From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling

The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.

Neurophysiological effects of cognitive behavioral therapy in social anxiety: An ERP study using a dot-probe task

BACKGROUND

Social anxious individuals show attention bias towards emotional stimuli, this phenomenon is considered to be an important cause of anxiety generation and maintenance. Cognitive-behavioral therapy (CBT) is a standard psychotherapy for social anxiety disorder. CBT decreases attention biases by correcting the maladaptive beliefs of socially anxious individuals, but it is not clear whether CBT alters neurophysiological features of socially anxious individuals at early automatic and/or late cognitive strategy stage of attentional processing.

METHOD

To address this knowledge gap, we collected pre-treatment event-related potential data of 22 socially anxious individuals while they performed a dot-probe task. These participants then received eight weeks of CBT, and post-treatment ERP data were collected after completion of CBT treatment. We also included 29 healthy controls and compared them with individuals with social anxiety to determine the neural mechanisms underlying the effectiveness of CBT.

RESULTS

Participants' social anxiety level was significantly alleviated with CBT. ERP results revealed that (1) compared to pre-treatment phase, P1 amplitudes induced by probes significantly decreased at post-treatment phase, whereas P3 amplitudes increased at post-treatment phase; the P1 amplitudes induced by probes following happy-neutral face pairs in socially anxious individuals after treatment was significantly different with that in healthy controls; (2) amplitude of components elicited by face pairs did not change significantly between pre-treatment and post-treatment phases; (3) changes of Liebowitz Social Anxiety Scale were positively correlated with changes of P1 amplitude, and negatively correlated with changes of N1 amplitude.

LIMITATIONS

Our sample was university students and lacked randomization, which limits the generalizability of the results.

CONCLUSION

The present results demonstrated that CBT may adjust cognitive strategies in the later stage of attentional processing, indicating by changed ERPs appeared in probe-presenting stage for social anxiety.

Is it time to agree upon a standardised approach to the assessment of contributing factors and impacts of adolescent pelvic pain?

BACKGROUND

A biopsychosocial approach to the understanding of pelvic pain is increasingly acknowledged. However, there is a lack of standardised instruments - or their use - to assess risk factors and their impact on pelvic pain in both clinical and research settings. This review aims to identify validated tools used to assess known contributory factors to pelvic pain, as well as the validated tools to measure the impact of pelvic pain in adolescents and young adults, in order to provide a framework for future standardised, adolescent specific assessment and outcome tools.

METHODS

Literature searches were performed in MEDLINE, PsycInfo and PubMed. Search terms included pelvic pain, dysmenorrhoea, endometriosis, adolescent, pain measurement, quality of life, sleep, mental health, coping strategies and traumatic experience.

RESULTS

We found validated instruments to assess adverse childhood experiences and coping strategies, both known contributing factors to pelvic pain. The impact of pain was measured through validated tools for health-related quality of life, mental health and sleep.

CONCLUSIONS

Pelvic pain evaluation in adolescents should include a multi-factorial assessment of contributing factors, such as childhood adversity and coping strategies, and impacts of pelvic pain on quality of life, mental health and sleep, using validated instruments in this age group. Future research should focus on the development of consensus amongst researchers as well as input from young women to establish a standardised international approach to clinical trials involving the investigation and reporting of pelvic pain in adolescents. This would facilitate comparison between studies and contribute to improved quality of care delivered to patients.

Psychotherapeutic and pharmacological agents for post-traumatic stress disorder with sleep disorder: network meta-analysis

OBJECTIVE

The current guidelines and canonical norms of diagnosis or treatment for Post-traumatic stress disorder (PTSD) with sleep disorder are still conflicting and have not yet reached a consensus. This study aimed to unravel the most effective countermeasures between two categories (psychotherapy and pharmacotherapy) put forward by the National Institute for Health and Clinical Excellence (NICE) and World Federation of Societies of Biological Psychiatry (WFSBP) respectively to treat PTSD individuals co-exist with sleep disorders.

METHODS

Four databases, including PubMed, EMBASE, Cochrane Library, and APA PsyNet, were searched from inception to February 02, 2023.

RESULTS

Twenty articles with 24 Randomized controlled trials (RCTs) and a total number of 1,647 participants were included. As demonstrated in the network meta-analysis comparison results, CBT-I (standardized mean differences (SMD) = -1.51,95% confidence interval (CI):-2.55 to -0.47), CBT-I plus IRT (SMD = -1.71, 95%CI:-3.39, -0.03), prazosin (SMD = -0.87,95%CI:-1.59 to -0.16) and hydroxyzine (SMD = -1.06, 95%CI: -1.94 to -0.19) significantly reduced PTSD symptoms compared with placebo. In contrast to placebo, CBT-I (SMD = -5.61,95%CI:-8.82 to -2.40) significantly improved sleep quality. For nightmare severity, IRT (SMD =-0.65, 95%CI:-1.00 to -0.31), prazosin (SMD = -1.20,95%CI:-1.72 to -0.67) and hydroxyzine (SMD = -0.98,95%CI:-1.58 to -0.37) significantly reduced nightmare severity in comparison with placebo.

CONCLUSIONS

This study suggested that under most circumstances, psychotherapy namely CBT-I had a favorable profile, but pharmacotherapy with prazosin was effective in managing nightmare severity. The sole avail of CBT-I was recommended to improving sleep quality while CBT-I and CBT-I plus IRT showed excellent management of PTSD symptom severity. Exposure to CBT-I isrecommended for depression. The relevant clinical guidelines for the management of individuals with PTSD and sleep disorders may regard this as a reference.

PROSPERO

CRD42023415240.

Distress variability during exposure therapy and its relationship with PTSD symptom decline

BACKGROUND AND OBJECTIVES

Inhibitory Learning Theory (ILT) framework implies that in-session distress variability may promote extinction learning and thereby enhance exposure therapy efficacy. Thus far, research has mainly focused on in-session distress reduction. The aim of the current study was to assess whether in-session distress variability predicts next session PTSD symptom decline in PTSD patients receiving prolonged exposure (PE).

METHODS

Eighty-six patients with PTSD received 14 to 16 sessions of PE. Using dynamic panel models, we assessed the temporal relation (i.e., within-persons) between in-session distress variability and PTSD symptom decline. Moreover, we assessed the averaged relation (i.e., between-persons) between in-session distress variability and PTSD symptom decline.

RESULTS

Temporal analyses showed that in-session distress variability did not precede PTSD symptom improvement. Averaged analyses showed that distress variability was related to PTSD symptom improvement.

LIMITATION

The operationalization of distress variability appeared to deviate from its theoretical conceptualization.

CONCLUSIONS

In absence of distress reduction, distress variability can vary. However, our findings suggest that in-session distress variability does not drive symptom reduction during PE. In contrast, averaged over participants, distress variability was related to symptom improvement, suggesting that those with a more variable distress pattern across sessions show better treatment response. More empirical work is needed to shed light on the effect of distress variability during exposure sessions on treatment outcome and to offer grounds for clinical recommendations.

Experience of pre-suicidal suffering: insights from suicide attempt survivors

PURPOSE

Psychache significantly contributes to the suicidal process. However, the transition from pre-suicidal suffering to a suicide crisis remains one of the least explored stages in suicidology.

METHODS

We retrospectively explored experience of pre-suicidal suffering through semi-structured, in-depth interviews with 12 individuals recruited from the Vilnius City Mental Health Center, Lithuania. Interpretative phenomenological analysis was employed to identify recurring patterns.

RESULTS

Nine primary group experiential themes emerged: Certain adverse life events occurring during the suicidal process were not immediately perceived as connected; Complex traumatic events laid the groundwork for a profound sense of lack; A compensatory mechanism balanced the experience of profound lack; Exhaustion ensued from efforts to sustain the compensatory mechanism; The main trigger directly challenged the compensatory mechanism; The affective state followed the experience of the main triggering event; Dissociation served to isolate psychache; Thoughts of suicide experienced as automatic; Suicide was perceived as a means to end suffering.

CONCLUSION

The findings suggest that the suicidal process unfolds over an extended period of suffering, culminating in a crisis to alleviate unbearable psychological pain. In clinical practice, identifying the main triggering event discussed in this study can be pivotal in understanding the essence of suffering characterized by profound lacking and developed compensatory mechanisms.

Development and initial testing of mindful journey: a digital mindfulness-based intervention for promoting recovery from Substance use disorder

BACKGROUND/OBJECTIVES

There is a great unmet need for accessible adjunctive interventions to promote long-term recovery from substance use disorder (SUD). This study aimed to iteratively develop and test the initial feasibility and acceptability of Mindful Journey, a novel digital mindfulness-based intervention for promoting recovery among individuals with SUD.

PATIENTS/MATERIALS

Ten adults receiving outpatient treatment for SUD.

METHODS

Phase 1 (n = 5) involved developing and testing a single introductory digital lesson. Phase 2 included a separate sample (n = 5) and involved testing all 15 digital lessons (each 30- to 45-minutes) over a 6-week period, while also receiving weekly brief phone coaching for motivational/technical support.

