The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Development and psychometric testing of a self-management scale for cancer survivors with radiotherapy/chemotherapy-induced oral mucositis in China

Objective

This study aims to develop and validate a self-management scale for radiotherapy/chemotherapy-induced oral mucositis (SMS-RIOM/CIOM) in cancer survivors, addressing the need for a comprehensive tool to assess self-management capabilities.

Methods

This study employed a two-phase process: (1) initial scale development through literature review, semi-structured interviews, and expert consultations, and (2) psychometric testing with 420 cancer survivors from five wards of Zibo Hospital. The psychometric evaluation included item analysis, content validity testing, reliability assessments, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).

Results

The finalized SMS-RIOM/CIOM consists of 15 items across four dimensions: medication management, oral pain management, disease monitoring, and daily life management. EFA explained 77.322% of the total variance, while CFA demonstrated an excellent model fit (χ²/df=1.909, RMSEA=0.064, RMR=0.052, GFI=0.911, CFI=0.964, NFI=0.928, TLI=0.955, IFI=0.964). Reliability metrics were robust, including Cronbach's alpha of 0.902, split-half reliability of 0.849, test-retest reliability of 0.862, and a scale content validity index of 0.910.

Conclusions

The SMS-RIOM/CIOM is a reliable and valid tool for assessing self-management in cancer survivors with RIOM/CIOM. It provides valuable insights for clinical practice, enabling targeted interventions to improve self-management and enhance the quality of life for cancer survivors. Further research is recommended to validate its application across diverse populations and healthcare settings.

Parents' wellbeing: perceptions of happiness and challenges in parenthood in Latin America

INTRODUCTION

Traditional research on parenthood and wellbeing often employs a positivist perspective and focuses on non-LA samples -limiting our knowledge and understanding of the influence of cultural components such as Machismo and Marianismo, have in parents' wellbeing. This study explored how Latin American (LA) parents' wellbeing is influenced by parenthood in a culture strongly influenced by such gender-based perspectives.

METHODS

An interpretative perspective was employed to qualitatively explore fifteen LA parents' lived experiences and data were analysed via Thematic Analysis. The American Psychological Association's Journal Article Reporting Standards for Qualitative Research (JARS-Qual), was followed to compile this paper.

RESULTS

Results showed that socio-economic factors such as crime, violence, and economic inequality, negatively influence parents' wellbeing -emotions experienced and life satisfaction.

DISCUSSION

Parents find joy in sharing own personal experiences with their children and passing on gender-based models. However, parents perceive family pressure as a "burden" when expected to follow principles of Machismo/Marianismo. Similar to Asian, but unlike European parents, LA parents experience a mixture of positive and negative emotions whilst parenting -shaped by Machismo and Marianismo. This study makes a unique contribution by uncovering the unique influence of LA socio-economic challenges and cultural impositions and expectations and its influence on parental wellbeing.

The interpersonal theory of suicide risk in male US service members/veterans: the independent effects of perceived burdensomeness and thwarted belongingness

Introduction: Suicide rates remain high among US military service member/veteran (SM/V) males with overall trends showing an upward trajectory. Several empirical studies and official US government reports show that interpersonal challenges can substantially increase suicide risk. One theory, the Interpersonal Theory of Suicide (IPT), focuses thwarted belongingness, perceived burdensomeness, capability for suicide, and their interactions, as key contributors to suicide risk. Extant military studies are subscribed to specific subsamples and/or do not test the full theory. This has resulted in mixed findings or findings with limited generalizability. The current study addressed these limitations.Method: A convenience sample of 508 male SM/Vs completed self-report measures of lifetime suicide ideation, likelihood of making a future attempt, thwarted belongingness, perceived burdensomeness, capability for suicide, and demographics. Suicide ideation and risk was regressed on IPT variables, relevant interactions, and covariates.Results: The variance accounted for in suicide ideation and likelihood of a future attempt was 32% and 62%, respectively. Higher perceived burdensomeness was associated with suicide ideation, and higher thwarted belongingness had a marginally significant association with suicide ideation. The presence of suicide ideation and higher thwarted belongingness were associated with the likelihood of making a future attempt. Capability for suicide was not associated with the likelihood of making a future attempt.Discussion: Perceived burdensomeness, suicide ideation, and thwarted belongingness appear to individually create risk for future suicide behaviour among US military service members and veterans. Additional work is needed to establish comprehensive theories of suicide risk in this population.

Epigenome-wide association study of perceived discrimination in the Multi-Ethnic Study of Atherosclerosis (MESA)

Perceived discrimination, recognized as a chronic psychosocial stressor, has adverse consequences on health. DNA methylation (DNAm) may be a potential mechanism by which stressors get embedded into the human body at the molecular level and subsequently affect health outcomes. However, relatively little is known about the effects of perceived discrimination on DNAm. To identify the DNAm sites across the epigenome that are associated with discrimination, we conducted epigenome-wide association analyses (EWAS) of three discrimination measures (everyday discrimination, race-related major discrimination, and non-race-related major discrimination) in 1,151 participants, including 565 non-Hispanic White, 221 African American, and 365 Hispanic individuals, from the Multi-Ethnic Study of Atherosclerosis (MESA). We conducted both race/ethnicity-stratified analyses as well as trans-ancestry meta-analyses. At false discovery rate of 10%, 7 CpGs and 4 differentially methylated regions (DMRs) containing 11 CpGs were associated with perceived discrimination exposures in at least one racial/ethnic group or in meta-analysis. Identified CpGs and/or nearby genes have been implicated in cellular development pathways, transcription factor binding, cancer and multiple autoimmune and/or inflammatory diseases. Of the identified CpGs (7 individual CpGs and 11 within DMRs), two CpGs and one CpG within a DMR were associated with expression of cis genes NDUFS5, AK1RIN1, NCF4 and ADSSL1. Our study demonstrated the potential influence of discrimination on DNAm and subsequent gene expression.

Considering the impact of vaccine communication in the COVID-19 pandemic among adults in Canada: A qualitative study of lessons learned for future vaccine campaigns

We aimed to understand how experiences with vaccine-related information and communication challenges during the COVID-19 pandemic impacted motivations and behaviors among Canadian adults regarding future vaccines. Semi-structured interviews were conducted with participants purposively selected to ensure diversity in age, sex at birth, self-identified gender, and region. Data were analyzed using thematic analysis; findings were mapped to the Information-Motivation-Behavioral Skills Model focusing on factors affecting vaccine hesitancy and uptake. Of 62 interviews completed, most were with woman (n = 32, 51.6%) and residents of Ontario (n = 36, 58.1%); the median age was 43.5 yr (interquartile range 23.3 yr). Themes included: 1) accessibility of information, 2) ability to assess information accuracy and validity, 3) trust in communications from practitioners and decision-makers, and 4) information seeking behaviors. Participants expressed various concerns about vaccines, including fears about potential side effects, particularly regarding the long-term effects of novel vaccinations. These concerns may reflect broader societal anxieties, which have been intensified by widespread misinformation and an overload of vaccine information. Moreover, participants highlighted a lack of trust in the information provided by government agencies and pharmaceutical companies, primarily driven by concerns regarding their underlying motives. Concerns about COVID-19 vaccine safety and effectiveness negatively impacted future vaccine attitudes and behaviors. Vaccine hesitancy studies should consider how individuals receive, perceive, and seek information within social contexts and risk profiles.

Maximizing expectancy violation and exposure outcomes in patients with PTSD

Background: It has been proposed that maximizing expectancy violation enhances the efficacy of exposure therapy. The clinical utility of expectancy violation remains unclear and it has not yet been studied in PTSD.Objective: We aimed to test whether explicitly focusing on expectancy violation leads to superior exposure outcomes.Method: Adult treatment-seeking patients with PTSD (N = 60) were randomly assigned to one 90-minute exposure session focusing on either expectancy violation or a control condition without an expectancy focus. Assessments occurred before the session and one week later, measuring changes in fear responses during a script-driven imagery task, and PTSD symptoms.Results: Using multilevel analyses, we found no between-condition differences. On average, fear responses to the imagery and PTSD symptoms decreased over time. The expectancy violation condition exhibited a greater decrease in threat appraisal, which appeared to mediate symptom reduction.Conclusions: We found no evidence that explicitly focusing on expectancy violation led to superior immediate effects. However, it may lead to more changes in expectancies which could affect symptom improvement over an extended period. Further research is needed to determine whether emphasizing expectancy violation in exposure therapy for PTSD is advantageous.

