Cindy L Ehlers’s research while affiliated with The Scripps Research Institute and other places

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Publications (391)


Protective effects of ethnic enclaves: Testing pathways to alcohol use and use disorders in Mexican American young adults
  • Article

June 2024

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6 Reads

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1 Citation

American Journal of Community Psychology

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Libo Li

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Sam Kosai

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[...]

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Ethnic enclave residence is associated with decreased risk for drinking and related problems, but less is known about the mechanisms that explain this association. Informed by theories of social control, we used a multilevel framework to examine whether negative attitudes toward drinking mediated associations between ethnic enclave residence (i.e., neighborhood linguistic isolation) and alcohol outcomes among Mexican American young adults (N = 628) in Southern California. Model 1 assessed mediation effects in the pathways from linguistic isolation to current drinking and alcohol use disorder (AUD). Model 2 adjusted for parental drinking attitudes and neighborhood alcohol availability. There were differential associations by gender in direct effects of linguistic isolation and negative drinking attitudes on both drinking and AUD. Among women only, linguistic isolation was related to greater abstinence and decreased AUD after accounting for social control proxies of parent attitudes and alcohol availability. Young adults' own drinking attitudes did not mediate relationships between linguistic isolation and alcohol outcomes. This study offers evidence on the importance of disaggregating Hispanic national groups by gender to uncover social mechanisms within ethnic enclave settings for tailored supports in reducing risk of drinking and alcohol-related harms.



Social zeitgeber and sleep loss as risk factors for suicide in American Indian adolescents

February 2024

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17 Reads

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1 Citation

Transcultural Psychiatry

American Indians / Alaska Natives (AI/AN) bear a high burden of suicide, the reasons for which are not completely understood, and rates can vary by tribal group and location. This article aims to identify circumstances reported by a community group of American Indian adolescent participants to be associated with their depression and/or suicide. American Indian adolescents (n = 360) were recruited from contiguous reservations and were assessed with a semi-structured diagnostic interview. Twenty percent of the adolescents reported suicidal thoughts (ideation, plans), an additional 8% reported a history of suicide attempts, and three deaths due to suicide were reported. Suicidal behaviors and major depressive disorder (MDD) co-occurred and were more common among female adolescents. The distressing events that adolescents most often reported were: death in the family, family disruption, peer relationship problems, and school problems. All of these events were significantly associated with suicidal behaviors, however those with suicidal acts were more likely to report death in the family. Those with MDD but no suicidal behaviors were more likely to report disruptions in the family. Disruptions in falling asleep were also associated with suicidal behaviors and having experienced a death in the family. Disruptions in important relationships, particularly through death or divorce, may be interpreted as a loss or disruption in “social zeitgebers” that may in turn disturb biological rhythms, such as sleep, thus potentially increase the risk for MDD and/or suicide. Prevention programs aimed at ameliorating the impact of disruptions in important relationships may potentially reduce suicidal behaviors in AI/AN adolescents.


Manhattan plot of bivariate genome-wide association analysis for suicidal behaviors and AUD severity in the American Indians.
Enrichment in tissue-specific differentially expressed gene sets (DEG) of top genes associated with SB-AUD
The tissue-specific differential gene expression test was conducted against all genes across genomes that exhibited significantly increased or decreased expression levels in a certain tissue sample compared to all other samples. The analysis was performed using FUMA and utilized tissue-specific transcriptome data across 54 tissue types from GTEx v8. From top to bottom: up-regulated, down-regulated, differentially expressed. Red: Significantly enriched (p < 0.05 with Bonferroni correction).
Networks of the rare-variant genes associated with suicidal behaviors in AI
Three of the enriched functional networks are highlighted in the gene nodes (see Table S9 for the complete list). Each circle represents a gene and the color on the circle indicates to which pathway the gene belongs to. Yellow: vascular endothelial growth factor (VEGF) receptor signaling pathway (FDR = 2.1E-04); Red: angiogenesis (FDR = 2.1E-04); Blue: response to decreased oxygen levels (FDR = 4.2E-03). The color of the edges linking the genes indicate the type of database used in the GeneMania analysis. Blue: Pathways; Green: Genetic interactions.
Genetic factors associated with suicidal behaviors and alcohol use disorders in an American Indian population
  • Article
  • Full-text available

