Exploring Affect Recall Bias and the Impact of Mild Depressive Symptoms: An Ecological Momentary Study

Objective and subjective suicidal intent are differentially associated with attempt lethality based on age of onset of suicidal behavior

Predicting the medical seriousness, or lethality, of suicide attempts remains challenging for clinicians, as impulsive and planned attempts can both be fatal and risk may vary with age and suicidal intent. We investigated whether attempt lethality is driven by practical preparedness (objective suicidal intent) and/or psychological resolve (subjective suicidal intent) and whether these associations vary with age of onset of suicidal behavior. The study used a cross-sectional lifespan sample (N = 95; age range 16-76 years) with current depression and recent suicidal behavior (≤ 5 years). Linear regression models indicated that older age of onset of suicidal behavior (B = 0.86, SE = 0.20, p < 0.001), and both higher objective intent (B = 0.69, SE = 0.19, p < 0.001) and subjective intent (B = 0.50, SE = 0.20, p = 0.014) were associated with more severe lethality at the most recent attempt, although the association with subjective intent was driven by its shared portion with objective intent. The association between objective intent and lethality was stronger with older age of onset (interaction B = 0.75, SE = 0.20, p < 0.001), whereas the association between subjective intent and lethality was stronger with younger age of onset (interaction B = - 0.42, SE = 0.20, p = 0.036). Our findings suggest that contextualizing suicidal intentions with age of onset, rather than age at the current suicidal crisis, can help clinicians better appraise suicide risk.

Can a kiss conquer all? The predictive utility of idealized first kiss beliefs on reports of romantic love among U.S. adults

Research indicates that idealized romantic expectations and the extent to which they are met, are important predictors of relationship outcomes (e.g., love). However, no studies have investigated the impact of idealized beliefs associated with specific behaviors (e.g., kissing) on reports of romantic love. Thus, the two studies comprising this research assessed the association between idealized beliefs related to one's first romantic kiss with their current partner, unmet first kiss expectations, and reports of romantic love. Romantic attachment was also examined as a moderator. In Study One, the First Kiss Beliefs Scale was created and the results from 208 adults revealed that increased endorsement of idealized first kiss beliefs was associated with greater romantic love (r = 0.25). Romantic attachment also moderated this relationship, such that idealized first kiss beliefs significantly predicted love for those high in attachment anxiety and low in avoidance (β = 0.68 and β = 0.18, respectively). In Study Two, the First Kiss Beliefs Scale was modified to assess outcomes and expectations to capture unmet expectations. The results from 234 adults indicated that idealized first kiss beliefs predicted a greater proportion of the variance in romantic love (sr2 = 0.10) than did unmet expectations (sr2 = 0.07). A three-way interaction was also detected such that, among those low in attachment anxiety, the relationship between kissing beliefs and love was positive for those high in attachment avoidance and negative for those low. These results indicate that idealized first kiss expectations with one's current romantic partner are important predictors of love (beyond whether these expectations were met), particularly for those high in attachment insecurity. Implications are discussed for practitioners and those in the primary stages of romantic relationships.

Evaluating the Modified Patient Health Questionnaire-2 and Insomnia Severity Index-2 for Daily Digital Screening of Depression and Insomnia: Validation Study

BACKGROUND

The Patient Health Questionnaire-2 (PHQ-2) and Insomnia Severity Index-2 (ISI-2) are screening assessments that reflect the past 2-week experience of depression and insomnia, respectively. Retrospective assessment has been associated with reduced accuracy owing to recall bias.

OBJECTIVE

This study aimed to increase the reliability of responses by validating the use of the PHQ-2 and ISI-2 for daily screening.

METHODS

A total of 167 outpatients from the psychiatric department at the Yongin Severance Hospital participated in this study, of which 63 (37.7%) were male and 104 (62.3%) were female with a mean age of 35.1 (SD 12.1) years. Participants used a mobile app ("Mental Protector") for 4 weeks and rated their depressive and insomnia symptoms daily on the modified PHQ-2 and ISI-2 scales. The validation assessments were conducted in 2 blocks, each with a fortnight response from the participants. The modified version of the PHQ-2 was evaluated against the conventional scales of the Patient Health Questionnaire-9 and the Korean version of the Center for Epidemiologic Studies Depression Scale-Revised.