The silent pandemic of stress: impact on menstrual cycle and ovulation

In the current age of technological advancement, stress has emerged as a silent pandemic affecting individuals, especially young generations, globally. Factors such as increased competition, social pressures fueled by social media and smartphones, and a sense of diminished control in the face of modern challenges contribute to rising stress levels. In addition to the negative implications on mental well-being, stress affects physiological processes such as the menstrual cycle. Functional hypogonadotropic hypogonadism is a spectrum ranging ranging from regular menstrual cycles with short or insufficient luteal phases to irregular cycles, oligomenorrhea, anovulation, and complete amenorrhea, depending on how stress variably disrupts gonadotropic-releasing hormone (GnRH) drive. Functional hypothalamic amenorrhea (FHA), the most severe manifestation, is a complex global neuroendocrinopathy with several serious health consequences in addition to amenorrhea and infertility. Concomitant health consequences include bone loss, endothelial dysfunction, and cardiovascular risks. The collective health burden underscores the need for clinical awareness and comprehensive treatment strategies addressing behavioral and biopsychosocial stressors that lead to chronic hypothalamic-pituitary-adrenal (HPA) axis activation. Despite its prevalence and numerous adverse health consequences, research on this condition remains limited, revealing a significant gap in understanding and addressing this condition. Larger and long-term follow-up studies are important to accurately assess FHA prevalence, its health consequences, intervention efficacy, and recovery outcomes.

Understanding and supporting parenting in parents seeking PTSD treatment: a qualitative study

Background: Parental post-traumatic stress disorder (PTSD) can impact parenting and child psychosocial wellbeing. Complementing trauma-focused psychotherapy with parenting interventions can thus have important preventive value. Understanding parents' lived experiences is necessary to tailor such interventions to their needs.Objective: This study addressed the question: how can preventive parenting support be shaped to the needs of parents entering specialized psychotherapy for PTSD? To answer this question, we investigated parenting challenges, parent-child communication about PTSD, strengths, and social support experiences of parents with PTSD.Method: The sample included 14 parents seeking PTSD treatment at a tertiary mental healthcare institution, while parenting children aged 4-17. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis.Results: On the one hand, parental dysregulation (e.g. exploding or shutting down) was an important challenge. On the other hand, parents' attempts to remain regulated (e.g. through overcontrol and overprotectiveness) also affected family life. When talking to their child about PTSD, parents were guided by what they considered beneficial for the child to know. An important strength was that parents tried to remain attuned to the child's needs, regardless of their own struggles. Parents also described experiences that could be understood as post-traumatic growth through parenting. Generally, parents experienced a lack of social support.Conclusion: Our findings illustrate that parents entering PTSD treatment are highly motivated to do what is best for their child. Based on parents' lived experiences, preventive parenting interventions should address the impacts of both dysregulation and overcontrolling regulation attempts. Another important goal is reducing feelings of incompetence. Integrating the parenting role in psychotherapy for PTSD could also be beneficial. For example, setting parenting-related therapy goals can be motivating. Furthermore, parent-child interactions can be a mirror that reflects the parents' inner state: considering these interactions can help recognize changes in symptomatology.

Childhood abuse and neglect and adult body attitude

Background: The body is the medium through which humans experience the world, and the body is key to most suffering, healing, and clinical mental diagnoses. Body attitude refers to the affective, cognitive, and behavioural aspects of embodiment, which typically is more negative in clinical samples.Objective: We examine how adult body attitude is associated with self-reported childhood abuse and neglect. We hypothesised that child sexual abuse is associated stronger with a negative adult body attitude than emotional or physical abuse/neglect would. Second, we expected that the association between body attitude and childhood sexual abuse was gender equivalent. Third, we expected a more positive body attitude in men than women after childhood physical abuse/neglect or emotional abuse/neglect.Method: Body attitude was measured with the Dresden Body Image Questionnaire (DBIQ-NL) and the severity and type of childhood trauma with the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in 749 Dutch adults aged 18-77. We fit multiple regression models and focused on childhood abuse and neglect with moderate to severe intensity.Results: Childhood sexual abuse (∼15%), physical neglect (∼14%), emotional abuse (∼20%) and emotional neglect (∼30%) are associated with a more negative body attitude, while childhood physical abuse (moderate/severe, ∼6%) associated with a slightly more positive adult body attitude. Body attitude associations with childhood abuse/neglect were similar for both genders (no moderation).Conclusion: Child maltreatment seems to precede the development of a more negative adult body attitude and more negative body experiences compared to individuals without child maltreatment.

Effectiveness of a resilience, gender equity and mental health group intervention for young people living in informal urban communities in North India: a cluster randomized controlled trial

BACKGROUND

Mental health problems are the leading cause of disease burden among young people in India. While evidence shows that youth mental health and resilience can be improved with group interventions in school settings, such an intervention has not been robustly evaluated in informal urban settings.

OBJECTIVE

This study aimed to evaluate whether the Nae Disha 3 group intervention could improve youth resilience, mental health and gender equal attitudes among disadvantaged young people from low-income urban communities in India.

METHODS

This cluster randomised controlled trial used an analytic sample of 476 adolescents and young adults aged 11-25 years from randomised clusters in urban Dehradun, India. The 251 intervention group participants were 112 boys and 139 girls, and the 225 young people in the wait-control group were 101 boys and 124 girls. Five validated tools measuring resilience gender equity and mental health were filled by participants at three different points in time.

RESULTS

Difference in difference (DiD) analysis at T2 showed that scores improved among girls in intervention group, for adjusted model, resilience (DiD = 4.12; 95% CI: 2.14, 6.09) and among boys, for resilience (DiD = 5.82; 95% CI: 1.57, 9.74).

CONCLUSIONS

The Nae Disha 3 intervention among disadvantaged urban youth moderately improved resilience for both young men and women, though it did not significantly impact mental health, self-efficacy, or gender-equal attitudes. We establish potential merit for this approach to youth mental health but recommend further research to examine active ingredients and the ideal duration of such group interventions.

Gut microbiome changes with micronutrient supplementation in children with attention-deficit/hyperactivity disorder: the MADDY study

Micronutrients have demonstrated promise in managing inattention and emotional dysregulation in children with attention-deficit/hyperactivity disorder (ADHD). One plausible pathway by which micronutrients improve symptoms is the gut microbiome. This study examines changes in fecal microbial composition and diversity after micronutrient supplementation in children with ADHD (N = 44) and highlights potential mechanisms responsible for the behavioral improvement, as determined by blinded clinician-rated global improvement response to micronutrients. Participants represent a sub-group of the Micronutrients for ADHD in Youth (MADDY) study, a double blind randomized controlled trial in which participants received micronutrients or placebo for 8 weeks, followed by an 8-week open extension. Stool samples collected at baseline, week 8, and week 16 were analyzed using 16S rRNA amplicon sequencing targeting the V4 hypervariable region. Pairwise compositional analyses investigated changes in fecal microbial composition between micronutrients versus placebo and responders versus non-responders. A significant change in microbial evenness, as measured by alpha diversity, and beta-diversity, as measured by Bray-Curtis, was observed following micronutrients supplementation. The phylum Actinobacteriota decreased in the micronutrients group compared to placebo. Two butyrate-producing bacterial families: Rikenellaceae and Oscillospiraceae, exhibited a significant increase in change following micronutrients between responders versus non-responders. These findings suggest that micronutrients modulated the composition of the fecal microbiota and identified specific bacterial changes associated with micronutrient responders.

Neural dynamics of deception: insights from fMRI studies of brain states

Deception is a complex behavior that requires greater cognitive effort than truth-telling, with brain states dynamically adapting to external stimuli and cognitive demands. Investigating these brain states provides valuable insights into the brain's temporal and spatial dynamics. In this study, we designed an experiment paradigm to efficiently simulate lying and constructed a temporal network of brain states. We applied the Louvain community clustering algorithm to identify characteristic brain states associated with lie-telling, inverse-telling, and truth-telling. Our analysis revealed six representative brain states with unique spatial characteristics. Notably, two distinct states-termed truth-preferred and lie-preferred-exhibited significant differences in fractional occupancy and average dwelling time. The truth-preferred state showed higher occupancy and dwelling time during truth-telling, while the lie-preferred state demonstrated these characteristics during lie-telling. Using the average z-score BOLD signals of these two states, we applied generalized linear models with elastic net regularization, achieving a classification accuracy of 88.46%, with a sensitivity of 92.31% and a specificity of 84.62% in distinguishing deception from truth-telling. These findings revealed representative brain states for lie-telling, inverse-telling, and truth-telling, highlighting two states specifically associated with truthful and deceptive behaviors. The spatial characteristics and dynamic attributes of these brain states indicate their potential as biomarkers of cognitive engagement in deception.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11571-025-10222-4.

Development of a dyadic mindfulness self-compassion intervention for patients with lung cancer and their family caregivers: A multi-method study

Objective

Lung cancer and its prolonged treatment are profoundly unsettling for patients and their family caregivers, and developing dyadic measures to alleviate their negative affectivity is pivotal. This study aimed to develop a complex intervention to alleviate dyadic psychological stress among patients with lung cancer and their family caregivers.

