
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    ABSTRACT: Background: Women report many nonvasomotor symptoms across the menopausal transition, including sleep disturbances, depressed mood, and sexual problems. The co-occurrence of these three symptoms may represent a specific menopausal symptom triad. We sought to evaluate the interrelatedness of disturbed sleep, depressed mood, and sexual problems in the Study of Women's Health Across the Nation (SWAN) and determine the characteristics of women exhibiting this symptom triad. Methods: SWAN is a multisite, multiethnic observational cohort study of the menopausal transition in the United States. Sleep disturbance, sexual problems, and depressed mood were determined based on self-report. Women who reported all three symptoms simultaneously were compared to those who did not. Logistic regression models estimated the association of demographic, psychosocial, and clinical characteristics with the symptom triad. Results: Study participants (n=1716) were 49.8 years old on average and primarily in very good or excellent health. Sixteen and a half percent had depressed mood, 36.6% had a sleep problem, and 42.2% had any sexual problem. Five percent of women (n=90) experienced all three symptoms. Women with the symptom triad compared with those without had lower household incomes, less education, were surgically postmenopausal or late perimenopausal, rated their general health as fair or poor, and had more stressful life events and lower social support. Conclusions: The symptom triad of sleep disturbance, depressed mood, and sexual problems occurred in only 5% of women, and occurred most often among women with lower socioeconomic status, greater psychosocial distress, and who were surgically menopausal or in the late perimenopause.
    Journal of Women's Health 01/2015; 24(2). DOI:10.1089/jwh.2014.4798 · 2.05 Impact Factor
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    ABSTRACT: To evaluate the association between neuromuscular blocking agents and outcome, intracranial pressure, and medical complications in children with severe traumatic brain injury. A secondary analysis of a randomized, controlled trial of therapeutic hypothermia. Seventeen hospitals in the United States, Australia, and New Zealand. Children (< 18 yr) with severe traumatic brain injury. None for this secondary analysis. Children received neuromuscular blocking agent on the majority of days of the study (69.6%), and the modified Pediatric Intensity Level of Therapy scores (modified by removing neuromuscular blocking agent administration from the score) were increased on days when neuromuscular blocking agents were used (9.67 ± 0.21 vs 5.48 ± 0.26; p < 0.001). Children were stratified into groups based on exposure to neuromuscular blocking agents (group 1 received neuromuscular blocking agents each study day; group 2 did not). Group 1 had increased number of daily intracranial pressure readings more than 20 mm Hg (4.4 ± 1.1 vs 2.4 ± 0.5;p = 0.015) and longer ICU and hospital length of stay (p = 0.003 and 0.07, respectively, Kaplan-Meier). The Glasgow Outcome Score-Extended for Pediatrics at hospital discharge and 3, 6, and 12 months after traumatic brain injury and medical complications observed during the acute hospitalization were similar between groups. Administration of neuromuscular blocking agents was ubiquitous and daily administration of neuromuscular blocking agents was associated with intracranial hypertension but not outcomes-likely indicating that increased injury severity prompted their use. Despite this, neuromuscular blocking agent use was not associated with complications. A different study design-perhaps using randomization or methodologies-of a larger cohort will be required to determine if neuromuscular blocking agent use is helpful after severe traumatic brain injury in children.
    Pediatric Critical Care Medicine 01/2015; 16(4). DOI:10.1097/PCC.0000000000000344 · 2.34 Impact Factor
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    ABSTRACT: Rapid, accurate, and cost-effective methods to identify the cause of respiratory tract infections are needed to maximize clinical benefit. Outpatients with acute respiratory illness were tested for influenza using a singleplex reverse transcriptase polymerase chain reaction (SRT-PCR) method. A multiplex RT-PCR (MRT-PCR) method tested for influenza and 17 other viruses and was compared with SRT-PCR using chi-square tests. Among 935 patients, 335 (36%) tested positive for influenza A and influenza B using SRT-PCR. Using MRT-PCR, 320 (34.2%) tested positive for influenza A and influenza B. This study supports MRT-PCR as a comparable method for detecting influenza among patients seeking outpatient care for acute respiratory illnesses.