RESULTS

Across both phases, quantitative ratings (rated on a 5-point scale) were all at or above a 4 (corresponding with 'agree') for key acceptability dimensions, such as usability, understandability, appeal of visual content, how engaging the content was, and helpfulness for recovery. Additionally, in both phases, qualitative feedback indicated that participants particularly appreciated the BOAT (Breath, Observe, Accept, Take a Moment) tool for breaking down mindfulness into steps. Qualitative feedback was used to iteratively refine the intervention. For example, based on feedback, we added a second core mindfulness tool, the SOAK (Stop, Observe, Appreciate, Keep Curious), and we added more example clients and group therapy videos. In Phase 2, 4 out of 5 participants completed all 15 lessons, providing initial evidence of feasibility. Participants reported that the phone coaching motivated them to use the app. The final version of Mindful Journey was a smartphone app with additional features, including brief on-the-go audio exercises and a library of mindfulness practices. Although, participants used these additional features infrequently.

CONCLUSIONS

Based on promising initial findings, future acceptability and feasibility testing in a larger sample is warranted. Future versions might include push notifications to facilitate engagement in the additional app features.

Influences of sleep, cortisol reactivity, and risk/reward-based decision-making on suicide

BACKGROUND AND OBJECTIVES

Poor sleep quality is a known contributor to suicidal thoughts and behaviors. This study examines whether sleep quality modulates the effect of an individual's stress response and risk/reward-based decision making on suicide risk.

METHODS

Participants were 160 adults at a residential substance use treatment facility with lifetime exposure to trauma who completed a clinician-administered measure of suicide risk, the Iowa Gambling Task (IGT), and a self-report measure of sleep. Cortisol reactivity (i.e., changes in cortisol before and after a personalized trauma script) was used to measure stress response. We used quantile regression to examine the effects of sleep, cortisol, and risk/reward decision-making on suicide risk.

RESULTS

We found poor sleep quality to be increasingly salient in individuals at greater risk for suicide than those at lower risk for suicide. Furthermore, individuals with moderate to moderate-high levels of suicide risk seem to have greater cortisol reactivity. In the low-moderate quantile, we found suicide risk to be associated with both high stress reactivity and low-risk, high-reward decision-making, as well as low stress reactivity and high-risk/low-reward decision-making.

LIMITATIONS

These findings should be interpreted considering several methodological constraints, such as the use of a pre-determined sample and instruments not tailored for our hypotheses, the MINI 'Suicide' Module's limited differentiation between suicidal ideation and behavior, and variably timed cortisol sampling.

CONCLUSIONS

Despite these limitations, the findings from this study support the use of evidence-based interventions focused on improving sleep quality and managing emotional reactivity to decrease suicide risk.

Widening the scope of mental health with a 'youth centred' approach: a qualitative study involving health care professionals in Sweden's youth clinics

PURPOSE

The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness".

METHODS

Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke.

RESULTS

The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'.

CONCLUSION

This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health.

Translation and validation of the Chinese version of the menstrual distress questionnaire

BACKGROUND

The Menstrual Distress Questionnaire (MDQ) is a commonly used questionnaire that assesses various symptoms and distress associated with the menstrual cycle in women. However, the questionnaire has not been completely translated into Chinese with rigorous reliability and validity testing.

METHODS

This study translated the Menstrual Distress Questionnaire Form Cycle (MDQC) from English into Chinese: MDQCC in two stages. First, it was translated forward and backward using Jones' model; second, to test the validity and reliability, 210 Chinese-speaking women were recruited through online announcements and posters posted between June 2019 and May 2020. Expert validity, construct validity, convergent validity, and factorial validity were determined using content validity index (CVI), intraclass correlation coefficient (ICC), composite reliability (CR), and exploratory factor analysis, respectively. For concurrent criterion validity, MDQCC score was compared with three existing pain scales. Reliability was evaluated using internal consistency across items and two-week test-retest reliability over time.

RESULTS

The CVI for content validity was .92. Item-CVI for expert validities among the 46 items ranged from .50 - 1; scale-CVI for the eight subscales, from .87 - 1; ICC, from .650 - .897; and CRs, from .303 - .881. Pearson correlation coefficients between MDQCC and short-form McGill pain questionnaire, present pain intensity, and visual analog scale scores were .640, .519, and .575, respectively. Cronbach's α for internal consistency was satisfactory (.932). ICC for test-retest reliability was .852 for the entire MDQCC.

CONCLUSION

MDQCC was valid and reliable for Mandarin Chinese-speaking women. It can be used to evaluate female psychiatric symptoms related to the menstrual cycle in future work.

Digital health outreach to promote postpartum screening after gestational diabetes: A randomized factorial pilot study

Objective

We examined the acceptability and feasibility of a multi-component digital health outreach intervention to promote uptake of guideline-recommended postpartum screening for type 2 diabetes among patients with gestational diabetes (GDM).

Methods

We conducted a 24 randomized factorial experiment as part of the Multiphase Optimization Strategy (MOST) preparation phase for developing behavioral interventions. Participants with current or recent GDM in an integrated healthcare system were randomized to receive an outreach message with up to four intervention components, designed to be self-administered in about 10 min and efficiently delivered online via REDCap: a streamlined values affirmation, personalized information on diabetes risk, an interactive motivational interviewing-based component, and an interactive action planning component. Patient-reported acceptability and feasibility outcomes were assessed via survey.

Results

Among 162 participants, 72% self-identified with a racial/ethnic minority group. Across components, acceptability scores averaged 3.9/5; ≥91% of participants read most or all of the outreach message; ≥89% perceived the amount of information as "about right"; and ≥ 87% completed ≥1 interactive prompt.

Conclusion

Each intervention component was acceptable to diverse patients and feasible to deliver in a brief, self-directed, online format.

Innovation

These novel components target unaddressed barriers to patient engagement in guideline-recommended postpartum diabetes screening and adapt theory-based behavior change techniques for large-scale use.

Perceptions of abused Chinese women on community-based participatory approach programme in addressing their needs

BACKGROUND

The community-based participatory approach (CBPA) has gained increasing recognition worldwide for enhancing the effectiveness of intervention. It is relatively new in Chinese societies and participants' perceptions are underexplored. This study aims to explore abused Chinese women's perceptions on the CBPA programme in addressing their needs.

METHODS

A total of 11 abused Chinese women were recruited for a focus group and individual interviews. A semi-structured interview guide was used. All interviews were audio-recorded and data were transcribed verbatim. Conventional content analysis was used for analysis.

RESULTS

Four themes were identified regarding the women's perceptions and experiences of the community-based participatory approach programme: (1) Women's perceived acceptability of the CBPA programme; (2) Women's perceived usefulness of the CBPA programme; (3) Women's perceived feasibility of the CBPA programme; and (4) Empowering the women through participating in CBPA.

CONCLUSIONS

Abused Chinese women had high perceived acceptance and positive experiences towards the community-based participatory approach. Women benefited from their robust participation throughout the process. The findings confirm the potential of using the community-based participatory approach in designing interventions for future programme planning and intervention to address the needs of abused Chinese women.

Virtual reality-based Mindfulness-Oriented Recovery Enhancement (MORE-VR) as an adjunct to medications for opioid use disorder: a Phase 1 trial

INTRODUCTION

Medications for opioid use disorder (MOUD) are the most effective interventions for this condition, yet many patients discontinue treatment. Though adjunct psychosocial treatments are recommended to increase retention and reduce relapse, the scarcity of trained providers hinders access to and utilization of evidence-based interventions. We conducted a Phase 1 study to assess the feasibility of a virtual reality-delivered Mindfulness-Oriented Recovery Enhancement (MORE-VR) intervention for patients receiving MOUD.

PATIENTS AND METHODS

Patients receiving buprenorphine or methadone for OUD (N = 34) were scheduled for 8 weekly sessions of MORE-VR. Enrollment and retention rates were analyzed. Participants reported on the usability and acceptability of MORE-VR, opioid use, and craving and affect before and after each VR session. Heart rate was monitored during one session of MORE-VR.

RESULTS

Twenty-three participants completed four or more MORE-VR sessions (minimum recommended intervention dose). Participants reported high usability and acceptability of MORE-VR, which had an excellent safety profile. Illicit opioid use decreased significantly from pre- to post-treatment (F = 4.44, p=.04). We observed a significant within-session decrease in opioid craving (F = 39.3, p<.001) and negative affect (F = 36.3, p<.001), and a significant within-session increase in positive affect (F = 23.6, p<.001). Heart rate shifted during cue-exposure and mindfulness practices (F = 6.79, p<.001).

CONCLUSIONS

High retention, usability and acceptability rates and low adverse events demonstrated that MORE-VR is a feasible, engaging, and safe intervention. Our findings show that MORE-VR can be delivered as an adjunctive intervention to MOUD and suggest that MORE-VR may improve OUD treatment outcomes and modulate autonomic responses. MORE-VR's efficacy will be tested in a subsequent Phase 2 trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05034276; https://classic.clinicaltrials.gov/ct2/show/NCT05034276.