Methods

A stepwise multi-method study was conducted following the Medical Research Council framework. Three phases were adopted, namely: (1) a preparation phase, a systematic review was conducted to identify the evidence base, (2) a development phase, empirical data from a quantitative study and a qualitative study were integrated to identify effective components, and (3) a modification phase, an online Delphi survey was carried out to refine the intervention.

Results

The dyadic Mindfulness Self-Compassion intervention developed in this study consists of six weekly sessions. The key components of the intervention include: (1) getting along with cancer (introductory session targets illness perception), (2) practising mindful awareness (core session for mindfulness), (3) defining dyadic relationships and introducing self-compassion (core session for self-compassion), (4) promoting dyadic communication (maintenance session targets communication skills), (5) promoting dyadic coping (maintenance session targets coping skills), and (6) a summary session reviewing the rewards and challenges of dyadic adaptation named embracing the future.

Conclusions

An evidence-based, theory-driven, and culturally appropriate dyadic Mindfulness Self-Compassion intervention was developed for patients with lung cancer and their family caregivers. Future studies are warranted to pilot and evaluate the usability, feasibility, acceptability, satisfaction, and effectiveness of this complex intervention.

Trial registration

ClinicalTrial.gov NCT04795700.

"They are just as different as the rest of us" - a focus group study of primary teachers' perceptions of children with ADHD who struggle socially

PURPOSE

Difficulties in peer interactions are common among children with ADHD and associated with severe consequences. Prevailing interventions have been criticized for not accounting for the significance of context and for limited effect on important social outcomes. Given the importance of the school environment and the teacher for children's social development, we wanted to explore how teachers perceive their own role and responsibilities when children are struggling socially, and how they intervene in their daily practice.

METHODS

We conducted semi-structured interviews in five focus groups of primary school teachers in Bergen, Norway and analysed the data through reflexive thematic analysis.

RESULTS

We discerned two overarching themes, each with several subthemes. The first theme, "Monitoring and Attending to Individual Needs in a Context", represents teachers' perceptions of their role and responsibilities. The second theme, "Tailoring Interventions Through Continuous Assessments", represents the teachers' strive to fulfil this role in their everyday practice.

CONCLUSION

Our findings reflect a complex, contextual understanding of social difficulties, acknowledging the uniqueness of each child, regardless of diagnosis. The teachers' practice was characterized by continuous tailoring to accommodate the specific, contextualized needs of each child, both "behind the scenes" and trough participating in children's everyday social interactions.

Metacognition of one's strategic planning in decision-making: the contribution of EEG correlates and individual differences

The metacognition of one's planning strategy constitutes a "second-level" of metacognition that goes beyond the knowledge and monitoring of one's cognition and refers to the ability to use awareness mechanisms to regulate execution of present or future actions effectively. This study investigated the relation between metacognition of one's planning strategy and the behavioral and electrophysiological (EEG) correlates that support strategic planning abilities during performance in a complex decision-making task. Moreover, a possible link between task execution, metacognition, and individual differences (i.e., personality profiles and decision-making styles) was explored. A modified version of the Tower of Hanoi task was proposed to a sample of healthy participants, while their behavioral and EEG neurofunctional correlates of strategic planning were collected throughout the task with decisional valence. After the task, a metacognitive scale, the 10-item Big Five Inventory, the General Decision-Making Style inventory, and the Maximization Scale were administered. Results showed that the metacognitive scale enables to differentiate between the specific dimensions and levels of metacognition that are related to strategic planning behavioral performance and decision. Higher EEG delta power over left frontal cortex (AF7) during task execution positively correlates with the metacognition of one's planning strategy for the whole sample. While increased beta activity over the left frontal cortex (AF7) during task execution, higher metacognitive beliefs of efficacy and less willingness to change their strategy a posteriori were correlated with specific personality profiles and decision-making styles. These findings allow researchers to delve deeper into the multiple facets of metacognition of one's planning strategy in decision-making.

EEG-based cross-subject passive music pitch perception using deep learning models

Pitch plays an essential role in music perception and forms the fundamental component of melodic interpretation. However, objectively detecting and decoding brain responses to musical pitch perception across subjects remains to be explored. In this study, we employed electroencephalography (EEG) as an objective measure to obtain the neural responses of musical pitch perception. The EEG signals from 34 subjects under hearing violin sounds at pitches G3 and B6 were collected with an efficient passive Go/No-Go paradigm. The lightweight modified EEGNet model was proposed for EEG-based pitch classification. Specifically, within-subject modeling with the modified EEGNet model was performed to construct individually optimized models. Subsequently, based on the within-subject model pool, a classifier ensemble (CE) method was adopted to construct the cross-subject model. Additionally, we analyzed the optimal time window of brain decoding for pitch perception in the EEG data and discussed the interpretability of these models. The experiment results show that the modified EEGNet model achieved an average classification accuracy of 77% for within-subject modeling, significantly outperforming other compared methods. Meanwhile, the proposed CE method achieved an average accuracy of 74% for cross-subject modeling, significantly exceeding the chance-level accuracy of 50%. Furthermore, we found that the optimal EEG data window for the pitch perception lies 0.4 to 0.9 s onset. These promising results demonstrate that the proposed methods can be effectively used in the objective assessment of pitch perception and have generalization ability in cross-subject modeling.

Imageless optical navigation system is clinically valid for total knee arthroplasty

Achieving optimal implant position and orientation during total knee arthroplasty (TKA) is a pivotal factor in long-term survival. Computer-assisted navigation (CAN) has been recognized as a trusted technology that improves the accuracy and consistency of femoral and tibial bone cuts. Imageless CAN offers advantages over image-based CAN by reducing cost, radiation exposure, and time. The purpose of this study was to evaluate the accuracy of an imageless optical navigation system for TKA in a clinical setting. Forty-two consecutive patients who underwent primary TKA with CAN were retrospectively reviewed. Femoral and tibial component coronal alignment was assessed via post-operative radiographs by two independent reviewers and compared against coronal alignment angles from the CAN. The primary outcome was the mean absolute difference of femoral and tibial varus/valgus angles between radiograph and intra-operative device measurements. Bland-Altman plots were used to assess agreement between the methods and statistically analyze potential systematic bias. The mean absolute differences between navigation-guided cut measurements and post-operative radiographs were 1.16 ± 1.03° and 1.76 ± 1.38° for femoral and tibial alignment respectively. About 88% of coronal measurements were within ±3°, while 99% were within ±5°. Bland-Altman analysis demonstrated a bias between CAN and radiographic measurements with CAN values averaging 0.52° (95% CI: 0.11°-0.93°) less than their paired radiographic measurements. This study demonstrated the ability of an optical imageless navigation system to measure, on average, femoral and tibial coronal cuts to within 2.0° of post-operative radiographic measurements in a clinical setting.

Examining attentional avoidance in post-traumatic stress disorder: an exploratory 'Face in the Crowd' paradigm using eye-tracking

Background: Maladaptive patterns of attention to emotional stimuli are a clinical feature of posttraumatic stress disorder (PTSD). Using eye-tracking-based methodology, research points out the presence of sustained attention to threatening stimuli in individuals with PTSD. However, most eye-tracking studies in this field used free-viewing tasks on negative stimuli.Methods: PTSD patients (n = 38), trauma-exposed healthy controls (TEHC; n = 30), and non-trauma-exposed healthy controls (HC; n = 33) performed a Face in the Crowd (FiC) task. The FiC task was chosen to explore specific responses to emotional stimuli within a competitive visual environment, thus providing insights into visual search patterns. Both reaction time and gaze patterns (dwell time, scanpath length, first fixation duration, and latency) were recorded.Results: Individuals with a provisional PTSD diagnosis presented decreased dwell time on both positive and negative targets in comparison with HC and TEHC, as well as shorter scanpath length for all matrixes when no targets were present. No evidence of attentional bias was observed in the TEHC group based on reaction times or eye-tracking measures in response to positive, negative, or neutral cues.Discussion: We found an attentional avoidance pattern among PTSD patients, along with indexes of lowered perceptual threshold for all emotional information. This study allows raising the question of cognitive load on the emergence of differential attentional strategies presented by PTSD participants. We discuss the generalization of fear processes across different emotional stimuli and underscore the need for incorporating a variety of emotional stimuli in PTSD research.

