Christopher A. Crawford

Background: Depression affects over 400 million adults worldwide and is associated with substantial morbidity and mortality. Although symptoms vary in their responsiveness to treatment, clinical trials typically report total scores, obscuring symptom-level effects. Despite collaborative care’s effectiveness for depression in primary care, its impact on individual depressive symptoms among racially and socioeconomically diverse patients remains unclear. Methods: We conducted a secondary analysis of the eIMPACT trial of 216 primary care patients (M _age = 59 years; 78% women; 50% Black; 46% with income <$10,000/year). Participants were randomized to 12 months of modernized collaborative care (internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care. Two path analytic models estimated simultaneous item-level effects on the Hopkins Symptom Checklist-20 (SCL-20) and Patient Health Questionnaire-9 (PHQ-9). Results: The intervention outperformed usual care on 15 of 20 SCL-20 items and 7 of 9 PHQ-9 items. Seventeen symptoms – including hopelessness, anxious distress, depressed mood, self-blame, worthlessness, disturbed sleep, and fatigue – showed moderate-to-large between-group improvement ( β s = −0.50 to −0.70). Smaller but significant gains were observed for six other symptoms ( β s = −0.35 to −0.49). No significant advantage emerged for suicidality, loneliness, sexual dysfunction, appetite change, or psychomotor symptoms ( β s = −0.03 to −0.37). Conclusions: Modernized collaborative care improves most depressive symptoms in diverse primary care patients, though cross-measure persistent symptoms highlight clinically consequential domains that may be obscured by total scores. Symptom-level analyses may help identify persistent symptom domains requiring targeted adjunctive treatment to optimize recovery.

We assess associations of somatic and cognitive/affective depressive symptom clusters with monocyte activation (soluble (s)CD14, sCD163), systemic inflammation (interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP)), and coagulation (D-dimer, fibrinogen) in people with HIV (PWH) on suppressive antiretroviral therapy with depression. Utilizing baseline data from a randomized controlled trial, we found no significant associations in linear regression models examining individual depressive symptom clusters; however, models examining both clusters simultaneously showed that the somatic cluster was positively associated with inflammation biomarkers, while the cognitive/affective cluster was negatively associated with inflammation and coagulation biomarkers (suggesting a cooperative suppression effect). Our findings indicate a differential association with depressive symptom clusters and biological mechanisms underlying cardiovascular disease (CVD) in HIV, which may be driven by unique components of each depressive symptom cluster. This line of research could identify subgroups of PWH with depression at elevated CVD risk needing early CVD prevention approaches. Supported by R01 HL126557.

Conceptual metaphor theory proposes that metaphor is a mental function, rather than solely a literary device. As such, metaphors may be present in any by-product of human cognition, including pictorial art. Crawford and Juricevic previously proposed two heuristic frameworks for the identification and interpretation of metaphor in pictures, which have been shown to be capable of describing how pictorial metaphors are identified and interpreted in the comic book medium. The present study tested artists’ preference for combinations of contextual and structural pictorial information in comic book cover images. We analysed usages of exaggerated size in comic book cover art, as exaggerated size is a pictorial device, which may be used both literally and metaphorically. The goal was to assess how contextual and structural information is combined, and how literal and metaphorical information interacts, both when it is congruent and incongruent. This analysis of the use of exaggerated size in comic book art indicates that artists prefer to produce images that have congruent combinations of literal and metaphoric pictorial information, or the incongruent combination of metaphoric contextual information and literal structural information. Artists do not, however, prefer to produce images that have the incongruent combination of metaphorical structural information and literal contextual information. Taken together with the Corpus Analysis Relevance Theory (CART) argument, this pattern suggests that when processing information, our cognitive systems prefer metaphorical interpretations over literal interpretations and contextual information over structural information.

Congenital heart defects (CHDs) occur in 8 of 1000 live-born children, making them common birth defects in the adolescent population. CHDs may have single gene, chromosomal, or multifactorial causes. Despite evidence that patients with CHD want information on heritability and genetics, no studies have investigated the interest or knowledge base in the adolescent population. This information is necessary as patients in adolescence take greater ownership of their health care and discuss reproductive risks with their physicians. The objectives of this survey-based study were to determine adolescents’ recall of their own heart condition, to assess patient and parent perception of the genetic contribution to the adolescent’s CHD, and to obtain information about the preferred method(s) for education. The results show that adolescent patients had good recall of their type of CHD. Less than half of adolescents and parents believed their CHD had a genetic basis or was heritable; however, adolescents with a positive family history of CHD were more likely to believe that their condition was genetic (p = 0.0005). The majority of patients were interested in receiving additional genetics education and preferred education in-person and in consultation with both parents and a physician. The adolescents who felt most competent to have discussions with their doctors regarding potential causes of their heart defect previously had a school science course which covered topics in genetics. These results provide insight into adolescents’ perceptions and understanding about their CHD and genetic risk and may inform the creation and provision of additional genetic education.