January 2024

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55 Reads

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1 Citation

Molecular Psychiatry

American Indians (AI) demonstrate the highest rates of both suicidal behaviors (SB) and alcohol use disorders (AUD) among all ethnic groups in the US. Rates of suicide and AUD vary substantially between tribal groups and across different geographical regions, underscoring a need to delineate more specific risk and resilience factors. Using data from over 740 AI living within eight contiguous reservations, we assessed genetic risk factors for SB by investigating: (1) possible genetic overlap with AUD, and (2) impacts of rare and low-frequency genomic variants. Suicidal behaviors included lifetime history of suicidal thoughts and acts, including verified suicide deaths, scored using a ranking variable for the SB phenotype (range 0–4). We identified five loci significantly associated with SB and AUD, two of which are intergenic and three intronic on genes AACSP1, ANK1, and FBXO11. Nonsynonymous rare and low-frequency mutations in four genes including SERPINF1 (PEDF), ZNF30, CD34, and SLC5A9, and non-intronic rare and low-frequency mutations in genes OPRD1, HSD17B3 and one lincRNA were significantly associated with SB. One identified pathway related to hypoxia-inducible factor (HIF) regulation, whose 83 nonsynonymous rare and low-frequency variants on 10 genes were significantly linked to SB as well. Four additional genes, and two pathways related to vasopressin-regulated water metabolism and cellular hexose transport, also were strongly associated with SB. This study represents the first investigation of genetic factors for SB in an American Indian population that has high risk for suicide. Our study suggests that bivariate association analysis between comorbid disorders can increase statistical power; and rare and low-frequency variant analysis in a high-risk population enabled by whole-genome sequencing has the potential to identify novel genetic factors. Although such findings may be population specific, rare functional mutations relating to PEDF and HIF regulation align with past reports and suggest a biological mechanism for suicide risk and a potential therapeutic target for intervention.

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FitBite activity in the control group in males (black bars) and females (shaded bars) at three time points (4 weeks vapor, 24 h withdrawn, 4 weeks withdrawn). Activity during the light (white bar) and dark (black bar) period is shown for each measure. *Significant (p < 0.01) time effect. †Significant (p < 0.01) sex effect.
Cosinor data in the control group in males (black bars) and females (shaded bars) at three time points (4 weeks vapor, 24 h withdrawn, 4 weeks withdrawn). *Significant (p < 0.01) time effect. †Significant (p < 0.01) sex effect.
Alcohol‐treated (shaded bars) and control (black bars) animals' activity measures during light and dark periods compared with each time point (4 weeks vapor, 24 h withdrawn, 4 weeks withdrawn). *Significant (p < 0.01) treatment effect.
Alcohol‐treated (shaded bars) and control (black bars) animals' cosinor results compared with each time point (4 weeks vapor, 24 h withdrawn, 4 weeks withdrawn). *Significant (p < 0.01) treatment effect.
Use of a Fitbit‐like device in rats: Sex differences, relation to EEG sleep, and use to measure the long‐term effects of adolescent ethanol exposure