Development and validation of the Oxford Benchmark Scale for Rating Vaccine Technologies (OBSRVT), a scale for assessing public attitudes to next-generation vaccine delivery technologies

Next-generation vaccine delivery technologies may provide significant gains from both a technical and behavioral standpoint, but no scale has yet been developed to assess public attitudes to novel vaccine delivery technologies. We therefore performed a cross-sectional validation study that included 1,001 demographically representative participants from the UK and US to develop and validate a novel scale, the Oxford Benchmark Scale for Rating Vaccine Technologies (OBSRVT). A sample of 500 UK participants was used to perform exploratory factor analysis with categorical variables (using a polychoric correlation matrix) followed by promax oblique factor rotation to develop the initial model. This yielded a 15-item 4-domain scale with domains including acceptance (6 items), effectiveness (4 items), comfort (3 items), and convenience (2 items). This model was tested for robustness on a 501-participant demographically representative sample from the US. A confirmatory factor analysis with a Satorra-Bentler scaled test statistic was performed, which demonstrated adequate goodness of fit statistics including the root mean squared error of approximation (0.057), standardized root mean squared residual (0.053), and comparative fit index (0.938). Reliability as internal consistency was excellent (alpha = 0.92). Convergent validity with the Oxford Needle Experience Scale was supported by an adequate correlation (r = 0.31, p < .0001), while discriminant validity was supported by a lack of correlation with an unrelated question (r = -0.03, p < .0001). These findings suggest that the OBSRVT scale represents a feasible, valid, and reliable scale that could be used to gauge the acceptability of existing and future vaccine delivery technologies, and further investigation and testing should be considered.

Effects of congruent and incongruent appetitive and aversive well-being comparisons on depression, post-traumatic stress, and self-esteem

Background: People compare their current well-being to different comparison standards (e.g. social or temporal comparisons). These standards are considered as aversive if perceived as threatening to self-motives or appetitive if perceived as consistent with self-motives. However, it remains unknown whether the congruence (vs. incongruence) of aversive and appetitive well-being comparisons (high levels of both vs. preponderance of aversive comparisons over appetitive comparisons) is differentially related to symptoms of depression and post-traumatic stress disorder (PTSD) and self-esteem.Methods: We conducted response surface analysis (RSA) on data from a study with two-timepoints three months apart (N = 921). RSA tests whether the degree of (in-)congruence of two variables is positively or negatively related to an outcome variable. Here, baseline aversive and appetitive well-being comparisons (comparison frequency, discrepancy, and affective impact) served as the two predictor variables, while depression, PTSD, and self-esteem three months later served as outcomes.Results: Findings partially confirmed our hypotheses. Congruently high (vs. low) levels of aversive and appetitive comparison frequency and discrepancy predicted more depressive/PTSD symptoms and lower self-esteem. Some evidence indicated more pronounced depressive symptoms and lower self-esteem (but not PTSD) for the preponderance of aversive over appetitive comparisons.Conclusions: The effects of congruent and incongruent aversive and appetitive comparisons as well as a potentially more crucial role of aversive than appetitive well-being comparisons in depression and self-esteem align with comparison theory.

Maladaptive appraisals and posttraumatic stress reactions in young terror survivors across 8 years: a random intercepts cross-lagged analysis

Background: Though there is substantial support for the importance of maladaptive appraisals for the development of posttraumatic stress reactions (PTSR), little is known about the long-term temporal relationship between maladaptive appraisals and PTSR beyond the first year after a traumatic event.Objective: We aimed to investigate three research questions: (1) Does the level of maladaptive appraisals change over time? (2) Are maladaptive appraisals and PTSR concurrently related to each other in the long term? (3) What is the direction of the temporal relationship between maladaptive appraisals and PTSR?Method: The participants were young survivors after the terror attack at Utøya island in Norway in 2011. We included data measured at 14-15 months, 30-32 months, and 102-108 months post trauma. The participants (N = 315) were all younger than 25 years at the time of the attack (mean age was 18.4, SD = 2.3), and 48.3% were female. The aims were investigated using correlations, paired t-tests, random intercept cross-lagged panel models (RI-CLPM), and cross-lagged panel models (CLPM).Results: We found a significant decrease in PTSR severity from 14-15 months to 30-32 months, and there was a significant increase in the mean level of maladaptive appraisals from 30-32 months to 102-108 months post trauma. Maladaptive appraisals and PTSR were highly associated across the three time points. Stable individual differences seem to account for most of the longitudinal relationship between maladaptive appraisals and PTSR, and we did not find clear indications of a direction of the temporal relationship between the variables.Conclusions: Our results indicate that the level of maladaptive appraisals can be quite stable once established, that they remain associated with PTSR, and that the long-term relationship between maladaptive appraisals and PTSR in the years following a trauma may best be explained by stable individual differences.

Adverse childhood experiences and intimate partner violence in adulthood among transgender women: exploring the chain mediating role of self-esteem and LGBT minority stress

BACKGROUND

Transgender women experience a high incidence of intimate partner violence (IPV) in adulthood. The well-documented risk factors contributing to IPV include adverse childhood experiences (ACEs), low self-esteem, and the minority stress experienced by LGBT individuals. The object of the present study was to examine how ACEs influence IPV in adulthood, and to explore the chain mediating function of self-esteem and LGBT minority stress.

METHODS

In February 2022, we recruited 264 transgender women through snowball sampling in Shenyang, China. Participants completed a questionnaire assessing background characteristics, ACEs, IPV in adulthood, self-esteem and LGBT minority stress. Relationships among study variables were examined through variance and correlation analyses. A chain mediation model was tested using PROCESS.

RESULTS

There was a significant correlation among the four variables. ACEs positively predicted IPV in adulthood (r = 0.449, p < 0.001). The sequential mediation model demonstrated that self-esteem (the estimated effect = 0.0708, 95%CI: 0.0152-0.1327) and minority stress (the estimated effect = 0.0404, 95%CI: 0016-0.0847) had the potential to mediate the connection between ACEs and IPV respectively. Additionally, the combined mediating influence of self-esteem and minority stress (the estimated effect = 0.0298, 95%CI: 0.0105-0.0591) similarly exerted such an effect. In summary, the mediating effect accounts for 34.59% of the overall effect size.

CONCLUSION

Taken together, the findings underscore the high prevalence of IPV among Chinese transgender women, highlighting the need for additional attention from violence service providers and other healthcare professionals on ACEs, low self-esteem, and minority stress, as these factors may place this population at risk for IPV.

Self-compassion, self-coldness, and social support and their relationship with depression, anxiety, and PTSD symptoms following a massive terror attack: a prospective study

Background: On 7 October 2023, Israel suffered a massive deadly terror attack with 1400 civilians murdered and 240 kidnapped. Recent studies have documented an increase in depression, anxiety, and posttraumatic symptoms in the aftermath of the attack. In the area of trauma, it has been shown that while some individuals are vulnerable to developing psychopathology following exposure to a traumatic event, the majority are not.Objective: In the present prospective study, we examined the contributions of internal (self-compassion and self-coldness) and external (social support) resources to depression, anxiety, and posttraumatic symptoms among civilians following a massive terror attack.Method: A total of 250 participants - 126 females (50.4%) and 124 males (49.6%); 156 Jews (62.4%) and 94 Arabs (37.6%) - aged 21-60 (M  = 41.7, SD = 10.63) completed questionnaires at two time points: T1 was in September 2023 (3-4 weeks before the attack) and T2 was in February-March 2024 (19-20 weeks after the attack). Participants were assessed using the Multidimensional Scale of Perceived Social Support (MSPSS), Self-Compassion Scale - Short Form (SCS-SF), Depression, Anxiety, and Stress Scale-21 Items (DASS-21), and International Trauma Questionnaire (ITQ).Results: Self-compassion and social support were negatively associated with depression and anxiety, while self-coldness was positively associated with depression and anxiety. In addition, self-coldness uniquely contributed to the prediction of psychopathological outcomes, including the sense of threat symptoms cluster of posttraumatic stress disorder, beyond known risk factors.Conclusions: Our study highlights the role of self-coldness as a vulnerability factor for civilians following a terror attack. It is important to view the distinct facets of self-compassion as a therapeutic target when building both intervention and prevention programs for people exposed directly and indirectly to trauma.

Study of glucose homeostasis in burnout cases using an oral glucose tolerance test

Burnout is caused by long term psychosocial stress and has, besides the fatigue and mental health burden, been associated with increased risk of adverse physical health, such as for example type 2 diabetes. This study aims to investigate the glucose and insulin levels in individuals with stress related burnout, by assessing these metabolic markers in response to a standard oral glucose tolerance test (OGTT). 38 cases with burnout (13 men and 25 women) and 35 healthy controls (13 men and 22 women) in the age 24-55 were included in the study. The burnout group overall did not differ from healthy controls in glucose or insulin levels during the OGTT. However, the burnout cases who reported more severe burnout symptoms exhibited significantly higher levels of both glucose and insulin levels during the OGTT compared to burnout cases reporting lower severity of symptoms. Furthermore, the group of burnout cases who reported symptoms of depression exhibited higher insulin levels during OGTT compared to the burnout cases without depressive symptoms. The observed higher levels in the burnout cases with most severe symptoms indicate an increased diabetic risk in these patients and it may be of importance to follow glucose and insulin levels in individuals with more severe symptoms of burnout i.e. to perform an OGTT.