RESULTS

According to the sensitivity and specificity analyses, an average score of 3.29 on the modified PHQ-2 was considered valid for screening for depressive symptoms. Similarly, the ISI-2 was evaluated against the conventional scale, Insomnia Severity Index, and a mean score of 3.50 was determined to be a valid threshold for insomnia symptoms when rated daily.

CONCLUSIONS

This study is one of the first to propose a daily digital screening measure for depression and insomnia delivered through a mobile app. The modified PHQ-2 and ISI-2 were strong candidates for daily screening of depression and insomnia, respectively.

Recall bias of students' affective experiences in adolescence: The role of personality and internalizing behavior

INTRODUCTION

Adolescence is characterized by multiple biopsychosocial changes, associated with a high intraindividual variability of emotional experiences. Previous findings suggest that this intraindividual variability is reflected in a recall bias of adolescents' emotion reports. However, corresponding findings are scarce and inconclusive. Studies on predictors of recall bias in adulthood indicate that personality traits, especially neuroticism and extraversion, as well as specific internalizing disorders might affect recall bias of emotion reports.

METHODS

The sample consists of 118 Swiss adolescent students in grade 8 and 9 (M_age  = 15.15, SD_age  = 0.89). The students' momentary affective experience was recorded using smartphones over seven consecutive days in situ at 42 randomly generated occasions (six per day), with a total of 1059 protocols on current events. At the end of the experience-sampling phase, students filled out an online questionnaire, providing information about their personality and typical behavior as well as their retrospective affective experience. In addition, the students' behavior was evaluated by their teachers. We applied two-level structural equation modeling with latent difference variables.

RESULTS

Adolescents high in extraversion showed retrospective overestimation of positive affective experiences and underestimation of negative affective experiences. Adolescents with high neuroticism tended to overestimate negative affect retrospectively, showing no significant effects for positive affect. However, internalizing behavior did not predict a negative recall bias in adolescents' affective experience.

CONCLUSIONS

Retrospective self-reports about adolescents' affective experience are biased by relatively stable individual factors, whereas less stable individual factors did not seem to have any influence.

Can rehabilitation adherence among stroke patients be measured using a single item?

AIMS AND OBJECTIVES

To assess the concurrent validity between logbooks and a single-item rehabilitation adherence measurement for patients with stroke. Agreement between caregivers and patients and between caregivers and physical therapists regarding a single-item measurement was investigated, and its predictive validity was explored.

BACKGROUND

Adherence to therapy is a primary determinant of treatment success. There are no standard instruments for measuring rehabilitation adherence available for stroke patients.

DESIGN

Prospective longitudinal study.

METHODS

Seventy-five patients with stroke were recruited, measured four times and followed for 6 months. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to ensure comprehensive reporting. Adherence was documented in logbooks, and single-item measurements were compared. Predictive validity was explored by assessing associations between adherence levels, self-care ability and health-related quality of life. The Spearman's correlation coefficients, weighted kappa, and generalised estimating equations statistics were used to explore the concurrent validity, measurement agreement, and predictive validity, respectively.

RESULTS

Logbook records had a fair correlation (r_s  = .23, p = .04) with the single-item rehabilitation adherence measurements. There was moderate agreement (kappa = 0.42, p < .001) between caregiver and patient assessments and fair agreement (kappa = 0.29, p = .017) between caregiver and physical therapist assessments of patients' rehabilitation adherence levels. Perfect rehabilitation adherence, based on the logbook and single-item measurements, predicted better scores for self-care ability and quality of life than imperfect rehabilitation adherence during 6 months after inclusion.

CONCLUSIONS

There was fair concurrent validity between logbooks and single-item rehabilitation adherence measurements and moderate and fair adherence measure agreement between caregivers and patients and caregivers and physical therapists, respectively. Logbooks and single-item rehabilitation adherence measurements had adequate predictive validity.

RELEVANCE TO CLINICAL PRACTICE

Single-item rehabilitation adherence measurement is a workable and straightforward method to assess stroke patients' rehabilitation adherence in busy clinical care settings. Caregivers can represent stroke patients regarding their reported rehabilitation adherence.