Chronic ethanol exposure produces long-lasting, subregion-specific physiological adaptations in RMTg-projecting mPFC neurons

Chronic ethanol exposure produces neuroadaptations in the medial prefrontal cortex (mPFC) that are thought to facilitate maladaptive behaviors that interfere with recovery from alcohol use disorder. Despite evidence that different cortico-subcortical projections play distinct roles in behavior, few studies have examined the physiological effects of chronic ethanol at the circuit level. The rostromedial tegmental nucleus (RMTg) is functionally altered by chronic ethanol exposure. Our recent work identified dense input from the mPFC to the RMTg, yet the effects of chronic ethanol exposure on this circuitry is unknown. In the current study, we examined physiological changes after chronic ethanol exposure in prelimbic (PL) and infralimbic (IL) mPFC neurons projecting to the RMTg. Adult male Long-Evans rats were injected with fluorescent retrobeads into the RMTg and rendered dependent using a 14-day chronic intermittent ethanol (CIE) vapor exposure paradigm. Whole-cell patch-clamp electrophysiological recordings were performed in fluorescently-labeled (RMTg-projecting) and -unlabeled (projection-undefined) layer 5 pyramidal neurons 7-10 days following ethanol exposure. CIE exposure significantly increased intrinsic excitability as well as spontaneous excitatory and inhibitory postsynaptic currents (sE/IPSCs) in RMTg-projecting IL neurons. In contrast, no lasting changes in excitability were observed in RMTg-projecting PL neurons, although a CIE-induced reduction in excitability was observed in projection-undefined PL neurons. CIE exposure also increased the frequency of sEPSCs in RMTg-projecting PL neurons. These data uncover novel subregion- and circuit-specific neuroadaptations in the mPFC following chronic ethanol exposure and reveal that the IL mPFC-RMTg projection is uniquely vulnerable to long-lasting effects of chronic ethanol exposure. This article is part of the Special Issue on "PFC circuit function in psychiatric disease and relevant models".

Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6

OBJECTIVE

The aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample.

METHODS

We used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors.

RESULTS

Among people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16-2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications.

CONCLUSION

Our findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.

Identifying momentary suicidal ideation using machine learning in patients at high-risk for suicide

BACKGROUND

Strategies to detect the presence of suicidal ideation (SI) or characteristics of ideation that indicate marked suicide risk are critically needed to guide interventions and improve care during care transition periods. Some studies indicate that machine learning can be applied to momentary data to improve classification of SI. This study examined whether the classification accuracy of these models varies as a function of type of training data or characteristics of ideation.

METHODS

A total of 257 psychiatric inpatients completed a 3-week battery of ecological momentary assessment and measures of suicide risk factors. The accuracy of machine learning models in classifying the presence, duration, or intensity of ideation was compared across models trained on baseline and/or momentary suicide risk data. Relative feature importance metrics were examined to identify the risk factors that were most important for outcome classification.

RESULTS

Models including both baseline and momentary features outperformed models with only one feature type, providing important information in both correctly classifying and differentiating individual characteristics of SI. Models classifying SI presence, duration, and intensity performed similarly.

LIMITATIONS

Results of this study may not generalize beyond a high-risk, psychiatric inpatient sample, and additional work is needed to examine temporal ordering of the relationships identified.

CONCLUSIONS

Our results support using machine learning approaches for accurate identification of SI characteristics and underscore the importance of understanding the factors that differentiate and drive different characteristics of SI. Expansion of this work can support use of these models to guide intervention strategies.

The association between aggressive behaviour and non-suicidal self-injury and shared risk factors in adults with mild intellectual disability

BACKGROUND

Aggressive behaviour (AB) and non-suicidal self-injury (NSSI) are common in people with mild intellectual disability or borderline intellectual functioning, leading to adverse consequences for themselves and those around them.

METHOD

We investigated the relationship between AB (both total and physical in particular) and NSSI and risk factors in 125 residents in a treatment clinic using incident reports and standard clinical measurements.

RESULTS

There was a weak correlation between AB and NSSI, as well as between impulsivity and total AB, and between coping and AB and NSSI. However, NSSI, impulsivity and coping skills did not predict AB.

CONCLUSION

Results do not corroborate those of other studies in this area. In future studies impulsivity, coping, aggression and NSSI may be measured using other instruments, and differences between people with and without intellectual disability regarding these variables may be explored.

Gender-specific factors of suicidal ideation among high school students in Yunnan province, China: A machine learning approach

BACKGROUND

Suicidal ideation (SI) assumes a pivotal role in predicting suicidal behaviors. The incidence of SI among high (junior and senior) school students is significantly higher than that of other age groups. The aim of this study is to explore the gender differences in SI among high school students in Yunnan Province.

METHOD

A total of 6180 students in grades 7-12 in Yunnan province, China from May 2021 to May 2022 participated in this survey. Univariate analysis was employed to describe the influencing factors of male and female students' SI. Subsequently, data were stratified by gender. Adopting machine learning technique, including Least Absolute Shrinkage and Selection Operator (Lasso) and Boruta algorithm, and logistic regression model to estimate the direction and effect magnitude of the influencing factors.

RESULTS

The prevalence of SI was significantly higher for females (31.34 %) than males (16.73 %). The logistic regression model was established using the variables screened by Boruta algorithm, indicated that anxiety, depression, suffering emotion abuse or emotion neglect in childhood, non-suicidal self-injury, evening chronotype are common risk factors for SI in male and female students. Notably, female students who exhibited aggressive behavior, have experienced bullying, and were in the junior high school learning stage were more likely to report SI than their male counterparts.

CONCLUSIONS

Females showed more vulnerability to SI than males especially among females in junior high school, reporting aggressive behavior and bullying experiences. Tailored prevention strategies, informed by these gender-related distinctions, should be developed and implemented.

Gender-specific motivational pathways in ADHD-related inattention and gaming disorder symptoms

Comorbidity between attention-deficit/hyperactivity disorder (ADHD) and gaming disorder (GD) is widely recognized in the literature. Previous research has indicated gender-dependent underlying mechanisms in the development and maintenance of problematic gaming. Motivational research presents an opportunity to provide further insight regarding the nature of this association. Self-report data were collected from videogame players (N = 14,740) using an online survey in collaboration with a popular gaming magazine. The survey included items concerning symptoms of ADHD and GD, motives for gaming, and time spent playing videogames. Structural equation modeling was used to create two parallel mediation models (one for males, one for females), including motives to play games as mediators. This was done to potentially explain psychological drivers of the association between ADHD and GD. Results demonstrated a common pathway from inattention to GD symptom severity through the immersion/escapism motivation for both males (β = 0.068; p < 0.001) and females (β = 0.081; p < 0.05), while the paths from inattention to GD symptom severity through the habit/boredom motive (β = 0.094; p < 0.001) and competition motive (β = 0.021; p < 0.001) were only significant for males. Gamers experiencing symptoms of ADHD, especially inattentive symptoms, are at risk of the occurrence of GD symptoms through videogames becoming a source of maladaptive coping with daily psychological disturbances. Males experiencing inattentive symptoms tend to additionally develop problematic patterns of use through videogame playing, becoming a subjectively meaningless and boredom-reduction-oriented habitual activity or a platform of virtual competition. Unique differences suggest the necessity of different treatment approaches for males and females.

Does cognitive-behavioral treatment affect putative mechanisms of change among individuals with problem gambling? A systematic review and exploratory meta-analysis

OBJECTIVE

The current study was a systematic review and meta-analysis of cognitive behavioral treatment (CBT) for problem gambling and gambling disorder and whether it produced different outcomes than minimal or no treatment controls on three putative change mechanisms: 1) gambling cognitions, 2) coping, and 3) self-efficacy.

METHOD

Studies were identified from five bibliographic databases (i.e., Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and PubMed). Included studies were randomized controlled trials of CBT that included posttreatment data on putative mechanisms. Between-group Hedges's g effect sizes were calculated to examine outcomes of CBT relative to minimal or no treatment control on gambling cognitions, coping, and self-efficacy at posttreatment. Risk of bias was determined using the Cochrane Risk of Bias tool.

RESULTS

Fifteen studies, representing 1,536 participants, were eligible for analysis. Participants in CBT had more favorable gambling cognitions (g = -0.41), coping behaviors (g = 0.27), and self-efficacy (g = 1.12) at posttreatment than minimal or no treatment control.

CONCLUSIONS

Results of the current study provided preliminary support for the effectiveness of CBT on three putative mechanisms of change among individuals experiencing problem gambling and gambling disorder. Although the results were promising, there was significant heterogeneity in the magnitude of effect sizes for all three outcomes, and outcomes were not consistently assessed with psychometrically established assessment tools.