    Advances in Virology 12/2014; 2014:274679. DOI:10.1155/2014/274679
  • Sharon C Sung · Stephen R Wisniewski · James F Luther · Madhukar H Trivedi · A John Rush
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    ABSTRACT: Most patients with major depressive disorder (MDD) report clinically significant sleep problems. Pre-treatment insomnia has been associated with poorer treatment outcomes in some antidepressant trials, leading to suggestions that combined treatment regimens may be more successful in this subgroup. This study investigated this question using data from the CO-MED trial. Adult outpatients with chronic and/or recurrent MDD were randomly assigned in 1:1:1 ratio to 28 weeks of single-blind, placebo-controlled antidepressant treatment with (1) escitalopram+placebo, (2) bupropion-sustained-release+escitalopram, or (3) venlafaxine-extended-release+mirtazapine. We compared baseline characteristics, tolerability, and treatment outcomes at 12 and 28 weeks for patients with and without pre-treatment insomnia. Of the 665 evaluable patients, the majority (88.3%) reported significant pre-treatment insomnia. Those with pre-treatment insomnia were more likely to be female (69.3% vs. 57.7%) and African-American (29.1% vs. 11.8%). Those with pre-treatment insomnia symptoms reported higher rates of concurrent anxiety disorders, lower rates of alcohol and substance use disorders, and greater impairment in psychosocial functioning. The two groups did not differ in either tolerability or treatment outcomes among the three antidepressant treatments. Insomnia symptoms, while common in patients with chronic/recurrent MDD were not predictive of response, remission, or tolerability with either single or combined antidepressant medications. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 11/2014; 174C:157-164. DOI:10.1016/j.jad.2014.11.026 · 3.38 Impact Factor
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    ABSTRACT: Objective: To examine the impact of prenatal exposure to both serotonin reuptake inhibitors (SRIs; during any trimester) and maternal major depressive disorder (MDD; by DSM-IV criteria) on infant functioning. We hypothesized that infants with prenatal exposure to SRIs or MDD would have lower psychomotor, mental, and behavioral scores compared with nonexposed infants. Method: This longitudinal study included 166 mother-infant dyads: 68 with prenatal MDD/SRI (n = 41) or MDD/no SRI exposure (n = 27) and 98 nonexposed controls. Maternal depression and SRI exposure assessments were completed at or as near to 20, 30, and 36 prenatal weeks and 12, 26, 52, and 78 weeks postpartum as feasible. Infants were evaluated with the Bayley Scales of Infant Development, Second Edition, including the psychomotor (Psychomotor Development Index; PDI), cognitive (Mental Development Index; MDI), and behavioral (Behavioral Rating Scale; BRS) components. Study assessments occurred between 2003 and 2009. Results: Neither prenatal exposure to MDD/SRI nor MDD/no SRI significantly impacted overall PDI, MDI, or BRS scores. However, we observed a significant SRI exposure by time interaction for the PDI (P = .038). MDD/SRI exposure was associated with lower PDI scores at 26 (mean = 97.0) and 52 weeks (mean = 92.9) compared with nonexposed infants (mean = 101.4 and 100.5). This difference was no longer significant at the 78-week assessment. Conclusions: Consistent with previous studies, we found no impact of prenatal MDD/SRI exposure on MDI scores. Less favorable PDI scores were observed in the first year; notably, these scores remained well within the normative range. The effects of prenatal MDD/SRI exposure on motor functioning may be transitory. A longitudinal pattern of poor developmental outcomes has not been established. Trial registration: identifier: NCT00279370.
    The Journal of Clinical Psychiatry 10/2014; 75(10):1088-95. DOI:10.4088/JCP.13m08902 · 5.50 Impact Factor
  • Jennifer L. Barkin · Katherine L. Wisner · Stephen R. Wisniewski
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    ABSTRACT: Objective To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF).DesignPrincipal component factor rotation was used to conduct an exploratory factor analysis of the BIMF to determine if more concise versions exist.SettingPatients were recruited from a large, urban medical center in the Northeast.ParticipantsThe BIMF was administered at an initial home visit along with several other self-report and clinical assessments to women who scored ≥ 10 on the Edinburgh Postnatal Depression Scale during the 4- to 6-week postpartum period.Methods The BIMF was administered between October 2008 and September 2010. The distribution of BIMF item responses was examined along with interitem correlations. To establish construct validity, correlation coefficients were produced for the BIMF in relation to several other variables or assessments. A factor analysis was performed using principal component factor rotation.ResultsThe factor analysis revealed a two-factor solution. The items that loaded on factor 1 gauged the mother's perception of her own competency in the maternal role and the items that made up factor 2 focused on the mother's needs. Items related to judgment from others and anxiety did not load on either factor.Conclusions The BIMF may be administered in its 18-item version, as two separate subscales, or in its original 20-item format. A clinical threshold should be developed to facilitate accurate identification of mothers who are struggling with functioning during the postpartum period.