June 2023

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67 Reads

Background Sleep difficulties and rhythm disturbances are some of the problems associated with adolescent binge drinking. Recently, animal models of alcohol‐induced insomnia have been developed. However, studies in human subjects have recently focused not only on nighttime EEG findings but also on daytime sleepiness and disrupted activity levels as typically measured by activity tracking devices such as the “Fitbit.” We sought to develop and test a Fitbit‐like device (the “FitBite”) in rats and use it to track rest‐activity cycles following adolescent alcohol exposure. Methods The effects of 5 weeks of adolescent ethanol vapor or control conditions were evaluated in 48 male and female Wistar rats using FitBite activity while intoxicated, and during acute (24 h post‐vapor exposure) and chronic withdrawal (4 weeks post‐vapor exposure). Data were analyzed using activity count and cosinor analyses. Fourteen rats were subsequently implanted with cortical electrodes, and data from the FitBite were compared with EEG data to determine how well the FitBite could identify sleep and activity cycles. Results Female rats were generally more active than males, with higher circadian rhythm amplitudes and mesors (rhythm‐adjusted means) across a 24‐h period. There were significant correlations between EEG‐estimated sleep and activity counts using the FitBite. When the rats were tested during intoxication after 4 weeks of ethanol vapor exposure, they had significantly less overall activity. Disruptions in circadian rhythm were also found with significant decreases in the circadian amplitude, mesor, and a later shift in the acrophase. At 24 h of ethanol withdrawal, rats had more episodes of activity with shorter durations during the daytime, when rats are expected to spend more of their time sleeping. This effect remained at 4 weeks following withdrawal, but circadian rhythm disruptions were no longer present. Conclusions A Fitbit‐like device can be successfully used in rats to assess rest‐activity cycles. Adolescent alcohol exposure produced circadian rhythm disturbances that were not observed after withdrawal. Fragmentation of ultradian rest‐activity cycles during the light period was found at 24 h and 4 weeks after withdrawal and support data demonstrating the presence of sleep disturbance long after alcohol withdrawal.



Suicidal behaviors and the Pittsburgh Sleep Quality Index items (n=477)
Poor Self-Reported Sleep Quality Associated with Suicide Risk in a Community Sample of American Indian Adults

May 2023

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25 Reads

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1 Citation

SLEEP Advances

Study Objectives Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population. Methods A semi-structured interview was used to collect data on suicidal ideation, suicidal plans and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality American Indian adults. Results In this sample (n=477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including 4 who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts (n=66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts (n=157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores. Conclusions Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.


Genetic Factors Associated with Suicidal Behaviors and Alcohol Use Disorders in an American Indian Population

May 2023

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47 Reads

American Indians (AI) demonstrate the highest rates of both suicidal behaviors (SB) and alcohol use disorders (AUD) among all ethnic groups in the US. Rates of suicide and AUD vary substantially between tribal groups and across different geographical regions, underscoring a need to delineate more specific risk and resilience factors. Using data from over 740 AI living within eight contiguous reservations, we assessed genetic risk factors for SB by investigating: (1) possible genetic overlap with AUD, and (2) impacts of rare and low frequency genomic variants. Suicidal behaviors included lifetime history of suicidal thoughts and acts, including verified suicide deaths, scored using a ranking variable for the SB phenotype (range 0–4). We identified five loci significantly associated with SB and AUD, two of which are intergenic and three intronic on genes AACSP1 , ANK1 , and FBXO11 . Nonsynonymous rare mutations in four genes including SERPINF1 (PEDF), ZNF30 , CD34 , and SLC5A9 , and non-intronic rare mutations in genes OPRD1 , HSD17B3 and one lincRNA were significantly associated with SB. One identified pathway related to hypoxia-inducible factor (HIF) regulation, whose 83 nonsynonymous rare variants on 10 genes were significantly linked to SB as well. Four additional genes, and two pathways related to vasopressin-regulated water metabolism and cellular hexose transport, also were strongly associated with SB. This study represents the first investigation of genetic factors for SB in an American Indian population that has high risk for suicide. Our study suggests that bivariate association analysis between comorbid disorders can increase statistical power; and rare variant analysis in a high-risk population enabled by whole-genome sequencing has the potential to identify novel genetic factors. Although such findings may be population specific, rare functional mutations relating to PEDF and HIF regulation align with past reports and suggest a biological mechanism for suicide risk and a potential therapeutic target for intervention.