Discriminative validity and interpretability of the mood and feelings questionnaire

BACKGROUND

Using the Mood and Feelings Questionnaire (MFQ) to differentiate between depression severity levels remains unexplored. We explored the discriminative validity of the MFQ to identify an optimal cut-off MFQ score to distinguish between subthreshold-to-mild and moderate-to-severe depression severity levels.

METHODS

An observational cross-sectional design was used in a sample (N = 67) of help-seeking youth (ages 13 to 18, inclusive) experiencing depressive symptoms. The MFQ was administered verbatim to youth by a research analyst over the phone. Youth were then grouped into subthreshold-to-mild or moderate-to-severe depression severity categories based on scores received on the Kiddie Schedule for Affective Disorders and Schizophrenia-Depression Rating Scale. Receiver Operating Characteristic curve analyses were conducted, with area under the curve (AUC) and Youden Index (J) as primary indices. We hypothesized that the lower limit of the 95 % confidence interval for the area under the curve would be ≥0.70.

RESULTS

The primary analysis yielded an AUC of 0.85 (95 % CI: 0.763-0.947) and an optimal cut-off of ≥43 (J = 0.60, positive predictive value = 91.4 %, negative predictive value = 62.5 %, sensitivity = 72.7 %, specificity = 87.0 %).

LIMITATIONS

Our study collected a small sample, and as such cannot identify how subgroup classification (e.g., based on race or gender) may moderate outcomes. Further, unknown measurement error of the predictor and reference variable measures can bias the estimates.

CONCLUSIONS

Our preliminary findings highlight the potential for the MFQ to support clinical decision-making relevant to adolescents experiencing varying severities of depressive symptoms in secondary care settings.

Mutual eye gaze and vocal pitch in relation to social anxiety and depression: A virtual interaction task

BACKGROUND

Individuals with high social interaction anxiety (SIA) and depression often behave submissively in social settings. Few studies have simultaneously examined the associations between objectively assessed submissive behaviors and SIA or depression, despite their high comorbidity and unknown mechanisms regarding submissiveness.

METHODS

A sample of 45 young adults self-reported trait SIA and depression, state positive/negative affect (PA/NA) before and after a virtual social interaction. Participants engaged in a four-minute conversation with a confederate who was trained to behave neutrally. Mutual eye gaze, via eye-tracking, and vocal pitch were assessed throughout the interaction.

RESULTS

Depression and SIA were positively correlated with NA, poorer self-rated performance, and vocal pitch. Highly socially anxious women engaged in less mutual eye gaze than highly socially anxious men. Also, vocal pitch was inversely associated with mutual eye gaze and positively related to NA and (nonsignificantly) to self-ratings of poor performance. Finally, our data partially replicated past research on the use of vocal pitch during social stress to detect social anxiety disorder.

LIMITATIONS

The current sample is relatively homogenous in educational attainment, age, and race. All research confederates were women. Future research should examine whether these archival data replicate with the latest telecommunication technologies.

CONCLUSION

Our findings highlight nuanced relationships among SIA, depression, emotions, self-perceptions, and biobehavioral indicators of submissive behavior-in response to an ambiguously negative/positive social interaction. Sex/gender may interact with these effects, emphasizing considerations for research method designs.

Psychological resilience and suicidality in the general population: A cross-sectional study based on data from the National Mental Health Survey of Korea 2021

BACKGROUND

The relationship between suicidality and resilience is underexplored among the general population. This study aimed to explore the relationship between lifetime, one-year, and one-month prevalence of suicidality (ideation, plan, attempt) and resilience in the general population.

METHODS

Data on suicidality, resilience, prevalence of major mental disorders, and other key psychological factors were collected from the National Mental Health Survey of Korea 2021. Interviewees comprised 5511 South Koreans aged 18-79 years. The contribution of resilience to suicidality was evaluated using Rao-Scot logistic regression, adjusting for possible confounders such as mental disorder prevalence and demographic and psychological characteristics.

RESULTS

Significantly lower resilience levels were noted among participants who reported lifetime, one-year, and one-month suicidal ideation, plan, or attempts. High resilience levels predicted no suicidal ideation, plans, and attempts in the lifetime, and no suicidal ideation and plans in the one-year and one-month time frames.

LIMITATIONS

First, this study's cross-sectional design has limitations for ascertaining a causal relationship between resilience and suicidality. Second, because the number of participants who had attempted suicide in the past year and reported suicidal thoughts/attempts in the past month was small, there were limitations in the analysis of suicidality in these time frames. Third, it was difficult to rule out the mediating effects of personality and temperament on the relationship between resilience and suicidality.

CONCLUSIONS

High resilience levels predicted lower lifetime and current suicidal ideation and suicidal planning in the general population. This study shows that psychological resilience is an important factor in evaluating an individual's current suicidality.

Average ages of onset and time to transition between self-injurious thoughts and behaviors: Retrospective evidence from two developmentally distinct samples

BACKGROUND

Suicidal thoughts and behaviors often emerge in a predictable sequence, with suicidal ideation (SI) preceding planning, and planning preceding actions. Few studies, however, have considered the timing and duration of non-suicidal self-injury (NSSI) in these transitions. Accordingly, this study examined: 1) the developmental sequencing of NSSI, SI and suicide attempts, and 2) whether age of onset or duration predict transitions from NSSI to other SITB, and from SI to NSSI.

METHODS

704 first-year students from a mid-sized Canadian university (Sample 1) and 2095 adults from an online research volunteer panel (Sample 2) completed the Self-Injurious Thoughts and Behaviors Interview self-report, which assessed the presence, age of onset, and recency of SITB.

RESULTS

NSSI and SI typically onset before age 15, while suicide planning and attempt usually began at or after age 15. Transition from NSSI to SI was likeliest in the first year after NSSI onset. Transition from NSSI to suicide attempt was likeliest in the second and third year after NSSI onset in Sample 1, and up to four years after NSSI onset in Sample 2. Early (before age 13) and late (after age 16) onsets of NSSI predicted higher odds of transitioning from NSSI to SI or attempt. Transition from SI to NSSI was likeliest in the first two years after SI onset and when SI began before age 13.

CONCLUSIONS

The first year after NSSI or SI onset are critical for transitions to other SITB. Targeted prevention and monitoring should be considered for people who recently initiated NSSI.

Distressing memories: A continuum from wellness to PTSD

BACKGROUND

Exposure to traumatic events is a frequent source of distress, provoking isolated symptoms such as distressing memories (DM) to full-blown post-traumatic stress disorder (PTSD). We aimed to assess the continuum theory using DM as an isolated symptom, and to examine trauma consequences in a exposed to traumatic events.

METHODS

Using data from the National Epidemiologic Study of Alcohol and Related Conditions III, we assessed the prevalence of DM in a trauma exposed sample, and examined their sociodemographic and lifetime psychiatric correlates, comparing three groups: (i) controls (no DM, no PTSD); (ii) participants with isolated DM without PTSD; (iii) participants with PTSD. We estimated the sensitivity and specificity of DM for PTSD diagnosis.

RESULTS

In our sample of 17,505 participants exposed to trauma, 13 % had PTSD and 42 % had DM without PTSD. The sensitivity of DM for the diagnosis of PTSD was 95.14 %, specificity was 51.91 %. Participants with DM and those with PTSD shared the same socio-demographic correlates. Participants with DM reported more lifetime psychiatric disorders (mood disorders - mainly depressive disorders and bipolar type 1 disorder; anxiety disorders - mainly social anxiety disorder, substance use disorders - mainly opioid use disorder and cannabis disorder; eating disorders - mainly binge eating disorder; personality disorders - mainly borderline personality disorder- and suicidality) than controls, but less than participants with PTSD.

CONCLUSION

DM represent an intermediate state between well-being and post-traumatic stress disorder; DM is also associated with other psychiatric disorders. It should be considered as a transdiagnostic psychiatric symptom useful for clinicians in identifying psychiatric vulnerability.

Provider and patient barriers and facilitators to integration of digital mental health applications in routine clinical care

BACKGROUND

The limited accessibility of mental healthcare providers highlights the need for innovative approaches to provide effective and efficient care. Digital mental health applications (DMHAs) can improve patient access to evidence-based treatments and reduce burden on the healthcare system. Here, we examined the provider and patient barriers and facilitators to integration of DMHAs in a healthcare system.

METHODS

Patients (n = 57) and providers (n = 100) were recruited from a large healthcare system over five months. Participants completed a survey assessing attitudes towards DMHAs, and perceived facilitators and barriers to adoption and utilization of DMHAs in mental healthcare.

RESULTS

DMHA credibility was a key facilitator for provider adoption, while usability and accessibility were identified as key facilitators for patient utilization. Provider barriers included patient cost/provider reimbursement, limited knowledge, perceived limits to credibility, patient outcome enhancement, and personalization of DMHAs for patient needs. Patients identified privacy concerns as the top barrier for using DMHAs.