    Journal of Obstetric Gynecologic & Neonatal Nursing 10/2014; 43(6). DOI:10.1111/1552-6909.12505 · 1.02 Impact Factor
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    ABSTRACT: Introduction The purpose of this study was to determine which of four common approaches to coding maternal-infant interaction best discriminates between mothers with and without postpartum depression. Methods After extensive training, four research assistants coded 83 three minute videotapes of maternal infant interaction at 12 month postpartum visits. Four theoretical approaches to coding (Maternal Behavior Q-Sort, the Dyadic Mini Code, Ainsworth Maternal Sensitivity Scale, and the Child-Caregiver Mutual Regulation Scale) were used. Twelve month data were chosen to allow the maximum possible exposure of the infant to maternal depression during the first postpartum year. The videotapes were created in a laboratory with standard procedures. Inter-rater reliabilities for each coding method ranged from .7-.9. The coders were blind to depression status of the mother. Results Twenty seven of the women had major depressive disorder during the 12 month postpartum period. Receiver Operating Characteristics analysis indicated that none of the four methods of analyzing maternal infant interaction discriminated between mothers with and without major depressive disorder. Conclusion Limitations of the study include the cross-sectional design and the low number of women with major depressive disorder. Further analysis should include data from videotapes at earlier postpartum time periods, and alternative coding approaches should be considered. Nurses should continue to examine culturally appropriate ways in which new mothers can be supported in how to best nurture their babies.
    Archives of Psychiatric Nursing 09/2014; 28(6). DOI:10.1016/j.apnu.2014.08.012 · 0.85 Impact Factor
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    ABSTRACT: Background Most depression rating scales are multidimensional and the resulting heterogeneity may impede identification of coherent biomarkers. The aim of this study was to compare the psychometric performance of the multidimensional 17-item Hamilton Depression Rating Scale (HAM-D17) and the 30-item Inventory of Depressive Symptomatology (IDS-C30) to that of their unidimensional six-item melancholia subscales (HAM-D6 and IDS-C6). Methods A total of 2,242 subjects from level 1 (citalopram) of the Sequenced Treatment Alternatives to Relieve Depression (STAR⁎D) study were included in the analysis. Symptom change, response and remission rates were compared for HAM-D6 versus HAM-D17 and for IDS-C6 versus IDS-C30. The changes in total scores on these scales were compared to the change in Quality of Life Enjoyment and Satisfaction Questionnaire (QLES-Q) score using correlation analysis. Results The response to treatment was significantly greater according to the HAM-D6 and IDS-C6. Furthermore, the correlation of changes in depression-ratings with changes in QLES-Q scores were comparable for the subscales and full scales. Limitations STAR⁎D was not designed to answer the research questions addressed in this analysis. Conclusions Our findings indicate that the HAM-D6 and IDS-C6 melancholia scales capture a coherent construct in depression. The syndrome reflected in these scales is unidimensional, sensitive to specific pharmacological intervention, and therefore likely to have biological validity. We therefore believe that “melancholia” thus defined could be a valuable construct under the Research Domain Criteria (RDoC), which specifically aims at identifying the neurobiology underlying mental disorders and provide drugable targets. Clinical trial registration NCT00021528
    Journal of Affective Disorders 07/2014; 163. DOI:10.1016/j.jad.2014.03.049 · 3.38 Impact Factor
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    M Ferguson · E B Dennehy · L B Marangell · J Martinez · S R Wisniewski
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    ABSTRACT: Abstract Objective: To explore relationships between baseline and changes in fatigue during treatment with outcomes in patients with major depressive disorder (MDD) receiving citalopram monotherapy. Research design and methods: Secondary analyses of data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Level 1 treatment phase (≤14 weeks citalopram monotherapy). Fatigue was assessed with item 14 on energy level from the 16-item Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR16; scored 0-3: 0=no fatigue, 3=maximal fatigue); prospective fatigue: assessment of fatigue at Level 1 entry and exit (no fatigue, treatment-emergent fatigue, remitted fatigue, or residual fatigue). Clinical trial registration:, NCT00021528 Main outcome measures: Remission of depressive symptoms (17-item Hamilton Rating Scale for Depression ≤7 or QIDS-SR16 ≤5); Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form; Short-Form Health Survey Mental and Physical subscales; and Work and Social Adjustment Scale (WSAS). Results: At baseline, of 2,868 patients included in the analyses, 5.5% had a QIDS-SR16 item 14 score of 0; 22.9%, a score of 1; 53.6%, a score of 2; and 18.0%, a score of 3. During Level 1 treatment, 3.5% of patients had no prospective fatigue, 2.1% had treatment-emergent fatigue, 33.6% had fatigue remitting during treatment, and 60.8% had residual fatigue. Female gender, unemployment, fewer years of education, and lower monthly income were significantly associated with higher rates of baseline fatigue (all P<.0001). Higher levels of baseline or prospective fatigue were associated with reduced likelihood of remission, decreased overall satisfaction (P<.0001), and reduced mental and physical function at outcome (P≤.05). Patients with higher baseline or prospective fatigue reported higher WSAS total scores (P<.0001), indicative of more severe functional impairment. Conclusions: Lower baseline fatigue, or remission of fatigue during antidepressant treatment in patients with MDD, are associated with higher rates of remission of depressive symptoms and better function and quality of life. Study limitations include use of the STAR*D Level 1 sample (citalopram as only antidepressant), use of a proxy measure of energy/fatigue (item 14 from the QIDS-SR16), and the secondary post-hoc analysis design.