Insights into depression prediction, likelihood, and associations in children and adolescents: evidence from a 12-years study

Purpose

The severity of depression among young Australians cannot be overstated, as it continues to have a profound impact on their mental health and general wellbeing. This study used machine learning (ML) algorithms to analyse longitudinal data, identifying key features to predict depression, assess future risk, and explore age-specific behaviours that contribute to its progression over time. The results emphasize the significance of early detection to prevent unfavourable consequences and shed light on the alterations in depressive symptoms during various stages of development.

Methods

Three widely regarded ML techniques-random forest (RF), support vector machine (SVM), and logistic regression (LR)-are being applied and compared with a longitudinal data analysis. Additionally, the Apriori algorithm is being utilized to explore potential relationships between health, behaviour, and activity issues with depression among different age groups (10-17).

Results

The analysis results indicate that the RF model is performing exceptionally well in diagnosing depression, with a 94% accuracy rate and weighted precision of 95% for non-depressed and 88% for depressed cases. In addition, the LR model shows promising results, achieving an 89% accuracy rate and 91% weighted precision. Moreover, insights from the Apriori algorithm underscore the significance of early detection by examining potential associations between health, behaviour, and activity problems and depression across diverse age groups.

Conclusion

Combining early screening programs with the RF model and the Apriori algorithm is crucial for understanding depression and developing effective prevention strategies. Emphasizing Apriori's factors and regularly updating strategies with new information will enhance depression management and prevention.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13755-025-00335-9.

MicroRNAs as potential biomarkers for diagnosis of post-traumatic stress disorder

Post-traumatic stress disorder is a mental disorder caused by exposure to severe traumatic life events. Currently, there are no validated biomarkers or laboratory tests that can distinguish between trauma survivors with and without post-traumatic stress disorder. In addition, the heterogeneity of clinical presentations of post-traumatic stress disorder and the overlap of symptoms with other conditions can lead to misdiagnosis and inappropriate treatment. Evidence suggests that this condition is a multisystem disorder that affects many biological systems, raising the possibility that peripheral markers of disease may be used to diagnose post-traumatic stress disorder. We performed a PubMed search for microRNAs (miRNAs) in post-traumatic stress disorder (PTSD) that could serve as diagnostic biomarkers and found 18 original research articles on studies performed with human patients and published January 2012 to December 2023. These included four studies with whole blood, seven with peripheral blood mononuclear cells, four with plasma extracellular vesicles/exosomes, and one with serum exosomes. One of these studies had also used whole plasma. Two studies were excluded as they did not involve microRNA biomarkers. Most of the studies had collected samples from adult male Veterans who had returned from deployment and been exposed to combat, and only two were from recently traumatized adult subjects. In measuring miRNA expression levels, many of the studies had used microarray miRNA analysis, miRNA Seq analysis, or NanoString panels. Only six studies had used real time polymerase chain reaction assay to determine/validate miRNA expression in PTSD subjects compared to controls. The miRNAs that were found/validated in these studies may be considered as potential candidate biomarkers for PTSD and include miR-3130-5p in whole blood; miR-193a-5p, -7113-5p, -125a, -181c, and -671-5p in peripheral blood mononuclear cells; miR-10b-5p, -203a-3p, -4488, -502-3p, -874-3p, -5100, and -7641 in plasma extracellular vesicles/exosomes; and miR-18a-3p and -7-1-5p in blood plasma. Several important limitations identified in the studies need to be taken into account in future studies. Further studies are warranted with war veterans and recently traumatized children, adolescents, and adults having PTSD and use of animal models subjected to various stressors and the effects of suppressing or overexpressing specific microRNAs.

Visuals versus textual scales: Optimizing reliability and user experience in observational assessment of parent-child interaction

Objective

Assessment of parent-child interaction by practitioners is of great importance but hindered by a lack of instruments that withstand the constraints daily practice places on usage. Visuals may offer an alternative format. Visualizations were tested on reliability, accuracy, and feasibility in observational assessment of parent-child interaction, as alternatives for textual rating scales.

Methods

In Study 1, 95 students rated parent-child interactions with a video or text anchor scale, and in Study 2, 217 professionals rated the same interactions with a decision tree including visual components or a text anchor scale.

Results

Students using the video anchor scale were less reliable and accurate, slower, and had a less positive user experience than students using the text anchor scale. Professionals using the decision tree did not differ in reliability and were comparable in user experience with professionals using the text anchor scale. Rater accuracy showed similar dependency on quality of parental behavior for both scales: ratings were less accurate when the quality of the parent-child interaction was low, and more accurate when the quality was high. However, professionals were less accurate and slower in using the decision tree than the text anchor scale.

Conclusion

With a first iteration of a decision tree performing the same to or only slightly worse, efforts to further develop decision trees might be worthwhile.

Innovation

These nonintuitive findings underscore the value of experimental testing in assessment design in daily practice.

Measuring implicit associations with behaviours to improve resident mood: development of implicit association tasks for nursing home care providers

Objective

To develop and evaluate instruments for measuring implicit associations of nursing home care providers with behaviours aimed at improving resident mood.

Method

Study 1 (N = 41) followed an iterative approach to develop two implicit association tasks measuring implicit attitude (positive versus negative valence) and motivation (wanting versus not wanting) regarding mood-improving behaviours, followed by an evaluation of the content validity for target stimuli representing these behaviours. In Study 2 (N = 230), the tasks were assessed for stimulus classification ease (accuracy and speed) and internal consistency. A subsample (n = 111) completed additional questionnaires to evaluate convergent validity (with self-reported attitudes towards depression, altruism, and mood-improving behaviours), and discriminant validity (against social desirability), and repeated the tasks after 2 weeks to assess test-retest reliability.

Results

Content validity indexes for target stimuli were satisfactory. Error rates were acceptable for attribute stimuli, but exceeded the 10 % limit for target stimuli. Response times for all stimuli exceeded the 800-millisecond threshold. Both tasks demonstrated good internal consistency but poor test-retest reliability. Regarding convergent validity, both tasks significantly correlated with altruism, the implicit attitude task associated with self-reported mood-improving behaviours, and the implicit motivation task correlated with the behavioural scale of attitudes towards depression. Discriminant validity was supported as neither task was significantly associated with social desirability.

Conclusions

The implicit association tasks show potential for measuring implicit associations with mood-improving behaviours of care providers, offering an innovative pathway for exploring processes influencing caregiving behaviours. However, limitations in psychometric properties were identified, aligning with challenges observed in similar measures.

Counterfactual thinking is associated with impoverished attentional control in women prone to self-critical rumination

BACKGROUND AND OBJECTIVES

Excessive engagement in counterfactual thinking (CFT), where individuals imagine alternative outcomes to past events, is associated with rumination, a process characterized by repetitive negative self-referential thoughts. Attentional control difficulties are closely linked with rumination, and negative thoughts can negatively impact attentional control among rumination-prone individuals. This study aimed to investigate the relationship between CFT and emotional and non-emotional attentional control among individuals with varying levels of self-critical rumination.

METHODS

A sample of 100 female participants, characterized by varying levels of self-critical rumination, completed a choice task resulting in goal failure, during which they reported their levels of CFT. Subsequently, participants performed an attentional control task involving eye-tracking measures to assess emotional attentional engagement, emotional attentional disengagement, and emotional and non-emotional attentional shifting.

RESULTS

Among women with high (but not low) self-critical rumination tendencies, increased levels of CFT were associated with slower attentional shifting from emotional stimuli of opposing valence, as well as between non-emotional stimuli.

LIMITATIONS

The correlational design of the study prevents causal interpretations of the findings. Additionally, the exclusive inclusion of female participants may limit the generalizability of the results.

CONCLUSIONS

This study underscores the association of CFT with subsequent attentional control among women prone to self-critical rumination, aligning with prior research suggesting a link between negative thoughts and attentional processes. Future research should explore these relationships in diverse populations and consider longitudinal designs to elucidate causal pathways.

A cross-sectional study on the association between executive functions and social disabilities in people with a psychotic disorder

Background

Social recovery (SR) in people with psychotic disorders involves taking on social roles and completing daily tasks. Functional recovery (FR), particularly executive functions, is critical for these roles. Psychotic disorder patients often experience severe cognitive impairments, especially in executive functions. This study investigates the relationship between functional and social recovery in individuals with psychotic disorders and examines the effect of employment status on this association.

Method

This cross-sectional study involved people with a psychotic disorder. SR was measured using the WHO-DAS, divided into Daily Functioning (DF) and Social Functioning (SF) scales. FR was measured using the BRIEF-A and the TOL. Employment status was categorized into Non-active, Otherwise Active, and Active. The Likelihood-ratio Test (LRT) was used for model selection.

Results

Data from 251 participants (mean age 41.5) showed that the BRIEF-A affected both DF and SF, while the TOL only affected DF. Only being Otherwise Active influenced DF. Employment status had no influence on SF. Being Otherwise Active positively influenced perceived disabilities in Daily Functioning.

