THE HEALTH OF YOUNG ADULTS WITH DISABILITIES IN THE UNITED STATES: THE COLLECTIVE ROLES OF RISK FACTORS IN SOCIAL ECOLOGIC FRAMEWORK

Background: Over the last few decades, the prevalence of young adults with disabilities (YAD) has steadily risen as a result of advances in medicine, clinical treatment, and biomedical technologythat enhanced their survival into adulthood. Despite investments in services, family supports, and insurance, they experience poor health status and barriers to successful transition into adulthood. Objectives: We investigated the collective roles of multi-faceted factors at intrapersonal, interpersonal and community levels within the social ecological framework on health related outcome including self-rated health (SRH) of YAD. The three specific aims are: 1) to examine sociodemographic differences and health insurance coverage in adolescence; 2) to investigate the role of social skills in relationships with family and peers developed in adolescence; and 3) to collectively explore the association of sociodemographic characteristics, social skills, and community participation in adolescence on SRH. Methods: Using longitudinal data (N=5,020) from the National Longitudinal Transition Study (NLTS2), we conducted multivariate logistic regression analyses to understand the association between insurance status as well as social skills in adolescence and YAD’s health related outcomes. Structural equation modeling (SEM) assessed the confluence of multi-faceted factors from the social ecological model that link to health in early adulthood. Results: Compared with YAD who had private insurance, YAD who had public health insurance in adolescence are at higher odds of experiencing poorer health related outcomes in self-rated health [adjusted odds ratio (aOR=2.89, 95% confidence interval (CI): 1.16, 7.23), problems with health (aOR=2.60, 95%CI: 1.26, 5.35), and missing social activities due to health problems (aOR=2.86, 95%CI: 1.39, 5.85). At the interpersonal level, overall social skills developed through relationship with family and peers in adolescence do not appear to have association with health related outcomes in early adulthood. Finally, at the community level, community participation in adolescence does not have an association with SRH in early adulthood. Conclusions: Having public health insurance coverage does not equate to good health. YAD need additional supports to achieve positive health outcomes. The findings in social skills and community participation suggest other potential factors may be at play for health related outcomes for YAD and the need for further investigation.

Cortisol Awakening Response in Preschoolers and Depression Risk: Relations with Maternal History of Depression and Child Temperament

Increasing research suggests that elevations in the cortisol awakening response (CAR), the natural increase of cortisol 30 to 40 minutes after waking, may serve as a vulnerability marker for depression. However, existing studies have focused on adolescence and adulthood; very little is known about the CAR in early childhood and the factors that are associated with it. The current study aimed to examine the validity of the CAR as a potential early-emerging vulnerability marker for depression in a sample of preschool-age children. We examined associations between the CAR and two well-established risk factors for depression: maternal psychopathology and early child temperament (high negative emotionality (NE) and/or low positive emotionality (PE)). The sample consisted of 146 preschool-age children, of whom 71 (49.3%) had a biological mother with a history of depression and 65 (45.5%) had a biological mother with a history of anxiety. To assess the CAR, salivary cortisol samples were collected from the child upon waking, 30 and 45 minutes post-waking on two weekdays. Children’s CAR was examined as the total volume of cortisol secreted (AUCg) and the total increase in cortisol (AUCi) across waking. Evening cortisol was collected 30 minutes before bedtime. Child temperament was assessed using observational laboratory measures. Maternal depression and anxiety were assessed with clinical interviews. Associations with children’s CAR, as indicated by AUCg or AUCi, appeared to be specific to maternal current psychopathology and symptoms of anhedonia. Additionally, we observed significant interactions for both maternal lifetime and current depression and anxiety, in combination with child NE and PE, on elevated evening cortisol levels and flattened diurnal cortisol rhythms, indicating altered patterns of basal cortisol activity in offspring. Our study contributes to the limited but growing knowledge on the development of the CAR in preschool age children and as a marker of early risk. Findings suggest that there is a complex interplay between familial risk, affective vulnerability, and their joint effects on neuroendocrine dysfunction in young children, and highlight the need for future research to examine which aspects of the early diurnal rhythm predict the emergence of later depressive illness.