    Current Medical Research and Opinion 06/2014; 30(10):1-29. DOI:10.1185/03007995.2014.936553 · 2.65 Impact Factor
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    ABSTRACT: Objective: Systemic sclerosis (SSc) is associated with a reduction in life expectancy, but there are no validated prognostic models for determining short-term mortality. The objective of this study was to derive and validate a prediction rule for 2-year mortality in patients with early diffuse cutaneous SSc (dcSSc). Methods: We studied a prospectively enrolled cohort of 387 US Caucasian patients with early dcSSc (<2 years from the appearance of the first symptom), randomly divided into a derivation cohort (n = 260) and a validation cohort (n = 127). Predefined baseline predictor variables were analyzed in a stepwise multivariable logistic regression model in order to identify factors independently associated with 2-year all-cause mortality using a cutoff of P < 0.05. We rounded the beta values to the nearest integer and summed the points assigned to each variable in order to stratify patients into low-risk, moderate-risk, and high-risk groups. We then applied this rule to an external validation cohort of 110 Caucasian patients with early dcSSc from a single UK center and compared stratum-specific mortality using chi-square statistics. Results: Four independent predictor variables (with assigned integer values) comprised the model: age at first visit (points allotted: -1, 0, or 1), skin thickness progression rate (points allotted: 0 or 1), gastrointestinal tract severity (points allotted: 0, 1, or 2), and anemia (points allotted: 0 or 2). The prediction model performed well, with no significant differences between the derivation cohort and the US or UK validation cohorts in the low-risk and moderate-risk groups. Conclusion: We derived a 4-variable prediction rule that can be used to stratify patients with early dcSSc into groups by risk of 2-year mortality, and we validated that prediction rule in US and UK cohorts.
    Arthritis and Rheumatology 06/2014; 66(6). DOI:10.1002/art.38381

Publication Stats

21k Citations
2,256.19 Total Impact Points


  • 1996–2015
    • University of Pittsburgh
      • • Graduate School of Public Health
      • • Department of Epidemiology
      • • Department of Psychiatry
      • • Safar Center for Resuscitation Research
      • • Department of Pediatric Neurosurgery
      Pittsburgh, Pennsylvania, United States
  • 2013
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 1998–2012
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 2011
    • University of California, San Diego
      • Department of Psychiatry
      San Diego, California, United States
  • 2004–2011
    • Columbia University
      • Department of Psychiatry
      New York, New York, United States
    • University of Colorado
      • Department of Psychiatry
      Denver, Colorado, United States
  • 2010
    • Virginia Commonwealth University
      • Institute for Women's Health
      Richmond, VA, United States
  • 2008–2010
    • University of Texas Southwestern Medical Center
      • Department of Psychiatry
      Dallas, TX, United States
    • University of Texas at Dallas
      Richardson, Texas, United States
    • University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, PA, United States
    • Eli Lilly
      Indianapolis, Indiana, United States
    • Northwestern University
      • Asher Center – Study & Treatment of Mood Disorders
      Evanston, Illinois, United States
    • Karolinska Institutet
      • Department of Neuroscience
      Solna, Stockholm, Sweden
  • 2008–2009
    • University of North Carolina at Chapel Hill
      • Department of Psychiatry
      Chapel Hill, NC, United States
  • 2007
    • U.S. Department of Veterans Affairs
      Washington, Washington, D.C., United States
    • University of Colorado at Boulder
      Boulder, Colorado, United States
    • Psychotherapy Associates
      Nebraska City, Nebraska, United States
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2006–2007
    • Boston University
      • Department of Psychology
      Boston, Massachusetts, United States
    • Harvard University
      Cambridge, Massachusetts, United States
    • Via Christi Health
      Wichita, Kansas, United States
    • Brown University
      • Department of Psychiatry and Human Behavior
      Providence, Rhode Island, United States
    • New York State Psychiatric Institute
      • Anxiety Disorders Clinic
      New York, New York, United States
  • 2005
    • Massachusetts General Hospital
      • Department of Psychiatry
      Boston, MA, United States
    • Harvard Medical School
      • Department of Psychiatry
      Boston, MA, United States