Conclusion

Measuring executive functions using both performance-based and self-report measures is important. Both measures are associated differently with perceived disabilities in daily and social functioning. Being a volunteer or looking for a job positively influences perceived disabilities in Daily Functioning.

Nicotine and cannabis vaping among early high school adolescents: Disparities of use across sociodemographic characteristics and associations with psychosocial factors

Objective. This study examines whether adolescent nicotine and cannabis vaping types (i.e., nicotine-only, cannabis-only, and dual use) differ across sociodemographic and school characteristics (e.g., age, gender, sexual identity, race/ethnicity, socioeconomic status [SES], school setting/type), and associations of vaping types with psychosocial factors. Methods. From 2021 to 2022, 9th and 10th grade adolescents (N = 2,476) in Colorado and Ohio participated in a survey measuring vaping behaviors and psychosocial factors including substance use attitudes, alcohol use, mental health, aggression, and family and school risk and protective factors. Results. Past month vaping prevalence was 89.7 % for non-use, 5.9 % for nicotine-only, 1.0 % for cannabis-only, and 3.4 % for dual use. Chi-square tests of independence showed several significant sociodemographic differences for past month vaping: higher nicotine-only vaping prevalence for females (vs. males) (p < 0.001), higher nicotine-only and dual vaping prevalence for LGB+ (vs. heterosexual) youth (ps < 0.01), higher dual vaping prevalence for Hispanic and multiethnic (vs. White) adolescents (p < 0.001), and higher nicotine-only, cannabis-only, and dual vaping prevalence for lower (vs. higher) mother education (ps < 0.001). Regression models examining associations between vaping types (vs. non-use) and psychosocial factors indicated a robust pattern of worse levels of substance use attitudes, alcohol use, mental health, aggression, and family and school factors for nicotine-only and dual users. Results followed a similar pattern but to a lesser degree for cannabis-only users. Conclusions. Findings identify characteristics of adolescents who may be particularly vulnerable to higher vaping risk (females, LGB+, Hispanic, multiethnic, low SES) and suggest needs for preventive interventions aimed to reduce all types of vaping for better adolescent behavioral health.

A Dual Biomarker Approach to Stress: Hair and Salivary Cortisol Measurement in Students via LC-MS/MS

Stress is a significant issue among students, affecting both their mental and physical health. In this study, we investigated cortisol levels, a key biomarker for stress, in students at the United Arab Emirates University (UAEU) during their exam period. Using a sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) methodology we measured cortisol concentrations in hair and saliva samples and explored the potential correlation between exam-induced stress and cortisol levels. The results revealed an increase in cortisol levels during the exam period, with male students showing an average hair cortisol concentration of 150.625 pg/mg and female students displaying an average of 77.756 pg/mg. Salivary cortisol levels ranged from 0.002 to 9.189 ng/mL, with an overall average of 4.505 ng/mL. Statistical analysis revealed significant differences in cortisol levels between male and female students, underscoring the impact of exam-related stress on both acute and chronic stress markers. This study underscores the importance of addressing academic stress and suggests targeted strategies to mitigate its impact on student health ultimately fostering an environment encouraging both academic success and psychological well-being within the student community. Future research directions include exploring additional clinical parameters and expanding the study population to further understand the long-term effects of academic stress.

Development and psychometric validation of the frontline health workers' occupational risk and characteristics in emergencies index (FORCE-index) - The covid Hospital cohort study

Objectives

A lack of tools for the systematic identification of frontline health workers' changing occupational risks, characteristics, and needs, poses a major barrier to supporting vital personnel to stay in practice through health emergencies and beyond. The current study reports on the development and psychometric evaluation of the Frontline health workers' Occupational Risk and Characteristics in Emergencies index (FORCE-index).

Study design

The Covid hospital study is a large, multisite, four-wave, open cohort study of frontline health workers responding to the first four waves of the COVID-19 pandemic (2020-2022).

Methods

2496 frontline health workers responded to questionnaires assessing various aspects of their work environment. Using exploratory factor analysis, we estimated the latent structure of the FORCE-index at the first and second waves. This structure was evaluated using confirmatory factor analysis at the third and fourth waves. The internal consistency of the instrument's subscales (e.g., factors) was evaluated using omega reliability, Cronbach's alpha coefficient, and mean inter-item correlation.

Results

A nine-factor solution provided best fit to the data. These factors mapped onto the following aspects of the work environment; competency, stress management, familiarity, workload manageability, work performance, infection safety, personal protective equipment, social safety, and social support. Internal consistency for the full FORCE-index and the nine factors was satisfactory.

Conclusions

The initial psychometric validation indicates that the FORCE-index is a valid measure which can be used by health authorities, services, and institutions to adequately and systematically assess central aspects of frontline health workers' work environment that are commonly challenged in health emergencies.

Advancing GIS-based suitability analysis of BtX, PtX, PBtX, and eBtX facilities using the fuzzy analytic hierarchy process

To address the urgent need for sustainable fuel production, this study proposes a novel methodology that integrates Geographic Information Systems (GIS) and Multi-Criteria Decision Analysis (MCDA) techniques to identify optimal sites for Biomass-to-X (BtX), Power-to-X (PtX), or hybrid (e-/PBtX) facilities. The proposed methodology provides a systematic and quantitative approach to evaluate location suitability, offering valuable insights for spatial decision-making in sustainable fuel production from BtX, PtX, or e-/PBtX. The CES-GIS-SAFAHP methodology uses selected and relevant geospatial data, which is processed to derive criteria-specific datasets, such as spatially resolved energy density maps for biomass-based systems and combined wind and solar energy datasets for hybrid processes. These data are then subjected to a Fuzzy Analytic Hierarchy Process (FAHP), which involves the use of pairwise comparisons and Fuzzy normalization to assign weights to the criteria, ultimately resulting in the generation of weighted overlay maps. The results of both the weighed overlay and a concurrently performed exclusion analysis, delineating areas that fail to meet key conditions or constraints, are combined to produce a final suitability map enabling the identification of optimal plant locations based on their overall suitability index. The proposed approach offers a robust, quantitative framework for spatial optimization in the siting of sustainable fuel production facilities with significant applications for policy-makers, industry, and researchers involved in BtX, PtX, and e-/PBtX scale-up. The methodology encompasses a comprehensive suitability analysis, …•Providing a recommended list of suitability and exclusion criteria, categorized into ``requisite,'' ``infrastructure,'' and ``environmental'' criteria, tailored for sustainable fuel production site selection.•Offering a structured workflow for deriving suitability maps through a combination of GIS-based FAHP with exclusion analysis.•Providing a practical, replicable algorithm that can guide users through the process, making it easier to apply in various geographic and project contexts.

Can an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? Results from a randomized controlled prevention trial

BACKGROUND AND OBJECTIVES

Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.

METHOD

A sample of 16-22-year-olds with elevated levels of RNT (N = 365) were randomly allocated to either use a one of two self-help apps designed to reduce RNT for 6 weeks or to a waitlist. The full RNT-focused intervention app encompassed a variety of RNT-reducing strategies, whereas the concreteness training app focused on one of these strategies, namely, concrete thinking.

RESULTS

The apps did not decrease depressive symptoms, anxiety symptoms and RNT relative to the waitlist. However, exploratory analyses using a minimum dose criterion showed that participants who used the full-RNT-focused intervention app more often, reported greater baseline to follow-up decreases in depressive symptoms compared to waitlist.

LIMITATIONS

Include decreased power due to slightly more dropout than expected and limited generalizability due to the mostly female and highly educated sample.

CONCLUSIONS

RNT-focused prevention via a self-help app did not decrease depression and anxiety, presumably due to too little engagement with the app content provided.

Real-time shear wave elastography in measuring normal ileocolon intestinal wall stiffness using colonoscopy as reference: A single-center research

Purpose

To investigate the feasibility of real-time shear wave elastography (SWE) in evaluating intestinal wall stiffness, and to establish the threshold SWE value of normal intestinal wall and explore the influencing factors of intestinal SWE.

Method

659 subjects who underwent intestinal SWE and colonoscopy were retrospectively enrolled. The wall elasticity of colonoscopy-confirmed normal/abnormal intestinal segment was measured by transabdominal SWE. Measurement reliability was evaluated by the intraclass correlation coefficient (ICC). The threshold value of SWE in differentiating normal and abnormal intestine was determined using ROC curve analysis with the largest Youden index, and the diagnostic performance of this threshold was evaluated. We explored the effects of gender, age, depth and type of the targeted intestinal segment on the intestinal wall elasticity by t test and logistic linear regression analysis.