PATIENT OR PUBLIC CONTRIBUTION

Patients were diagnosed with stroke in the study hospital. Rehabilitation physicians transferred patients to a research nurse who then screened them for the inclusion criteria and invited them and their family caregivers to participate in this study if they met the requirements. We also recruited seven physical therapists responsible for the physical therapy of the study participants. After participants signed informed consent, the research nurse encouraged participants to respond to research questions face to face, including rehabilitation adherence data, daily physical function, and quality of life. Each participant was measured four times at baseline and at 1, 3, and 6 months after inclusion in this study. Physical therapists had to score their patients' rehabilitation adherence levels before discharge.

TRIAL REGISTRATION DETAILS

Not applicable.

Individual Differences Facing the COVID-19 Pandemic: The Role of Age, Gender, Personality, and Positive Psychology

Research on individual differences in facing the COVID-19 pandemic seems to be crucial in order to design diverse and highly effective intervention strategies. This study uses a sample of 302 North American participants who were recruited through the crowdsourcing platform ProA; different profiles were established, profiling variables of interest in facing the COVID-19 outbreak. Socio-demographic and psychological (personality traits, gratitude, life purpose, and religiosity) variables were explored. These results are of interest if we want to deepen the study of individual differences at both a theoretical and applied level.

Brief Acceptance and Commitment Therapy for Fibromyalgia: Feasibility and Effectiveness of a Replicated Single-Case Design

Objective

Overall, the literature on the effectiveness of psychological treatments in general and those for fibromyalgia in particular has been dominated by research designs that focus on large groups and explore changes on average, so the treatment impact at the individual level remains unclear. In this quasi-experimental, replicated single-case design, we will test the feasibility and effectiveness of a brief acceptance and committed therapy intervention using ecological momentary assessment supported by technology.

Methods

The sample comprised 7 patients (3 in the individual condition and 4 in the group condition) who received a brief, 5-week psychological treatment. Patient evolution was assessed one week prior to treatment onset and during the whole study with a smartphone app. Because ecological momentary assessment and the use of an app are not frequent practices in routine care, we also evaluated the feasibility of this assessment methodology (i.e., compliance with the app). Change was investigated with a nonoverlap of all pairs index. Outcomes were pain interference with sleep and social activities, fatigue, sadness, and pain intensity.

Results

Patient change was not uniform across outcomes. Four patients (two in each condition) showed relatively moderate levels of change (approximately 60% nonoverlap in several outcomes). The remaining patients showed more modest improvements which affected a reduced number of outcomes. Based on nonoverlapping indices, there was no clear evidence in favor of any treatment format.

Conclusions

An alternative design to large-scale trials, one that focuses on the individual change, exists and it can be implemented in pain research. The use of technology (e.g., smartphones) simplifies such designs by facilitating ecological momentary assessment. Based on our findings showing that changes were not homogeneous across patients or outcomes, more single-case designs and patient-centered analyses (e.g., responder and moderation analyses) are required.

Affect Recall Bias: Being Resilient by Distorting Reality

Background

According to a growing body of literature, people are quite inaccurate in recalling past affective experiences. Nevertheless, the mechanism underlying this recall bias (i.e., the tendency to overestimate and/or underestimate positive or negative past emotional experiences) remains unclear, and its association with mental health has not been studied yet.

Methods

We adopted a smartphone-based Ecological Momentary Assessment to monitor daily affect (n = 92) and investigate the association between affect recall bias, mental health and resilience.

Results

While the tendency to overestimate negative affective experiences was observed in participants reporting mild depressive symptoms, positive affect (PA) overestimation as compared to PA underestimation was associated with better mental health (i.e. higher psychological well-being and lower depressive and anxiety symptoms) through the enhancement of resilience. Furthermore, positively biased participants (i.e. PA over estimators) benefited from greater well-being, even when compared to accurate individuals.

Conclusions

While people appear to use retrospective PA overestimation as a strategy to enhance well-being and resilience, they are not likely to underestimate past negative experiences to feel better. Accordingly, owning an optimistic vision of the past may represent an adaptive “distortion” of reality that fosters people’s mental health. The clinical implications of cultivating PA and learning strategies to regulate both negative and positive emotions are discussed.