Figure 1. Manhattan plot of bivariate genome-wide association analysis for AUD severity and suicidal behaviors in AI.
Top genes with rare and low-frequency variants associated with suicidal behaviors in the American Indians.
Genetic Factors Associated with Suicidal Behaviors and Alcohol Use Disorders in an American Indian Population

May 2023

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35 Reads

American Indians (AI) demonstrate the highest rates of both suicidal behaviors (SB) and alcohol use disorders (AUD) among all ethnic groups in the US. Rates of suicide and AUD vary substantially between tribal groups and across different geographical regions, underscoring a need to delineate more specific risk and resilience factors. Using data from over 740 AI living within eight contiguous reservations, we assessed genetic risk factors for SB by investigating: (1) possible genetic overlap with AUD, and (2) impacts of rare and low frequency genomic variants. Suicidal behaviors included lifetime history of suicidal thoughts and acts, including verified suicide deaths, scored using a ranking variable for the SB phenotype (range 0-4). We identified five loci significantly associated with SB and AUD, two of which are intergenic and three intronic on genes AACSP1 , ANK1 , and FBXO11 . Nonsynonymous rare mutations in four genes including SERPINF1 (PEDF), ZNF30 , CD34 , and SLC5A9 , and non-intronic rare mutations in genes OPRD1 , HSD17B3 and one lincRNA were significantly associated with SB. One identified pathway related to hypoxia-inducible factor (HIF) regulation, whose 83 nonsynonymous rare variants on 10 genes were significantly linked to SB as well. Four additional genes, and two pathways related to vasopressin-regulated water metabolism and cellular hexose transport, also were strongly associated with SB. This study represents the first investigation of genetic factors for SB in an American Indian population that has high risk for suicide. Our study suggests that bivariate association analysis between comorbid disorders can increase statistical power; and rare variant analysis in a high-risk population enabled by whole-genome sequencing has the potential to identify novel genetic factors. Although such findings may be population specific, rare functional mutations relating to PEDF and HIF regulation align with past reports and suggest a biological mechanism for suicide risk and a potential therapeutic target for intervention.


Citations (74)


... Furthermore, alcohol consumption, a crucial factor in the calculation of MDS, exhibits distinct patterns across ethnic groups. For instance, Mexican-American adults have been identified as having high alcohol consumption rates within the Hispanic community (43), indicating that drinking habits may vary significantly between ethnicities. ...

Reference:

Magnesium depletion score and depression: a positive correlation among US adults
Protective effects of ethnic enclaves: Testing pathways to alcohol use and use disorders in Mexican American young adults
  • Citing Article
  • June 2024

American Journal of Community Psychology

... With the accelerated pace of modern life and changes in lifestyle, the sleep time of residents has gradually decreased, the incidence of sleep problems has gradually increased, and sleep disorders have increasingly become a prominent medical and public health problem [2]. The causes of sleep disorders are complex, and they are often the result of the combined effects of multiple factors, such as biological, psychological, familial, environmental, and even socioeconomic status [3][4][5]. The outbreak of novel coronavirus pneumonia has further exacerbated sleep problems, and a meta-analysis that included nearly half a million people noted that the global prevalence of sleep problems in the general population during the COVID-19 pneumonia epidemic was as high as 40.5% [6]. ...

Social zeitgeber and sleep loss as risk factors for suicide in American Indian adolescents
  • Citing Article
  • February 2024

Transcultural Psychiatry

... In a second, they examined the relationship between trauma, historical trauma exposure, PTSD, and STB among AI/AN adults (Ehlers et al., 2022). This year, the group sought to identify genetic risk associated with STB by conducting a genome-wide bivariate association analysis to identify genetic variants that were correlated with both STB and AUD (Peng et al., 2024). ...

Genetic factors associated with suicidal behaviors and alcohol use disorders in an American Indian population

Molecular Psychiatry

... Of those who transition from ideation to attempt, 86% did so within a year of the onset of their ideation. Other studies of adolescents related to suicidal thoughts and behaviors found suicidal ideation/planning reached 20% and suicide attempts reached 9% in a sample living near reservations, and another study found that suicidal ideation/planning varied by gender and place of residence (reservation vs. urban) resulting in suicidal ideation/planning of 12-18% and suicide attempts from 16 to 20% [8,9]. As illustrated in Fig. 1, there is a small portion of susceptible adolescents (possibly, as much as 30%) who are impulsive and with inadequate coping skills who move from suicidal ideation to suicide attempts within 10 min or less [10,11]. ...