Results

The technical success rate of SWE examination is 95.3 % (628/659). The mean SWE value of normal intestinal walls is (5.45 ± 1.34) kPa, which was significantly lower than that of abnormal ones (15.38 kPa±7.22, P < 0.001). Using 8.1 kPa as the threshold， the sensitivity and specificity were 93.5 % and 96.0 % with an AUC of 94.8 %. The overall ICC for SWE measurements was 0.933. Gender (ß=0.278, P = 0.013), depth (ß=0.220, P = 0.043) and type of the targeted segment (ß=0.522, P < 0.001) was associated with the SWE value of intestinal wall, but age was not (ß=0.050, P = 0.484).

Conclusions

SWE is feasible in evaluating the stiffness of intestinal wall with high reliability. The SWE threshold value differentiating normal intestinal wall and abnormal intestinal wall is 8.1 kPa.

Difficulties with positive, but not negative, emotion regulation moderate the association between positive alcohol expectancies and alcohol use in college students

Background

Positive alcohol expectancies are linked to increased alcohol use among college students. Difficulties regulating emotion have been shown to moderate this relationship, though little research accounts for differences based on the valence of the emotion being regulated.

Objective

To examine the independent moderating roles of positive and negative emotion dysregulation on the association between positive alcohol expectancies and alcohol use.

Methods

College students (N = 165, Mage = 20.48, SDage = 1.90; 66.1 % Female; 66.7 % White; 65.5 % non-Hispanic) who reported regular substance use (≥ 3 times in the past week) completed a one-time survey. Linear regression analyses with moderation were conducted.

Results

Correlational analyses suggested that positive alcohol expectancies, positive emotion dysregulation, and negative emotion dysregulation were positively associated with greater alcohol use. Linear regression analyses indicated that difficulties with positive emotion regulation moderated the relationship between positive alcohol expectancies and alcohol use. However, difficulties with negative emotion regulation did not moderate this relationship. College students who reported greater positive alcohol expectancies and concurrently greater difficulties with positive emotion regulation also report greater alcohol consumption, compared to those who reported greater positive alcohol expectancies and fewer difficulties regulating positive emotion.

Discussion

Difficulties with positive, not negative, emotion regulation may serve as a risk factor for hazardous alcohol use in college students. Findings may inform the modification of existing intervention programs across university counseling centers and other health sectors to promote the development of positive emotion regulation skills for individuals who endorse positive emotion regulation difficulties, thereby reducing hazardous alcohol use amid this high-risk developmental period.

An online group behavioral activation therapy for major depressive disorder: Adaptation, effectiveness, and trajectories of change in a lower-middle income country

BACKGROUND AND OBJECTIVE

Depressive disorders are common mental illnesses associated with high burden of disease. In this study, the effects of an online group behavioral activation on depressive symptoms and rumination were evaluated, and trajectories of change in patients with major depressive disorder adapted for a lower-middle income context investigated.

METHODS

This study was an online single-group non-randomized trial. Patients were recruited from various parts of the country through social media and medical university clinics. In total, 79 women with major depressive disorder were included. We measured Beck Depressive Inventory-II (BDI-II) scores, depressive rumination and behavioral activation scores, sudden gains, depression spikes, early response, and clinical change. Patients attended an online weekly ten-session behavioral activation therapy. K-nearest neighbor was used to impute missing data and estimate the importance of candidate predictors of clinical change. However, due to a high attrition rate, paired tests were performed using per-protocol analysis without data imputation.

RESULTS

The mean difference (SD) of the BDI-II score from the beginning to the end of the study was 21.10 (10.21), P < 0.001. Improvement was observed for depressive rumination (P < 0.001), and for behavioral activation (P < 0.001). Clinical change and early response were significantly related to BDI-II change (both P < 0.001). Favorable changes in behavioral activation, depressive symptoms, or rumination showed linear patterns. Clinical change (P = 0.453) and BDI-II (P = 0.050) were not statistically different between patients with moderate versus severe symptoms.

LIMITATIONS

Participants were solely women. Some patients did not attend all sessions, and participants were not followed in the post-treatment period.

CONCLUSION

online group behavioral activation therapy is suggested as an appropriate and accessible front-line treatment for moderate to severe major depressive disorder in lower-middle income countries.

Following the science to understand how to reduce prejudice and its harmful consequences: A guide for evaluators and program planners

"Follow the Science" was the cry heard worldwide during the COVID-19 global pandemic. This approach was used to develop evidence-based prevention measures (e.g., social distancing, hand washing, and mask-wearing), COVID treatments, and vaccines and to prevent significant declines in well-being (Donaldson, Cabrera, and Gaffaney, 2021). Leveraging this approach, the study aimed to understand promising ways to disrupt patterns of prejudice and its harmful consequences and identify the most exemplary interventions. The current study systematically reviewed 2515 published peer-reviewed studies included in 13 meta-analyses and systematic reviews on prejudice reduction interventions, using inclusion and exclusion criteria focused on gender and/or race/ethnicity. Phase 1 identified 13 studies, highlighting four exemplary evidence-based approaches: Contact Interventions, Perspective Taking, Interactive and Narrative Modalities, and Multi-faceted Interventions. These approaches presented notable success with the largest effect sizes and should be considered carefully when planning new prejudice reduction efforts. In Phase 2, the study extracted specific interventions from the 13 studies, identifying six specific exemplary interventions for mitigating prejudice and its adverse effects. The study discusses the implications of these findings for program planners and evaluators, suggesting the use of empirical insights to design post-COVID interventions, such as cultural exchange programs, virtual reality experiences, and cross-cultural music initiatives, to create meaningful social changes. Despite these practical insights, the study has limitations, including partial adherence to PRISMA guidelines and the omission of risk of bias assessment for individual studies.

Behavioral manifestations and neural mechanisms of empathic pain

Empathy is an important trait that allows individuals to comprehend and share the emotions and sentiments of others. It not only facilitates effective interpersonal communication, but also helps in establishing meaningful connections and fostering trust and understanding. Impaired empathy development can manifest as excessive self-centeredness, extreme egoism, and antisocial behaviors. Many psychiatric disorders, such as autism, narcissistic personality disorder, and schizophrenia, are often accompanied by empathy disorders. Pain empathy, which is a common behavioral paradigm of empathic behavior, is not only observed in humans but also in animals. By delving into the study of pain empathy, we can gain a deeper understanding of empathy itself. This understanding not only contributes to the advancement of scientific, clinical, and social fields, but also promotes the cultivation of emotional resonance and social harmony among humans, with profound significance and impact. This article provides a brief overview of the current understanding and mechanistic studies of pain empathy, as well as suggests future research directions.

The neural basis of affective empathy: What is known from rodents

Empathy is the cornerstone of social interactions between conspecies for human beings and other social animals. Human beings with empathy defects might either suffer unpleasant or failed social interactions as ASD patients, or even display antisocial behaviors. To find efficient cure for empathy defects, first of all, the neural mechanisms underpinning various empathy behaviors should be well studied and understood. And the research in the field of affective empathy thrives fast in recent years. It is necessary to review the important contributions in this field, especially for understanding the delicate neural mechanisms of diverse forms of affective empathy. Here, we have summarized the characteristics of various types of affective empathy. We also discuss the distinctions between empathy for pain and fear, as well as instinctive and experienced empathy. Our analysis further highlights the findings in the complex neural mechanisms and potential brain regions underlying different affective empathy behaviors. Above all, this work is expected to help enhance our comprehension of behavioral dynamics and neural basis of affective empathy along with its role in emotional regulation and social behavior.

Comparing psychiatric symptom networks between individuals in resilience and non-resilience trajectories of adaptation amid the global pandemic

OBJECTIVE

The current study compared symptom networks between individuals exhibiting resilience and non-resilience trajectories of adaptation two years after the COVID-19 outbreak.

METHOD

A population-representative sample (N = 906) reported symptoms of anxiety and depression in February-July 2020 (T1), March-August 2021 (T2), and September 2021-February 2022 (T3), as well as symptoms of post-traumatic stress disorder (PTSD) and adjustment disorder (AD) at T3. After differentiating between individuals with resilience and non-resilience trajectories using growth mixture modeling, network analyses were conducted to investigate group differences in T3 network symptoms (undirected and directed).

RESULTS

Despite non-significant group differences (M = 0.184, p = .380; S = 0.096, p = .681), distinctive qualitative characteristics were observed between networks. Difficulty relaxing was identified as the single root cause in the more diffused resilience network, with anxiety and depressive symptoms as additional starting points in the non-resilience network, which was more interconnected into clusters with clear-cut diagnostic boundaries. Sad mood demonstrated a transdiagnostic communicative role across common mental disorders.

CONCLUSION

Our results contribute to the understanding of anxiety-depression-PTSD-AD symptom networks in resilient and non-resilient individuals by highlighting the consequences of heterogeneity in adaptation capacity in the development of pandemic-related psychopathology.