LIMITATIONS

The self-report survey nature of this study, modest sample size, and majority of sample identifying as White and upper middle class make results subject to biases and limitations. Given the potential of DMHAs to address disparities in access to mental healthcare, more research is needed including populations who are at greatest risk.

CONCLUSIONS

Findings provide new insights to inform the development of intervention strategies to improve the integration of DMHAs within healthcare systems. Additional research examining key stakeholders at different levels of care is critical to address barriers, optimize facilitators, and develop roadmaps for best-practice use in healthcare systems.

Investigating the association between Work Family Conflicts (WFC) and suicidal ideation in an Australian community-based cohort study

BACKGROUND

Suicidal ideation, a significant public health issue, necessitates further investigation of its correlates and precursors. Extensive research highlights the association between Work Family Conflicts (WFC) and psychological distress, including depression. However, research examining the correlation between high WFC experiences and suicidal ideation is sparse. This study explores the association between WFC and suicidal ideation within an occupation non-specific community sample.

METHODS

Community-based, representative data from the Australian-based Personality and Total Health (PATH) Through Life project formed the basis of this study. Participants eligible for the study (N = 1312) were employed either full-time or part-time and took part in an online questionnaire. Importantly, the data include robust measures of WFC, active suicidal ideation, and depression.

RESULTS

After adjusting for psychosocial job characteristics, history of suicidal ideation, and other socio-demographic factors, high WFC was associated with increased odds of active suicidal ideation (Model 4: OR: 1.58, CI: 1.04-2.40). Further, supplementary analyses indicated that depression is an important component of this relationship. Analyses exploring an interaction effect by gender showed that while a significant association between high WFC and suicidality was observed among men after adjustment for all covariates, this association was not evident for women.

LIMITATIONS

A small number of participants reported suicidal ideation, potentially affecting the statistical power to detect significant effects. WFC was measured at one time-point, prohibiting the exploration of its causal and/or chronic impact on suicidal ideation.

CONCLUSION

We find evidence that high WFC is linked to increased active suicidal ideation - specifically for men.

Borderline personality features in relationship to childhood trauma in unipolar depressive and bipolar disorders

BACKGROUND

Childhood trauma, including emotional neglect, emotional abuse, physical abuse, and sexual abuse, may contribute to borderline personality features like affective instability, identity problems, negative relationships, and self-harm. This study aims to explore how different types of childhood trauma affect these features in bipolar versus unipolar depressive disorders.

METHODS

We included 839 participants of the Netherlands Study of Depression and Anxiety (NESDA) with a lifetime diagnosis of major depressive disorder single episode (MDDS; N = 443), recurrent major depressive disorder (MDD-R; N = 331), or bipolar disorder (BD; N = 65). Multivariate regression was used to analyze data from the Childhood Trauma Interview and borderline features (from the self-report Personality Assessment Inventory).

RESULTS

On average, participants were 48.6 years old (SD: 12.6), with 69.2 % being women, and 50.3 % of participants assessed positive for childhood trauma. Adjusted analyses revealed that participants diagnosed with BD, followed by MDD-R, exhibited the highest number of borderline personality features. Additionally, within the entire group, a strong association was found between childhood trauma, especially emotional neglect, and the presence of borderline personality features.

CONCLUSION

Given the high prevalence of childhood trauma and borderline personality features, screening for these factors in individuals with mood disorders is crucial. Identifying these elements can inform and enhance the management of the often fluctuating and complex nature of these comorbid conditions, leading to more effective and tailored treatment strategies.

Subcortical volumes in offspring with a multigenerational family history of depression - A study across two cohorts

BACKGROUND

Having multiple previous generations with depression in the family increases offspring risk for psychopathology. Parental depression has been associated with smaller subcortical brain volumes in their children, but whether two prior generations with depression is associated with further decreases is unclear.

METHODS

Using two independent cohorts, 1) a Three-Generation Study (TGS, N = 65) with direct clinical interviews of adults and children across all three generations, and 2) the Adolescent Brain Cognitive Development Study (ABCD, N = 10,626) of 9-10 year-old children with family history assessed by a caregiver, we tested whether having more generations of depression in the family was associated with smaller subcortical volumes (using structural MRI).

RESULTS

In TGS, caudate, pallidum and putamen showed decreasing volumes with higher familial risk for depression. Having a parent and a grandparent with depression was associated with decreased volume compared to having no familial depression in these regions. Putamen volume was associated with depression at eight-year follow-up. In ABCD, smaller pallidum and putamen were associated with family history, which was driven by parental depression, regardless of grandparental depression.

LIMITATIONS

Discrepancies between cohorts could be due to interview type (clinical or self-report) and informant (individual or common informant), sample size or age. Future analyses of follow-up ABCD waves will be able to assess whether effects of grandparental depression on brain markers become more apparent as the children enter young adulthood.

CONCLUSIONS

Basal ganglia regional volumes are significantly smaller in offspring with a family history of depression in two independent cohorts.

Risk and protective correlates of suicidality in the military health and well-being project

Suicidality disproportionately affects Veterans, and in 2020 the Military Health and Well-Being Project was conducted in part to study the link between risk and protective constructs with suicidality among Veterans. In the present study, we investigate the relative contribution of risk (i.e., military self-stigma, daily stress, combat exposure, substance use, traumatic brain injury, and moral injury) and protective constructs (i.e., social integration, social contribution, public service motivation, purpose and meaning, and help-seeking) with suicidality. Using cross-sectional Pearson correlation and linear regression models, we studied the independent and relative contribution of risk and protective correlates in a sample of 1469 Veterans (male: n = 985, 67.1 %; female: n = 476, 32.4 %; transgender, non-binary, prefer not to say: n = 8, 0.5 %). When we investigated protective constructs individually as well as simultaneously, social contribution (β = -0.39, t = -15.59, p < 0.001) was the strongest protective construct against suicidality. Social integration (β = -0.13, t = -4.88, p < 0.001) additionally accounted for significant reduction in suicidality when all protective constructs were considered together. When we investigated the contribution of risk constructs towards suicidality, moral injury was most strongly associated with suicidality (r = 0.519, p < 0.001), yet when studied simultaneously for their relative contribution none of the constructs accounted for a significant amount of the variance in suicidality (|t|s ≤ 1.98, ps ≥ 0.07). These findings suggest that among Veterans it is possible that social contribution is protective against suicidality and could be a possible treatment target for the prevention or reduction of suicidality among Veterans.

Emotion dysregulation in participants with substance use disorders: A metacognitive perspective

BACKGROUND

Using the metacognitive model of emotion dysregulation as a basis, this study explored whether, among participants with substance use disorders (SUDs), metacognitive beliefs and repetitive negative thinking were associated with emotion dysregulation.

METHODS

127 participants with SUDs and 127 controls without SUDs were recruited. Emotion dysregulation, metacognitive beliefs, rumination, worry, anxiety, and depression were assessed. t-tests, Mann-Whitney tests, logistic regression, correlation, and hierarchal regression analyses were run.

RESULTS

Participants with SUDs reported significantly higher levels of emotion dysregulation, positive beliefs about worry, beliefs about the need to control thoughts, rumination, and worry, compared to controls without SUDs. Among participants with SUDs negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence, beliefs about the need to control thoughts, rumination, and worry were significantly associated with an increase of emotion dysregulation.

LIMITATIONS

The cross-sectional design.

CONCLUSION

Emotion dysregulation, metacognitive beliefs, and repetitive negative thinking may contribute to increase the risk of substance use. Among participants with SUDs emotion dysregulation is associated with the tendency to endorse dysfunctional metacognitive beliefs and report repetitive negative thinking. Metacognitive beliefs and repetitive negative thinking could be a suitable therapeutic target to reduce emotion dysregulation among participants with SUDs.

Does e-cigarette use predict short-term smoking cessation behaviors among adults who smoke in Mexico? A longitudinal study

INTRODUCTION

This study assessed quit attempts among adults who use cigarettes either exclusively or with e-cigarettes in Mexico, where non-daily smoking predominates.

METHODS

An open cohort of Mexican adults who smoke was surveyed every four months from November 2018 to March 2021. Participants followed to the next survey were analyzed (n = 2220 individuals, 4560 observations). Multinomial logistic models regressed smoking quit attempts reported at the followup survey (ref = no attempt; tried to quit; sustained attempt of ≥30 days) on e-cigarette use frequency (none = ref; 1-2 days/week; ≥3 days/week), adjusting for sociodemographics and smoking-related variables. Additional models subdivided e-cigarette users by intentions to quit smoking in the next six months (i.e., yes/no), use of nicotine (i.e., yes/no), and vaping device used (i.e., open/closed).