Comorbidity of anxiety/affective, conduct/antisocial, attention deficit, and alcohol use disorders with suicidal behaviors in an American Indian community sample of adults and adolescents
  • Citing Article
  • October 2023

Journal of Psychiatric Research

... In one study, they explored the comorbidity of anxiety/affective, conduct/antisocial, ADHD, and AUD with suicidal thoughts and behaviors (STB) among AI/AN adolescents and adults (Ehlers et al., 2023). In a second, they examined the relationship between trauma, historical trauma exposure, PTSD, and STB among AI/AN adults (Ehlers et al., 2022). This year, the group sought to identify genetic risk associated with STB by conducting a genome-wide bivariate association analysis to identify genetic variants that were correlated with both STB and AUD (Peng et al., 2024). ...

Trauma, historical trauma, PTSD and suicide in an American Indian community sample
  • Citing Article
  • October 2022

Journal of Psychiatric Research

... Previous preclinical research has shown that while some alcohol-related effects are consistent across sexes, others vary significantly between males and females due to a combination of biological, physiological, and hormonal factors. This variability highlights the critical importance of considering sex as a biological variable when studying the effects of adolescent alcohol exposure [for review see [14]]. ...

The role of sex in the persistent effects of adolescent alcohol exposure on behavior and neurobiology in rodents
  • Citing Chapter
  • August 2021

International Review of Neurobiology

... However, assessing individuals at the extremes of PGSs may provide more information and be a better predictor of risk (32). A PGS for alcohol dependence was associated with a more rapid progression from regular drinking to dependence, an effect that was independent of the age at onset of regular drinking (33). Although only 18.6% of cases had PGS that were at least 1 standard deviation above the sample mean, this may be in part due to ceiling effects, as the sample was enriched for alcohol dependence (34), suggesting that many of these individuals have greater genetic risk than the general population even if their risk is average within this ascertainment sample. ...

Effects of genetic risk for alcohol dependence and onset of regular drinking on the progression to alcohol dependence: A polygenic risk score approach
  • Citing Article
  • October 2021

Drug and Alcohol Dependence

... A meta-analysis of human functional neuroimaging study revealed the clusters in the primary visual cortex (V1) and secondary visual cortex (V2) were consistently activated by drug cues but not neutral cues in substance dependent populations (Hanlon et al. 2014). Another study found that chronic intermittent ethanol during adolescence and adulthood reduced the density of filopodia and the length of long-shaped spines in the V1/V2 in rats (Amodeo et al. 2021). V2, react to the illusions that underpin disparity capture as well as disparitydefined illusory outlines (Bakin et al. 2000), has also been shown to play a crucial role in associative learning. ...

Chronic intermittent ethanol during adolescence and adulthood alters dendritic spines in the primary motor and visual cortex in rats
  • Citing Article
  • October 2021

Alcohol

... This is particularly true among AI/AN youth who experience high rates of victimization in childhood such as abuse and neglect (Brockie et al., 2015;Kenney & Singh, 2016). This type of victimization has been found to have long term impacts on behavioral and mental health in AI/AN populations, including substance misuse and alcoholism (Boyd-Ball et al., 2006;Greenfield et al., 2021;Whitesell et al., 2009). Identifying factors that support healthy psychological functioning after experiencing violence or other adversities in childhood, adolescence, and young adulthood can improve prevention and intervention efforts. ...

Childhood Experiences and High-Intensity Drinking Among American Indian and Alaska Native Adults: Findings From the 2000–2015 National Alcohol Surveys
  • Citing Article
  • September 2021

Journal of Studies on Alcohol and Drugs

... According to a previous study, the standards for BDE were reported differently in each country (Archie et al., 2012). Additionally, countries with lower legal alcohol drinking ages had a higher prevalence of BDE among adolescents than countries with higher legal drinking ages (Ehlers et al., 2022;Patrick et al., 2013). Most countries, including France, China, and Australia, define the age of 18 as the legal drinking age, which is lower than the legal drinking age of 19 in Korea (SAMHSA, 2022). ...

Extreme Binge Drinking During Adolescence: Associations With Subsequent Substance Use Disorders in American Indian and Mexican American Young Adults
  • Citing Article
  • January 2021

Journal of Addiction Medicine