Differential effect of three types of exoskeletons and handling height on muscular activity, postural control and perceived effort during simulated bedside mobilization task

Home care workers are affected by musculoskeletal disorders caused by biomechanical factors. This study investigated the effect of three exoskeletons devices (HAPO, HAPO FRONT and Japet.W) during load mobilization tasks at three bed heights in order to reduce physical risk factor. Anterior deltoid and longissimus bilateral muscular activities were recorded by EMG, a force platform was used to record center of pressure (CoP) displacement, and perceived exertion parameters were assessed using the Borg scale while nineteen healthy subjects performed a load manipulation. The use of the HAPO FRONT decreased global muscular activity by 5,6% and deltoid activity by 10,7%, exoskeletons reduced perceived effort, from 42% to 25%. Bed height has an inverse effect on deltoid and longissimus activity. These findings show that exoskeletons can reduce perceived effort and for overall and deltoids muscular activity. Therefore, the combination of shoulder and low back assistance appears as an interesting line of thought.

Virtual reality obstacle avoidance training can be enhanced by physical feedback via perturbations: A proof-of-concept study

BACKGROUND

Fall injuries resulting from trips are a major health concern. Virtual reality (VR) offers an effective way of training obstacle avoidance while walking due to its ability to provide safe and meaningful real-time feedback during rehabilitation. This proof-of-concept study examined the benefit of providing physical feedback during obstacle avoidance gait training using VR.

METHODS

Twenty-six young adults walked on an instrumented treadmill while wearing a head-mounted display in two 8-min conditions. Virtual obstacles to be avoided were presented in a VR-only condition and a VR + Perturbation (VR + P) condition where additional rapid belt acceleration simulated tripping on an obstacle.

RESULTS

A lower obstacle collision rate, greater step length and height of the leading foot over the obstacles were found in the VR + P condition compared to the VR-only condition (p < 0.05). Step height of the trailing foot over the obstacles significantly decreased over time during the VR-only condition (p < 0.01) but not during the VR + P condition. The margin of stability significantly improved over time during the VR + P condition only (p < 0.01).

CONCLUSIONS

Immediate physical feedback via treadmill belt acceleration can improve obstacle avoidance performance in a virtual environment. Future research is required to examine the generalizability of this finding to other populations and real-world falls.

Exploring the dynamic relationships between nocturnal heart rate, sleep disruptions, anxiety levels, and depression severity over time in recurrent major depressive disorder

BACKGROUND

Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity.

METHODS

This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions.

RESULTS

Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR.

CONCLUSIONS

Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

The correlation between mindfulness and problematic smartphone use: A meta-analysis

OBJECTIVES

In the modern era of constant digital technological advancements, problematic smartphone use has become a key issue in educational psychology. This phenomenon affects individual psychological well-being and academic or other performance and encompasses interpersonal relationships and societal aspects, divulging the intricate correlation between technology usage and human behavior. This study aims to explore mindfulness as an intervention measure to lessen problematic smartphone use.

METHODS

Based on the PRISMA method, this study used a meta-analytic approach to explore the relationship between mindfulness and problematic smartphone use systematically. Systematic literature searches for papers published before February 2024 yielded 29 studies, including 17,534 individuals and 30 effect sizes. The sample comprised participants from Eastern cultures (n = 22 studies) and Western cultures (n = 8 studies).

RESULTS

The meta-analysis revealed a significant negative correlation between mindfulness and problematic smartphone use (r = -0.399, 95 % CI [-0.457, -0.338], p < 0.001). Moderator analyses revealed the strongest relationship when using the Child and Adolescent Mindfulness Measure (CAMM) (r = -0.498), while the Five Facet Mindfulness Questionnaire (FFMQ) showed the weakest (r = -0.245). Cultural background analyses indicated stronger effects in Eastern cultures (r = -0.428) compared to Western cultures (r = -0.316). Gender analyses revealed stronger effects among female participants (β = -0.510, p < 0.05).

CONCLUSION

These findings demonstrate that mindfulness serves as an effective approach to addressing problematic smartphone use. The significant moderating effects identified have important implications for the implementation of mindfulness-based interventions in educational settings.

Stressor-evoked heart rate, perceived physiological arousal, and anxiety symptoms in young adults

BACKGROUND

Acute psychological stress is associated with increases in heart rate (HR) and state anxiety. Stressor-evoked perceived HR changes relate more strongly to state anxiety than actual HR reactivity. However, research has yet to examine these associations in the context of general anxiety symptoms.

METHODS

Participants (N = 160) completed a resting baseline period followed by a standardized acute psychological stress task; HR was recorded throughout. After the stress task, participants rated their perceived stressor-evoked physiological arousal and anxiety intensity. Participants also completed a general anxiety symptoms measure ~17 days later.

RESULTS

The a priori hypothesized model demonstrated a good fit to the data, χ2 (59) = 93.15, p = .003; CFI = 0.94; TLI = 0.91; SRMR = 0.05; RMSEA = 0.06 (90 % CI = 0.04-0.08). After controlling for covariates, perceived physiological arousal was positively related to both cognitive and somatic anxiety. In turn, only somatic anxiety was positively associated with general anxiety symptoms. Perceived physiological arousal was related to general anxiety symptoms through state somatic anxiety. HR reactivity was not statistically significantly associated with either cognitive or somatic anxiety.

LIMITATIONS

The study was correlational, which limits the ability to determine causation.

CONCLUSIONS

Perceived HR, rather than actual HR, is more closely associated with anxiety intensity during acute psychological stress. Stressor-evoked perceived HR and general anxiety symptoms are related indirectly through stressor-evoked somatic anxiety intensity. The findings have implications for elucidating the mechanisms of the stress-anxiety relationship.

Genome-wide Mendelian randomization mapping the influence of plasma proteome on major depressive disorder

Plasma proteins play critical roles in a series of biological processes and represent a major source of translational biomarkers and drug targets. In this study, we performed Mendelian randomization (MR) to explore potential causal associations of protein quantitative trait loci (pQTL, n = 54,219) with major depressive disorder (MDD) using summary statistics from the PGC (n = 143,265) and further replicated in FinnGen cohort (n = 406,986). Subsequently, gene expression quantitative trait loci (eQTL) of identified proteins were leveraged to validate the primary findings in both PGC and FinnGen cohorts. We implemented reverse causality detection using bidirectional MR analysis, Steiger test, Bayesian co-localization and phenotype scanning to further strengthen the MR findings. In primary analyses, MR analysis revealed 2 plasma protein significantly associated with MDD risk at Bonferroni correction (P < 3.720 × 10-5), including butyrophilin subfamily 2 member A1 (BTN2A1, OR = 0.860; 95 % CI, 0.825-0.895; P = 1.79 × 10-5) and butyrophilin subfamily 3 member A2 (BTN3A2, OR = 1.071; 95 % CI, 1.056-1.086; P = 3.89 × 10-6). Both the identified proteins had no reverse causality. Bayesian co-localization indicated that BTN2A1 (coloc.abf-PPH4 = 0.620) and BTN3A2 (coloc.abf-PPH4 = 0.872) exhibited a shared variant with MDD, a finding that was subsequently validated by HEIDI test. In the replication stage, BTN2A1 and BTN3A2 were successfully validated in the FinnGen cohort. This study genetically determined BTN2A1 and BTN3A2 were associated with MDD and these findings may have clinical implications for MDD prevention.

Bidirectional association between clustering of health-related behaviours and depression in mid- and older-aged adults: A longitudinal study in China and Japan

OBJECTIVES

To disentangle the direction between health-related behaviours (HRBs) and depression in East Asia, we examined the bidirectional longitudinal relationship of HRBs clustering and depression in Chinese and Japanese ageing populations gender-specifically.

METHODS

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) (N = 18,739) (2011-2015) and the Japan Study of Ageing and Retirement (JSTAR) (N = 7116) (2007-2011). Cross-lagged panel models (CLPM) were applied to assess bidirectional longitudinal relationships between HRB clustering and depression in adjacent waves, stratified by cohort and gender. Sensitivity analyses were conducted to explore key risk factors in risky clusters.

RESULTS

The prevalence of baseline depression was approximately 20 % in China and 4 % in Japan, with over 70 % of participants belonging to the risky cluster. A unidirectional negative association between the risky cluster and depression was observed only in Chinese females (βstandardized = -0.039, 95%CI: -0.054 to -0.024, P < 0.001). However, no association was found in Japanese females or males in either country. Further sensitivity analyses revealed that this association was primarily driven by overweight/obesity cluster. Sensitivity analyses also identified a positive effect of depression on the smoking and drinking cluster and a negative effect on the overweight/obesity cluster in Chinese females.

LIMITATION

This study was limited by reliance on self-report data, the CES-D cannot be used to diagnose depression and some other confounding factors were not considered (e.g., use of antidepressants).

CONCLUSIONS

Our findings highlight a unidirectional negative association of the risky cluster on depression in Chinese females, with notable variations observed across different countries and genders.