RESULTS

At 4-month follow-up, 32.7 % had tried to quit, and 2.9 % had quit for 30 days or more. Compared to those who smoke exclusively, occasional, and frequent e-cigarette users were more likely to try to quit (Adjusted Relative Risk Ratio or ARRR = 1.26 and 1.66, respectively) but no more likely to sustain their quit attempt. Among those who intended to quit smoking, e-cigarette users were no more likely to either try or sustain quit attempts. Furthermore, use of e-cigarettes with nicotine (59.6 %) was unassociated with cessation except that those who frequently used e-cigarettes with nicotine were more likely to try to quit than those who smoke exclusively (ARRR = 1.88). Device type used was not differentially associated with outcomes.

CONCLUSIONS

Mexicans who smoke and use e-cigarettes appear more likely than those who smoke exclusively to try to quit but not to sustain abstinence.

Effortful retrieval of semantic memories induces forgetting of related negative and neutral episodic memories

Retrieval-induced forgetting (RIF) experiments show that the act of retrieving some recently encoded items from a given conceptual category leads to greater forgetting of competing items from that same category. However, RIF studies using emotional stimuli have produced mixed results, perhaps due to the reinstatement of arousal or negative affect during retrieval practice. To induce forgetting of negative episodic memories more indirectly, we examined if retrieving neutral semantic memories leads to RIF of related negative memories. In two experiments, participants studied eight categorized lists comprised of an equal number of negative and neutral words (Experiment 1) or neutral words preceded by neutral or negative images (Experiment 2). To avoid re-exposing individuals to negative material during retrieval practice, participants then performed a semantic memory retrieval task in which they generated (i.e., completed word-stems for) new neutral words from half of the studied categories. We found that semantic retrieval, or word generation, induced forgetting of recently studied words irrespective of their emotional valence or original emotional context. Additionally, across both experiments, less successful word generation was associated with stronger RIF effects. In Experiment 2, the magnitude of RIF was also correlated with higher subjective ratings of retrieval effort during word generation. Together, these results suggest that even when retrieving neutral semantic memories, effortful retrieval may enhance inhibitory processes that lead to forgetting of both neutral and negative episodic memories.

Mindful Parenting Group Intervention for Parents of Children with Anxiety Disorders

Parenting behaviour and rearing style contribute to the intergenerational relationship between parental and child anxiety. Current psychological interventions for child anxiety typically do not adequately address parental mental health, parenting behaviours or the parent-child relationship. The current pilot study examines the effectiveness of a mindful parenting intervention (MPI) for parents of young children with clinical anxiety. It was hypothesised that the intervention would be associated with improvements in parental stress, mental health, and mindfulness, and a reduction in child clinical anxiety symptoms. Twenty-one parents of children aged 3-7 years diagnosed with anxiety disorders participated in an 8-week group MPI program that aimed to increase their intentional moment to moment awareness of the parent-child relationship. Parental (anxiety, depression, hostility, stress, burden, mindfulness, mindful parenting) and child (anxiety diagnoses, anxiety severity, comorbidities) outcomes were assessed at pre- and post-intervention, and at 3-month follow-up. Parents reported a significant increase in mindful parenting and a significant reduction in parent-child dysfunctional interaction, but no change in mental health symptoms. There was a significant reduction in parent-rated child anxiety symptoms, severity of child anxiety diagnosis and number of comorbid diagnoses at post and 3-month follow-up. Limitations include a lack of waitlist control, small sample size, and participants were largely mothers, from intact families and highly educated. There was attrition of 43% and outcomes were predominantly self-report. MPIs offer a novel and potentially effective method of increasing mindful parenting, decreasing dysfunctional parent-child interactions, reducing parenting stress and might also be an effective early intervention for indirectly decreasing young children's clinical anxiety symptoms. Larger-scale controlled trials of MPIs are needed.

Contextual and Behavioral Correlates of Coping Strategies Among an Ethnically Diverse Sample of Urban Adolescents in the Midwestern United States

Coping is recognized as an important life skill. In the present cross-sectional analysis, early adolescents' relationships with their caregivers (support, conflict) and exposure to stressors (uncontrollable life events, violence) were examined as contextual correlates of both positive and negative coping strategies. Coping strategies were examined as mediators of associations between adolescents' family and community contexts and adjustment outcomes (externalizing symptoms, internalizing symptoms, academic investment). Participants were recruited from an urban Pre-K-8 school and Boys and Girls Club. Adolescents who reported greater support from caregivers reported greater engagement in all forms of positive coping (behavioral/problem-focused coping, cognitive/emotion-focused coping, and coping through seeking support); they also reported less engagement in coping through anger and helplessness. Adolescents who reported greater conflict with caregivers or violence exposure reported greater engagement in coping through avoidance, anger, and helplessness. Problem-focused coping, coping through anger, and coping through helplessness mediated associations between different contextual factors and outcomes.

Trajectories of negative affect prior to and following disordered eating behaviors among women with eating disorder pathology: An examination of the role of state-interoception

OBJECTIVE

Affect regulation theories of eating disorders (ED) posit that negative affect increases in the hours before and decreases following disordered eating behaviors (DEBs) in daily life, yet findings from studies assessing affective changes post-DEBs are mixed. This inconsistency may be due to the previously unassessed role of other transdiagnostic processes in these associations, such as interoception (the ability to sense and integrate information from bodily sensations). To address this research gap, the present study examined whether different interoception dimensions moderated negative affect trajectories surrounding DEBs in the natural environment.

METHOD

150 women with ED pathology (Mage = 21.0, SD = 4.1) completed 4 surveys targeting affect and DEBs each day for a 10-day ecological momentary assessment period. Polynomial multilevel models examined negative affect trajectories pre- and post-DEBs (dietary restriction, overeating, loss of control eating), and whether these trajectories varied based on daily interoception dimensions (not distracting, self-regulation, body listening and trust).

RESULTS

Negative affect increased prior to loss of control eating-but not dietary restriction or overeating-and decreased following all DEBs. Further, the magnitude of the decrease in negative affect that emerged post-dietary restriction decreased in strength as daily "not distracting" interoception increased. The other interoception dimensions did not moderate negative affect trajectories surrounding DEBs.

CONCLUSIONS

Allowing oneself to experience (vs. distract from) uncomfortable bodily sensations may weaken affect dysregulation processes that follow dietary restriction in daily life and are theorized to maintain DEBs. These results provide insight that may strengthen EDs theories, research, and inform interoception-focused interventions.

Empirical clustering to identify individuals for whom insomnia is more closely related to suicidal ideation

BACKGROUND

Although the effect sizes are modest, insomnia is consistently associated with suicidal thoughts and behaviors. Subgroup analyses can efficiently identify for whom insomnia is most relevant to suicidal ideation. To improve clinical case identification, the present study sought to identify subclusters of lifetime suicidal ideators for whom insomnia was most closely related to current suicidal ideation.

METHODS

Data on N = 4750 lifetime suicidal ideators were extracted from the Military Suicide Research Consortium's Common Data Elements. Data on sociodemographic characteristics, severity and history of suicidal thoughts and behaviors, and related clinical characteristics were clustered by unsupervised machine learning algorithms. Robust Poisson regression estimated cluster by insomnia associations with current suicidal ideation.

RESULTS

Three clusters were identified: a modest symptom severity cluster (N = 1757, 37.0 %), an elevated severity cluster (N = 1444 30.4 %), and a high severity cluster (N = 1549 32.6 %). In Cluster 1, insomnia was associated with current suicidal ideation (PRR 1.29 [1.13-1.46]) and remained significant after adjusting for sociodemographic and clinical covariates. In Cluster 2, insomnia was associated with current suicidal ideation (PRR 1.14 [1.01-1.30]), but not after adjusting for sociodemographic and clinical covariates. In Cluster 3, insomnia was associated with current suicidal ideation (PRR 1.12 [1.03-1.21]) and remained significant after adjusting for sociodemographic covariates, but not clinical covariates.

LIMITATIONS

Cross-sectional design, lack of diagnostic data, non-representative sample.

CONCLUSION

Insomnia appears more closely related to current suicidal ideation among modest severity individuals than other subgroups. Future work should use prospective designs and more comprehensive risk factor measures to confirm these findings.

A network analysis of positive psychosocial factors and indication of suboptimal HIV care outcomes among Black women living with HIV

Black women living with HIV (BWLWH) face barriers that impact health outcomes. However, positive psychosocial indicators may influence HIV care outcomes. Among this cross-sectional study of 119 BWLWH, a network analysis was utilized to examine relationships between positive psychosocial factors and HIV-related health outcomes. A preliminary polychoric analysis was conducted to examine correlations between the variables, and the network analyzed connections between resilience, self-efficacy, self-esteem, perceived social support, religious coping, post-traumatic growth, and an indicator variable for suboptimal HIV care outcomes (low medication adherence, detectable viral load, and missed HIV-related health visits) and determined the centrality measures within the network. Seven significant associations were found among the factors: self-efficacy and self-esteem, post-traumatic growth and resilience, post-traumatic growth and self-efficacy, post-traumatic growth and religious coping, perceived social support and resilience, self-esteem and resilience, self-esteem and perceived social support (bootstrapped 95% CI did not contain zero). Self-efficacy was the strongest indicator associated with the other factors. Although not statistically significant, the indicator for suboptimal HIV care outcomes was negatively associated with perceived social support and religious coping. Future interventions incorporating self-efficacy may be beneficial to the overall well-being of Black women.

