The State of Ohio Adversity and Resilience (SOAR) Study Protocol: A Comprehensive, Multimodal, Family-based, Longitudinal Investigation of Risk and Resilience in Mental Health and Substance Use Disorders

IntroductionDeaths related to drug overdose and suicide in the United States have increased 500% and 35%, respectively, over the last two decades. The human and economic costs to society associated with these "deaths of despair" are immense. Great efforts and substantial investments have been made in treatment and prevention, yet these efforts have not abated these increasing trajectories of deaths over time.The COVID-19 pandemic has exacerbated and highlighted these problems. Notably, some geographical areas (e.g. Appalachia, farmland) and some communities (e.g. low-income persons, "essential workers", minoritized populations) have been disproportionately affected. Risk factors have been identified for substance use and suicide deaths: forms of adversity, neglect, opportunity indexes, and trauma. Yet, the biological, psychological, and social mechanisms driving risk are not uniform. Notably, most people exposed to risk factors do not become symptomatic and could broadly be considered resilient. Achieving a better understanding of biological, psychological, and social mechanisms underlying both pathology and resilience will be crucial for improving approaches for prevention and treatment and creating precision medicine approaches for more efficient and effective treatment. Methods and analysisThe State of Ohio Adversity and Resilience (SOAR) study is a prospective, longitudinal, multimodal, integrated familial study designed to identify biological, psychological, and social risk and resilience factors and processes leading to disorders of the brain, including overdose, suicide and psychological/medical comorbidity (e.g., alcoholism) that are associated with alcohol use disorder whichdreducedreducedreduced life expectancy and quality of life. It includes two nested longitudinal samples: (i) Wellness Discovery Survey: an address-based random population epidemiological sample of 15,000 individuals (unique households) representative of the state of Ohio assessed for psychosocial, psychiatric, and substance use factors, and (ii) Brain Health Study: a family-based, multimodal, deep-phenotyping study conducted in 1200 families (up to 3600 persons aged 12-72) including MRI, EEG, blood biomarkers, psychiatric diagnostic interviews, as well as neuropsychological, psychosocial functioning, and family / community history, dynamics, and support assessments. SOAR is designed to discover, develop and deploy advanced predictive analytics and interventions to transform mental health prevention, diagnosis, treatment, and recovery. Ethics and disseminationAll participants will provide written informed consent (or assent for minors). The study was approved by The Ohio State University Institutional Review Board (study numbers 2023H0316 and 2023H0350). Findings will be disseminated to academic peers, clinicians and healthcare consumers, policymakers, and the general public, using local and international academic channels (academic journals, evidence briefs and conferences) and outreach (workshops and seminars). STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIThis study is a unique combination of a large address-based (ABS) epidemiological random sample Wellness Discovery survey (N=15,000) representative of the State of Ohio, and a nested multimodal deep neurophenotyping study (N=3,600). C_LIO_LIThe Brain Health neurophenotyping study is nested in families, allowing for direct study of family dynamics, contextual factors, and intergenerational transmission and redirection from mental illness. C_LIO_LIThe neurophenotyping study includes advanced multimodal MRI and EEG at five fixed sites (and one rotating mobile site) with centralized data management and advanced standardized acquisition, multisite harmonization, pre-processing, and analyses pipelines. C_LIO_LIWe intend cross-saturation of the Wellness Discovery Survey and Brain Health samples over time. At present, overlap is minimal due to time and funding limitations. C_LIO_LIWe have an ambitious plan to actively engage communities across the state in two-way communication over time in this study. Due to time limitationslimitation, the first wave of data collection did not involve community-based participatory research. C_LI