Long Covid includes symptoms of fatigue, sleep changes, anxiety and depression lasting at least three months following infection with COVID-19 and occurs in 10-20% of individuals following infection. Approximately 16% of children experience persistent mood symptoms as part of their Long Covid symptoms. This amounts to over two million children with new symptoms of anxiety and depression after COVID-19 in the US since the onset of the pandemic. Studies show that gradual increases in exercise targets or “pacing” improves symptoms in adults with Long Covid, but this treatment remains to be evaluated in children. Most pacing programs require weekly in-person physical therapy visits and therefore, are difficult to access. Our group has demonstrated improvement in mental health outcomes for adolescents following concussion using a virtual paced exercise program, Mobile Subthreshold Exercise Program (MSTEP). This project aims to evaluate MSTEP as an intervention to improve function and improve mental health symptoms in adolescents and young adults with Long Covid.
Geographic Area: Seattle/Puget Sound
Decreasing engagement and transmission of suicide-related content on TikTok
In the US, approximately one in five adolescent and young adults have seriously thought about suicide and one in 11 have made a suicide attempt. Unfortunately, a third to half of adolescent and young adults who are experiencing suicidal and self-injurious thoughts do not seek professional help and when they do, there is a nationwide shortage of mental health professionals available to support them. When adolescent and young adults are in distress, many seek out support and validation through social media. Some content can be helpful and allow them to find a community where they feel connected, receive the support they need, or share effective coping strategies. Other content can be harmful by encouraging them to commiserate and share or promote harmful coping strategies.
TikTok is the most popular digital platform currently used by over 63% of US adolescent and young adults. Its content recommendation algorithms select and display highly personalized content to each individual user such that the more a user engages with a specific type of content, the more this content will be displayed to them. Many other social media platforms are developing similar content recommendation algorithms to increase user engagement. For adolescent and young adults who are experiencing suicidal thoughts and urges, these content recommendation algorithms can amplify their exposure to suicide-related content and increase suicide risk. The purpose of our project is to identify TikTok content and usage behaviors that increase suicide risk. These findings can inform the development of social media interventions for adolescent and young adults who are experiencing suicidal thoughts and urges.
Adapting a resilience intervention for youth athletes
Youth mental health is in crisis and we do not have adequate providers to treat the current burden of illness. We must identify innovative approaches to support youth mental health that utilize the existing infrastructure and can be administered by non-clinicians. While sports are predominantly a positive outlet for youth, they also bring stressors due to experiences with failure, injury and challenging time commitments, and thus provide an ideal laboratory to develop coping skills for managing stress.
This project aims to build psychological resilience in high school athletes by adapting an intervention developed for youth with chronic illness (PRISM). The intervention will be delivered through the coach via an educational platform with five modules: 1) background/ psychoeducation; 2) creating a supportive team culture; 3) stress management (breathing exercises, visualization and mindfulness); 4) mindset (goal setting, cognitive reframing and meaning making); and 5) fueling the machine (sleep and nutrition). The team will utilize a community-engaged research process to adapt the PRISM approach to an athletic space, using the term “Mentally Strong” to center it in the sport context, and will partner with youth athletes and coaches to ensure the tools we develop support their needs. The Mentally Strong approach has the potential to increase the emotional literacy of a broad swath of high school youth beyond the athletic environment, enhancing their ability to negotiate the acute and chronic stressors they encounter in daily life. The ultimate goal of the project is to prevent the outcomes which occur with negative emotional coping—including depression, anxiety, substance use, burnout, violence, withdrawal from school and even suicide.
Improving diagnostic imaging to guide treatment of neuroinflammation
Infection by West Nile Virus can lead to encephalitis, or harmful inflammation of the brain. The immune system is critical for controlling viral replication and spread early in West Nile Virus infection, but persistent immune activation causes encephalitis that can result in brain damage even after the virus has been cleared. Recent pharmacologic advances have produced drugs that modulate the body’s immune response and can control inflammation, but these drugs have not yet been tested in conditions of viral encephalitis. In order for patients to benefit from these therapies, clinicians need tools that help identify when excessive immune activity is causing encephalitis.
The key innovation of this project is the combination of noninvasive imaging with novel immune modulating drugs to improve the diagnosis and treatment of encephalitis. Our central hypothesis is that specialized immune cells known as macrophages are key drivers of encephalitis in West Nile Virus infection, and that preventing their activation will preserve memory and other cognitive functions. Our studies will explore and develop noninvasive positron emission tomography (PET) imaging as a tool for diagnosing brain inflammation. We will test our hypothesis utilizing West Nile Virus infection of mice, which captures the key elements of human disease including encephalitis. This model allows us to evaluate existing diagnostic and therapeutic tools currently used in humans for other purposes, from which we will define new clinical applications. We will thus be poised to translate our findings to human studies defining and treating viral encephalitis.
Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)
PTSD is one of the most common mental health conditions affecting Veterans and is associated with significant burden. Highly effective treatments exist for PTSD, evidence-based psychotherapies, but very few Veterans receive them. Although VA has trained over 8,500 providers in evidence-based psychotherapies for PTSD over the past 10 years, only 6% of the 650,000 VHA patients with PTSD receive an evidence-based psychotherapy. It is critical that we connect Veterans with our most effective PTSD treatments and that we do so in a way that is Veteran-centered. Shared decision making is a patient-centered approach to choosing healthcare treatment options. It has been shown to increase patients’ motivation for treatment and ability to stay in treatment long enough to get benefit. It has also been shown to help providers align their practice with evidence-based guidelines. This proposal will refine and pilot test a shared decision making intervention for PTSD to be used in VA primary care clinics, where the vast majority of Veterans with PTSD are treated.
A cluster-randomized controlled trial testing the effectiveness of the Life Enhancing Alcohol-management Program (LEAP) for Housing First residents
| People experiencing chronic homelessness comprise a small yet high-morbidity, high-cost subset of the larger homeless population and are disproportionately impacted by alcohol-related harm. This study proposes a cluster randomized controlled trial of an innovative, community-based, and client-driven program known as the LEAP to explore its impact on substance use and quality of life outcomes among individuals with lived experience of homelessness and alcohol use problems living in Housing First settings. Analyses will test LEAP effectiveness in increasing engagement in meaningful activities, decreasing alcohol use, ameliorating both first- and secondhand alcohol-related harm, and improving quality of life for this population. |
The PREDICT study: a personalized medicine approach to prazosin for PTSD
Prazosin, like many of our most effective treatments for PTSD, seems to be significantly more effective for some individuals than others. We have hypothesized that this is because prazosin works to compensate for increased noradrenergic signaling, which is a primary driver of symptoms in some, but not all, individuals with PTSD. If we could identify individuals where increased or inappropriate noradrenergic signaling is driving PTSD symptoms, it would not only help us match individuals with treatments that will work well for them, but would also help us identify new treatment options.
The PREDICT study is a 5-year clinical trial designed to (1) test whether clinically-relevant biomarkers can predict in advance who is most likely to benefit from prazosin for PTSD; and (2) test a working model of how pre-synaptic and post-synaptic changes in the regulation of noradrenaline may combine together to produce the symptoms of PTSD.
Leveraging peer mentor texting to support maternal wellbeing in the perinatal period
Perinatal mood and anxiety disorders affect one in seven pregnant and postpartum women nationwide, making them the most common complication of pregnancy. Unfortunately, only one in 20 women who need treatment for these conditions actually receives it. This translates to a multigenerational issue, which can negatively affect the mother and child’s long-term physical, emotional and developmental health. It also means an estimated $14.2 billion annually in societal costs in the U.S. alone. While not every perinatal individual with mental health concerns has access to a mental health provider, cell phones and text messaging are ubiquitous. Nonjudgmental support delivered through text messaging may be a low cost approach to reaching women who need emotional support in the perinatal period.
Our project aims to evaluate a text-based mentoring program, the Nurture Program, and assess whether it is possible to support mothers through their third trimester of pregnancy and nine months postpartum and enhance their emotional well-being. The Nurture Program combines the convenience of secure text messaging with the personalization of having a trained peer mentor with whom the mother can develop a trusting relationship. This program also provides resources on child development, connections to local support agencies and suggestions for parent-child bonding and parental wellness activities. Surveyed participants of the Nurture Program consistently report their mentor helped them feel less stressed and more confident in their role as a parent. This study will allow us to measure the impact of this cost-effective approach to promoting perinatal emotional well-being.
The RECOVER study: testing online platforms to identify patients with persistent post-COVID symptoms
After COVID infection, 10-50% of people experience persistent symptoms such as fatigue, palpitations, insomnia, cognitive problems, and headache – often with significant associated distress and functional impairment. The exact combination of symptoms varies from person to person, and it is expected that the specific causes vary from person to person as well.
Because of this variability, the current recommendation is for an evaluation by a multidisciplinary team. This creates a demand on our medical system that far outstrips current resources, and risks exposing patients to long, complex medical evaluations whose results are hard to interpret. In addition, clinical treatment trials that mix patients with similar symptoms but different underlying causes have high failure rates.
To address these challenges, a team of investigators including Rebecca Hendrickson, MD, PhD (Department of Psychiatry and Behavioral Sciences), John Oakley, MD, PhD (Department of Neurology), and Aaron Bunnell, MD (Department of Rehabilitation Medicine) are testing an online platform to identify patients whose pattern of symptoms suggest a particular underlying cause that is common after certain physiologic (i.e. illness or injury) and psychological stressors: increased adrenergic (adrenaline/noradrenaline) signaling in the brain and peripheral nervous system. We will pair this with a smaller number of detailed in-person assessments to validate our symptom-based measures and characterize associated biomarkers.
Our results will provide a detailed assessment of the patterns of symptoms caused by high amounts of adrenergic signaling that are seen in persistent post-COVID syndrome, how they change over time, and their association with objective measures of cognition and physiology. The project will provide the information needed to begin clinical treatment trials using existing, well-tolerated treatments that modulate adrenergic signaling. We hope the results will also have strong relevance to other potentially related disorders such as Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia.
Developing measurement-based care tools for addiction treatment clinics
This research develops and tests digital technology to help clinicians and patients systematically measure and monitor clinical progress during addiction treatment. The technology is being developed based on end-user input and user-centered design methods and will be pilot tested as an add-on to real-world care in an addiction treatment clinic.