Cannabis use trajectories over time in relation to minority stress and gender among sexual and gender minority people

Substance use disparities among sexual and gender minority (SGM) people are attributed to minority stress, but few studies have examined minority stress and cannabis use over time or investigated differences in cannabis use trajectories by less-studied gender subgroups. We examined if longitudinal cannabis use trajectories are related to baseline minority stressors and if gender differences persisted after accounting for minority stress. Cannabis use risk was measured annually over four years (2017-2021) within a longitudinal cohort study of SGM adults in the United States (N = 11,813). Discrimination and victimization, internalized stigma, disclosure and concealment, and safety and acceptance comprised minority stress (n = 5,673). Latent class growth curve mixture models identified five cannabis use trajectories: 'low or no risk', 'low moderate risk', 'high moderate risk', 'steep risk increase', and 'highest risk'. Participants who reported past-year discrimination and/or victimization at baseline had greater odds of membership in any cannabis risk category compared to the 'low risk' category (odds ratios [OR] 1.17-1.33). Internalized stigma was related to 'high moderate' and 'highest risk' cannabis use (ORs 1.27-1.38). After accounting for minority stress, compared to cisgender men, gender expansive people and transgender men had higher odds of 'low moderate risk' (ORs 1.61, 1.67) or 'high moderate risk' (ORs 2.09, 1.99), and transgender men had higher odds of 'highest risk' (OR 2.36) cannabis use. This study indicates minority stress is related to prospective cannabis use risk trajectories among SGM people, and transgender men and gender expansive people have greater odds of trajectories reflecting cannabis use risk.

Examining time-varying dynamics of co-occurring depressed mood and anxiety

BACKGROUND

Dimensional frameworks of psychopathology call for multivariate approaches to map co-occurring disorders to index what symptoms emerge when and for whom. Ecological momentary assessment (EMA) offers a method for assessing and differentiating the dynamics of co-occurring symptoms with greater temporal granularity and naturalistic context. The present study used multivariate mixed effects location-scale modeling to characterize the time-varying dynamics of depressed mood and anxiety for women diagnosed with social anxiety disorder (SAD) and major depression (MDD).

METHODS

Women completed five daily EMA surveys over 30 days (150 EMA surveys/woman, T ≈ 5250 total observations) and two clinical diagnostic and retrospective self-report measures administered approximately two months apart.

RESULTS

There was evidence of same-symptom lagged effects (bs = 0.08-0.09), but not cross-symptom lagged effects (bs < 0.01) during EMA. Symptoms co-varied such that momentary spikes from one's typical level of anxiety were associated with increases in momentary depressed mood (b = 0.19) and greater variability of depressed mood (b = 0.06). Similarly, spikes from one's typical levels of depressed mood were associated with increases in momentary anxiety (b = 0.19). Furthermore, the presence and magnitude of effects demonstrated person-specific heterogeneity.

LIMITATIONS

Our findings are constrained to the dynamics of depressed and anxious mood among cisgender women with primary SAD and current or past MDD.

CONCLUSIONS

Findings from this work help to characterize how daily experiences of co-occurring mood and anxiety fluctuate and offer insight to aid the development of momentary, person-specific interventions designed to regulate symptom fluctuations.

Associations of adverse childhood experiences with depression and anxiety among children in the United States: Racial and ethnic disparities in mental health

OBJECTIVE

To assess associations of ACEs with depression and anxiety, with special emphasis on potential racial and ethnic disparities.

METHOD

Data were from the National Survey of Children's Health (NSCH), 2021-2022, a large, cross-sectional, nationally representative, population-based study of United States children aged 0-17. The associations of cumulative ACEs with depression and anxiety among 104,205 children and adolescents were assessed via multivariable logistic regression, including adjustment for age, sex, race, household income, and parental educational attainment.

RESULTS

ACEs were associated with depression and anxiety in a linear, dose-dependent manner. After adjustment for covariates, compared to no ACE exposures, participants with exposures to one, two, and three ACEs exhibited significantly higher odds of depression (fully-adjusted ORs and 95 % CIs = 2.18 [2.03, 2.35], 4.95 [4.55, 5.39], and 11.39 [10.18, 12.75], respectively). For anxiety, compared to no ACEs exposures, participants with exposure to one, two, and three ACEs had significantly higher odds of anxiety (fully-adjusted ORs and 95 % CIs = 1.90 [1.81, 2.00], 3.66 [3.44, 3.90], and 6.91 [6.30, 7.58], respectively). Notably, stratified analyses indicated potential effect modification by race, wherein the associations of ACEs with depression and anxiety were strongest in Black and White participants.

CONCLUSION

ACEs were robustly associated with depression and anxiety in a national sample of U.S. children and adolescents, with differential impacts of ACES on mental health observed across racial and ethnic groups. These findings underscore the need for urgent government and healthcare interventions and policies to ameliorate ACEs' health effects, especially among disproportionately impacted minority groups.

Effects of game-based digital interventions for mental disorders: A meta-analysis

With increasing research attention on game-based digital interventions for mental disorders, a number of studies have been conducted to explore the effectiveness of digital game-based interventions on mental disorders. However, findings from previous research were inconsistent. Thus, we conducted a comprehensive meta-analytic review of the effectiveness of game-based digital interventions for mental disorders. By searching the articles in databases, we identified 53 studies in which 2433 participants were involved, and 282 effect sizes were extracted. Among the 53 studies, 14 employed within-group (pre/post) designs, and the remaining 39 utilized controlled trial designs. Using a three-level random-effects meta-analytic model, a medium effect size of game-based digital interventions (g = 0.47, 95 % CI: 0.33, 0.61) was revealed in the controlled trial designs and a close-to-medium effect size (g = 0.45, 95 % CI: 0.32, 0.58) was found in the within-group (pre/post) designs, indicating close-to-medium-sized efficacy of game-based digital interventions for mental disorders. Moderator analyses showed that age in the controlled trial designs had contributed to the heterogeneity in previous studies, suggesting that interventions might be more effective for the elderly. However, given that only a limited number of studies were focused on the elderly, more studies with older participants should be conducted in the future to provide more robust evidence and explore the mechanisms of how digital gaming interventions can be more effective in improving mental disorders symptoms.

Activation of α7 nicotinic receptors attenuated hyperalgesia and anxiety induced by palatable obesogenic diet withdrawal

Consumption of palatable food (PF) can alleviate anxiety, and pain in humans. Contrary, spontaneous withdrawal of long-term PF intake produces anxiogenic-like behavior and abnormal pain sensation, causing challenges to weight-loss diet and anti-obesity agents. Thus, we examined α7-nicotinic acetylcholine receptors (α7nAChR) involvement since it plays essential role in nociception and psychological behaviors.

METHODS

Adult male C57BL/6 mice were placed on a Standard Chow (SC) alone or with PF on intermittent or continuous regimen for 6 weeks. Then, mice were replaced with normal SC (spontaneous withdrawal). Body weight, food intake, and calories intake with and without the obesogenic diet were measured throughout the study. During PF withdrawal, anxiety-like behaviors and pain sensitivity were measured with PNU-282987 (α7nAChR agonist) administration.

RESULTS

Six weeks of SC + PF-intermittent and continuous paradigms produced a significant weight gain. PF withdrawal displayed hyperalgesia and anxiety-like behaviors. During withdrawal, PNU-282987 significantly attenuated hyperalgesia and anxiety-like behaviors.

CONCLUSION

The present study shows that a PF can increase food intake and body weight. Also, enhanced pain sensitivity and anxiety-like behavior were observed during PF withdrawal. α7nAChR activation attenuated anxiolytic-like behavior and hyperalgesia in PF abstinent mice. These data suggest potential therapeutic effects of targeting α7 nAChRs for obesity-withdrawal symptoms in obese subjects.

Maximizing the reach of universal child sexual abuse prevention: Protocol for an equivalence trial

Background

Child sexual abuse (CSA) affects 1 in 5 girls and 1 in 12 boys before age 18. Universal school-based prevention programs are an effective and cost-efficient method of teaching students an array of personal safety skills. However, the programmatic reach of universal school-based programs is limited by the inherent reliance on the school infrastructure and a dearth of available alternative delivery modalities.

Methods

The design for this study will use a rigorous cluster randomized design (N = 180 classrooms) to determine the equivalence of two delivery modalities of Safe Touches: as usual vs. modified. The as usual workshop will be delivered by two facilitators with live puppet skits (n = 90). Whereas, the modified workshop will be delivered by one facilitator using prerecorded skit videos (n = 90). We will determine the equivalence by measuring concept learning acquisition preworkshop to immediate postworkshop (Aim 1) and retention at 3-months postworkshop (Aim 2) among students in classrooms that receive the as usual or modified workshops. To conclude equivalence, it is imperative to also examine factors that may impact future dissemination and implementation, specifically program adoption among school personnel and implementation fidelity between the two modalities (Aim 3).

Conclusion

Study findings will inform the ongoing development of effective CSA prevention programs and policy decisions regarding the sustainable integration of such programs within schools.

Clinical trial registration

NCT06195852.

A systematic review and meta-analysis of psychosocial interventions for persons with comorbid anxiety and substance use disorders

BACKGROUND & AIMS

Anxiety and substance use disorders are highly comorbid and represent two of the leading causes of disease burden globally. Psychosocial interventions are important treatment options for people with co-occurring anxiety and substance use (A-SUD). To date, few reviews have assessed the efficacy of psychosocial treatments for patients with A-SUD. This systematic review and meta-analysis aims to synthesize this literature and assess the efficacy of psychosocial interventions among patients with A-SUD.

METHODS

We searched all relevant records published until March 2023 in Medline, EMBASE, PsycINFO, CINAHL and Google Scholar. Two authors extracted and reconciled relevant data and assessed risk of bias. Random effects models were used to calculate effect sizes using Hedges' g for post treatment and follow-up time points. Main outcomes of the review were anxiety, alcohol use, and use of other substances. We examined effects on depression as a secondary outcome since it commonly co-occurs with A-SUD.

RESULTS

Psychosocial interventions for co-occurring A-SUD showed moderate effects on anxiety (g = 0.44), alcohol (Hedges' g = 0.29), and other substance use (g = 0.38) at post intervention. Large effects were observed on depression (g = 0.88) at post intervention with high heterogeneity. These effects were maintained at follow-up for anxiety (Hedges' g = 0.38), other substances (g = 0.44), and depression (g = 0.50). Moderation analyses for demographic factors, intervention characteristics, community level factors, anxiety reduction, and alcohol use reduction, were non-significant.

CONCLUSIONS

The current meta-analysis investigated the effects of psychosocial interventions on patients with anxiety and co-occurring SUD. The analyses indicated promising moderate-sized effects of treatment on anxiety, alcohol, all other drug use, and depression. The findings point to important avenues for psychosocial treatment while highlighting critical gaps in knowledge to be addressed in future research.

Impulse and reason? Justifications in problem gambling

People often use justifications to make desirable choices, but little is known about these justificatory thoughts in gambling. We conducted an exploratory Study 1 (n = 101) and a confirmatory Study 2 (n = 154) using online surveys, recruiting gamblers with prior and current experience of trying to reduce their gambling. Using justifications recognized in the domains of eating and consumer behavior (e.g., prior use of effort, feelings of achievement), we examined whether justifications were associated with problem gambling severity, and whether they explained additional variance above trait impulsivity and cognitive distortions. In both studies, justifications were positively associated with problem gambling severity, after accounting for trait impulsivity and cognitive distortions. Additionally, justifications were positively correlated with trait urgency and cognitive distortions, indicating that such thinking may not be antithetical to impulsivity. These data provide proof-of-principle evidence that justificatory thinking occurs in the context of gambling, is related to problem gambling severity, and may therefore represent a neglected aspect of gambling-related cognitions.

Tailoring opioid use prevention content for juvenile diversion programs with adolescents and their caregivers

INTRODUCTION

Opioid use (OU) skyrockets as youth transition into young adulthood, indicating adolescence is a critical time for prevention. The juvenile legal system (JLS) presents an ideal setting for OU prevention, as it is the single largest referral source for youth outpatient OU treatment, after self-referral. However, no OU prevention programs have been developed for youth in JLS diversion programs or their families. The current formative study established specific OU prevention needs and preferences of families in JLS programs, to guide future tailored prevention efforts.

METHODS

We interviewed 21 adolescents with substance use and 20 of their caregivers referred by a JLS diversion program in the northeastern United States to explore their OU-related knowledge, personal experiences, motivations, and behavioral skills. We used a deductive qualitative analysis approach wherein data were analyzed using an a priori coding framework based on the Information Motivation Behavioral Skills model.

RESULTS

Caregivers knew more about OU than youth, several of whom misidentified both opiates and non-opiates. Few participants reported a history of personal OU, though many knew of others' OU. Participants perceived several potential motivations for OU: mental health problems, relationships, life stressors, difficulty accessing preferred substances, and experimentation. Though often unfamiliar with the symptoms, participants were eager to learn skills to identify and manage a suspected overdose.

CONCLUSIONS

Youth involved in a JLS diversion program and their caregivers were open to and eager for tailored opioid use prevention content to help them reduce risks. We discuss implications for OU prevention and intervention program development.

Positive and Negative Life Events in Association with Psychopathology: An Examination of Sex Differences in Early Adolescence

Negative life events (NLEs) are associated with psychopathology in older adolescents and adults, particularly for women. However, less is known about the association between positive life events (PLEs) and psychopathology. This study examined associations between NLEs, PLEs, and their interaction, and sex differences in associations between PLEs and NLEs on internalizing and externalizing psychopathology. Youth completed interviews about NLEs and PLEs. Parents and youth reported on youth internalizing and externalizing symptoms. NLEs were positively associated with youth-reported depression and anxiety and parent-reported youth depression. Female youth had stronger positive associations between NLEs and youth-reported anxiety than male youth. Interactions between PLEs and NLEs were non-significant. Findings for NLEs and psychopathology are extended to earlier in development.

Maternal immune response during pregnancy and neurodevelopmental outcomes: A longitudinal approach

Background and objectives

The neurodevelopment of the offspring is suggested to be influenced by the maternal immune system's responses throughout pregnancy, which in turn is also vulnerable to maternal psychosocial stress conditions. Therefore, our main goal was to investigate whether maternal peripheral immunological biomarkers (IB) during two stages of gestation are associated with distinct neurodevelopmental trajectories in the first two years of life. As a second goal, we also explored the association between maternal distal (childhood) and proximal (gestation) stressful experiences and the immunological markers assessed during pregnancy.

Methods

Maternal childhood trauma, depressive and anxiety symptoms, and peripheral IB (IFNγ, IL-10, IL1β, IL6, IL8, TNFα, EGF, IL13, IL17, IL1Ra and IL4) were measured at baseline (8-16 weeks of pregnancy) and at 30 weeks of pregnancy in 160 women. The participants had the blood samples collected from two randomized clinical trials conducted by the same team and methods in the same community. A Principal Component Analysis (PCA) was implemented to create meaningful composite variables that describe the cytokines joint variation. Finally, linear mixed-effects modeling was used to investigate the influence of inflammatory biomarkers, maternal childhood trauma, anxiety, and depressive symptoms on Bayley's III scores trajectories.

Results

The IB profile during the 3rd trimester of pregnancy predicted the offspring's neurodevelopmental trajectories in the first two years of life. The components derived from PCA were important predictors and captured different immune responses, reflecting both pro- and anti-inflammatory states. Maternal stressful experiences did not correlate with the immunological markers. Although not a reliable predictor alone, maternal psychosocial stress at the 1st trimester of pregnancy interacted with the mother's immune response while predicting the neurodevelopmental scores during the first two years of life.

Conclusions

Our results underscore the importance of the maternal immune response during pregnancy in shaping the neurodevelopmental trajectory of the offspring. Additionally, we observed that the maternal distress at the early stages of pregnancy has an incremental effect on the neurodevelopmental outcome but depends upon the immune response.

Sleeping for two: A randomized controlled trial of cognitive behavioural therapy for insomnia (CBTI) delivered in pregnancy and secondary impacts on symptoms of postpartum depression

BACKGROUND

Insomnia in pregnancy is common and highly comorbid with depression.

OBJECTIVE

To investigate if: 1) depressive symptoms decrease after cognitive behavioural therapy for insomnia (CBTI) delivered in pregnancy, and 2) changes in insomnia symptoms represent a mechanism linking CBT-I treatment and reduced symptoms of postpartum depression.

METHODS

A two-arm, single-blind, parallel groups randomized controlled trial (RCT) design was used to evaluate the impact of a 5-week CBT-I intervention adapted for pregnant people with insomnia (N = 62). Participants were eligible if they were pregnant, between 12 and 28 weeks gestation, and met diagnostic criteria for insomnia. Participants completed questionnaires assessing symptoms of insomnia and depression pre-intervention (T1), post-intervention (T2), and six months postpartum (T3). A path analysis model was used to test direct and indirect effects simultaneously.

RESULTS

There was a significant direct effect of CBT-I on postpartum depressive symptoms at T3. Additionally, significant indirect treatment effects on depressive symptoms at T3 emerged, through depressive symptoms at T2 and through improvements in insomnia that persisted from T2 to T3.

LIMITATIONS

Limitations to the current study include limited generalizability, the non-depressed sample, and variability in treatment and assessment delivery (in-person vs. online).

CONCLUSIONS

CBT-I treatment in pregnancy may indirectly reduce postpartum depressive symptoms, through sustained improvements in insomnia symptoms.